The Childhood Acute Illness & Nutrition (CHAIN) Network brings together a network of clinical scientists to build the evidence base to help undernourished children survive, thrive and grow during and after an acute illness.
Globally, there has been a remarkable reduction in overall child mortality since 1990. However, undernutrition underlies almost half of all child mortality because it causes an increased susceptibility to common infections, such as pneumonia and diarrhoea.
When undernourished children become sick, they have a greatly elevated risk of death whilst in hospital, despite current medical and nutritional management guidelines. Recent evidence has revealed that they also have a markedly increased risk of death at home following discharge from hospital. Reasons for this may include complex infections, antibiotic resistance, immunological, metabolic, and socioeconomic problems. For example, intestinal inflammation is widespread in low and middle-income countries, leading to malabsorption, impaired immune function and growth.
The principle behind the CHAIN Network is that an episode of illness occurs within the child’s ‘health trajectory’. Low birth weight, frequent infections with too little time been each episode to fully recover, suboptimal feeding and social constraints result in ongoing risks of mortality and poor growth despite treatment. To find out what aspects of these could be addressed to improve outcomes, CHAIN is initially conducting an observational study. This will lead on to clinical trials to test potential interventions that could be added to current treatment policies in hospitals, in communities and improve linkage between the two.
The CHAIN cohort study is large multi-site study of children under 2 years old who are hospitalised with an acute illness. They are followed up for 6 months after discharge from hospital. The study will help us better understand underlying characteristics that determine increased risk of mortality in this vulnerable population.
CHAIN investigators are working in Kenya, Malawi, Uganda, Burkina Faso, Bangladesh and Pakistan. The project is coordinated from the KEMRI/Wellcome Trust Research Programme, Kenya, and the Department of Global Health, University of Washington, Seattle, USA. Collaborating centres are in the UK, USA, Canada and the Netherlands. The project is supported by the Bill & Melinda Gates Foundation as a grant to the Centre for Tropical Medicine & Global Health, University of Oxford, UK. The principal investigator is Professor James A Berkley.