The CHildhood Acute Illness and Nutrition Network (CHAIN) is a global research network focused on optimizing the management and care of highly vulnerable children in resource-limited settings to improve survival, growth and development.
Despite an overall reduction of child mortality in low and middle income countries, acutely-ill undernourished children continue to have a greatly elevated risk of death, both during hospitalization and following discharge. However, we currently lack robust evidence to guide optimal management. The ultimate goal of the CHAIN Network is to identify and prioritize actionable intervention time points and targets to reduce mortality amongst acutely ill undernourished children.
The CHAIN Network aims to identify the biological mechanisms and the socio-economic factors that determine a child’s risk of mortality in the six months following presentation to medical care with an acute illness. Ultimately, The CHAIN Network aims to improve care for acutely ill children living in countries with limited resources and prevent both in-hospital and post-discharge mortality. To do this, the progress of acutely ill children across a range of nutritional status will be tracked throughout their hospital stay and for 6 months after returning to their home and communities. This research will guide the choice of strategies to be taken forth into clinical trials to reduce mortality in this highly vulnerable population.
The CHAIN Network will achieve its goals through the development of three complementary work streams:
I) Establishing prospective cohorts of acutely ill young children across different geographies with differing population, social and environmental characteristics (stunted vs. wasting, rural vs. urban and presence of risk factors such as malaria and HIV);
II) Leveraging already-funded clinical trials to harmonize data for comparative or pooled analyses, and to evaluate additional specific questions related to the care of the acutely ill undernourished child;
III) Utilizing a rich network of sites with existing data and samples in order to rapidly test preliminary hypotheses, develop and prioritize assays to efficiently move promising findings into interventional trials including the subgroups of children likely to benefit from specific targeted interventional approaches
We aim to understand the complex factors that increase mortality, hospital readmission and poor recovery in young acutely ill children. These include biological factors (e.g. infections, immune responses and metabolism), nutritional factors (e.g. breast-feeding, diet and food security), health systems (e.g. accessibility to care and clinical management) and sociological factors (e.g. economic constraints, income loss, time spent with/away from the child, mental health and care seeking behavior).
The CHAIN Network currently includes study sites in eight sites across five countries in Africa (3 in Kenya, 1 in Uganda, 1 in Malawi) and three in Asia (2 in Bangladesh, and 1 in Pakistan).
Approximately 5 000 young children between the ages of 2 and 23 months will be recruited. Each site will follow ~500 children admitted to hospital for an acute illness who have varying degrees of malnutrition i.e., being severely to moderately to not malnourished. Additionally, each site will study 125 non-acutely ill children living within the community of the hospital catchment area.
This study aims to improve the care, survival and life quality of ill children living in countries with low resources. Findings from this research will directly inform guidelines and policies related to the management and care of highly vulnerable children and will help prioritize interventions that warrant further testing in clinical trials.
The CHAIN Network brings together diverse teams of clinicians and scientists from institutions across the globe. In addition, the Network works with international bodies, governments, communities and other stakeholders to maximize the impact of the network. Many of the participating partner institutions are listed below;