The CHAIN Network aims to identify modifiable biomedical and social factors driving the greatly increased risk of mortality among young undernourished children admitted to hospital with acute illness, as inpatients and after discharge. The study will inform priorities, risks and targeting for multi-faceted interventional trials.
CHAIN is a multi-centre cohort study with a nested case control analysis of stored biological samples. Study sites are located in Africa and South Asia. Children will be recruited at admission to hospital, stratified by nutritional status. Exposures will be assessed at admission, during hospitalisation, at discharge, and at two time points after discharge. The main outcomes of interest are mortality, re-admission to hospital and failure of nutritional recovery up to 180 days after discharge. To determine community health norms, an additional sample of children living in the same communities will be enrolled and assessed at one time point only.
Who can participate
Age range
2 Months – 23 Months
Sex
ALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion criteria (hospitalized participants):
* Children 2 months-23 months.
* Admitted to hospital.
* Planning to remain within the hospital catchment area and willing to come for specified visits during the 6 month follow up period.
* Parent or guardian consents on child's behalf.
Inclusion criteria (community participants):
* Aged 2 to 23 months
* Living in the same community as the acutely ill children recruited.
* Not having an acute illness requiring hospital admission
* Absence of known, but untreated HIV or TB
* Not admitted to hospital within the last 14 days
* Not previously included in the study
* Parent or guardian consents on child's behalf.
Exclusion Criteria (all participants):
* Requiring immediate resuscitation at admission to hospital\*
* Unable to tolerate oral feeds while in his/her usual state of health
* Underlying terminal illness that in the opinion of the treating physician is likely to lead to death within 6 months (e.g., cancer, congenital heart disease)
* Diagnosed with a condition that in the opinion of the treating physician is likely to require surgery within 6 months
* Diagnosed chromosomal abnormality (syndromically or genetically diagnosed abnormality)
* Primary reason for admission is poisoning, trauma or a surgical condition
* Previously enrolled in this study
* Sibling currently or previously enrolled in this study
(\* children requiring resuscitation will be defined as those with on-going cardiac or pulmonary arrest or judged to b…
Questions worth asking your doctor
Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.
1Based on my diagnosis and history, is this trial worth exploring for me — or is there a standard treatment we should try first?
2What does this trial's phase tell us about how much is already known about its safety and benefit?
3What would taking part actually involve for me — visits, tests, time, and travel?
4What are the known and possible risks or side effects I should weigh, and how would they be monitored?
5If this trial isn't the right fit, what other options or trials would you suggest I look into?
Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.
Questions for the trial coordinator
The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.
1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?
A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.
What they're measuring
1
Mortality
Timeframe: Up to 30 days after admission to hospital
2
Mortality
Timeframe: Up to 180 days after discharge from hospital