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 range2 Months – 23 Months
SexALL
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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…
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