People

CHAIN Network is made up of passionate experts from around the world.

Leadership

The CHAIN Network is led by a core group of individuals that have, over the years, fostered and built solid foundations. With vision and perseverance, The CHAIN Network has recruited, one by one, accomplished researchers, doctors, nurses, as well as coordinators and other skilled staff to work together as teams with a common goal. The CHAIN Network leaders have extensive experience in running clinical trials in difficult settings and have been embedded within the communities they serve for years. The CHAIN Network will grow from these solid foundations.

James ‘Jay’ Berkley

ProfessorJay Berkley is the Principal Investigator of the CHAIN Network and co-directs the Network with Judd L. Walson. Jay is based full-time at the KEMRI/Wellcome Trust Research Programme in Kilifi, Kenya.

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Judd L. Walson

Dr. Judd Walson, an Associate Professor at the University of Washington, completed his Internal Medicine and Pediatrics training at Duke University, and his fellowship in Infectious Disease at the University of Washington.

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Advisory Committee

A panel of experts provides high level oversight and guidance to the CHAIN Network through the CHAIN Advisory Committee. With expertise across policy, nutrition programming, clinical management and research, the CHAIN Advisory Committee routinely review the objectives and progress of the Network and provide critical linkages to global stakeholders working to improve pediatric survival and development.

Saskia van der Kam

Saskia van der Kam is a specialist in nutrition from the Netherlands that is currently working in the Public Health Department of Médecins Sans Frontières (MSF). She has more than 25 years of experience engaging with various organizations that distribute emergency aid to developing countries, and often during crisis.

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Mark J. Manary

Dr. Mark J. Manary, is a pediatrician currently appointed as the Helen B. Roberson Professor of Pediatrics at Washington University School of Medicine, in St-Louis. He has dedicated his career to “solving malnutrition in children” and the clinical use of ready-to-use-food (RUTF) is a product of that ambition.

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Nigel C. Rollins

Dr. Nigel Rollins trained as pediatrician at Queen’s University, in Belfast, Northern Ireland. He completed his doctoral research in Tanzania before going to South Africa where he lived and worked for 14 years.

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Ethics Advisor

Maureen Kelley

Dr. Maureen Kelley is Associate Professor of Bioethics at The Ethox Centre in Nuffield Department of Population Health, University of Oxford. She serves as an ethics advisor and collaborating social scientist for CHAIN. Dr. Kelley is a moral philosopher and qualitative researcher by training, specializing in reproductive, maternal, newborn and child health.

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Working Groups

The CHAIN Network is led by a core group of individuals that have, over the years, fostered and built solid foundations. With vision and perseverance, The CHAIN Network has recruited, one by one, accomplished researchers, doctors, nurses, as well as coordinators and other skilled staff to work together as teams with a common goal. The CHAIN Network leaders have extensive experience in running clinical trials in difficult settings and have been embedded within the communities they serve for years. The CHAIN Network will grow from these solid foundations.

Social & Behavioral Science

Acute illness and undernutrition in children usually occur against a background of social and economic disadvantage. It is conceivable that no amount of nutritional or anti-infective interventions will be effective in preventing longer term post-discharge mortality if key social constraints exist. CHAIN’s social science working group aims to understand the contribution of modifiable social factors to mortality and to other poor outcomes of acutely ill children, both in hospital and in the post-discharge period. In addition, the Network seeks to understand the true societal and financial costs associated with poor nutrition and acute illness.

Team

Maureen Kelley

Nutrition & Metabolism

‘Undernutrition’ encompasses a range of macro- and micronutrient deficiencies that usually co-exist. For children with acute illness, metabolic disturbances affect nutrient metabolism, energy production and cellular homeostasis, while enteropathy impacts nutrient absorption and growth recovery. Evidence suggests that glycogen depletion reduces tolerance to physiological insults, such as hypoxia, while interfering with basic cellular membrane function. These nutritional and metabolic deficits are potential reasons why malnourished children fail to cope with infection and are mechanisms that may cause death without preceding warning signs. The Nutrition and Metabolism working group seeks to identify a definable metabolic phenotype that leads to inpatient death and that may be amenable to novel intervention.

Team

Robert Bandsma

Causes of Death

The causes of death among malnourished children are hard to elucidate and not well understood. The gold standard in establishing cause of death is to conduct post mortem studies but these are limited by social and cultural barriers. This working group focuses on the design of ethically and culturally appropriate tools to help improve acceptance of autopsy or of targeted tissue sampling in order to better understand the causes of death among children with acute illness and malnutrition.

Team

Wieger Voskuijl

Team Lead

Kirk Tickell

Donna Denno

Respiratory Disease & Tuberculosis

Many clinicians suspect that undiagnosed tuberculosis (TB) may be responsible for many cases of acute illness and malnutrition. However, TB is notoriously difficult to diagnose in children. A significant proportion of inpatient and post-discharge mortality may be due to either occult undiagnosed TB or to incident TB that occurs in the setting of continued vulnerability and susceptibility. If TB is an important factor in acute illness among undernourished children, they may benefit from empiric tuberculosis treatment. The Respiratory Disease and TB Working Group aims to utilize the cohort follow up to determine the frequency of undiagnosed TB among malnourished children suffering from acute illnesses.

Team

Dr. Christina Lancioni

Team Lead

Ezekiel Mupere

Tahmeed Ahmed

Mohammod Jobayer Chiisti

Principal Investigator

Immunity & Invasive Infection

Children with malnutrition are at increased risk of life-threatening infection, even after therapeutic feeding. However, the nature of immunological dysfunction is unclear and only a small proportion of children with a sepsis-like clinical presentation have positive bacterial cultures. Using the CHAIN platform, this group will examine clinical data and tissue samples for evidence of invasive infection and impaired immune function associated with malnutrition. This work will lead to a better understanding of the sepsis-like presentment that appears to cause death in many acutely unwell malnourished children.

Team

James A Berkley 'Jay'

Team Lead

Enteric function & Infection

The enteric system is critical for the maintenance of normal immune function, and nutrient absorption. Alterations in the biology of the gut caused by pathogens or medical intervention may be associated with poor recovery from acute illness. The CHAIN Network’s Enterics group aims to understand the role of intestinal pathogens, enteropathy and gut microbiome in causing death and growth failure in acutely ill children in order to then target these with treatment interventions.

Team

Dr. Donna Denno

Team Lead

Robert Bandsma

Undernutrition in Infancy

Malnourished infants experience very high mortality and incidence of severe infections such as pneumonia and diarrhoea. However, nutritional rehabilitation guidelines for infants under 6 months are currently based on minimal evidence. This working group will describe the patterns and consequences of breastfeeding practices among children that are acutely unwell. In addition, they will determine how inpatient re-lactation and other breast-feeding support prevents further deterioration in child health.

Team

James A Berkley 'Jay'

Team Lead

Acute Care & Monitoring

Children with malnutrition and an acute illness often die unexpectedly, usually with a rapid deterioration preceded by few warning signs. Unlike well-nourished children, mortality often occurs late in the hospitalization period or after discharge. The CHAIN Network will develop and validate tools that predict these deterioration at admission and during hospitalization. Secondly we will better define clinical recovery during hospitalization and in the post-discharge period.

Team

Kirk Tickell

Kirk Tickell

Robert Bandsma

Jenala Njirammadzi

Neuro-cognitive Development

Malnutrition can impair the neurocognitive development of a child which can lead to extended disabilities and impact their survival. In low resource settings, little is known about the prevalence of neurodevelopmental disability and its impact on childhood survival. Therefore, The CHAIN Cohort will screen children with and without malnutrition to assess the burden and extent of disabilities. Validated, developmental screening tools and questionnaires will be used and children will be followed longitudinally to assess progression and impact on mortality.

Team

James A Berkley 'Jay'

Team Lead