Strengthening the paediatric clinical trial ecosystem to better inform policy and programmes
The first WHO Global Clinical Trials Forum was convened in November 2023 to develop a shared vision of an effective global clinical trial infrastructure. In this paper, the Paediatric Clinical…
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Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study
Abstract Introduction Childhood illness and hospitalisation result in both direct and indirect costs to families before, during and after admission. We aimed to estimate the catastrophic expenditure during hospitalisation for children…
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Differentiating mortality risk of individual infants and children to improve survival: opportunity for impact
Children are not born equal in their likelihood of survival. The risk of mortality is highest during and shortly after birth. In the immediate postnatal period and beyond, perinatal events,…
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Barriers and enablers to the effective implementation of omics research in low- and middle-income countries
Abstract Addressing the hurdles and opportunities associated with omics research in low- and middle-income countries may inform strategies for its effective execution, and thus increase our ability to tackle health…
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Intestinal disturbances associated with mortality of children with complicated severe malnutrition
Abstract Background Children admitted to hospital with complicated severe malnutrition (CSM) have high mortality despite compliance with standard WHO management guidelines. Limited data suggests a relationship between intestinal dysfunction and…
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Rebalancing of mitochondrial homeostasis through an NAD+ – SIRT1 pathway preserves intestinal barrier function in severe malnutrition
Abstract Background The intestine of children with severe malnutrition (SM) shows structural and functional changes that are linked to increased infection and mortality. SM dysregulates the tryptophan-kynurenine pathway, which may…
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Inhibition of mTOR improves malnutrition induced hepatic metabolic dysfunction
Abstract Severe malnutrition accounts for half-a-million deaths annually in children under the age of five. Despite improved WHO guidelines, inpatient mortality remains high and is associated with metabolic dysfunction. Previous…
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Organoids as a model to study intestinal and liver dysfunction in severe malnutrition
ABSTRACT Hospitalized children with severe malnutrition face high mortality rates and often suffer from hepatic and intestinal dysfunction, with negative impacts on their survival. New treatments cannot be developed without…
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The role of the tryptophan-NAD + pathway in a mouse model of severe malnutrition induced liver dysfunction
Abstract Mortality in children with severe malnutrition is strongly related to signs of metabolic dysfunction, such as hypoglycemia. Lower circulating tryptophan levels in children with severe malnutrition suggest a possible…
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Characterising paediatric mortality during and after acute illness in Sub-Saharan Africa and South Asia: a secondary analysis of the CHAIN cohort using a machine learning approach
Background A better understanding of which children are likely to die during acute illness will help clinicians and policy makers target resources at the most vulnerable children. We used machine…
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Treatment-seeking and recovery among young undernourished children post-hospital discharge in Bangladesh
Abstract Introduction Post-hospital discharge mortality is high among undernourished children in many low and middle-income countries. Although a number of quantitative studies have highlighted a range of potential socio-cultural, economic…
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Introducing Precision Nutrition for Vulnerable Children in Low-Resource Settings
Introducing Precision Nutrition for Vulnerable Children in Low-Resource Settings. Read full article here Precision Nutrition for Low-and Middle-Income Countries: Hype or Hope? Link to the whole magazine
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Predicting the risk of mortality during hospitalization in sick severely malnourished children using daily evaluation of key clinical warning signs.
Abstract Background Despite adherence to WHO guidelines, inpatient mortality among sick children admitted to hospital with complicated severe acute malnutrition (SAM) remains unacceptably high. Several studies have examined risk factors…
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Minimally invasive post-mortem intestinal tissue sampling in malnourished and acutely ill children is feasible and informative
Abstract Background Intestinal disorders such as environmental enteric dysfunction (EED) are prevalent in low- and middle-income countries (LMICs) and important contributors to childhood undernutrition and mortality. Autopsies are rarely…
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Systemic inflammation and metabolic disturbances underlie inpatient mortality among ill children with severe malnutrition.
Abstract Children admitted to hospital with an acute illness and concurrent severe malnutrition have a high risk of dying. The biological processes underlying their mortality are poorly understood. In this…
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The role of albumin and the extracellular matrix on the pathophysiology of oedema formation in severe malnutrition.
Background While fluid flows in a steady state from plasma, through interstitium, and into the lymph compartment, altered fluid distribution and oedema can result from abnormal Starling's forces, increased endothelial…
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The Childhood Acute Illness and Nutrition (CHAIN) network nested case-cohort study protocol: a multi-omics approach to understanding mortality among children in sub-Saharan Africa and South Asia.
Abstract Introduction: Many acutely ill children in low- and middle-income settings have a high risk of mortality both during and after hospitalisation despite guideline-based care. Understanding the biological mechanisms underpinning…
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The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting Among Hospitalized Children Aged 6-23 months in Sub-Saharan Africa and South Asia
Abstract Abstract - “…on providing therapeutic and supplementary foods…” – the supplementary foods are included in the therapeutic, so the sentence needs reformulation; Read full report here
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Toll-Like Receptor-Induced Immune Responses During Early Childhood and Their Associations With Clinical Outcomes Following Acute Illness Among Infants in Sub-Saharan Africa
Abstract Severely ill children in low- and middle-income countries (LMICs) experience high rates of mortality from a broad range of infectious diseases, with the risk of infection-related death compounded by…
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Childhood mortality during and after acute illness in sub-Saharan Africa and South Asia – The CHAIN cohort study
Abstract Objectives Mortality during acute illness among children in low- and middle-income settings remain unacceptably high and there is increasing recognition of the importance of post-discharge mortality. A comprehensive understanding of…
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Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh
Abstract Background: Post-hospital discharge mortality risk is high among young children in many low and middle-income countries (LMICs). The available literature suggests that child, caregiver and health care provider gender all…
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Model for developing context-sensitive responses to vulnerability in research: managing ethical dilemmas faced by frontline research staff in Kenya
Abstract Health research in low-resource settings often involves individuals and populations defined as 'vulnerable'. There is growing attention in the literature to the ethical dilemmas that frontline research staff face…
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Vulnerability, Agency, and the Research Encounter: Family Members’ Experiences and Perceptions of Participating in an Observational Clinical Study in Kenya
Abstract Pediatric clinical research in low-resourced countries involves individuals defined as "vulnerable" in research ethics guidance. Insights from research participants can strengthen the design and oversight of studies. We share…
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Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya
Abstract Background: Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role…
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Applying a gender lens to understand pathways through care for acutely ill young children in Kenyan urban informal settlements
Abstract Background: In many African settings, gender strongly influences household treatment-seeking and decision-making for childhood illnesses. While mothers are often the primary engagers with health facilities, their independence in illness-related decisions…
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Vulnerability and agency across treatment-seeking journeys for acutely ill children: how family members navigate complex healthcare before, during and after hospitalisation in a rural Kenyan setting.
Abstract Background: Child mortality rates during hospitalisation for acute illness and after discharge are unacceptably high in many under-resourced settings. Childhood vulnerability to recurrent illness, and death, is linked to…
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Childhood Acute Illness and Nutrition (CHAIN) Network: a protocol for a multi-site prospective cohort study to identify modifiable risk factors for mortality among acutely ill children in Africa and Asia
The Childhood Acute Illness and Nutrition Network Introduction Children admitted to hospitals in resourcepoor settings remain at risk of both inpatient and postdischarge mortality. While known risk factors such as…
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The impact of malnutrition on childhood infections
Judd L. Walson and James A. Berkley Purpose of review Almost half of all childhood deaths worldwide occur in children with malnutrition, predominantly in sub- Saharan Africa and South Asia.…
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Severe childhood malnutrition
AUTHORS: Zulfiqar A. Bhutta, James A. Berkley, Robert H. J. Bandsma, Marko Kerac, Indi Trehan and André Briend Use the term ‘severe malnutrition’ to describe these conditions to better reflect the…
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Knowledge of, and attitudes to giving expressed breastmilk to infants in rural coastal Kenya; focus group discussions of first time mothers and their advisers.
AUTHORS: Talbert AW, Tsofa B, Mumbo E, Berkley JA, Mwangome M Explored knowledge of, and attitudes to, the practice of giving expressed breastmilk in a mixed methods observational study of breastfeeding in rural Kenyan mothers.
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The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study.
AUTHORS: Ngari MM, Thitiri J, Mwalekwa L, Timbwa M, Iversen PO, Fegan GW, Berkley JA Investigated the associations of clinically diagnosed rickets with life-threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated SAM. This…
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Severe malnutrition in infants aged <6 months-Outcomes and risk factors in Bangladesh: A prospective cohort study.
AUTHORS: Munirul Islam M, Arafat Y, Connell N, Mothabbir G, McGrath M, Berkley JA, Ahmed T, Kerac M. argue that severe acute malnutrition (SAM) affects ~4 million infants under 6 months (u6m) worldwide, but evidence underpinning their care is…
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Featured PUBLICATIONS
New technology to help unravel why millions of undernourished children die
CHAIN's Dr. James Njunge is one of the 6 finalists in the Wellcome/WHO Early Career Researcher competition. He writes about a new technology that can help us understand why millions…
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