CHAIN Network's Research
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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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 magazineRead More
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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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 hereRead More
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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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…Read More
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.…Read More
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…Read More
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.Read More
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…Read More
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…Read More
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…Read More
CHAIN Malawi responds to The Lancet’s, “Closing the door on parachutes and parasites.”
AUTHORS: Philliness Prisca Harawa, Emmie Mbale, Mac Mallewa, Queen Dube, Josephine Langton, Jenala Njiram’madzi, Benjamin Kumwenda, Robert Bandsma, Wieger VoskuijlRead More
Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia
AUTHORS: Chisti MJ, Salam MA, Bardhan PK, Faruque AS, Shahid AS, Shahunja KM, Das SK, Hossain MI, Ahmed T (more…)Read More