SITES & COORDINATING CENTRES CHAIN The Childhood Acute Illness & Nutrition Network INTRODUCTION SITES & COORDINATING CENTRES COHORT DESIGN Children admitted to hospital with undernutrition are at high risk of mortality as inpatients and after discharge despite current practice. We need to better understand biomedical and social risks and barriers in order to develop better interventions for the most vulnerable children. Admitted with acute illness (500 per site) Spectrum of nutritional status (SAM, MAM, well-nourished) 1 to 23 months old Follow up 6 months Community controls Young age Acute illness (hospitalization) Low anthropometry Target population Admission Day 45 Day 90 Day 180 Day 5 Day 2 Household Survey Daily Review 2nd DISCHARGE POST-DISCHARGE FOLLOW –UP ADMISSION OBSERVATION & SAMPLE COLLECTION Follow up Discharge 1st 3rd 4th 5th 6th 7th FOCUS AREAS AIMS Sub-Studies Understand and reduce mortality risks associated with undernutrition: In hospital After discharge Identify agency & vulnerability Biomedical & Social factors Ethical conduct of research in vulnerable groups Design and conduct more effective trials Social Science: Qualitative – rural/urban in Kenya/Bangladesh Immunology – ability to respond in vitro to pathogen challenge TB - enhanced screening, burden and mortality Enteric function: inflammation & permeability Microbiology: pathogens and antimicrobial resistance Body composition: health growth & recovery PARTNERS CORE ACTIVITIES Harmonized international prospective cohort of acutely-ill children across a spectrum of nutritional status Demographic, clinical, laboratory and social phenotyping Leverage existing clinical data and samples for comparative or pooled analyses Identify potential interventional trial priorities