The REACH study and the CHAIN Network cohort study

CHAIN (www.chainnetwork.org) is a multidisciplinary research network aiming to understand the mechanisms contributing to young child mortality in hospital and after discharge in Low and Middle Income Countries (LMICs) in order to identify interventions to improve survival.²⁹ The Network conducted a prospective observational cohort study at nine hospital sites in Africa and South Asia, recruiting more than 3000 acutely ill children at admission to hospital and following them for 6 months after discharge to identify pathways underlying mortality risk despite adherence to current treatment guidelines and protocols. The main study procedures in CHAIN are outlined in figure 1 (top image), with the overall design being observational, that is, building into, learning about and referring to existing services rather than creating new systems for study participants.

Childhood Acute Illness & Nutrition Network outcomes, measures and the embedded ethics approach.

The integrated REACH empirical ethics study included input on overall study design, consent processes, ancillary care planning and regular review and discussion of emerging ethical issues and dilemmas across all sites (MK served as an ethics advisor for the CHAIN Network). Cycles of learning, advice, discussion and corresponding action were embedded into study processes, including annual meetings, as outlined in figure 1 (bottom image). These cross-site processes were informed by in-depth qualitative research involving research team members and homes and communities in four sites, including Kilifi and Nairobi counties in Kenya.³¹