Enteric Pathogens and Post-discharge Outcomes among Children in sub-Saharan Africa and South Asia (The EPPO-SASA Study)
Wellcome Trust
KEMRI Wellcome Trust Research Programme
Enteric pathogens are a major cause of hospitalisation among children and are associated with diarrhoea, enteric dysfunction, dysbiosis, and increased risk of mortality and readmission especially in low- and middle-income countries. When admitted to hospital, treatment failure may occur despite following guidelines. Furthermore, carriage of pathogens or disturbance in the intestinal microbiome may be hospital-acquired and/or resistant to first-line antimicrobials potentially increasing the risk of readmission. I aim to determine whether molecular evidence of enteric pathogens and gut dysbiosis at hospital discharge, when children were judged as clinically well, is associated with readmission post-discharge among children across the nutritional stratum. This case-control study is nested within the completed CHAIN cohort study (six countries) that aims to characterise demographic, clinical, and social risk factors for mortality among children <2 years old, with an extensive nested case-cohort systems biology sub-study targeting mortality. Cases will be children readmitted to hospital within 6 months of index discharge and controls will be age, nutritional stratum and site matched children who were not readmitted. I will utilise targeted faecal TaqMan multiplex PCR (Kilifi, Kenya), culturomics and metagenomics (Sanger Institute, UK). Findings may support policies for post-discharge screening, prophylaxis, targeted diagnostics, and revision of treatment protocols.
2.2 Factors relating to physical environment