Malnutrition in women of reproductive age remains a public health concern in Sub-Saharan Africa (SSA). Malnutrition during pregnancy affects foetal growth with a tendency of the exposed infants to also develop it. The interaction of the mother with the infant shapes the seeding and the trajectory of the infant intestinal microbiota which is crucial for development of a healthy immune system Malnutrition has been associated with intestinal inflammation, intestinal leakage and reduced calorie absorption. Early life malnutrition and environmental enteric dysfunction (EED) immunopathology remains poorly described in the context of mother-infant dyads. This is essential as malnutrition, poor water, sanitation and hygiene (WASH), including the presence of infectious diseases limit the developmental potential of the exposed infants in SSA, including Zimbabwe. In addition, maternal stress and poor mental health may also affect standard hygiene practices, including how a mother cares for her baby, potentially aggravating EED and the risk of the infant being malnourished. Primary outcomes 1. Infant malnutrition and recovery. 2. Gut dysfunction (gut inflammation, leaky gut, malabsorption, dysbiosis) 3. Diarrhea episodes, defined as any episode of acute diarrhoea (≥3 passages of loose stool within 24 hours as reported by the mother) occurring before the next study visit. Definition of malnutrition outcomes to be assessed in babies born to malnourished women, is a mid- upper arm circumference (MUAC) \<23cm; * MUAC for age: Malnourished defined as those below -2 standard (SD) of the World Health Organisation (WHO) reference * Weight-for-age: Underweight defined as those below -2SD WHO reference * Weight-for-height: Wasted defined as those below -2SD WHO reference * Height-for-age: Stunted defined as those below -2SD WHO reference * Z-scores (as they are i.e. a continuous variable, taking age of infants into account) * A composite variable, any of malnourished, underweight, wasted or stunted.
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Alpha diversity of maternal gut microbiota
Timeframe: Third trimester of pregnancy, week(s) 1, 6, 14, 24, 48, 96, 144 after delivery
Beta diversity of maternal gut microbiota
Timeframe: Third trimester of pregnancy, week(s) 1, 6, 14, 24, 48, 96, 144 after delivery
Alpha diversity of human breast milk microbiota
Timeframe: Week(s) 1, 6, 14, 24, 48, 96, 144 after delivery/ until weaning
Beta diversity of human breast milk microbiota
Timeframe: Week(s) 1, 6, 14, 24, 48, 96, 144 after delivery/ until weaning
Protein content of breast milk
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24, 48 post birth.
Fat content of breast milk
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24, 48 post birth.
Lactose content of breast milk
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24, 48 post birth.
Micronutrient content of breast milk
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24, 48 post birth.
Metabolic composition of breast milk Assessing whether compositional differences in maternal milk are associated with infant intestinal development potential
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24, 48 post birth.
Impact of breast milk on infant intestinal organoid barrier function
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24 post birth.
Impact of breast milk on infant intestinal organoid morphology
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24 post birth.
Impact of breast milk on infant intestinal organoid size
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24 post birth.
Impact of breast milk on infant intestinal organoid gene expression
Timeframe: Maternal breast milk samples collected at week(s) 1, 6, 14, 24 post birth.
Alpha diversity of infant gut microbiota
Timeframe: Week(s) 1, 6, 14, 24, 48, 96, 144 of age
Beta diversity of infant gut microbiota
Timeframe: Week(s) 1, 6, 14, 24, 48, 96, 144 of age
Relative abundance of dominant bacterial taxa and microbial metabolic pathways
Timeframe: Maternal stool: third trimester, birth, 6, 12, and 24 months postpartum • Breast milk: birth, 6, and 12 months postpartum • Infant stool: birth, 6, 12, and 24 months old.
Maternal serum immunoglobulin concentrations
Timeframe: From pregnancy and once every year for 3 years
Maternal levels of serum proteins
Timeframe: From pregnancy and once every year for 3 years
Maternal levels of serum inflammatory markers
Timeframe: Once in pregnancy, and once every year for 3 years.
Maternal biomarkers of epithelial and microbial translocation
Timeframe: Once in pregnancy, and once every year for 3 years.
Maternal Iron and anabolism-related biomarkers
Timeframe: Mother from pregnancy and once every year for 3 years
Maternal serum biochemical indicators
Timeframe: Once in pregnancy, and once every year for 3 years after delivery.
Timing of infant malnutrition and oral health status
Timeframe: From 6 months after delivery or birth and once a year for 2 years
Correlation between Oral Health of mother and that of the child
Timeframe: From 6 months after delivery or birth and once a year for 2 years
Maternal socio-demographic and the development of infant malnutrition and gut dysfunction and mortality
Timeframe: Mothers; from pregnancy and every 6 months until 3 years after deliveryInfants; from birth and every 6 months until 3 years old
Maternal stress assessment using Cohen Perceived Stress Scale (CPSS)
Timeframe: In pregnancy , weeks 6 and 24 months after delivery
Maternal stress measurement using Edinburgh Post Partum Depression Scale (EPDS)
Timeframe: weeks 6 and 24 weeks and 48 weeks after delivery
Maternal sleeping disorders as indicator of stress using Pittsburgh Sleep Quality Index (PSQI)
Timeframe: In pregnancy, weeks 6 and 24 months after delivery
Sleeping disorders assessment using Epworth Sleepiness Scale (ESS)
Timeframe: In pregnancy, weeks 6 and 24 months after delivery
Maternal assessment of life stressful events
Timeframe: In pregnancy, weeks 6 and 24 months after delivery
Maternal sleep quality measurements
Timeframe: In pregnancy, weeks 6 and 24 months after delivery
Maternal empowerment status using SWPER tool
Timeframe: In pregnancy, weeks 6 and 24 months after delivery
Women's marital satisfaction status using Kansas tool
Timeframe: In pregnancy, weeks 6 and 24 months after delivery
Concentrations of infant gut intestinal inflammation
Timeframe: Stool samples at 12, 24, and 36 months of age
Concentrations of infant intestinal permeability
Timeframe: Stool samples at 12, 24, and 36 months of age •
Infant fecal pH and fecal fat content
Timeframe: Stool samples at 12, 24, and 36 months of age •
Infant systemic endotoxemia from gut leakage
Timeframe: Stool samples at 12, 24, and 36 months of age •
Percentages of circulating T and B lymphocyte subsets and natural killer
Timeframe: Infant blood samples collected at 12, 24, and 36 months of age. Expected measures/ Unit of measures: Percentage (%) of total PBMCs per cell subset (e.g., % CD4⁺ T cells, % CD56⁺ NK cells)
Metabolic dysregulation and vaccine immune responses in infants presenting with malnutrition
Timeframe: weeks 48, 96 and 144 old.
Short and long term relationship between presence and frequency of early life diarrhea episodes and infant malnutrition, neurodevelopment and mental health
Timeframe: From birth and followed up to 3 years of age
Intestinal leakage of severely malnourished babies
Timeframe: From 1 years old up until 3 years of age
Intestinal calory extraction in severely malnourished babies
Timeframe: Weeks 48, 96 and 144 old regardless of whether or not the babies recover from malnutrition.
Colonisation patterns of Clostridioides difficile in Zimbabwe and Switzerland maternal-infant dyads
Timeframe: From birth and followed up every 6 months up until 3 years of age
Intestinal inflammation assessment via endoscopy
Timeframe: Any affected babies from one year of age