Early life exposures of enteric pathogens and nutritional outcomes in Timor-Leste: a longitudinal birth cohort study protocol
12 affiliations
- 1National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- 2Menzies School of Health Research – Timor-Leste, Charles Darwin University, Dili, Timor-Leste
- 3Department of Paediatrics, Guido Valadares National Hospital, Dili, Timor-Leste
- 4Global and Tropical Health, Menzies School of Health Research, Casuarina, Northern Territory, Australia
- 5Instituto Nacional da Saúde Pública – Timor-Leste (INSP-TL), Ministry of Health, Dili, Timor-Leste
- 6National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia
- 7Planning for Nutrition, Ministry of Health, Dili, Timor-Leste
- 8Instituto Nacional da Saúde Pública, Ministry of Health, Dili, Timor-Leste
- 9Ministry of Agriculture, Livestock, Forestry and Fisheries (MALFF), Dili, Timor-Leste
- 10Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- 11Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- 12Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
Abstract
Introduction: Child undernutrition remains a major public health problem in low- and middle-income countries. Timor-Leste has one of the highest childhood stunting rates worldwide, affecting an estimated 47% of children under 5 years. Repeated exposure to enteric pathogens is increasingly recognised as a contributor to malnutrition, yet the interplay between enteric infection, environmental exposure and socioeconomic factors remains poorly understood in this setting. This protocol describes a longitudinal birth cohort study, conducted within a One Health framework, examining early-life enteric pathogen exposure and its relationship with nutritional outcomes in Timor-Leste.
Methods and analysis: This mixed-methods longitudinal birth cohort study, part of the Bacteria, Enteropathy and Nutrition research programme, is being conducted in three municipalities of Timor-Leste (Dili, Ermera and Ainaro) from November 2024 to October 2027. We will recruit 450 infants at birth and follow them for 24 months, with home visits at 3 monthly intervals in year 1 and 6 monthly intervals in year 2. Faecal, food, water, soil and domestic animal samples will be tested for bacterial, viral and parasitic pathogens; child growth will be assessed using anthropometry. Structured surveys, household observations and in-depth interviews will capture food safety practices, feeding behaviours and socioeconomic factors. Associations between enteric infection and child growth will be assessed using multivariable regression and longitudinal mixed-effects models; qualitative data will be analysed thematically.
Ethics and dissemination: Ethical approval has been granted by the Human Research Ethics Committee and Veterinary Research Ethics Committee of the Ministry of Health, Timor-Leste (1827/INSP-TL/UEPD-AL/X/2024), Menzies School of Health Research (EC00153) and the Australian National University (H/2024/0964). Written informed consent will be obtained from parents or guardians. Findings will be disseminated through peer-reviewed publications, conference presentations, community workshops and policy briefs in English and Tetum.
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BibTeX
@article{sarma2026early,
title = {{Early life exposures of enteric pathogens and nutritional outcomes in Timor-Leste: a longitudinal birth cohort study protocol}},
author = {Haribondhu Sarma and Salvador Amaral and Milena Santos Lay and Lesy Careca Atok and Tessa Oakley and Nevio Sarmento and Domingos Soares and Kathryn Bright and Carolina Da Costa Maia and Claudia Goodman and Christine Labond and Melita Monteiro and Noel Gama Soares and Felisiano Da Conceição and Ingrid Bucens and Nicholas S S Fancourt and Jennifer Yan and Kathryn Glass and Martyn D Kirk and Samantha Colquhoun},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2025-110180},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-110180},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Early life exposures of enteric pathogens and nutritional outcomes in Timor-Leste: a longitudinal birth cohort study protocol
AU - Haribondhu Sarma
AU - Salvador Amaral
AU - Milena Santos Lay
AU - Lesy Careca Atok
AU - Tessa Oakley
AU - Nevio Sarmento
AU - Domingos Soares
AU - Kathryn Bright
AU - Carolina Da Costa Maia
AU - Claudia Goodman
AU - Christine Labond
AU - Melita Monteiro
AU - Noel Gama Soares
AU - Felisiano Da Conceição
AU - Ingrid Bucens
AU - Nicholas S S Fancourt
AU - Jennifer Yan
AU - Kathryn Glass
AU - Martyn D Kirk
AU - Samantha Colquhoun
PY - 2026
DA - 2026/10/07
JO - BMJ Open
DO - 10.1136/bmjopen-2025-110180
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2025-110180
AB - Introduction: Child undernutrition remains a major public health problem in low- and middle-income countries. Timor-Leste has one of the highest childhood stunting rates worldwide, affecting an estimated 47% of children under 5 years. Repeated exposure to enteric pathogens is increasingly recognised as a contributor to malnutrition, yet the interplay between enteric infection, environmental exposure and socioeconomic factors remains poorly understood in this setting. This protocol describes a longitudinal birth cohort study, conducted within a One Health framework, examining early-life enteric pathogen exposure and its relationship with nutritional outcomes in Timor-Leste. Methods and analysis: This mixed-methods longitudinal birth cohort study, part of the Bacteria, Enteropathy and Nutrition research programme, is being conducted in three municipalities of Timor-Leste (Dili, Ermera and Ainaro) from November 2024 to October 2027. We will recruit 450 infants at birth and follow them for 24 months, with home visits at 3 monthly intervals in year 1 and 6 monthly intervals in year 2. Faecal, food, water, soil and domestic animal samples will be tested for bacterial, viral and parasitic pathogens; child growth will be assessed using anthropometry. Structured surveys, household observations and in-depth interviews will capture food safety practices, feeding behaviours and socioeconomic factors. Associations between enteric infection and child growth will be assessed using multivariable regression and longitudinal mixed-effects models; qualitative data will be analysed thematically. Ethics and dissemination: Ethical approval has been granted by the Human Research Ethics Committee and Veterinary Research Ethics Committee of the Ministry of Health, Timor-Leste (1827/INSP-TL/UEPD-AL/X/2024), Menzies School of Health Research (EC00153) and the Australian National University (H/2024/0964). Written informed consent will be obtained from parents or guardians. Findings will be disseminated through peer-reviewed publications, conference presentations, community workshops and policy briefs in English and Tetum.
SN - 2044-6055
SN - 2044-6055
ER -