{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:56:52Z","timestamp":1791381412408,"version":"4.3.3"},"reference-count":29,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000974","name":"Australian Centre for International Agricultural Research","doi-asserted-by":"publisher","award":["LS-2021-126"],"award-info":[{"award-number":["LS-2021-126"]}],"id":[{"id":"10.13039\/501100000974","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,15]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>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\u2009monthly intervals in year 1 and 6\u2009monthly 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110180","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:25:18Z","timestamp":1791379518000},"page":"e110180","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Early life exposures of enteric pathogens and nutritional outcomes in Timor-Leste: a longitudinal birth cohort study protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1553-8498","authenticated-orcid":false,"given":"Haribondhu","family":"Sarma","sequence":"first","affiliation":[{"name":"National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Amaral","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research \u2013 Timor-Leste, Charles Darwin University, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Santos Lay","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Guido Valadares National Hospital, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesy Careca","family":"Atok","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research \u2013 Timor-Leste, Charles Darwin University, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Oakley","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research \u2013 Timor-Leste, Charles Darwin University, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevio","family":"Sarmento","sequence":"additional","affiliation":[{"name":"Global and Tropical Health, Menzies School of Health Research, Casuarina, Northern Territory, Australia"},{"name":"Instituto Nacional da Sa\u00fade P\u00fablica \u2013 Timor-Leste (INSP-TL), Ministry of Health, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domingos","family":"Soares","sequence":"additional","affiliation":[{"name":"Instituto Nacional da Sa\u00fade P\u00fablica \u2013 Timor-Leste (INSP-TL), Ministry of Health, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Bright","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Da Costa","family":"Maia","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research \u2013 Timor-Leste, Charles Darwin University, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Goodman","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Labond","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melita","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Planning for Nutrition, Ministry of Health, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel Gama","family":"Soares","sequence":"additional","affiliation":[{"name":"Instituto Nacional da Sa\u00fade P\u00fablica, Ministry of Health, Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felisiano","family":"Da Concei\u00e7\u00e3o","sequence":"additional","affiliation":[{"name":"Ministry of Agriculture, Livestock, Forestry and Fisheries (MALFF), Dili, Timor-Leste"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Bucens","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S S","family":"Fancourt","sequence":"additional","affiliation":[{"name":"Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Yan","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia"},{"name":"Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Glass","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martyn D","family":"Kirk","sequence":"additional","affiliation":[{"name":"National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, 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Paris OECD; 2022."},{"key":"2026100706251248000_16.10.e110180.5","unstructured":"Ministry of Health, Timor-Leste . Food and nutrition survey 2020. Dili Ministry of Health; 2022."},{"key":"2026100706251248000_16.10.e110180.6","doi-asserted-by":"crossref","unstructured":"Alflah YM . Severe Acute Malnutrition and Its Consequences Among Malnourished Children. J Clin Ped Res 2023. doi:10.37191\/Mapsci-2583-4525-2(1)-011","DOI":"10.37191\/Mapsci-2583-4525-2(1)-011"},{"key":"2026100706251248000_16.10.e110180.7","doi-asserted-by":"crossref","unstructured":"Amir-ud-Din R , Fawad S , Naz L . Nutritional inequalities among under-5 children: an analysis of cross-country and within-country hotspots and cold spots in the developing world. 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