Non-invasive biomarkers of stress in mothers, fathers and infants in urban and rural Malawi: a feasibility study

众所周知，生命早期的健康是晚年患高血压、糖尿病和心脏病等一些重要疾病风险的关键决定因素。应激激素的变化被认为是重要的潜在机制。应激激素可以通过非侵入性方式收集到生物样本中，例如唾液、头发和母乳。然而，这只是在高收入环境中进行了真正的测试，目前还不知道在马拉维收集这些样本是否可以接受和可行。可能存在当地文化和技术问题-例如，头发的长度、对收集婴儿样本的看法、在家中收集样本的困难、在家中储存样本的挑战。马拉维婴儿在世界上最不发达国家之一长大，在儿童时期面临感染的高风险，在青年时期面临心脏病、糖尿病和高血压的高风险。有一个巨大的机会，以连接到这些研究，并进行更详细的研究，在较小的群体的参与者，看看潜在的潜在机制，如压力激素的变化，因此，在这项资金申请，我们希望确定的可行性和可接受性，收集非侵入性生物样本测量的“压力”激素从母亲，他们的合作伙伴和他们的婴儿。我们将邀请50名妇女和她们的伴侣，在家中收集她们自己和婴儿的唾液样本。我们训练有素的研究人员也将寻求许可收集头发样本，我们将要求妇女提供母乳样本。我们会研究是否可行，并会询问参与者及研究人员对样本收集的意见，以及研究样本的质素和研究程序是否需要作出任何改动，这些研究结果会为日后申请拨款进行大型研究的嵌套研究铺平道路。这将通过探索将早期生命发育与晚年疾病联系起来的潜在生物学机制来增加现有研究的价值。拟议的种子资金还将建设当地使用非侵入性生物样本的能力和专门知识，我们认为这对马拉维的其他工作具有更广泛的相关性。

It is known that health in early life is a key determinant of later life risk of a number of important diseases including high blood pressure, diabetes and heart disease. Changes in stress hormones are thought to be important underlying mechanism. Stress hormones can be collected in biological samples collected in non-invasive ways - such as in saliva, hair and breast milk. However, this has only really been tested in high income settings and it is not known whether collection of these samples will be acceptable and feasible in Malawi. It is likely that there are local cultural and technical issues - for example, length of hair, views on collecting samples in infants, difficulty with collecting samples at home, challenges with storing samples at home.Two large population studies have been funded to look at the relationships between health in early life and later life disease in Malawi. Malawian infants are growing up in one of the least developed countries in the world and are at high risk of infections in childhood and heart disease, diabetes and high blood pressure in young adulthood. There is a huge opportunity to link to these studies and conduct more detailed studies in smaller groups of participants to look at potential underlying mechanisms, such as changes in stress hormones.Therefore in this funding application we wish to determine the feasibility and acceptability of collecting non-invasive biological samples for measurement of 'stress' hormones from mothers, their partners and their infants. We will ask 50 women and their partners, to collect samples of saliva at home from themselves and their infants. Our trained research staff will also seek permission to collect hair samples and we will ask women to provide breast milk samples. We will find out whether it is feasible to do these collections, ask the participants and the research staff for their views about the sample collections, and look at the quality of the samples collected and whether the protocols need to be changed in any way.The findings will pave the way for a future funding application for a nested study within the larger studies. This will add value to the existing studies through exploration of underlying biological mechanisms linking early life development with later life disease. The proposed seed-funding will also build local capacity and expertise in use of non-invasive biological samples, which we identify to be of wider relevance for other work in Malawi.