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

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.

Two recently funded major population research studies on chronic conditions in Malawi will include the capacity to monitor a family's physical and mental health during the mother's pregnancy and the subsequent health of her infants. 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 cardiometabolic disease in young adulthood. In this seed-funding application we wish to determine the feasibility and acceptability of collecting non-invasive biological samples for measurement of 'stress' hormones (glucocorticoids) from mothers, their partners, and their infants. These include hair, breast milk as well as self-collected saliva samples, collected at home. We will explore both participants' and staff views of collecting the samples, assess the quality of samples collected and make any necessary changes to our protocols. 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 MRC- and Wellcome-funded work 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.

Alterations in actions of stress hormones are important in the aetiology of many common chronic conditions and are also a key mechanism underpinning the link between early life development and later life disease. This mechanism is likely very relevant in Malawi, one of the poorest countries in the world where children are exposed to malnutrition in utero, risk of childhood infection and risk of non-communicable diseases such as high blood pressure and diabetes in young adulthood. As stress hormones can be measured in biological samples which can be collected in a non-invasive way, this study will be the first to test whether this approach is feasible and acceptable in Malawi.

We anticipate the following impacts:

Pregnant women and their children:
Better health and management during pregnancy and the post-partum period. Improved health in childhood. Better education and health awareness.

Health care professionals (diabetologists, obstetricians, midwives and others) directly involved in the care of pregnant women:
Better understanding of the key roles of stress hormones on health of women and their children.

Academic:
Open access publications and presentations at appropriate regional/international meetings
Training and capacity building of early career/senior researchers/research support staff, enhancing skill set and career development
Project specific meetings to foster future multi-disciplinary collaborations and grant applications
Data sharing partners, academic community and local study populations.
New knowledge targeted to local needs.

Economic/societal:
Improved health and quality of life for mothers and newborns
Economic productivity through improved health of mothers and their children

Improvements in research quality and impact:
Higher profile of partner organisations from skills development and publications.
Public engagement leading to greater health knowledge and empowerment of populations.

We plan for impact to be achieved via multiple channels:
Knowledge exchange (publications and presentations; direct communication with policymakers, practitioners and public) via range of appropriate communications channels
Development of relevant new skills
Improvement in effectiveness of local health services and health policy (through implementation of new knowledge)