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Article History

Received: 20 August 2025

Accepted: 26 November 2025

First Online: 12 December 2025

Declarations

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: The Human Research and Ethics Committee of the Faculty of Health Science, University of Cape Town (HREC/REF: 451/2014) approved the parent study, and additional ethical approval for the bacteriome study, Human Research and Ethics Committee (HREC/REC: 668/2020), was obtained. Written informed consent was obtained from all parents or legal guardians of children included in this study. All research activities were in compliance with the ethical principles under the World Medical Association Declaration of Helsinki. Consent for publication by study participants is not applicable as no identifying information is included.

: R.L.G. serves as a co-founder, scientific advisor, consultant, and equity holder in MatriSys Biosciences, and holds a position as a consultant, receiving income, and equity holder in Sente Inc. R.K. is a scientific advisory board member and consultant for BiomeSense, Inc., holding equity and receiving income. He is a member of the scientific advisory board and has equity in GenCirq. He has equity in and acts as a consultant for Cybele. He is a co-founder of Biota, Inc., and has equity. He is a co-founder of Micronoma, holds equity, and serves on the scientific advisory board. He is a board member of Microbiome Vault, Inc. He is a N=1 IBS advisory board member and receives income. He is a Senior Visiting Fellow of the HKUST Jockey Club Institute for Advanced Study. The terms of these arrangements have been reviewed and approved by the University of California, San Diego, in accordance with its conflict-of-interest policies. C.C. is the founder of Phiome and receives income from Dr. Armpit. He serves as a scientific advisor to NAOS, MyMicrobiome, and Parallel Health, Inc. C.L.D. is a co-founder, president, chief strategic officer, and equity holder of Biorentis, Inc.