Camplyobacter colonization and undernutrition in infants in rural eastern Ethiopia - a longitudinal community-based birth cohort study

Authors: CHEN, DEHAO - University Of Florida; MCKUNE, SARAH - University Of Florida; YANG, YANG - University Of Georgia; USMANE, IBSA - Ethiopia Haramaya University; AHMED, IBSAA - Ethiopia Haramaya University; AMIN, JAFER - Ethiopia Haramaya University; IBRAHIM, ABDULMUEN - Ethiopia Haramaya University; SERAN, ABADIR - Ethiopia Haramaya University; SHAIK, NURMOHAMMAD - Washington University; OJEDA, AMANDA - University Of Florida; HASSEN, BAHAR - Ethiopia Haramaya University; DEBLAIS, LOIC - The Ohio State University; AHMEDO, BELISA - Ethiopia Haramaya University; HASSEN, KEDIR - Ethiopia Haramaya University; BHRANE, MUSSIE - Ethiopia Haramaya University; LI, XIAOLONG - University Of Florida; SINGH, NITYA - University Of Florida; ROBA, KEDIR - Ethiopia Haramaya University; FRENCH, NIGEL - Massey University; RAJASHEKARA, GIREESH - The Ohio State University; MANARY, MARK - Children'S Nutrition Research Center (CNRC); HASSEN, JEMAL - Ethiopia Haramaya University; HAVELAAR, ARIE - University Of Florida

Submitted to: FRONTIERS IN PUBLIC HEALTH
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/5/2024
Publication Date: 1/7/2025
Citation: Chen, D., McKune, S.L., Yang, Y., Usmane, I.A., Ahmed, I., Amin, J.K., Ibrahim, A.M., Seran, A.J., Shaik, N., Ojeda, A., Hassen, B.M., Deblais, L., Ahmedo, B.U., Hassen, K.A., Bhrane, M., Li, X., Singh, N., Roba, K.T., French, N.P., Rajashekara, G., Manary, M.J., Hassen, J.Y., Havelaar, A.H. 2025. Camplyobacter colonization and undernutrition in infants in rural eastern Ethiopia - a longitudinal community-based birth cohort study. Frontiers in Public Health. 12. Article 1467462. https://doi.org/10.3389/fpubh.2024.1467462.
DOI: https://doi.org/10.3389/fpubh.2024.1467462

Interpretive Summary: In rural eastern Ethiopia, Campylobacter infection is associated with gut inflammation and malnutrition in children, potentially serving as a critical link between livestock fecal exposure and poor health outcomes in smallholder settings with limited resources. Researchers followed 106 infants in rural smallholder households for 13 months, finding that Campylobacter load in infant stools increased with age while stunting prevalence rose from 3% to 51%, with most risk factors associated with increased Campylobacter infection related to suboptimal feeding practices and hygiene. This study provides evidence that prelacteal feeding significantly increases Campylobacter load in the first month of life, and that over the follow-up period, Campylobacter load is increased by keeping chickens unconfined at home and unsanitary disposal of infant stools while decreased by mothers' handwashing with soap, establishing critical determinants for intervention in similar settings.

Technical Abstract: Campylobacter is associated with environmental enteric dysfunction (EED) and malnutrition in children. Campylobacter infection could be a linchpin between livestock fecal exposure and health outcomes in low-resource smallholder settings. We followed a birth cohort of 106 infants in rural smallholder households in eastern Ethiopia up to 13 months of age. We measured anthropometry, surveyed sociodemographic determinants, and collected stool and urine samples. A short survey was conducted during monthly visits, infant stool samples were collected, and Campylobacter spp. was quantified using genus-specific qPCR. In month 13, we collected stool and urine samples to assay for EED biomarkers. We employed regression analyses to assess the associations of household determinants with Campylobacter colonization, EED, and growth faltering. The Campylobacter load in infant stools increased with age. The mean length-for-age Z-score (LAZ) decreased from -0.45 at 3–4 months of age to -2.06 at 13 months, while the prevalence of stunting increased from 3 to 51%. The prevalence of EED at 13 months of age was 56%. A higher Campylobacter load was associated with more frequent diarrhea. Prelacteal feeding significantly increased Campylobacter load in the first month of life. Over the whole follow-up period, Campylobacter load was increased by keeping chickens unconfined at home and unsanitary disposal of infant stools while decreased by mothers’ handwashing with soap. Longitudinally, Campylobacter load was positively associated with food insecurity, introduction of complementary foods, and raw milk consumption. There were no significant associations between Campylobacter load, EED, and LAZ. This study found that most determinants associated with increased Campylobacter infection were related to suboptimal feeding practices and hygiene. The findings related to livestock-associated risks were inconclusive. Although stunting, EED, and Campylobacter prevalence rates all increased to high levels by the end of the first year of life, no significant association between them was identified. While additional research is needed to investigate whether findings from this study are replicable in other populations, community efforts to improve infant and young child feeding practices and food hygiene, and water, sanitation, and hygiene (WaSH) at the household level, could reduce (cross-)contamination at the point of exposure.