Campylobacter colonization and undernutrition in infants in rural Eastern Ethiopia: a longitudinal community-based birth cohort study

Abstract Background Campylobacter is associated with environmental enteric dysfunction (EED) and malnutrition in children. Campylobacter infection could be a critical link between determinants of livestock fecal exposure and health outcomes in low-resource smallholder settings. Methods We followed a birth cohort of 106 infants in a community of rural smallholder households in eastern Ethiopia up to 13 months of age. We measured anthropometry, surveyed socio-demographic 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 biomarkers of EED. We employed regression analyses to assess the associations of household determinants with Campylobacter colonization, EED, and growth faltering. Results 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 mother’s 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. Conclusions This study found that most determinants associated with an increase in Campylobacter infection were related to suboptimal feeding practices and hygiene. Findings related to livestock-associated risks were inconclusive. Though 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 replicated in other populations, community efforts to improve infant and young child feeding practices, including age at introduction of complementary foods and exclusive breastfeeding, and WaSH at the household level, could reduce (cross-) contamination at the point of exposure.