Campylobacter Colonization, Environmental Enteric Dysfunction, Stunting, and Associated Risk Factors Among Young Children in Rural Ethiopia: A Cross-Sectional Study From the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) Project

Abstract

Livestock farming provides a possible mechanism by which smallholder farmers can meet their household need for animal source foods (ASF), which may reduce the risk of stunting. However, direct/indirect contacts with domestic animals may increase colonization by Campylobacter spp., which has been associated with Environmental Enteric Dysfunction (EED) and stunting. A cross-sectional study involving 102 randomly selected children between 12 and 16 months of age was conducted in rural eastern Ethiopia to establish prevalence rates of Campylobacter colonization, EED, and stunting, and evaluate potential risk factors. Data were collected between September and December 2018. The prevalence of EED and stunting was 50% (95% CI: 40-60%) and 41% (95% CI: 32-51%), respectively. Among enrolled children, 56% had consumed some ASF in the previous 24 h; 47% had diarrhea and 50% had fever in the past 15 days. 54, 63, 71 or 43% of households owned at least one chicken, cow/bull, goat, or sheep; 54 (53%) households kept chickens indoors overnight and only half of these confined the animals. Sanitation was poor, with high levels of unimproved latrines and open defecation. Most households had access to an improved source of drinking water. The prevalence of Campylobacter colonization was 50% (95% CI: 41-60%) by PCR. In addition to the thermotolerant species Campylobacter jejuni, Campylobacter coli and Campylobacter upsaliensis, non-thermotolerant species related to Campylobacter hyointestinalis and Campylobacter fetus were frequently detected by Meta-total RNA sequencing (MeTRS). Current breastfeeding and ASF consumption increased the odds of Campylobacter detection by PCR, while improved drinking water supply decreased the odds of EED. No risk factors were significantly associated with stunting. Further studies are necessary to better understand reservoirs and transmission pathways of Campylobacter spp. and their potential impact on child health.

Keywords: Campylobacter; Ethiopia; cross-sectional study; environmental enteric dysfunction; smallholder farming; undernutrition.

Figure 1

Distribution of LAZ & WLZ compared to WHO normal growth standards in five rural kebeles in Haramaya woreda, Eastern Ethiopia. The histograms show the distribution of LAZ and WLZ in the sample; the blue curve shows a standard normal distribution of WHO growth reference (μ = 0, σ = 1). Orange and red dotted lines indicate thresholds for stunting/wasting (Z score <-2) and severe stunting/wasting (Z score <-3), respectively.

Figure 2

Putative relationships between animal ownership and management, WASH conditions, diets and the main outcome variables in this study: colonization of children with Campylobacter spp., environmental enteric dysfunction (EED) and stunting. The rounded-dot dash lines represent the complex interactions between livestock ownership and risk factors explored in this study. The thick bold lines represented significant (p < 0.05) associations in the multivariate models. The thinner lines represent tested associations in the single exposure models. aOR: adjusted odds ratio (p-value in parenthesis).