Campylobacter colonization, environmental enteric dysfunction stunting, and associated risk factors among young children in rural Ethiopia: A cross-sectional study from the CAGED project

Authors: CHEN, DEHAO - UNIVERSITY OF FLORIDA; MCKUNE, SARAH - UNIVERSITY OF FLORIDA; SINGH, NITYA - UNIVERSITY OF FLORIDA; HASSEN, JEMAL YOUSUF - ETHIOPIA HARAMAYA UNIVERSITY; GEBREYES, WONDWOSSEN - THE OHIO STATE UNIVERSITY; MANARY, MARK - WASHINGTON UNIVERSITY; BARDOSH, KEVIN - UNIVERSITY OF FLORIDA; YANG, YANG - UNIVERSITY OF FLORIDA; DIAZ, NICHOLAS - UNIVERSITY OF FLORIDA; MOHAMMED, ABDULMUEN - ETHIOPIA HARAMAYA UNIVERSITY; TEREFE, YITAGELE - ETHIOPIA HARAMAYA UNIVERSITY; ROBA, KEDIR TEJI - ETHIOPIA HARAMAYA UNIVERSITY; KETEMA, MENGISTU - ETHIOPIA HARAMAYA UNIVERSITY; AMEHA, NEGASSI - ETHIOPIA HARAMAYA UNIVERSITY; ASSEFA, NEGA - ETHIOPIA HARAMAYA UNIVERSITY; RAJASHEKARA, GIREESH - THE OHIO STATE UNIVERSITY; DEBLAIS, LOIC - THE OHIO STATE UNIVERSITY; GHANEM, MOSTAFA - THE OHIO STATE UNIVERSITY; YIMER, GETNET - THE OHIO STATE UNIVERSITY; HAVELAAR, ARIE - UNIVERSITY OF FLORIDA

Submitted to: FRONTIERS IN PUBLIC HEALTH
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/17/2020
Publication Date: 1/21/2021
Citation: Chen, D., McKune, S.L., Singh, N., Yousuf Hassen, J., Gebreyes, W., Manary, M.J., Bardosh, K., Yang, Y., Diaz, N., Mohammed, A., Terefe, Y., Roba, K.T., Ketema, M., Ameha, N., Assefa, N., Rajashekara, G., Deblais, L., Ghanem, M., Yimer, G., Havelaar, A.H. 2021. 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. Frontiers in Public Health. 8:615793. https://doi.org/10.3389/fpubh.2020.615793.
DOI: https://doi.org/10.3389/fpubh.2020.615793

Interpretive Summary: Livestock farming provides small farmers in Ethiopia access to needed animal source protein foods, however, direct/indirect contact with domestic animals may increase individual’s exposure to Campylobacter bacterial infections which has been connected with Environmental enteric dysfunction (EED) and associated with stunting, a major public health problem linked to increased childhood morbidity and mortality. A group of children aged 12 – 16 months were evaluated to establish incidences of Campylobacter colonization, EED, and stunting. This study revealed high burdens of Campylobacter colonization, EED, and stunting in the traditional rural settings of smallholder farmers and child health may be negatively influenced by poor diversity of diet, low level of sanitation, in combination with poor livestock management. Further studies are needed to better understand transmission pathways and the impact on child health.

Technical 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.