Epidemiology and Impact of Campylobacter Infection in Children in 8 Low-Resource Settings: Results From the MAL-ED Study
Authors: Amour Caroline , Gratz Jean , Mduma Estomih , Svensen Erling , Rogawski Elizabeth T. , McGrath Monica , Seidman Jessica C. , McCormick Benjamin J. J. , Shrestha Sanjaya , Samie Amidou , Mahfuz Mustafa , Qureshi Shahida , Hotwani Aneeta , Babji Sudhir , Trigoso Dixner Rengifo , Lima Aldo A. M. , Bodhidatta Ladaporn , Bessong Pascal , Ahmed Tahmeed , Shakoor Sadia , Kang Gagandeep , Kosek Margaret , Guerrant Richard L. , Lang Dennis , Gottlieb Michael , Houpt Eric R. , Platts-Mills James A. ,   for the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) Network Investigators, Acosta Angel Mendez , de Burga Rosa Rios , Chavez Cesar Banda , Flores Julian Torres , Olotegui Maribel Paredes , Pinedo Silvia Rengifo , Salas Mery Siguas , Trigoso Dixner Rengifo , Vasquez Angel Orbe , Ahmed Imran , Alam Didar , Ali Asad , Bhutta Zulfiqar A. , Qureshi Shahida , Rasheed Muneera , Soofi Sajid , Turab Ali , Zaidi Anita K.M. , Bodhidatta Ladaporn , Mason Carl J. , Babji Sudhir , Bose Anuradha , George Ajila T. , Hariraju Dinesh , Jennifer M. Steffi , John Sushil , Kaki Shiny , Kang Gagandeep , Karunakaran Priyadarshani , Koshy Beena , Lazarus Robin P. , Muliyil Jayaprakash , Raghava Mohan Venkata , Raju Sophy , Ramachandran Anup , Ramadas Rakhi , Ramanujam Karthikeyan , Rose Anuradha , Roshan Reeba , Sharma Srujan L. , Sundaram Shanmuga , Thomas Rahul J. , Pan William K. , Ambikapathi Ramya , Carreon J. Daniel , Charu Vivek , Doan Viyada , Graham Jhanelle , Hoest Christel , Knobler Stacey , Lang Dennis R. , McCormick Benjamin J.J. , McGrath Monica , Miller Mark A. , Mohale Archana , Nayyar Gaurvika , Psaki Stephanie , Rasmussen Zeba , Richard Stephanie A. , Seidman Jessica C. , Wang Vivian , Blank Rebecca , Gottlieb Michael , Tountas Karen H. , Amour Caroline , Bayyo Eliwaza , Mduma Estomih R. , Mvungi Regisiana , Nshama Rosemary , Pascal John , Swema Buliga Mujaga , Yarrot Ladislaus , Ahmed Tahmeed , Ahmed A.M. Shamsir , Haque Rashidul , Hossain Iqbal , Islam Munirul , Mahfuz Mustafa , Mondal Dinesh , Tofail Fahmida , Chandyo Ram Krishna , Shrestha Prakash Sunder , Shrestha Rita , Ulak Manjeswori , Bauck Aubrey , Black Robert , Caulfield Laura , Checkley William , Kosek Margaret N. , Lee Gwenyth , Schulze Kerry , Yori Pablo Peñataro , Murray-Kolb Laura E. , Ross A. Catharine , Schaefer Barbara , Simons Suzanne , Pendergast Laura , Abreu Cláudia B. , Costa Hilda , Di Moura Alessandra , Filho José Quirino , Havt Alexandre , Leite Álvaro M. , Lima Aldo A.M. , Lima Noélia L. , Lima Ila F. , Maciel Bruna L.L. , Medeiros Pedro H.Q.S. , Moraes Milena , Mota Francisco S. , Oriá Reinaldo B. , Quetz Josiane , Soares Alberto M. , Mota Rosa M.S. , Patil Crystal L. , Bessong Pascal , Mahopo Cloupas , Maphula Angelina , Nyathi Emanuel , Samie Amidou , Barrett Leah , Dillingham Rebecca , Gratz Jean , Guerrant Richard L. , Houpt Eric , Petri William A. , Platts-Mills James , Scharf Rebecca , Shrestha Binob , Shrestha Sanjaya Kumar , Strand Tor , Svensen Erling 
Published: August 2016

Abstract
Background.  Enteropathogen infections have been associated with enteric dysfunction and impaired growth in children in low-resource settings. In a multisite birth cohort study (MAL-ED), we describe the epidemiology and impact of Campylobacter infection in the first 2 years of life.
Methods.  Children were actively followed up until 24 months of age. Diarrheal and nondiarrheal stool samples were collected and tested by enzyme immunoassay for Campylobacter. Stool and blood samples were assayed for markers of intestinal permeability and inflammation.
Results.  A total of 1892 children had 7601 diarrheal and 26 267 nondiarrheal stool samples tested for Campylobacter. We describe a high prevalence of infection, with most children (n = 1606; 84.9%) having a Campylobacter-positive stool sample by 1 year of age. Factors associated with a reduced risk of Campylobacter detection included exclusive breastfeeding (risk ratio, 0.57; 95% confidence interval, .47–.67), treatment of drinking water (0.76; 0.70–0.83), access to an improved latrine (0.89; 0.82–0.97), and recent macrolide antibiotic use (0.68; 0.63–0.74). A high Campylobacter burden was associated with a lower length-for-age Z score at 24 months (−1.82; 95% confidence interval, −1.94 to −1.70) compared with a low burden (−1.49; −1.60 to −1.38). This association was robust to confounders and consistent across sites. Campylobacter infection was also associated with increased intestinal permeability and intestinal and systemic inflammation.
Conclusions.  Campylobacter was prevalent across diverse settings and associated with growth shortfalls. Promotion of exclusive breastfeeding, drinking water treatment, improved latrines, and targeted antibiotic treatment may reduce the burden of Campylobacter infection and improve growth in children in these settings.