title: Epidemiology and Impact of Campylobacter Infection in Children in 8 Low-Resource Settings: Results From the MAL-ED Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: Haydom Lutheran Hospital, Haydom, Tanzania.
authors: Caroline
authors: C
authors: Amour
authors: Haydom Lutheran Hospital, Haydom, Tanzania Division of Infectious Diseases and International Health, University of Virginia, Charlottesville.
authors: Jean
authors: J
authors: Gratz
authors: Haydom Lutheran Hospital, Haydom, Tanzania.
authors: Estomih
authors: E
authors: Mduma
authors: Haukeland University Hospital, Bergen, Norway.
authors: Erling
authors: E
authors: Svensen
authors: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville.
authors: Elizabeth T
authors: ET
authors: Rogawski
authors: Fogarty International Center, National Institutes of Health.
authors: Monica
authors: M
authors: McGrath
authors: Fogarty International Center, National Institutes of Health.
authors: Jessica C
authors: JC
authors: Seidman
authors: Fogarty International Center, National Institutes of Health.
authors: Benjamin J J
authors: BJ
authors: McCormick
authors: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
authors: Sanjaya
authors: S
authors: Shrestha
authors: University of Venda, Thohoyandou, South Africa.
authors: Amidou
authors: A
authors: Samie
authors: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors: Mustafa
authors: M
authors: Mahfuz
authors: Aga Khan University, Karachi, Pakistan.
authors: Shahida
authors: S
authors: Qureshi
authors: Aga Khan University, Karachi, Pakistan.
authors: Aneeta
authors: A
authors: Hotwani
authors: Christian Medical College, Vellore, India.
authors: Sudhir
authors: S
authors: Babji
authors: Asociación Benéfica PRISMA, Iquitos, Peru.
authors: Dixner Rengifo
authors: DR
authors: Trigoso
authors: Clinical Research Unit and Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil.
authors: Aldo A M
authors: AA
authors: Lima
authors: Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
authors: Ladaporn
authors: L
authors: Bodhidatta
authors: University of Venda, Thohoyandou, South Africa.
authors: Pascal
authors: P
authors: Bessong
authors: International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors: Tahmeed
authors: T
authors: Ahmed
authors: Aga Khan University, Karachi, Pakistan.
authors: Sadia
authors: S
authors: Shakoor
authors: Christian Medical College, Vellore, India.
authors: Gagandeep
authors: G
authors: Kang
authors: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Asociación Benéfica PRISMA, Iquitos, Peru.
authors: Margaret
authors: M
authors: Kosek
authors: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville.
authors: Richard L
authors: RL
authors: Guerrant
authors: Foundation for the National Institutes of Health, Bethesda.
authors: Dennis
authors: D
authors: Lang
authors: Foundation for the National Institutes of Health, Bethesda.
authors: Michael
authors: M
authors: Gottlieb
authors: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville.
authors: Eric R
authors: ER
authors: Houpt
authors: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville.
authors: James A
authors: JA
authors: Platts-Mills
mesh_terms: D002169:Campylobacter Infections / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D002657:Child Development; D015331:Cohort Studies; D017281:Cost of Illness; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
keywords: Campylobacter; children; growth; inflammation; risk factors