Campylobacter infection and household factors are associated with childhood growth in urban Bangladesh: An analysis of the MAL-ED study

Abstract

The dual burden of enteric infection and childhood malnutrition continues to be a global health concern and a leading cause of morbidity and death among children. Campylobacter infection, in particular, is highly prevalent in low- and middle-income countries, including Bangladesh. We examined longitudinal data to evaluate the trajectories of change in child growth, and to identify associations with Campylobacter infection and household factors. The study analyzed data from 265 children participating in the MAL-ED Study in Mirpur, Bangladesh. We applied latent growth curve modelling to evaluate the trajectories of change in children’s height, as measured by length-for-age z-score (LAZ), from age 0–24 months. Asymptomatic and symptomatic Campylobacter infections were included as 3- and 6-month lagged time-varying covariates, while household risk factors were included as time-invariant covariates. Maternal height and birth order were positively associated with LAZ at birth. An inverse association was found between increasing age and LAZ. Campylobacter infection prevalence increased with age, with over 70% of children 18–24 months of age testing positive for infection. In the final model, Campylobacter infection in the preceding 3-month interval was negatively associated with LAZ at 12, 15, and 18 months of age; similarly, infection in the preceding 6-month interval was negatively associated with LAZ at 15, 18, and 21 months of age. Duration of antibiotic use and access to treated drinking water were negatively associated with Campylobacter infection, with the strength of the latter effect increasing with children’s age. Campylobacter infection had a significant negative effect on child’s growth and this effect was most powerful between 12 and 21 months. The treatment of drinking water and increased antibiotic use have a positive indirect effect on linear child growth trajectory, acting via their association with Campylobacter infection. Campylobacter infection is a gastrointestinal bacterial infection that is widespread, particularly in low- and middle-income countries. Children in poor living conditions are particularly at risk for infection and are often also suffering from poor linear growth. We conducted an analysis of data collected from children in urban Bangladesh who participated in the MAL-ED study, a project that examined the effect of gastrointestinal infection on growth. We used innovative analytic methods to examine the linear growth of the children from 0 to 24 months of age and whether Campylobacter infection as well as household factors were associated with growth. We found that the height of the mother and the birth order of the child had a positive relationship with child’s length at birth. Campylobacter infection was found to have a negative impact on linear growth in children between 12–21 months of age. A longer duration of antibiotic use in the children, as well as the treatment of drinking water in the household had a negative relationship with Campylobacter infection, thus indirectly had a positive effect on the children’s growth. The negative relationship between Campylobacter and growth highlights the importance of reducing infection and addressing associated factors, such as water quality.