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.
Highlights
Growth impairment in children continues to be a major global health concern, in low- and middle-income countries (LMICs)
Enteric infection has been recognized as an important cause of child growth impairment since enteric infection rates are negatively associated with child growth, in LMICs [8]
We explored temporal variation in the effect of Campylobacter infection on length-for-age z-score (LAZ) by first fitting a model in which the 3-month lag and 6-month lag effects were both free to vary across all time points; having examined the pattern of coefficients from this model, we fitted a series of simpler models based on these patterns, with fixings in place to model the effect of Campylobacter infection on LAZ being stronger/weaker at particular periods of the child’s development
Summary
Growth impairment in children continues to be a major global health concern, in low- and middle-income countries (LMICs). Linear growth impairment, expressed as low height/ length for age, is partly a consequence of fetal growth restriction, preterm birth, intergenerational effects. It is a result of low household socioeconomic status which leads to inadequate dietary intake and inadequate sanitation, water quality and poor hygienic conditions; all of which contribute to greater exposure of children to infections and clinical disease [2,5,6,7]. Enteric infection has been recognized as an important cause of child growth impairment since enteric infection rates are negatively associated with child growth, in LMICs [8]. This may be due to decreased nutrient absorption, inflammatory responses, reduced appetite, changing feeding practices, and the high prevalence of frequent episodes of infection in these settings [5,9,10,11]
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