Cranfield University, Cranfield, United Kingdom.
British Geological Survey, Environmental Science Centre, Keyworth, Nottingham, United Kingdom.
PLoS One. 2020 May 8;15(5):e0232541. doi: 10.1371/journal.pone.0232541. eCollection 2020.
Early infection from enteropathogens is recognised as both a cause and effect of infant malnutrition. Specifically, evidence demonstrates associations between growth shortfalls and Campylobacter infection, endemic across low-income settings, with poultry a major source. Whilst improvements in water, sanitation and hygiene (WASH) should reduce pathogen transmission, interventions show inconsistent effects on infant health. This cross-sectional, formative study aimed to understand relationships between infant Campylobacter prevalence, malnutrition and associated risk factors, including domestic animal husbandry practices, in rural Ethiopia. Thirty-five households were visited in Sidama zone, Southern Nations, Nationalities and Peoples' region. Infant and poultry faeces and domestic floor surfaces (total = 102) were analysed for presumptive Campylobacter spp. using selective culture. Infant anthropometry and diarrhoeal prevalence, WASH facilities and animal husbandry data were collected. Of the infants, 14.3% were wasted, 31.4% stunted and 31.4% had recent diarrhoea. Presumptive Campylobacter spp. was isolated from 48.6% of infant, 68.6% of poultry and 65.6% of floor surface samples. Compared to non-wasted infants, wasted infants had an increased odds ratio (OR) of 1.41 for a Campylobacter-positive stool and 1.81 for diarrhoea. Positive infant stools showed a significant relationship with wasting (p = 0.026) but not stunting. Significant risk factors for a positive stool included keeping animals inside (p = 0.027, OR 3.5), owning cattle (p = 0.018, OR 6.5) and positive poultry faeces (p<0.001, OR 1.34). Positive floor samples showed a significant correlation with positive infant (p = 0.023), and positive poultry (p = 0.013, OR 2.68) stools. Ownership of improved WASH facilities was not correlated with lower odds of positive stools. This formative study shows a high prevalence of infants positive for Campylobacter in households with free-range animals. Findings reaffirm contaminated floors as an important pathway to infant pathogen ingestion and suggest that simply upgrading household WASH facilities will not reduce infection without addressing the burden of contamination from animals, alongside adequate separation in the home.
早期肠病原体感染被认为既是营养不良的原因，也是营养不良的结果。具体而言，有证据表明，在低收入环境中普遍存在的弯曲杆菌感染与生长发育迟缓之间存在关联，而家禽是主要的传染源。虽然水、环境卫生和个人卫生（WASH）的改善应该会降低病原体的传播，但干预措施对婴儿健康的影响并不一致。本横断面形成性研究旨在了解埃塞俄比亚农村地区婴儿弯曲杆菌流行率、营养不良和相关危险因素之间的关系，包括家庭畜牧业做法。在南方各族州 Sidama 区，访问了 35 户家庭。使用选择性培养法分析了 35 户家庭中 102 份婴儿和家禽粪便以及家庭地面样本，以检测疑似弯曲杆菌 spp.。收集了婴儿的人体测量学和腹泻流行率、WASH 设施和动物养殖数据。在这些婴儿中，14.3%体重不足，31.4%发育迟缓，31.4%最近腹泻。从 48.6%的婴儿、68.6%的家禽和 65.6%的地面样本中分离出疑似弯曲杆菌 spp.。与非体重不足的婴儿相比，体重不足的婴儿粪便呈弯曲杆菌阳性的优势比（OR）为 1.41，腹泻的优势比（OR）为 1.81。阳性婴儿粪便与消瘦（p = 0.026）显著相关，但与发育迟缓无关。阳性粪便的显著危险因素包括将动物养在室内（p = 0.027，OR 3.5）、拥有牛（p = 0.018，OR 6.5）和阳性家禽粪便（p<0.001，OR 1.34）。阳性地面样本与阳性婴儿（p = 0.023）和阳性家禽（p = 0.013，OR 2.68）粪便呈显著相关性。拥有改良的 WASH 设施与较低的阳性粪便几率无关。这项形成性研究表明，家中有自由放养动物的婴儿中，弯曲杆菌阳性的比例很高。研究结果证实，受污染的地面是婴儿摄入病原体的重要途径，并表明，如果不解决家庭中动物造成的污染负担，同时进行充分的隔离，仅仅升级家庭 WASH 设施并不能降低感染率。
