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

PLoS Negl Trop Dis. 2020 May 14;14(5):e0008328. doi: 10.1371/journal.pntd.0008328. eCollection 2020 May.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anthropometry
  • Bangladesh / epidemiology
  • Biostatistics
  • Campylobacter Infections / complications
  • Campylobacter Infections / epidemiology*
  • Child, Preschool
  • Developmental Disabilities / etiology*
  • Family Characteristics*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Malnutrition / complications
  • Malnutrition / epidemiology*
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Young Adult

Grant support

This research protocol (MAL-ED birth cohort study) was funded by University of Virginia (UVA) with support from MAL-ED Network Investigators in the Foundation of National Institute of Health (FNIH) (, Fogarty International Centre (FIC) ( with overall support from the Bill & Melinda Gates Foundation (BMGF) (, grant number GR-681. This analysis of the Bangladesh MAL-ED data did not receive additional funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.