Associated factors, post infection child growth, and household cost of invasive enteritis among under 5 children in Bangladesh

Abstract

Both Campylobacter- and Shigella-induced invasive enteritis are common in under-5 Bangladeshi children. Our study aimed to determine the factors associated with Campylobacter and Shigella enteritis among under-5 children, the post-infection worsening growth, and the household cost of invasive enteritis. Data of children having Shigella (591/803) and Campylobacter (246/1148) isolated from the fecal specimen in Bangladesh were extracted from the Global Enteric Multicenter Study (GEMS) for the period December 2007 to March 2011. In multiple logistic regression analysis, fever was observed more frequently among shigellosis cases [adjusted OR 2.21; (95% CI 1.58, 3.09)]. Breastfeeding [aOR 0.55; (95% CI 0.37, 0.81)] was found to be protective against Shigella. The generalized estimating equations multivariable model identified a negative association between Shigella and weight-for-height z score [aOR − 0.11; (95% CI − 0.21, − 0.001)]; a positive association between symptomatic Campylobacter and weight-for-age z score [aOR 0.22; (95% CI 0.06, 0.37)] and weight-for-height z score [aOR 0.22; (95% CI 0.08, 0.37)]. Total costs incurred by households were more in shigellosis children than Campylobacter-induced enteritis ($4.27 vs. $3.49). Households with low-level maternal education tended to incur less cost in case of their shigellosis children. Our findings underscore the need for preventive strategies targeting Shigella infection, which could potentially reduce the disease burden, associated household costs, and child growth faltering.

Enteric viral pathogens and child growth among under-five children: findings from South Asia and sub-Saharan Africa

“…The MAL-ED study identified Shigella and rotavirus as the primary causes of antibiotic treatment, accounting for 11.7% and 8.6% of diarrhea treatments, respectively 21 due to their high burden and severity. Antibiotic treatment could act as a confounding factor when estimating the actual impact of enteric viral infections on child growth, as evidenced by similar findings in a systematic review and meta-analysis on Campylobacter infection 22 and similar findings from the GEMS Bangladesh site 23 . A cross-sectional study conducted in Uganda found no significant association between rotaviral diarrhea and nutritional status 24 .…”

Shigella and childhood stunting: Evidence, gaps, and future research directions

“…Our search uncovered 5 studies that reported either nonsignificant or negative associations between Shigella infection and LGF-related factors [ 15 , 27 , 28 , 31 , 34 ]. Although most of these studies were not designed to directly investigate the link between Shigella and LGF, they are worth noting, as they point to other factors that might explain observed differences in the relationship between enteric infections and LGF.…”

“…The authors mentioned that reinfections and postinfection shedding were of unknown occurrence, and in the absence of longitudinal data, the lack of association between Shigella infection and stunting should be considered with caution. In a post hoc analysis of GEMS samples from Bangladesh, Shigella spp were negatively associated with weight-for-height Z scores, but not with HAZ scores [ 27 ]. Donowitz and colleagues (2021) conducted a secondary analysis of child stool samples from a longitudinal birth cohort study in Dhaka and found that socioeconomic indicators had a greater impact on growth and neurodevelopment than most pathogens studied (including Shigella spp) [ 34 ].…”

Symptomatic and Asymptomatic Campylobacter Infections and Child Growth in South Asia: Analyzing Data from the Global Enteric Multicenter Study

“…All stool samples were immediately shifted to the respective laboratory from each site following standard procedures of cold chain maintenance. 22 – 24 Bacterial pathogens ( Salmonella, Shigella, Campylobacter spp., Aeromonas spp., Vibrio cholerae , and Escherichia coli [enterotoxigenic (ETEC), enteropathogenic, and enteroaggregative (EAEC)]), viruses (rotavirus, norovirus, sapovirus, astrovirus, and adenovirus), and protozoa ( Entamoeba histolytica , Giardia intestinalis , and Cryptosporidium spp.) were detected following standard laboratory methods as described elsewhere.…”