Geospatial Analysis of Multilevel Socio-environmental Factors Impacting the Campylobacter Burden Among Infants in Rural Eastern Ethiopia: A One Health Perspective

Increasing attention has focused on health outcomes of Campylobacter infections among children under five years in low-resource settings. Recent evidence suggests colonization of Campylobacter species contributes to environmental enteric dysfunction, malnutrition, and growth faltering in young children. Campylobacter species are zoonotic, and factors from humans, animals, and the environment are involved in transmission. Few studies have assessed geospatial effects of environmental factors along with human and animal factors on Campylobacter infections. Here, we leveraged Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) project data to model multiple socio-environmental factors on Campylobacter burden among infants in Eastern Ethiopia. Stool samples from 106 infants were collected monthly from birth through the first year of life (December 2020 - June 2022). Genus-specific Taqman real-time PCR was performed to detect and quantify Campylobacter spp. and calculate cumulative Campylobacter burden for each child as the outcome variable. Thirteen regional environmental covariates describing topography, climate, vegetation, soil, and human population density were combined with household demographics, livelihoods/wealth, livestock ownership, and child-animal interactions as explanatory variables. We dichotomized all continuous outcome and explanatory variables and built logistic regression models for the first and second half of the infants first year of life. Infants being female, living in households with cattle, reported to have physical contact with animals, or reported to have mouthed soil or animal feces had increased odds of higher cumulative Campylobacter burden in Eastern Ethiopia. Future interventions should focus on infant-specific transmission pathways and create adequate separation of domestic animals from humans to prevent potential fecal exposures.