GETcampy_BurkinaFaso

Diarrhoeal disease remains a major cause of child morbidity, growth faltering and mortality in low and middle income countries (LMICs), with Campylobacter among the most common causes. The major infection sources in the UK include contaminated food, but transmission routes in LMICs are unknown. This means that transmission among the children at highest risk (85% infected before 1yr in LMICs) is the least studied. House crowding, cohabitation with animals and poor sanitation/food safety are all potential risk factors, but effective interventions depend upon quantitative estimates of infection sources. So why is Campylobacter largely overlooked in LMICs? While the answer to this question, in part, relates to the perceived sub-clinical sporadic nature of infection and difficulties in culturing microaerophilic bacteria, a more unsettling reason is that the countries where people are at the greatest risk have low economic and development status. Building on an established collaborative network in the UK and Africa (The Gambia, Ghana, Burkina Faso), we will develop a program of globalized Campylobacter NGS surveillance. Specifically, we will: (i) sample and genome sequence thousands of isolates from animals, food, environmental sources and people (symptomatic, asymptomatic, and matched cases and controls); (ii) develop open-access databases and novel analysis pipelines (association study and machine learning) to characterize Campylobacter population structure and identify source attribution markers; (iii) quantify the relative contribution of different human infection sources; (iv) use a cost-benefit risk models to identify the most effective interventions in the transmission network. This evidence-based approach will enable effective local public health and policy interventions and focus efforts to reducing the burden of diarrhoeal disease in Africa.