Prevalence and associated socio-demographic factors of chronic suppurative otitis media among rural primary school children of Bangladesh

Abstract

Background

Chronic suppurative otitis media (CSOM) is a common community health disorder of childhood in all developing countries including Bangladesh. In children, it may cause significant delays in speech, cognitive, educational and psychological development.

Objectives

To determine prevalence of CSOM and its relationship with certain socio-demographic factors among rural primary school going children of Bangladesh.

Methodology

4280 rural primary school children of palash upazilla of Narsingdi district, Bangladesh had underwent ENT check up by doctors trained in ENT and their guardians were interviewed regarding certain socio demographic factors using a pre tested protocol.

Results

48% of them were boys and 52% were girls with a mean age of 8.8 years (SD ± 2.35). 5.63% of study population revealed to have CSOM and girls were relatively more sufferer than boys (6.6% vs 4.5%). Our study revealed statistically significant association of CSOM with age, sex, guardian's income, maternal education, family size, and sanitation of children. Housing though an important risk factor of CSOM but it was not evident in this study.

Conclusion

Thus, improvement of the socio-demographic status and primary ear care education to children, their teachers and guardians can prevent these vulnerable children from developing CSOM and resultant complications.

Introduction

Chronic suppurative otitis media (CSOM) is one of the most common community health disorders of childhood in developing countries including Bangladesh [1]. CSOM is typically a persistent disease, insidious in onset, often capable of causing severe destruction and irreversible sequel and clinically manifests with deafness and discharge [2]. Discharge and healing of the perforation and middle ear is a virtuous circle of events dictated by the classic sequence of acute inflammatory change. A vicious circle exists when incomplete healing predisposes the ear to further acute episodes and these become so frequent that they merge and appear continuous and chronic [3]. Its incidence appear to depend to some extent on race and socio economic factors [4]. High rates of chronic OM have been attributed to overcrowding, inadequate housing, poor hygiene, lack of breast feeding, poor nutrition, passive smoking, high rates of nasopharyngeal colonization with potentially pathogenic bacteria and inadequate or unavailable health care. Poverty is a major risk factor in developing countries and in certain neglected populations. Since CSOM begins with an acute onset of otitis media, either acute OM or OME, risk factors associated with acute OM also be initially involved such as viral or bacterial infections, eustachian tube dysfunction, young age and immature and impaired immunologic status, upper respiratory allergy, familial predisposition, presence of older siblings, male sex, bottle feeding, congenital anomalies, day care attendance and passive smoking [4]. Moreover, repeated episodes of acute otitis from infected adenoids in the nasopharynx may overwhelm the drums capacity to heal. Scar tissue may form in the wrong place, thickening the residual drum head with tympanosclerosis instead of repairing the perforation. Contaminated water may also enter the middle ear through the perforations before it has had time to heal. The otoscopic finding in a patient with CSOM includes presence of a defect or perforation of the tympanic membrane. CSOM has been classified into tubotympanic and atticoantral disease, the latter category is usually associated with cholesteatoma [3].

In Bangladesh, several hospital and rural studies had found prevalence of CSOM between 7.39% and 39.50% of the study population [5], [6], [7], [8], [9]. With the advent of antimicrobial therapy, the incidence and prevalence of CSOM have been markedly decreased in developed countries and that of OME have been increased [4]. In a cross sectional survey among young aboriginal children from remote communities in Northern and central Australia, it was evident that 1 in 4 children had perforated TM on otoscopy [10]. 12.44% of the rural school going children of Bangladesh aged 4–13 years were reported to suffer from CSOM and 11.11% of them came from lower income group, 1.33% from middle income group, none from high income group [11]. In two separate studies in Nigeria, it was revealed that 6% and 7.3% of the rural school going children had CSOM [12]. In a study done in New Delhi, India, of the school children examined between 2–5 years 19.6% of the children of lower socio economic status were found to be suffering from ear diseases compared to 2.13% of children with higher socio economic status [13]. Among rural south Indian children 6% of the children had CSOM. Of them, 4.8% had tubotympanic and 1.2% had attico-antral disease [14]. In a study in a village of Haryana, India, 613 children were evaluated, 94 (15.3%) had CSOM [15]. In two selected slums of Dhaka, Bangladesh among the children (0–15 years), 7.39% were reported to have CSOM with highest incidence (53.3%) in 2–5 years age group. Among the reported positives, 93.3% lived in kachha houses, 6.7% in semipaka houses [9].

Traditionally, the prevalence of CSOM has been found as a byproduct of surveys for hearing loss of which it is the major cause [3] and prevalence of CSOM and its relation with studied socio demographic factors were only byproducts of the primarily addressed issues. In children, undetected hearing loss can impact and cause significant delays in speech, cognitive, educational and psychological development [16], [17]. The World Health Organization (WHO) suggests that children should be screened at school entry in all developing countries [18]. Every year large number of rural children undergoes ear surgery for CSOM because of the various complication and squeal that result from the disease [2], [3], [4]. In a previous hospital based study, it was found that of 360 patients who underwent mastoid surgery for CSOM, 152 (42.2%) were children below 15 years of age [19]. It was also found that complication of CSOM were commonest in the first two decades of life.

Our study was based on the rural school children of Bangladesh where there is homogeneity in race, culture, geography and ethnicity, addressed primarily on CSOM. So far, sanitation, maternal education and their relationship with CSOM were new questions of research. Most of these CSOM related factors/practices studied here are preventable and need to be addressed to reduce the prevalence and resultant complications CSOM in Bangladesh.