Abstract
BackgroundChronic suppurative otitis media (CSOM) causes preventable deafness and disproportionately affects children living in poverty. Our hypothesis was that health promotion in women’s groups would increase their knowledge, attitudes and practices (KAP) regarding ear disease and reduce the prevalence of CSOM in their children.MethodsWe did a cluster randomised trial in two village development committees (VDCs) in Jumla, Nepal. In July 2014, 30 women’s groups were randomly allocated to intervention or control, stratified by VDC and distance to the road. The intervention groups participated in three sessions of health promotion using the WHO Hearing and Ear Care Training Resource Basic Level. The primary outcome was women’s KAP score and the secondary outcome was prevalence of CSOM in their children at 12 month follow-up. Analyses were by intention to treat. Participants and the research team were not masked to allocation.ResultsIn June and July 2014 we recruited 508 women and 937 of their children. 12 months later there was no difference in the women’s KAP score (mean difference 0.14, 95% CI − 0.1 to 0.38, P = 0.25) or the prevalence of CSOM in their children (OR 1.10, 95%CI 0.62 to 1.84, P = 0.75) between intervention and control groups. However, overall, there was a significant improvement in the KAP score (mean difference − 0.51, 95% CI − 0.71,to − 0.31, P < 0.0001) and in the prevalence of CSOM from baseline 11.2% to follow-up 7.1% (P < 0.0001).ConclusionsHealth promotion in women’s groups did not improve maternal KAP or reduce prevalence of CSOM. Over time there was a significant improvement in women’s KAP score and reduction in the prevalence of CSOM which may be attributable to our presence in the community offering treatment to affected children, talking to their parents and providing ciprofloxacin drops to the local health posts. More research is needed in low resource settings to test our findings.Trial registrationAustralia and New Zealand Clinical Trial Registry 12,614,000,231,640; Date of registration: 5.3.2014: Prospectively registered.
Highlights
Chronic suppurative otitis media (CSOM) causes preventable deafness and disproportionately affects children living in poverty
Otitis media is a spectrum of disease beginning with an acute respiratory infection leading to acute otitis media and otitis media with effusion, which can result in a chronic perforation of the tympanic membrane, chronic inflammation of the middle ear cavity and otorrhoea or discharge (CSOM) [1]
The study setting consisted of two village development committees (VDCs) in the remote mountain district of Jumla, Nepal
Summary
Chronic suppurative otitis media (CSOM) causes preventable deafness and disproportionately affects children living in poverty. Our hypothesis was that health promotion in women’s groups would increase their knowledge, attitudes and practices (KAP) regarding ear disease and reduce the prevalence of CSOM in their children. Chronic suppurative otitis media (CSOM) is a multifactorial disease of poverty. Appropriate treatment of acute otitis media with oral antibiotics and early treatment of CSOM with topical antibiotics and ear mopping are simple, inexpensive and effective [3]. The prevalence of CSOM in Nepal is 5 to 10% in the available studies which mostly rely on cross-sectional groups of school children in less remote settings or patients attending ear, nose and throat specialist clinics [4,5,6,7]. Every study that has been conducted in Nepal has revealed a prevalence above the 4% level satisfying the WHO definition of a ‘massive public health problem’ requiring ‘urgent attention’ [1]
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