Abstract
ObjectiveTo estimate the prevalence of World Health Organization-defined chronic suppurative otitis media (CSOM) and mild hearing impairment in a population representative sample of school-entry age children in rural Malawi. A secondary objective was to explore factors associated with CSOM in this population.MethodsWe performed a community-based cross-sectional study of children aged 4–6 years in Chikhwawa District, Southern Malawi, utilising a village-level cluster design. Participants underwent a structured clinical assessment, including video-otoscopy and screening audiometry. Diagnoses were made remotely by two otolaryngologists who independently reviewed clinical data and images collected in the field. Hearing impairment was classified as failure to hear a pure tone of 25dB or greater at 1, 2 or 4kHz.ResultsWe recruited 281 children across 10 clusters. The prevalence estimates of CSOM, unilateral hearing impairment and bilateral hearing impairment were 5.4% (95%CI 2.2–8.6), 24.5% (95%CI 16.3–30.0), and 12.5% (95%CI 6.2–16.9) respectively. Middle ear disease was seen in 46.9% of children with hearing impairment. A trend towards increased risk of CSOM was observed with sleeping in a house with >2 other children.InterpretationWe found a high burden of middle ear disease and preventable hearing impairment in our sample of school-entry age children in rural Malawi. There are important public health implications of these findings as CSOM and hearing impairment can affect educational outcomes, and may impact subsequent development. The identification and management of middle ear disease and hearing impairment represent major unmet needs in this population.
Highlights
Chronic suppurative otitis media (CSOM) is an infection of the middle ear cleft characterised by perforation of the tympanic membrane and persistent ottorhoea
Middle ear disease was seen in 46.9% of children with hearing impairment
A trend towards increased risk of CSOM was observed with sleeping in a house with >2 other children
Summary
Chronic suppurative otitis media (CSOM) is an infection of the middle ear cleft characterised by perforation of the tympanic membrane and persistent ottorhoea. CSOM is a substantial global health problem with an estimated incidence of about 31 million cases per year.[1,2] Approximately 22.6% of cases occur in children under five.[1]. In sub-Saharan Africa, CSOM is a leading cause of preventable childhood hearing loss. CSOM is independently associated with decreased academic performance and may lead to long-term effects on language and cognitive development.[2,4] a substantial proportion of those with untreated CSOM (1–18%) develop serious complications including mastoid abscess, otitic meningitis, venous sinus thrombosis and cholesteatoma.[5,6] Approximately 28000 deaths are attributed to the complications of CSOM annually.[1,2] The complications of CSOM require specialist intervention, frequently unavailable in low-resource healthcare systems
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