Prevalence of otitis media with effusion among school going children in Bangladesh

A Prospective study was carried out from Jan 2000 Jan 2003, to find out the prevalence of OME among School children The study was done in Dhaka City and adjacent areas of Dhaka City in Savar, Munshigonj and Keranigonj, Altogether 280 Students aged 4-9 years were interviewed and examined. Nineteen percent children were found to have OME. In the urban community it was 17%, but in rural areas it was 21%. In our study children with OME were more in poorer people, smoker parents and bottle fed babies.


Introduction:
OME is a very common disease in children and since it is largely silent, it is often unnoticed.The presence of fluid in the middle ear attenuates sound transmission which result in a hearing loss.Symptoms of acute infection are not present in OME 1 .
The presence of OME in Bangladesh has been studied in a limited fashion.In Bangladesh, population is with mixed ethnic background.Weather is moderately variable.Prevalence of OME is supposed to be variable in rural and urban area of Bangladesh with different socioeconomic background.
Children of 4 to 9 years of age were included in the study all of which were school going.Children with CSOM and wax in the wear excluded from the study.
Total 280 students were interviewed and examined for the study.We have carried out this study by collecting information through questionnaire survey, Clinical exam and tympanometry.Clinical exam and Otoscopy was done first, then findings were judged and supported by tympanometry A Type B tympanogram is 93% sensitive in detecting OME with 76% specificity which is associated with a 25 dB hearing loss and its negative predictive value is 98%.
All data were analysed by using SPSS.

Results:
Total 280 children from 6 schools were observed and examined; 3 schools from urban and 3 from rural area.

Discussions:
Many studies of otitis media with effusion have already been undertaken in different countries of the world, especially in European countries and some developing Asian countries.Various risk factors have been identified.These studies have also recommended some measures for prevention and diagnosis for this major health problem worldwide especially mostly in children aged between 2 to 10 years of age.So far in Bangladesh no study has been carried out yet.The disease is a major health problem in school going children in Bangladesh and it affects the children most and people of all socioeconomic status.But it is significantly higher in lower socioeconomic group.This finding is also common with other study. 1 Prevalence of the present series is similar with the findings of some other Asian and European countries of the world.
The study shows decreasing rate of prevalence with advancing age.There was similar findings in Williamson et al. 2 1994 study in UK.No statistically significant difference between male and female children or between rural and urban children in Minza BM et al 1996 study in Tanzania and kim CS et al 3,4 .
Some countries have very low prevalence rate of OME while some have abnormally high prevalence of OME in comparison to our study.
We have of obtained prevalence more in rural population than urban area.But the difference is not statistically significant.This finding is also similar with Saim et al 5 .Some other studies also revealed same findings.Regarding sex we found no difference.
We found OME in children of illiterate mothers in highest percentage.We obtained increased prevalence in large family.Rasmussen 6 has got relation between OME and family size.Housing standard also affect the prevalence of OME.Probably this is because of bad hygiene and poor sanitation.This leads to more RTI and thereby OME.We have found clear relation between OME and parental smoking. 6,7,8,9,10.We have found more prevalence of OME in bottle fed babies and less is breast-fed babies.
No relation has been found in relation to the climate of the residence, parental occupation or educational status and family income.Also we have found statistically significant difference between the prevalence rate in rural and urban area.This observation is also similar with some other studies 10,11,12 .
The study was conducted in purposively selected six schools, 3 from Dhaka city and 3 from rural area.Samples are not representing the whole Dhaka city or the whole country.So findings can not be generalized for the whole Bangladesh or Dhaka city.
The age in which OME is more prevalent in whole population can not be detected as the study was done in children only aged between 4-9 year age.The amount of hearing lost of the cases could not be assessed as we failed to use free field audiometer excepting using tuning fork test and cost was other two constraints of this study.
It can be concluded from this study that OME is still a prevalent disease in a developing country like Bangladesh.It can also be concluded that it is prevalent amongst poor populations like slum dwellers, villagers and especially illiterate people, children of smoker parents, from poor housing standard, polluted bathing source and large family size.OME is a major cause of hearing impairment and this effect is a matter of serious concern, particularly in children, because it may have long term effects on early communication, language development, auditory processing, psychological and cognitive development and educational progress and achievement.
On the basis of the findings of the study certain recommendations are general health promotion measures; breast feeding and hygiene are systematically encouraged and strengthened in communities concerned.Avoidance of smoking, improved housing, reduced over crowding and adequate access to clean water should be considered wherever possible.Primary ear care should be incorporated into primary health care (PHC).The diagnosis of OME needs to be made earlier to prevent its long term effects especially on hearing impairment.Health educations to aware people, Feasibility should be ensured.

Table - I
Distribution of children by sex.

Table - III
Distribution of the respondents by monthly income of family.Our study points to that 133 parents were smoker and 147 (52.5%) were nonsmoker.Among the smoker parents 42% of children had OME.(Table-V).