Burden and outcome of acute otitis media in rural Bangladesh
AbstractObjectives. To report on the burden and outcome of episodes of acute otitis media (AOM) based on awareness of AOM and compliance to referral by community health workers (CHWs) in rural children aged under 2 in Bangladesh.
Study design. Retrospective population-based cohort study.
Method. Secondary data analysis on episodes of AOM, care-seeking pattern, compliance with referral, antibiotic use and duration of episodes from morbidity data collected by CHWs on 252 children aged under 2 who completed biweekly household surveillance starting from birth.
Results. A total of 375 episodes of AOM were observed in 45.6% (115/252) of the study subjects; 19.4% (49/252) experienced single and
26.2% (66/252) recurrent episodes. Just over 34% (129/375) of episodes were recognised by caregivers and reported to CHWs, and the remaining 246 episodes, unrecognised by caregivers, were detected by CHWs during home visits. CHWs referred all subjects with AOM to the study doctor. The caregivers complied with referral in all episodes they had recognised, but in only 21.5% (53/246) of episodes they had not recognised (p<0.0001). Compliance was best among caregivers of babies in the first 3 months of life. Resolution occurred in 95.0% (356/375) of acute episodes of AOM in .6 weeks, comprising 176/182 of antibiotic-treated and 180/193 of untreated episodes (p<0.13). Five per cent of episodes (19/375) progressed to chronic suppurative otitis media (CSOM). Doctor visits resulting in antibiotic use resulted in a 51% lower progression to CSOM (relative risk 0.49, 95% confidence interval 0.19 - 1.26).
Conclusion. AOM is a disease of public health importance in rural children aged under 2 in Bangladesh. Early assessment, community awareness of AOM intensified by motivational activities, and increased compliance with referral to the doctor in caregiver-unreported cases may help to decrease morbidity and burden from the disease.