Chronic Suppurative Otitis Media (CSOM) is one of the common community health disorders of childhood in all developing countries. The prevalence of CSOM in children from developing countries varies from 1.3 to 17% [3
It is more common in rural children where poverty, over crowding, illiteracy, ignorance, poor hygiene, malnutrition and lack of medical facilities have been suggested as a basis for the widespread prevalence of CSOM. In the context of Bangladesh, in the absence of any national program for the detection and treatment of CSOM, almost all these factors are likely to be a contributor to overall high prevalence. The majority children with CSOM came from the communities living in subsistence agricultural or slam areas [13
In this cross sectional study among the 1468 rural primary school children, total 77 cases of CSOM were detected and the prevalence of CSOM was 5.2%. Prevalence of CSOM was more among girls 46 (5.7%) than the boys 31 (4.7%). This result is consistent with other studies done recently at home, Naraynganj 4.3% [23
], Dhaka 7.3%[18
] and abroad Kathmando 5.7% [24
], Nigeria 6% [25
], and India 6% [13
]. However, the present study showed lower prevalence than some other Bangladeshi studies done previously Magura 12.4% [19
], Rajbari [17
], and Dhaka 15.06% [14
This lower prevalence of CSOM in our study can be explained by the gradual improvement of the socioeconomic factors of our rural community. The relative higher prevalence rate of CSOM among the girls can be explained by the social and familial indifference to them.
According to our study, 52.6% of the samples were from low income group where CSOM were also more prevalent (7.1%). 71.4% of total CSOM cases were detected from this group. The yearly income of the guardians had significant association with the prevalence of CSOM (P =
0.006).The findings of this study simulates with such studies done in our country [17
] and abroad [24
Most of the subjects were from the medium sized family (87.8%). CSOM was also more prevalent among the students from that group (5.3%).Though the overcrowding is a recognized risk factors for CSOM, but in our study the size of the family had no impact on the occurrence of the CSOM (P = 0.990).
Regarding the maternal education of the subjects, 41.3% of their mothers were Illiterate followed by Primary (31.2%) and Secondary (21.1%) education. It was shown that CSOM was more prevalent (7.4%) among the children of the illiterate mothers. CSOM was absent among the children of the mothers educated above HSC level. The relation between the maternal education and the prevalence of CSOM was statistically significant (P
= 0.007). This finding mimics with a study done among the children of the slum area of Dhaka city [18
] and in India [10
]. More over, maternal education has got direct relation with personal hygiene, health consciousness, and treatment seeking practice, nutrition and other factors that influence overall health of the child.
Most of the study population lived in kachha house. CSOM was also found more among the Kachha house dwellers (76.6% of total CSOM group). In the Kachha house most of the lower socioeconomic group of rural community lives which are less ventilated, humid and less hygienic. These are the predisposing factors for URTI and subsequent CSOM. In a recent study regarding CSOM, housing also revealed significant association with the prevalence of CSOM between rural and urban residents [18
This was also supported by WHO/CIBA foundation workshop 1996.
Most of the children (85.62%) used safe sanitation (closed slab, isolated sanitary latrine). Only a small number (14.38%) of student used unsafe sanitation systems (open or trench latrine). Though, safe sanitation is important factor for prevention of diarrhoea, worm infestations, malnutrition and for overall wellbeing but statistically in this research, the safe sanitation habit showed to have no relation with the prevalence of CSOM.
Most of the children in this series used to bath in the fresh water of the tube well (84.1%) whereas only a few (15.4%) used to bath in the pond, canal or river. It was shown that children used to bath in the pond or river water were affected more by CSOM (9.3%) than that of tube well users (4.5%). There was a statistically significant association between bathing habit and the CSOM (P
value 0.005). Bathing in the polluted water of the ponds, river or canals allows the contaminated water to the nose and nasopharynx and frequently infect the middle ear cleft and also enter the middle ear through the pre existing pathology or perforation of the tympanic membrane which cause the ear chronically infected before it had time to heal [12
Among the students, 48.9% had no ear cleaning habit. Others had some forms of ear cleaning habit with cotton bud (10%), feather/wooden stick/vegetable stick (36.6%) and clothing (4.7%). The patterns of ear cleaning habit in rural children in Bangladesh were found more or less similar with another study [19
]. These forms of habits proved statistically significant effect on occurrence of CSOM (P
= 0.017) in our study.
Most of the student completed their EPI vaccination schedule (93.5%). 4.7% had the history of incomplete vaccination and only 1.8% were never vaccinated. Though the EPI vaccination had not shown any relation with the occurrence of CSOM but our study reflected the real EPI coverage in rural Bangladesh [29
Most of them (84.7%) seek their primary medical treatment from Quack medical practitioners (mostly the village medicine shopkeepers) of their own locality. Only a few numbers (12.3%) attended the qualified doctors (MBBS & specialist).In a study done in the rural area of Rajbari, Bangladesh (1994) revealed that only 8.49% cases attended qualified physician [17
]. Prevalence of CSOM had statistically significant relation with the medical consultation seeking practice between qualified doctors (MBBS and above) and non qualified medical practitioners (P
value 0.035). The continued reliance of the guardian on traditional and unqualified practitioners leading to inadequate and inappropriate treatment may explain this.
In this study, 838 (60.2%) students had no detectable ear problem or diseases. Ear wax (26.4%) and otitis media with effusion (OME) (9.8%) were the other commoner form of ear disorder detected among those children. Regarding CSOM, 97.4% of CSOM were tubotympanic type and rest of other had atticoantral type. 42 (54.5%) children had right sided, 30(38.9%) had left sided CSOM and 5 (06.5%) had bilateral CSOM (Table ). This result is consistent with other studies done in rural areas of the Dinajpur, Bangladesh [30
], and Nepal [24
] and mimic well with different texts [12
]. It should be noted that in every year large number of rural children undergo ear surgery for CSOM because of the various complication and squeal that result from the disease [12
]. It was also found that complication of CSOM were commonest in the first two decades of life [2
]. Many of these complications could probably have been prevented by early identification and treatment of the preexisting CSOM.
Thus in our study, children from lower socio economic strata were found more vulnerable to CSOM. Potential loss of hearing due to CSOM has important consequence on speech, cognation and academic performance of the children [5
]. Thus the gap between the fortunate and less privileged is further widened by an innate difficulty in learning caused by CSOM.