Prevalence of otitis media and associated factors in patients attending ear, nose and throat clinic at Mnazi mmoja hospital, Zanzibar

Abstract

Background: Otitis media (OM) is an inflammation of the middle ear tissue especially the eardrum and tissue surrounded. OM is a major public health problem worldwide. Its prevalence and incidence are high in both developed and developing countries. OM can be in acute or chronic form and is characterized by suppurative or non-suppurative conditions. Acute suppurative otitis media (ASOM) is a common childhood illness and chronic suppurative otitis media CSOM is a disease condition of ear cleft characterized by the presence of persistent perforation of the tympanic membrane with recurrent or persistent mucoid or mucopurulent discharge for at least eight (8) weeks. OM can be due to bacterial, fungal, viral, or respiratory infection with underlying conditions including asthma allergy, and sore throat. Objective: To determine the prevalence, etiological agents, antimicrobial susceptibility testing patterns, and factors associated with otitis media (OM) in patients attending Ear Nose and Throat (ENT) clinic at Mnazi Mmoja Hospital Methodology: A hospital-based analytical cross-sectional study was conducted. The study population included all outpatients attending ENT clinic with ear complaints with an age range of 0 to 60 years. Data on social demographic characteristics, medical history and a physical examination were collected using a structured questionnaire. Clinical diagnosis was performed by the attending clinician using required otorhinolaryngology tests and pus swabs were taken from infected ears using sterile tipped cotton swabs. Laboratory method; Samples were tested for culture, identification of pathogens (gram stain and biochemical test) and antimicrobial susceptibility testing using Kirby Bauer disc diffusion method, at Mnazi Mmoja Hospital Pathology Laboratory. Result: A total of 205 patients were recruited in the study. The overall median age of the study participants was 11years. Male and female participants were 120 (58.5%) and 85 (41.5%), respectively. Many of the participants, 74 (35.9%), were children who have not started school and the majority of the participants 125 (61%), were from the Urban West region. Of 205 study participants, 98 (48%) were clinically diagnosed with otitis media (OM) of whom 52 (25%) were laboratory-confirmed with bacterial infection, 46 (22%) had ear wax and 61 (30%) had other ear problems. The study found that the most prevalent pathogens; 44 (21.4%) were gram-negative. The most common bacteria isolated were P. aeruginosa (26, 12.7%), P. mirabilis (12, 5.8%), K. pneumoniae (10, 4.8%), S. aureus (7, 3.4%), and E. coli (6, 2.6%). All isolated pathogens were sensitive to ciprofloxacin (90% to 100%) and Gentamicin ranged from 75% to 100%. Multi drugs resistance has been noted to some of the common organisms; P. mirabilis to different common antibiotics: Meropenem 33%, Amoxiclav 67%, Ampicillin, Ceftazidime & Ceftriaxone 75%, The study found that self-ear cleaning using cotton bud was significantly associated with OM (ARR = 0.79, 95% CI = 0.72-0.86). Conclusions: About a quarter of the study participants had laboratory-confirmed OM. The prevalence of multiple microbial nature and antimicrobial resistance among isolates OM cases warrants the need for culture and sensitivity on the diagnosis of OM. Recommendations: Health education on ear care and early seeking behavior for diagnosis and treatment of OM are needed for inpatients and the community to prevent progression to chronic disease. A study with a large sample size to the community is needed.