CHAPTER ONE

1.0 INTRODUCTION

This chapter comprises of background of the study, problem statement, and purpose of the study,
Specific objectives, and research questions, Significance of the study, Scope of the study, Definition
of Key terms and finally conceptual framework.

1.1 BACKGROUND

Acute otitis media (AOM) is one of the most common diseases that affects the young children and
also is a major indication for antimicrobial treatment in the outpatient setting (Vergison et al. 2010).
The most common cause of hearing disability in developing countries is Chronic suppurative otitis
media (CSOM), and it may further lead to more complications if left untreated, such as hearing loss,
mastoiditis ,meningitis, sepsis, , brain abscess, and subdural empyema (Davidson et el, 1989).

It has been estimated recently that nearly 20,000 people die yearly from complications associated
with OM, with the highest mortality rates in the children under five years of age (Monasta et el, 2012)
By the age of three years, 50 – 85% of children will have had acute otitis media(AOM):The incidence
peaks between age 6 – 12 months, and about 10 – 20% of children by the age of one year suffer from
recurrent acute otitis media (Rovers et el,2004).

In the developing countries one of the most important cause of preventable hearing loss is chronic
suppurative otitis media (CSOM), and a reason of serious concern, particularly in children, because it
may have long-term impacts on early communication, language development, auditory processing,
psychosocial and cognitive development, and educational progress and achievement (Acuin,2004).

In Africa, the prevalence of Chronic suppurative otitis media(CSOM) among school children is high
with rates ranging from 16 of 1000 in Tanzania (Bastes I et.el ,1995), 24 of 1000 in Kenya(hatcher
et.el,1995) and to 23 of 1000 in Nigeria(Olatoke f et.el,2008).

In a study conducted in Ilorin, Nigeria, 64 of 200 febrile children had OM, 40 (2 of 3) of whom had
purulent discharge associated with a tympanic membrane perforation (Roland PS, 2002). Likewise, in
Addis Ababa, 1232 of 1360 children with OM had purulent discharge (Prymula R et.el 2006)
In sub-Saharan Africa, CSOM is a leading cause of preventable childhood hearing loss.( WHO, 2004
and Monasta L et.el 2012). CSOM is independently associated with decreased academic performance
and may lead to long-term effects on language and cognitive development. (WHO,2004 and Olatoke
F,2008) Additionally, a substantial proportion of those with untreated CSOM (1–18%) develop
serious complications including mastoid abscess, otitic meningitis, venous sinus thrombosis and
cholesteatoma (Dubey SP,2007 and Thornton D,2011) Approximately 28000 deaths are attributed to
the complications of CSOM annually (WHO, 2004 and Monasta L et.el 2012).
1.2 PROBLEM STATEMENT

In worldwide otitis media is highly prevalent and is the main cause of hearing impairment in
developing countries and also It has been estimated recently that about 20,000 people die annually
from complications associated with Otitis media, with the highest mortality rates in the children <5
years of age (Monasta et el, 2012).

The second most important cause of hearing loss is Otitis media (OM), which is ranked fifth on `the
global burden of disease and affected1.23 billion people in 2013 (Global Burden of Disease Study
2013Collaborators, 2015).World Health Organization (WHO) has reported that hearing impairment in
42 million people (above 3 years) in the world was mainly caused by otitis media (OM (ronfani et el,
2012).

The overall prevalence among schoolchildren with AOM in Kenya was 7 of 1000, 15 of 1000 for
OME, and 15 of 1000 for CSOM, A history of ear discharge was associated with abnormal
tympanograms and mild-to-severe hearing loss even in children without ear disease (Eric et al, 2015).

As we observed in hospitals otitis media is one of the common diseases that leads the children to
attend Mogadishu pediatric hospitals and As far as the researchers know, there are no studies
conducted in Mogadishu’s pediatric hospitals regarding prevalence and associated risk factors of
otitis media among children under five years,

If not prevented well, the cases of ottitis Media may become too complicated and cause death to a
large number of our children. Therefore, the present study aimed to determine the prevalence and
identify the role played by various risk factors responsible for onset of OM among children under five
years in selected Mogadishu pediatric hospitals.
1.3 GENERAL OBJECTIVE

The general purpose of the study is to determine prevalence and risk factors associated with otitis
media among children under five years in selected Mogadishu pediatric hospitals.

1.4 SPECIFIC OBJECTIVES

1) To determine the prevalence of otitis media among children under five years in selected
Mogadishu pediatric hospitals.

2) To identify the child related factors associated with otitis media among children under five
years in selected Mogadishu pediatric hospitals.

3) To find out the environmental related factors associated with otitis media among children
under five years in selected Mogadishu pediatric hospitals.

1.5 RESEARCH QUESTIONS

1) What is the prevalence of otitis media among children under five years in selected Mogadishu
pediatric hospitals?

2) What are the child related factors associated with otitis media among children under five years
in selected Mogadishu pediatric hospitals?

3) What are the environmental related factors associated with otitis media among children under
five years in selected Mogadishu pediatric hospitals?

1.6 SIGNIFICANCE OF THE STUDY

Studying the prevalence and associated risk factors for OM is important for several reasons:

First, the result of this study will help the policy makers and other responsible bodies to plan for the
necessary training program for health professionals based on the result which will help them improve
their knowledge regarding the problem.

Second, it will give clues to better Understanding of the risk factors of the disease. This may indicate
possibilities for (primary) prevention.
Third, knowledge of risk factors will help doctors (GPs and others) to diagnose the disease and
manage it early to prevent hearing disabilities.

This study is important for the community because knowing the risk factors of otitis media helps
prevention of this disease from the community.

1.7 SCOPE OF THE STUDY

Content: This cross-sectional study is to determine the prevalence and risk factors of otitis media
among children under five years.

Geographical area: the research was conducted in selected Mogadishu pediatric hospitals.

Time: the research was started in sep,2017 and end in sept ,2018.

1.8 DEFINITION OF KEY TERMS

Otitis media is an ear infection of the middle ear, the area just behind the eardrum. It happens when
the Eustachian tubes, which connect the middle ear to the nose, get blocked with fluid. Mucus, pus,
and bacteria can also pool behind the eardrum, causing pressure and pain.

Acute otitis media: is Inflammation of the middle ear in which there is fluid in the middle ear
accompanied by signs or symptoms of ear infection: a bulging eardrum usually accompanied by pain;
or a perforated eardrum, often with drainage of purulent material (pus).

Chronic supportive otitis media: is the result of an initial episode of acute otitis media and is
characterized by a persistent discharge from the middle ear through a tympanic perforation.

Malnutrition is a condition which occurs when there is a deficiency of certain vital nutrients in a
person’s diet. The deficiency fails to meet the demands of the body leading to effects on the growth,
physical health, mood, behavior and other functions of the body. Malnutrition commonly affects
children and the elderly. 9
1.9 CONCEPTUAL FRAMEWORK

IV DV

CHILD RELATED OTTITIS MEDIA

FACTORS

a. Age
b. Gender
c. Malnutrition

MODERATING
VARIABLES

 URTI
Feeding Position
 Parental smoking
a.

Figure 1.1. The above diagram shows that environmental and child related factors have strong
relationship with the prevalence of otitis media .