Prevalence and factors associated with Acute Otitis Media among febrile children aged below 5 years attending Mulago Hospital

Abstract

Background: Acute Otitis Media is a common disease among young children worldwide. It has potential complications which can affect the development of children. It is under-diagnosed in Mulago hospital owing to the infrequent otoscopic examination of children. No study had previously been dedicated to studying AOM and its associated factors among febrile children below 5 years in Uganda. Objective: To determine the prevalence and factors associated with Acute Otitis Media among febrile children aged below 5 years attending Mulago Hospital. Study design: Cross-sectional analytical study. Study setting: Assessment Centre of Mulago National referral hospital. Study population: Febrile children aged below 5 years who attended Mulago Assessment Centre during the study period and met inclusion criteria. Study Methods: Children who met the inclusion criteria were enrolled. After obtaining consent, history was taken and physical examination and pneumatic otoscopy done. Abnormal tympanic membrane findings included redness, bulging, decreased mobility, dullness, perforation and fluid levels. Blood samples were taken for malaria blood slide, Complete Blood Count, and HIV antibody testing. Results: This study enrolled 289 patients, 53.3% of whom were male. The median age of participants was 15 months. The prevalence of AOM was 28.4% (CI, 23.2-33.6). The factors that remained statistically significantly associated with AOM after multivariate analysis were, age below 2 years, AOR 2.14 (1.03-4.47) (p-value 0.042), history of vomiting AOR 1.79 (1.01-3.97) (p-value 0.046) and leucocytosis AOR 1.81 (1.09- 3.01) (p-value 0.023). AOM was diagnosed in 17% of patients with malaria. Limitations: Tympanometry and acoustic reflectometry were not employed in diagnosis of AOM. Seasonal variation in AOM prevalence could not be determined. Conclusions: The prevalence of AOM was high among febrile children under 5 years attending Mulago hospital. Age below two years and leucocytosis were independently associated with AOM. Recommendations: Clinicians should have high index of suspicion of AOM in febrile children below two years of age with vomiting, including those with malaria. Studies employing more objective diagnostic methods for AOM need to be done in Mulago and other Ugandan settings so as to inform local clinical guidelines for diagnosis, treatment and prevention of AOM in Uganda.