Epidemiology and etiology of otitis media among children under five years of age in an urban setting of Bangladesh

Otitis media (OM) is one of the most common and neglected childhood diseases, characterized by inflammation of the middle ear and accumulation of fluid. In addition to acute illness, otitis media is the leading cause of mild to moderate hearing impairment in children, contributing to delayed language development. It is observed that there is limited data available on its epidemiology and etiology in some countries like Bangladesh. Data were collected retrospectively from medical records of under five children of an urban surveillance system of the International Centre for Diarrheal Disease Research Bangladesh (icddr,b) during the period of 2004 to 2014. The total number of children under five was 5500. We enrolled one child from each household if they met the inclusion criteria. Blood samples were collected for culture and nasopharyngeal aspirates were collected for RT-PCR and tissue culture. During the study period 2,943 OM episodes were recorded in the database with an overall prevalence of OM of 7.7%. The mean age of children was 23.5 months, with 52.7% cases being male. Children under one year had a higher rate of OM 957/2943 (32.5%). The study found the mean duration of OM as 10.3 days. No differences were observed in the outcome of OM among males and females ( p = 0.208). Blood culture results were positive among 2.4% of children. Among the bacterial microorganisms identified in blood culture, Streptococcus pneumoniae comprised 5.7%. Viruses were identified among 18.8% of cases. Influenza virus was the most common (38.2%). During the study period, the majority of OM visits occurred in Spring (35.3%), followed by summer (32.5%) and fall (32.2%). There was no hospitalization primarily due to OM. Hospitalization occurred in 1% cases due to the presence of comorbid conditions. Due to the scarcity of data in Asian countries, including Bangladesh, we conducted this retrospective study. Study results showed a considerably high disease burden of OM among children under five, with the highest burden observed among children under one year. This study identified Streptococcus species in 8.6% positive blood specimens. Based on available information, this was the first study to evaluate the pathogen in blood culture. Furthermore. Influenza virus was detected among 38.2% of NPW samples. Given the strong association of viral infections and OM, further research is warranted to see the current status. Additionally, this finding underscores the need for the incorporation of the influenza vaccine into the national immunization schedule, which may serve as an effective strategy to prevent influenza associated OM.