Socio-economic status and hearing loss in chronic suppurative otitis media in Nigeria

BACKGROUND: Hearing loss is reported in about 50% of cases of chronic suppurative otitis media (CSOM). AIM: To report the prevalence, type and severity of hearing loss in CSOM and identify risk factors. METHODS: A prospective study of hearing loss in CSOM was undertaken in University College Hospital, Ibadan, two general hospitals and two primary health care centres, all in densely populated, semi-urban areas in south-west Nigeria. Controls were selected from school children, hospital workers' children and children whose parents were visiting the hospitals, all of whom claimed that there had been no episode of otitis media in the past. An oral questionnaire was administered to all, followed by audiometry and examination of the ear, nose and throat in study children. RESULTS: There were 189 CSOM subjects and 100 controls aged between 4 and 150 months [mean (SD) 59.25 (44.55), 173 girls and 116 boys, M:F 1.5:1]. The prevalence of hearing loss in CSOM was 89/189 (47%) and was conductive in 73/89 (82%) and sensorineural (SHL) in 16/89 (18%). Of the subjects with hearing loss, 72% had had otitis media during the 1st year of life. Of the 89, 61 (69%) were of low social class, 13/37 (35%) were middle class and 15/63 (24%) upper class. The duration of CSOM ranged from 4 weeks to 12 years [mean (SD) 4 yrs (2.04)] and from 5 to 12 years in those with SHL [mean (SD) 9 yrs (6.21)]. There was significant correlation between socio-economic status and hearing loss (r=0.138, p=0.02) while no correlation was found with upper respiratory infection (r=0.054, p=0.36), age of onset (r=0.037, p=0.62) or frequency of attacks (r=-0.068, p=0.35). CONCLUSION: About one fifth of patients with CSOM have SHL. Early diagnosis and management of CSOM is imperative to improve outcome. CSOM is strongly associated with low socio-economic status.     

Chronic suppurative otitis media in children of Luanda, Angola

Aim: Evaluation of clinical characteristics, bacteriology and hearing in paediatric patients with and without chronic suppurative otitis media (CSOM) in Luanda, Angola. Methods: Interview, clinical examination, ear‐discharge culture, open air pure‐tone audiometry and brainstem auditory‐evoked potentials of 23 outpatients with CSOM and 23 controls in a paediatric hospital. Results: Of the CSOM vs. control children, 35% vs. 26% had running water, 70% vs. 70% electricity, 64% vs. 0% HIV (p < 0.0001) and 36% vs. 0% tuberculosis in history (p = 0.002). Ten (43%) children had bilateral CSOM. The major ear‐discharge pathogens were Proteus spp. (44%) and Pseudomonas (22%). Hearing impairment of >25 dB was present in 52% of CSOM‐affected ears and bilateral hearing loss in 7 (30%) CSOM children vs. zero control child (p = 0.009). Only one hearing‐impaired child’s family had previously detected the handicap. Conclusion: CSOM occurred in children with high co‐morbidity. Persistent otorrhoea was usually caused by Proteus spp. or Pseudomonas, and often suggestive of either HIV or hearing impairment. In the developing countries, prompt diagnosis and treatment of CSOM would enhance the children’s linguistic and academic development.     

Topical ciprofloxin versus topical framycetin-gramicidin-dexamethasone in Australian aboriginal children with recently treated chronic suppurative otitis media: a randomized controlled trial

BACKGROUND: Chronic suppurative otitis media (CSOM) affects many children in disadvantaged populations. The most appropriate topical antibiotic treatment in children with persistent disease is unclear. METHODS: Children with CSOM despite standard topical treatment were randomized to 6-8 weeks of topical ciprofloxacin (CIP) versus topical framycetin-gramicidin-dexamethasone (FGD). Otoscopic, audiologic, and microbiologic outcomes were measured using standardized assessments and blinding. RESULTS: Ninety-seven children were randomized. Ear discharge failed to resolve at the end of therapy in 70% children regardless of allocation [risk difference = -2%; (95% CI: -20 to 16)]. Healing of the tympanic membrane occurred in one of 50 children in the CIP group and none of 47 children in the FGD group. Severity of discharge failed to improve in more than 50% children in each group, and mean hearing threshold (38 dB and 35 dB) and proportion of children with greater than 25 dB hearing loss (98% and 88%) were not significantly different between the CIP and FGD groups. Side effects were rare. CONCLUSIONS: This study showed a similarly low rate of improvement or cure in children with persistent CSOM for both CIP and FGD topical therapies. Complications and side effects were insufficient to cease therapy or inform prescribing of either therapy.     

Prevalence and determinants of undernutrition and its trends among pre-school tribal children of Maharashtra State, India

A community-based cross-sectional study carried out in tribal areas of Maharashtra covering 1751 pre-school children to assess nutritional status. Nutritional status was assessed using new WHO Growth Standards. Household wealth index was constructed using principle component analysis. The prevalence of underweight, stunting and wasting was 64, 61 and 29%, respectively. There was a significant (p?相似文献   

Visual attention in deaf and hearing infants: the role of auditory cues

BACKGROUND: Successful communication with profoundly deaf children is heavily dependent on visual attention. Previous research has shown that mothers of deaf children--notably those who are deaf themselves--use a variety of strategies to gain their children's attention. This study compares patterns of visual attention in deaf and hearing children to determine how they are affected by the absence of auditory cues, especially when looking to the mother's face. METHOD: The visual attention of 18-month-old infants to their mothers was examined in two groups of deaf children (6 with deaf mothers and 6 with hearing mothers) and two of hearing children (6 with deaf mothers and 8 with hearing mothers). Dyads were observed in free play and 10 minutes of videorecorded interaction was analysed. All looks to the mother were classified as Spontaneous, Responsive (Child turns in response to something done by mother) or Elicited (Mother actively seeks to gain child's attention by, e.g., tapping or waving). The kind of event that attracted the child's attention in Responsive and Elicited episodes was also determined (e.g., object movement, speech, physical contact), as was the focus of the child's attention (e.g., mother's face, mother's body). RESULTS: Responsive looks to the mother were the most frequent for all groups but on only about 25% of occasions were they directed to her face. Elicited and spontaneous looks occurred less often but were frequently directed to the mother's face. Spontaneous looking occurred in all groups but elicited looking very seldom occurred in Hearing-Hearing dyads. Overall, there were fewer looks to the mother in the two groups where mother and child had congruent hearing status, although the proportion of the looks to the mother's face was similar. CONCLUSIONS: Both spontaneous and elicited looks are likely to involve attention to the mother's face. However, while active elicitation of attention is an important part of successful communication with young deaf children, this does not appear necessary for typically developing hearing children who turn to look at their mother's face on hearing her voice. The implications of these findings for differences in the dynamics of communication with young deaf and hearing children are discussed.     

The relationship between socio-economic status and physical activity patterns in South African children

AIM: To examine: (1) the associations between socio-economic status, physical activity, anthropometric and body composition variables in South African children; (2) the influence maternal characteristics have on children's physical activity levels; and (3) associations between television watching, activity level and body composition. METHODS: In 381 South African children, physical activity and socio-economic status were assessed via structured retrospective interview using validated questionnaires. An asset indicator score was calculated as a proxy measure of socio-economic status and used to divide children into quartiles. RESULTS: Children falling into the highest socio-economic status quartile had mothers with the highest educational levels, generally came from dual parent homes, were highly physically active, watched less television, weighed more and had greater lean tissue than children in lower quartiles. A greater percentage of children living in dual parent homes and with mothers of a higher educational status were highly active compared with children living in single parent homes and with mothers of a lower educational status. We found greater levels of lean mass with increased activity level after controlling for television watching time and fat mass. There were high levels of low activity and high television watching time among lower socio-economic status groups. There were significant racial differences in patterns of activity. White children were found to be more active than black children, more likely to participate in physical education classes at school and watched less television than black children. CONCLUSION: Physical activity levels and socio-economic variables are closely related in this population of South African children.     

Does growth monitoring work as it ought to in countries of low literacy?

The paper examines various aspects of the growth monitoring (GM) component of the Integrated Child Development Services (ICDS) programme of India. Data of 3704 rural children, 0-6 years of age revealed that growth of almost half of the children had never been monitored, and monitored inadequately in another 25 per cent of cases. While very few mothers (1 per cent) could interpret growth charts (GC) correctly, 87 per cent of the ICDS functionaries could do this. There was a significant and positive relationship between maternal knowledge and functionary knowledge of the growth chart (GC), and coverage of children for GM. Impact of mothers' GC knowledge on nutritional status of children was determined largely by their literacy status; however, only 17 per cent were literate. Analysis of covariance of the effect of GM on weight-for-age and morbidity controlling for socio-economic status and other programme services showed that GM did not have an impact on the nutritional or health status of children. It is therefore concluded that very high levels of illiteracy amongst mothers may be a major determinant to the success of GM programmes in India.     

Child rearing and positive deviance in the development of preschoolers: a microanalysis

OBJECTIVE: To study the maternal child-rearing behaviors, parental attributes and socio-economic status of the family and to analyze their association with positive deviance in the developmental status of preschool children between 1-5 years of age. DESIGN: Cross-sectional. SETTING: Rural community. METHODS: A total of 260 children and their mothers were evaluated. Weight and height-for-age indices were used to assess growth. ICMR Developmental Screening Test was used to assess psychosocial development. Bhatia's Performance Test was used to assess maternal intelligence. Narayan Rao's Rating Scale was used to assess socio-economic status and a child-rearing interview schedule developed and pretested for the purpose of the study to assess maternal child-rearing practices and behaviors. RESULTS: Stepwise multiple regression with psychosocial development as dependent variable indicated significant associations between specific maternal behavioral categories and psychosocial development of 1-5 year old children. Children, whose mothers were responsive to their needs, were consistent in their interaction with them and were also emotionally stable during specific child rearing situations were those identified as "positive deviants" with regard to their development. Other factors, which were significantly associated with positive deviance in children, were paternal literacy and nuclear type of family. Significant differences were observed between genders. CONCLUSIONS: The data generated from the study could identify the important factors that were associated with "positive deviance" in the development of children. These factors can be useful components for parental counseling in clinical practice and as educational material in community programmes such as the ICDS and self-help groups at the village level.     

Phonological processing, language, and literacy: a comparison of children with mild-to-moderate sensorineural hearing loss and those with specific language impairment

Phonological skills, language ability, and literacy scores were compared for four groups: 19 children with mild-to-moderate sensorineural hearing loss (SNH), 20 children with specific language impairment (SLI), 20 controls matched on chronological age to the SNH group (CA), and 15 controls matched on receptive vocabulary level to a subset of the SLI group (CB). In common with the SLI group, mean scores of children with mild-to-moderate hearing loss were significantly poorer on tests of phonological short-term memory, phonological discrimination, and phonological awareness than CA controls. No differences between group means were observed in SNH and CA control groups on vocabulary, digit and sentence recall, sentence comprehension, and literacy scores. However, there was considerable individual variation within the SNH group. Nearly 50% of the SNH group showed phonological impairment associated with poorer expressive and receptive vocabulary and higher hearing thresholds than remaining children without phonological impairment. Nonword repetition deficits were observed in SNH subgroups with and without phonological impairment and were of a similar magnitude to those observed in children with SLI. Indeed, poorer repetition in children with SLI could only be differentiated from children with SNH on phonologically complex nonwords. Overall, findings suggested major problems in nonword repetition and phonological impairment occurred without clinically significant deficits in wider language and literacy abilities in children with mild-to-moderate sensorineural hearing loss. Implications for theories of SLI are discussed.     

Oral health and oral health-related behaviour in preschool children: evidence for a social gradient

This study aims to investigate the social gradient in the reported oral health-related behaviour and oral health status of preschool children. Participants were 1,057 children born between October 2003 and July 2004 in Flanders, Belgium. Oral health examinations were performed by trained dentists when the children were 3 and 5 years old (respectively, in 2007 and 2009); data on dietary habits, oral hygiene habits and dental attendance of the children were obtained through structured questionnaires completed by the parents. Maternal educational level, measured in four categories, was used as a proxy of socio-economic status. Logistic and ordinal regressions showed a social gradient for the oral health-related behaviours: a lower educational level of the mother was related to a higher consumption of sugared drinks between meals and to a lower brushing frequency and dental attendance of the child. Children from low-educated mothers also had seven times more chance to present with caries experience than children from mothers with a bachelor degree. Contrary to the expectations, there was a deviation from the gradient in 3-year-olds from the highest educational group showing an increased risk for caries experience (OR?=?3.84, 95 % CI?=?1.08–13.65). Conclusion. Already in very young children, a graded relationship is observed between socio-economic position, oral health and related behaviours. The results suggest that different approaches are required to promote oral health during early childhood depending on the mother’s educational background. As children from the highest social group also have an increased caries risk, specific techniques may be needed.     

Maternal nutrition in rural Kenya: health and socio-demographic determinants and its association with child nutrition

High levels of food insecurity and human immunodeficiency virus (HIV) infection place most breastfeeding mothers in Kenya at high risk of malnutrition. We examined the role of selected socio-economic, demographic and health factors as determinants of nutritional status among HIV-infected and HIV-uninfected mothers in rural Kenya and further examined the interrelationship between maternal nutritional and child nutritional status within this population. A cross-sectional design was used to collect data from non-pregnant mothers with children ages 4-24 months in Kisumu District, Kenya. Over 80% of the mothers were breastfeeding at the time of the study. Mean maternal body mass index (BMI) (21.60 ± 3.15) and percent body fat (22.29 ± 4.86) values were lower than among lactating mothers in other Sub-Sahara African countries. Maternal HIV status was not significantly associated with any of the maternal nutritional indicators assessed in the study. Breastfeeding, recent severe illness and having multiple children below 2 years of age were negatively associated with maternal nutritional status, while higher maternal age, socio-economic status and household food security were each positively associated with maternal nutritional status. Significant positive association was reported between maternal weight, height, BMI, mid-upper arm circumference (MUAC), body fat and fat-free mass estimates, and children's height-for-age, weight-for-age, weight-for-height and MUAC-for-age z-score. This analysis identifies determinants of maternal nutritional status in rural Kenya and highlights the importance of interventions that address malnutrition in both HIV-infected and HIV-uninfected mothers in rural Kenya. Significant association between maternal and child nutritional status stresses the importance of addressing maternal and young child nutritional status as interrelated factors.     

Factors influencing prevalence of breastfeeding in a resettlement colony of New Delhi

Influence of some family and maternal characteristics on prevalence of breastfeeding was studied in a cross sectional study using WHO suggested methodology. 547 mothers with children less than three years of age were interviewed with the help of a schedule. Age and parity of the mother, sex of the child, length of urban stay, mother’s going for work did not influence the prevalence of breastfeeding. Prevalence was higher among illiterate mothers and mothers belonging to lower socio-economic status. The mothers from higher socio-economic status initiated breastfeeding earlier. More mothers from higher socio-economic status and those with better education thought that supplementation was needed before the child was 4 months old and felt that breastfeeding was needed for less than two years.     

Influence of maternal literacy on the nutritional status of preschool children

The impact of maternal literacy status on the nutritional status of preschool children in Parbhani was studied. Results revealed that the children of literate mothers had better anthropometric measurements than children of illiterate mothers. Nutrient deficiency signs especially of protein energy malnutrition were more predominant among the children of illiterate mothers. Food consumption pattern was better in children with literate mothers as compared to children of illiterate mothers. The consumption of milk and milk products, fruits, sugar and jaggery was significantly greater in children with literate mothers.     

Seroprevalence of Helicobacter pylori infection among children and their parents in eastern Turkey

OBJECTIVES: To determine the seroprevalence of Helicobacter pylori infection among healthy children in eastern Turkey, to assess risk factors for seroconversion, and to assess the role of parental infection status in the transmission of H. pylori. METHODS: A commercial enzyme immunoassay test for IgG to H. pylori was used. Demographic information obtained included age, gender, socio-economic status and living conditions. RESULTS: One hundred and fifty-two (43.9%) of 346 children were seropositive. There was no significant difference in rates of seroprevalence between boys and girls (P > 0.05), but a significant rise was noted with increasing age (P < 0.001). We found a strong inverse correlation between family income and seropositivity (P < 0.001). Seroprevalence also varied significantly with the educational level of the mother (P < 0.001). There were no significant differences in seroprevalence associated with place of residence, water supply and the number of persons per room (P > 0.05). The prevalence of infection in the corresponding parents was 85.4% for mothers and 76.3% for fathers. Seroprevalence was higher in children whose mother was infected (P < 0.001). CONCLUSIONS: In eastern Turkey, as in other developing countries, H. pylori infection occurs early and increases with age. Infected parents, especially infected mothers, may have a important role in the transmission of H. pylori within families.     

Hearing loss in children with congenital cytomegalovirus infection born to mothers with preexisting immunity

OBJECTIVE: To define hearing outcomes in children with congenital cytomegalovirus (CMV) infection born to mothers with non-primary CMV infection. STUDY DESIGN: A cohort of 300 children with congenital CMV infection identified by newborn virologic screening at the University of Alabama Hospital and a private community hospital in which the type of maternal infection could be classified constituted the study population. Maternal infections were categorized by analyzing serum samples. Children were followed prospectively and underwent serial audiologic evaluations. RESULTS: The frequency of hearing loss was not different between children born to mothers with non-primary infection (10%) and those with primary infection (11%). Significantly more children in the primary infection group had progressive and severe/profound hearing loss compared with children in the non-primary group. The frequency of bilateral, delayed onset, high-frequency, and fluctuating hearing loss was not different between the 2 groups. The mean age of diagnosis of hearing loss was 39 +/- 53 months for children born to mothers with non-primary infection and 13 +/- 21 months for the primary infection group (P = .16). CONCLUSIONS: Maternal preexisting seroimmunity to CMV does not provide complete protection against hearing loss in infants with congenital CMV infection.     

Screening for psychosocial development among infants in an urban slum of Delhi

Objective Psychosocial developmental screening of the infants in an urban slum of Delhi and studying the factors influencing the development. Methods In this cross-sectional study 202 infants and their mothers were included. Psychosocial Development Screening Test developed by Indian Council of Medical Research was used to asses the development status of infants, and the mothers were interviewed for socio-demographic details Results Infants who achieved milestones in time were 92.5% for personal skills, 91.8% for hearing language and concept development and 90.6% for gross motor milestones, respectively. These percentages were lower for Vision and fine motor (88.6) and social skills (81.4). Sex of the infant and socioeconomic status of their families significantly influences the few domains of development. Other factors like age of the infant, literacy of their mothers were not significantly influencing the development of infants. Conclusion The objective evaluation and screening for psychosocial development of infants living tin urban slums is necessary for early detection and intervention.     

Maternal and cord plasma selenium levels in full term neonates

Selenium is a part of the enzyme glutathione peroxidase and has an important role in the prevention of oxygen free radical injury. Hence good selenium nutrition is of special relevance to the neonate. The present study evaluated plasma selenium levels in cord plasma of 82 full term, appropriate for gestational age babies and their mothers at delivery. The plasma selenium levels in babies were 54.17±1.34 ppb which was significantly lower than 70.63±1.62 ppb seen in their mothers. Anemic mothers with a Hb <8 gJ/dl had a plasma selenium level (60.74±4.57 ppb) which was lower than those with a Hb >8 gJdl i.e. 74.19±2.17 ppb. Maternal age, parity, literacy and socio-economic status did not affect the plasma selenium levels.     

Growth velocity and survival of full-term low birth weight infants in an African rural area (Burkina Faso)]

The objective of the study was to compare weight gain and mortality between full-term low birth weight (LBW) and normal birth weight (NBW) children. METHODS: One hundred and fifty-five full-term children born with LBW (<2500 g) and 280 NBW were recruited retrospectively in a rural health district of Burkina. Growth velocity, maternal characteristics and socio-economic status of families were investigated. RESULTS: Difference in weight means between the two groups decreased gradually from 3 months of age and did no more significantly differ from 8 months (P = 0.213). LBW, higher mother's BMI and number of antenatal care visits were associated with higher weight gain at 7 months. Lower weight gain was observed in children whose mothers had no education or high parity. Mortality risk was higher for LBW children (RR = 4.53; P = 0.005). LBW children's weight gain at 3 months was better than that of NBW infants. Nevertheless LBW children had a high mortality risk in the first year of life. CONCLUSION: Our results suggest that it could be interesting to focus early attention on LBW children without spontaneous catch up growth, to improve maternal nutritional status and girl's education.     

Immunization status of children of India

OBJECTIVE: To assess the immunization status of children in 90 districts of the country giving due representation to all States and UTs. METHODS: WHO 30 cluster survey methodology with certain modifications incorporating information on sex, literacy and distance of the village. RESULTS: Information was collected for about nineteen thousand children. Immunization program could touch about 90% of target children. About 63% of children received all the vaccines (BCG, DPT, OPV, Measles). In the states of Bihar, Rajasthan, UP, MP, and NE States (combined) coverage levels were relatively lower. The coverage levels were also lower for children of illiterate mothers and in small, inaccessible and tribal village. CONCLUSION: Immunization coverage of children has improved in recent years. Further improvement may be achieved by targeting illiterate mothers, inaccessible and tribal areas and low performing states.     

National immunization day to assess nutritional status of underfives in chandigarh

National Immunization Days (NIDs) are an additional opportunity to reach a large number of children and can be used to undertake additional activities beside immunization. This study highlights an attempt to assess nutritional status of under five children by using a NID. Seven thousand four hundred and thirteen underfives were selected randomly from urban, rural and slums areas of Chandigarh. Nutritional status was assessed by using weight for age criteria. Prevalence of protein energy malnutrition (PEM) was found to be about 42% while 22.7%, 14.5%, 4.1% and 0.7% children had grade I, II, III and IV PEM respectively. The prevalence of PEM was significantly higher among females (47.6%), in 1–3 years age group (53.80%), in slum area (67%) and children of labour class (60.5%) (p < 0.001). With increase in family size, the prevalence of malnutrition also significantly increased, and decreased with high literacy rate in parents (p < 0.001). The prevalence of PEM in present study (42%) was comparable to a community based survey (51.6%) among pre-school children of an ICDS block of Chandigarh. National immunization days can be successfully used to assess nutritional status of children. This approach can be used by others for screening common childhood problems, preparing normogram for a region or country, administering Vitamin A and educating mothers.