Keywords

Ear infections; Complications; Butembo; DRC

Introduction

In developing countries where we have a poor socioeconomic status, Ear infections are common health problems for children and adults. Both ear inflammation and ear discharge are the commonest symptoms of ear infection [1]. The Ear is an important part of our body that allows us to hear and to be in touch with others, and also help in the function of balance for the body. Infections of the ear disturb the homeostasis of the human body [2]. Otitis is skin or mucous membrane inflammation of the ear. According to which part is affected by the inflammation, the otitis can be named as the external, media and inner otitis [3]. The external otitis is an inflammation of the auditory external conduit, and may be caused by infections in 90% of cases or fungus in 10% [4]. Otitis media is an inflammation of the middle ear and mastoid process which could be clinically classified as an acute otitis media (AOM), an otitis media with effusion (OME) and chronic suppurative otitis media (CSOM) [5]. An otitis interna is technically an infection of the innermost part of the ear. Often, an otitis interna is not an infection, but an inflammation or irritation of the parts of the ear responsible for balance and hearing. Less commonly, an otitis interna is a true infection caused by a virus or bacteria [6]. Otitis is an otolaryngology emergency that threatens the functional prognostic (deafness and facial paralysis) but also the vital prognostic by its interbrain complications (meningitis, encephalitis). Some numerous works showed the importance of the bacterial epidemiology of the otitis and the virulence of some germs [7-10]. Every year, it is estimated that there are more than 70 million numbers of the cases of the otitis worldwide. In 2017 World Health Organisation (WHO) declared that 330 millions of people endure problems of chronic otitis [11,12]. Every year 21 000 people, worldwide, die from the complications due to otitis media or its resulting illnesses and to that 31 people out of 10000 develop an auditory deficiency following infection with middle otitis [13].

Fifty percent among 709 millions of yearly cases of the acute otitis media are presented in developing countries [2]. In sub- Saharan Africa, acute otitis media is characterized by its high rate of the complications. The delay of diagnosis, in this part of the world, explains the high prevalence of adults patients with Ear infections as well as a high rate of complications [14]. In Guinea Conakry, among 1877 patients received in service of otorhinolaryngology, 13.96% of them were diagnosed with otitis [4]. During a survey held in five countries of sub-Saharan Africa of which Kenya, Gabon, Cameroon, Congo and Democratic Republic of the Congo, 18.9% (100/528) patients had acute media otitis.

As ear infection or otitis remains a great public health problem worldwide due to its impact and complications which are associated to a high rate of morbidity, the aim of this survey was to determine the epidemiology and complications of ear infections in the Middle Eastern Environment of the Democratic Republic of the Congo. Furthermore the survey will enable health workers to be aware of ear infections in general on purpose to timely take care of patients suffering from ear infections to reduce the rate of their complications in a Middle Eastern Environment of the Democratic Republic of the Congo.

Methods

It was a transversal retrospective survey carried out from the 01st January 2017 to 31st December 2017 in Health facilities located in two Health zones in Butembo Health District, Eastern part of the Democratic Republic of the Congo. The targeted population was constituted of 2865 patients admitted and diagnosed with ENT pathology in all health centers in our survey site. Our sample was exhaustive and constituted of 714 patients diagnosed Ear infections and whose health files were found and well filled.

The following parameters were screened: Socio-demographics (age, sex, and origin), types of otitis (otitis externa, otitis media, otitis inner) and complications of otitis. Data was processed and analyzed using Epi-Info software, version 3.5.4 and Microsoft Excel 2007. Association of variables was analyzed by using odds ratio (or), at confidence interval of 95% (95% CI). We considered associations as significant when CI did not contain 1or the Pvalue is less than 0.05. The research protocol was approved by the administrative officers of KATWA and BUTEMBO Health zones (Figure 1).

Figure 1: Maps of the health zones of Butembo showing the study site.

Results

Prevalence of ear nose and throat diseases in 2017

During our survey about Ear infections and their complications in Middle Eastern Environment of the Democratic Republic of the Congo carried out from 1^st January 2017 to 31st December 2017 in Health facilities located in two Health zones in Butembo Health District, Eastern part of the Democratic Republic of the Congo, we found among 2865 patients admitted and diagnosed with Ear Nose and Throat diseases, 714 patients presented Ear infections, which is 24.9% (Figure 2).

Figure 2: Prevalence of ear nose and throat diseases.

Socio-demographic characteristics of patients with ear infections

The majority of our patients were young with an age range between 0 to 10 years; Men were more affected than women with a ratio of 1.59; The high prevalence of Ear infections comes from rural area in our survey either 29.82% in farming environment against 25.82% in urban environment (Table 1).

Table 1: Prevalence of ear infections in heath zones.

Prevalence of ear infections in heath zones of Butembo city

Katwa health zone was carried a high prevalence of Ear infections in Butembo city, with 61.34% (Table 2).

Table 2: Ear infections and Socio-demographic characteristics.

Distribution of patients according to ear infections and their complications

Otitis media was more prevalent with 85.6% followed by otitis externa with 13.5% and otitis interna with 1.05%. Chronic otitis constituted the most frequent complication with 33.3% (Table 3).

Table 3: Type of ear infections and complications.

Discussion

During our survey about Ear infections and their complications in a middle eastern of environment of the Democratic Republic of the Congo, the average age of our patients was similar to the one of Tall H et al. in Senegal, who had found an average age of 26 years old [15]. In Mali, Keita in his survey carried out on the otolaryngology practice in sub- Saharan, obtained an average age of 31 years old [16]. The majority of our patients were young with an age range between 0 to 10 years. This can be explained by the fact that Ear infection affects essentially children. This result is different from the one found by Tall H et al. in Senegal, who found a high prevalence between 11 and 20 years old [15]. Otherwise, our results prove that children aged between 0 to 10 years old have twice the risk to develop an Ear infection with the p value lower than 0.05. While the group aged from 71 to 80 years old has a risk to develop an Ear infection with OR in 1.24. This risk is insignificant because of a CI 95% contains 1. Other average age are protected with OR lower than 1. The men predominated in our survey. We found variable frequencies in our survey about sex. In 2013, Njifou et al. in Doula and Attifi H et al. in Guinea-Conakry as well as Tall et al. in Senegal recovered a male predominance while Keita in Mali didn't find any predominance of sex [15-21]. This predominance can be explain by the fact that men are neglecting to take care of their diseases in developing countries and as the high rate of ear infections comes from rural area where men do not take care regularly of their diseases. Even if the most of patients came from urban area in our survey, the high prevalence of Ear infections comes from rural area in our survey either 29.82% in farming environment against 25.82% in urban environment. Indeed, rural people are at a risk to contract an Ear infection with an OR of 1.1462 and a p value lower than 0.05, either 0.26. However, urban people can develop otitis by their OR OF 1.146 with the urban source multiplies by 1.1462 the risk to develop an Ear infection. This risk is insignificant because of the CI 95% contains. This is due to the fact that in urban environment, rules of hygiene are respected more than rural environment.

We found 714 patients presented with Ear infections among 2865 consulted patients and treated for ENT problems, representing 24.9%. This result is not different from the one of Tall et al. of Senegal that had found a prevalence of 24.7% [15]. However, our results are different from those found by Attifi H et al. in Guinea. In his survey done in 2014, in Guinea-Conakry, on the experience otolaryngology Moroccan rural hospital, Attifi H found a prevalence of 27.9% [20]. This survey shown that otitis media was more prevalent with 85.6% followed by otitis externa with 13.5% and otitis interna with 1.05%. These results are not far from the ones of Attifi H et al. who found 75.19% for otitis media and 24.81% for the otitis externa, in his survey done in 2014, in Guinea-Conakry [20]. Moreover, Amana et al., found a prevalence of 11.9% for external otitis [22]. This can be explaining by the fact that the diagnostic was found later because of the unwariness of no specialist workers in our area. Apart that, otitis media was the most otitis found in our survey at child patients who are at a risk, regarding literature, to develop otitis media as said H. Teele et al. in their survey that Otitis media is very common, with around 80 % of children should have experienced at least one episode by their third [23]. The chronic otitis constituted the most frequent complication, either 33.3% among patients presented complication of Ear infections. This result is similar to the one of Attifi H in Guinea- Conakry who found 49.6% on population with Ear infection [20]. This can be explain by the fact that many of our patients reached the health centers later and the diagnostics were found also later by health workers which indicate the bad management of ear infections in our area. It has been estimated that there are 31 million new cases of chronic otitis per year, with 22.6% in children less than 5 years old [24]. The populations with the highest reported prevalence of chronic otitis are the Inuits of Alaska, Canada and Greenland, American Indians and Australian Aborigines.

Conclusion

Ear infections remain a serious public health problem in Butembo; early and serious consultation by an otolaryngologist might be a solution to the high rate of their complications in a Middle Eastern Environment of the Democratic Republic of the Congo.

Conflits of Interest

Authors declared that there are no conflicts of interest exist.

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