title: Epidemiology of acute otitis media in children of Latin America and the Caribbean: a systematic review and meta-analysis.
abstract: BACKGROUND
  Acute otitis media (AOM) is one of the most common childhood diseases requiring antimicrobial prescription in pre-school children. This systematic review aimed to estimate the AOM incidence, bacterial etiology and use of resources in children aged <6 years in Latin America and the Caribbean (LA&C).
  
  
  METHODS
  A systematic search using keywords otitis or middle ear and inflammation was performed for articles published during 1988-2008 in MEDLINE, Cochrane Library, EMBASE, LILACS, generic and academic internet searches, Ministries of Health, PAHO, regional proceedings, reference lists and consulting experts. Pairs of reviewers independently selected articles and assessed their methodological quality with a checklist of essential items from the STROBE statement according to pre-specified criteria. Studies involving immune-competent children with AOM were considered. Arcsine transformations were used for proportion meta-analyses.
  
  
  RESULTS
  Annual AOM incidence in four studies in children aged <5 years ranged from 1,171-36,000 episodes/100,000 children. Meta-analysis on etiology and pneumococcal serotypes included 18 studies and 125, 519 children with AOM from six LA&C countries. Meta-analysis per serotype showed that Streptococcus pneumoniae (32.4%; 95%CI=27.1-38.0%) and Haemophilus influenzae (26%; 95%CI=19.5-33.1%), including non-typeable H. influenzae (18.3%; 95%CI=9.5-33.1%) were the most prevalent. The most commonly observed pneumococcal serotype was 19F (24.0%; 95% CI 17.0-32.0%). Data on use of health resources were scarce.
  
  
  CONCLUSIONS
  Streptococcus pneumoniae and H. influenzae were the most frequent AOM bacterial pathogens, consistent with the international literature from other regions. Future studies on AOM incidence and health resources usage will help better define the impact of this disease.
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. abardach@iecs.org.ar
authors.forename: Ariel
authors.initials: A
authors.lastname: Bardach
authors.forename: Agustín
authors.initials: A
authors.lastname: Ciapponi
authors.forename: Sebastian
authors.initials: S
authors.lastname: Garcia-Marti
authors.forename: Demian
authors.initials: D
authors.lastname: Glujovsky
authors.forename: Agustina
authors.initials: A
authors.lastname: Mazzoni
authors.forename: Alicia
authors.initials: A
authors.lastname: Fayad
authors.forename: Romulo E
authors.initials: RE
authors.lastname: Colindres
authors.forename: Angela
authors.initials: A
authors.lastname: Gentile
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D017691:Caribbean Region / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007843:Latin America / Q000453:epidemiology; D008297:Male; D010033:Otitis Media / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012008:Recurrence; D012720:Severity of Illness Index; D017678:Sex Distribution