title: Prevalence of Chronic Suppurative Otitis Media (CSOM) and Associated Hearing Impairment Among School-aged Children in Yemen.
abstract: BACKGROUND
  Chronic suppurative otitis media (CSOM) is one of the leading causes of preventable disabling hearing impairment (DHI) in developing countries. Early detection and management complements advances made in other survival programs, improves work capacity, and enhances learning opportunities for school children. We aimed to determine the prevalence of CSOM and associated DHI among school children aged six to 16 years in Socotra Island, Yemen.
  
  
  METHODS
  We conducted a cross-sectional community-based survey, from 20 April 2011 to 20 June 2011. The study procedures involved completing a questionnaire, an otoscopic ear examination, an audiometric test of hearing, and tuning fork tests for the type of DHI.
  
  
  RESULTS
  A total of 686 children were interviewed and examined for CSOM and associated DHI of CSOM cases. The prevalence of CSOM was 7.4%, (95% CI 5.5-9.4). CSOM status was significantly associated with DHI (p=0.001), but no significant associations were found between demographic characteristics and CSOM status. Logistic regression identified four significant independent contributing factors: history of ear discharge in the last 12 months (odds ratio (OR) 7.8, 95% CI 3.9-15.6); swimming in local pools (OR 6.0, 95% CI 1.4-25.4); recurrent respiratory tract infection more than three times per year (OR 5.3, 95% CI 2.5-11.0); and overcrowding with more than three families per house (OR 4.4, 95% CI 1.7-11.5). .
  
  
  CONCLUSIONS
  The burden of CSOM in the children studied indicates a high level of DHI in these communities within Yemen. A history of ear discharge, swimming in local pools, recurrent respiratory infections, and overcrowded housing were the strongest predictors for CSOM. There is a need for better ear care and screening programs for early detection and management of this disease.
authors.affiliation: WHO Collaborating Centre on Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Salem
authors.initials: S
authors.lastname: Muftah
authors.affiliation: WHO Collaborating Centre on Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Mackenzie
authors.affiliation: WHO Collaborating Centre on Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Faragher
authors.affiliation: WHO Collaborating Centre on Hearing Impairment, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK ; Global Child Health Group, Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam,   Amsterdam, The Netherlands ; Department of Community Child Health, Royal Liverpool Children's NHS Trust, Liverpool, UK.
authors.forename: Bernard
authors.initials: B
authors.lastname: Brabin
keywords: Children; Hearing Impairment; Otitis Media, Suppurative; Yemen