title: Predictors of disease complications and treatment outcome among patients with chronic suppurative otitis media attending a tertiary hospital, Mwanza Tanzania.
abstract: BACKGROUND
  Chronic suppurative otitis media (CSOM) is a major health problem in developing countries causing hearing loss and life threatening complications. Early and effective treatment based on the knowledge of causative micro-organisms and predictors of outcome are crucial in preventing these associated complications. This study was conducted to determine the predictors of CSOM complications, treatment outcome and antimicrobial susceptibility of pathogens, thus providing essential evidence to formulate a policy for management of CSOM.
  
  
  METHODS
  This was a prospective hospital based cross sectional study involving 301 patients attending Ear Nose and Throat (ENT) clinics at Bugando Medical Centre (BMC) between October 2013 and March 2014. A standardized data collection tool was used to collect demographics and clinical characteristics of patients with CSOM. Ear swabs were collected using sterile cotton swabs and transported to the laboratory for culture and antibiotic susceptibility testing.
  
  
  RESULTS
  Out of 301 patients with CSOM; 187 (62.1 %) had positive aerobic culture within 48 h of incubation. Disease complications and poor treatment outcome were observed in 114 (37.8 %, 95 % CI; 32.2-43.3) and 46 (15.3 %, 95 % CI; 11.2-19.3) respectively. On multivariate logistic regression analysis factors found independently to predict both disease complications and poor treatment outcome were otalgia, being infected by multi drug resistant bacteria and being HIV positive. Prolonged illness duration before seeking medical attention was also found to be associated with disease complications (OR 1.029, 95 % CI 1.007-1.05, p = 0.01). A total of 116 (61 %) of gram negative bacteria were isolated. Of 34 Staphylococcus aureus, 14 (41 %) were found to be methicillin resistant Staphylococcus aureus (MRSA) while of 116 g negative enteric bacteria, 49 (42 %) were extended spectrum beta lactamases producers (ESBL).
  
  
  CONCLUSIONS
  Findings of this study suggest that positive HIV status, infection due to multidrug resistant pathogens and otalgia are significantly associated with disease complications and poor treatment outcome. Of great importance this study confirms that prolonged illness duration without seeking medical attention significantly predicts disease complications. Urgent preventive measures and laboratory guided early treatment are necessary to reduce complications associated with CSOM.
authors.affiliation: Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Martha F
authors.initials: MF
authors.lastname: Mushi
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania.
authors.forename: Alfred E
authors.initials: AE
authors.lastname: Mwalutende
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania.
authors.forename: Japhet M
authors.initials: JM
authors.lastname: Gilyoma
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania.
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
authors.affiliation: Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Jeremiah
authors.initials: J
authors.lastname: Seni
authors.affiliation: Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Mariam M
authors.initials: MM
authors.lastname: Mirambo
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P. O. BOX 1464, Mwanza, Tanzania.|Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mshana