title: Hearing Loss in HIV-Infected Children in Lilongwe, Malawi.
abstract: BACKGROUND
  With improved access to antiretroviral therapy (ART), HIV infection is becoming a chronic illness. Preliminary data suggest that HIV-infected children have a higher risk of disabilities, including hearing impairment, although data are sparse. This study aimed to estimate the prevalence and types of hearing loss in HIV-infected children in Lilongwe, Malawi.
  
  
  METHODS
  This was a cross-sectional survey of 380 HIV-infected children aged 4-14 years attending ART clinic in Lilongwe between December 2013-March 2014. Data was collected through pediatric quality of life and sociodemographic questionnaires, electronic medical record review, and detailed audiologic testing. Hearing loss was defined as >20 decibels hearing level (dBHL) in either ear. Predictors of hearing loss were explored by regression analysis generating age- and sex-adjusted odds ratios. Children with significant hearing loss were fitted with hearing aids.
  
  
  RESULTS
  Of 380 patients, 24% had hearing loss: 82% conductive, 14% sensorineural, and 4% mixed. Twenty-one patients (23% of those with hearing loss) were referred for hearing aid fitting. There was a higher prevalence of hearing loss in children with history of frequent ear infections (OR 7.4, 4.2-13.0) and ear drainage (OR 6.4, 3.6-11.6). Hearing loss was linked to history of WHO Stage 3 (OR 2.4, 1.2-4.5) or Stage 4 (OR 6.4, 2.7-15.2) and history of malnutrition (OR 2.1, 1.3-3.5), but not to duration of ART or CD4. Only 40% of caregivers accurately perceived their child's hearing loss. Children with hearing impairment were less likely to attend school and had poorer emotional (p = 0.02) and school functioning (p = 0.04).
  
  
  CONCLUSIONS
  There is an urgent need for improved screening tools, identification and treatment of hearing problems in HIV-infected children, as hearing loss was common in this group and affected school functioning and quality of life. Clear strategies were identified for prevention and treatment, since most hearing loss was conductive in nature, likely due to frequent ear infections, and many children with hearing loss qualified for hearing aids. Screening strategies need to be developed and tested since caregivers were not reliable at identifying hearing loss, and often mis-identified children with normal hearing as having hearing loss. Children with frequent ear infections, ear drainage, TB, severe HIV disease, or low BMI should receive more frequent ear assessments and hearing evaluations.
authors.affiliation: Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence Malawi, Lilongwe, Malawi.|Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America.|Baylor International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, Texas, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Hrapcak
authors.affiliation: International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
authors.affiliation: African Bible College (ABC) Hearing Clinic and Training Centre, Lilongwe, Malawi.
authors.forename: Peter
authors.initials: P
authors.lastname: Bartlett
authors.affiliation: Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence Malawi, Lilongwe, Malawi.
authors.forename: Akash
authors.initials: A
authors.lastname: Devendra
authors.affiliation: Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence Malawi, Lilongwe, Malawi.
authors.forename: Atupele
authors.initials: A
authors.lastname: Makawa
authors.affiliation: Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence Malawi, Lilongwe, Malawi.|Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America.|Baylor International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, Texas, United States of America.
authors.forename: Maria
authors.initials: M
authors.lastname: Kim
authors.affiliation: Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence Malawi, Lilongwe, Malawi.|Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America.|Baylor International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, Texas, United States of America.
authors.forename: Peter
authors.initials: P
authors.lastname: Kazembe
authors.affiliation: Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence Malawi, Lilongwe, Malawi.|Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America.|Baylor International Pediatric AIDS Initiative, Texas Children's Hospital, Houston, Texas, United States of America.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D001301:Audiometry, Pure-Tone; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D034381:Hearing Loss / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008295:Malawi; D008297:Male; D011788:Quality of Life