H. O. Oburra

A prevalence study of ear problems in school children in Kiambu district, Kenya, May 1992

Information on the prevalence of hearing impairment and related ear pathologies in children in sub-Saharan Africa is scarce. A pilot study for a clinical trial of simple treatments for chronic suppurative otitis media (CSOM) in school children in Kiambu district, Kenya, provided information on the prevalence of hearing impairment and ear pathologies. Five-thousand-three-hundred-sixty-eight children from 57 randomly chosen primary schools in Kiambu district were examined. Simple otoscopy was performed by clinical officers with specialty training in ENT, and hering testing was performed by trained nurses, using a hand held field audiometer. Microbiological specimens were obtained from those children with CSOM. Five-point-six percent of the children had a hearing impairment of > 30 dB HL in one or both ears, with 2.2% having bilateral hearing impairment. Two-point-four percent had at least one perforated tympanic membrane, and 1.1% had CSOM. Eight-point-six percent of the children had wax obstructing the tympanic membrane. There is evidence of a relationship between hearing impairment and both CSOM and wax obstructing the tympanic membrane. The most common organisms found were Pseudomonas spp. (34%), Proteus spp. (34%) and Eschericia coli (19%). These results are comparable with other studies in Africa and indicate a considerable burden of ear disease in Kiambu district, Kenya.

Randomised controlled trial of treatment of chronic suppurative otitis media in Kenyan schoolchildren

BACKGROUND The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled trial of treatment of CSOM among children in Kenya; unaffected schoolchildren were taught to administer the interventions. METHODS We enrolled 524 children with CSOM, aged 5-15 years, from 145 primary schools in Kiambu district of Kenya. The schools were randomly assigned treatments in clusters of five in a ratio of two to dry mopping alone (201 children), two to dry mopping with topical and systemic antibiotics and topical steroids (221 children), and one to no specific treatment (102 children). Schools were matched on factors thought to be related to their socioeconomic status. The primary outcome measures were resolution of otorrhoea and healing of tympanic membranes on otoscopy by 8, 12, and 16 weeks after induction. Absence of perforation was confirmed by tympanometry, and hearing levels were assessed by audiometry. 29 children were withdrawn from the trial because they took non-trial antibiotics. There was no evidence of differences in timing of withdrawals between the groups. FINDINGS By the 16-week follow-up visit, otorrhoea had resolved in a weighted mean proportion of 51% (95% CI 42-59) of children who received dry mopping with antibiotics, compared with 22% (14-31) of those who received dry mopping alone and 22% (9-35) of controls. Similar differences were recorded by the 8-week and 12-week visits. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% (10-21) in the dry-mopping plus antibiotics group, 13% (5-20) in the dry-mopping alone group, and 13% (3-23) in the control group. The proportion with resolution in the dry-mopping alone group did not differ significantly from that in the control group at any time. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times. INTERPRETATION Our finding that dry mopping plus topical and systemic antibiotics is superior to dry mopping alone contrasts with that of the only previous community-based trial in a developing country, though it accords with findings of most other trials in developed countries. The potential role of antibiotics needs further investigation. Further, similar trials are needed to identify the most cost-effective and appropriate treatment regimen for CSOM in children in developing countries.

Topical quinolone vs. antiseptic for treating chronic suppurative otitis media: a randomized controlled trial.

Objective  To compare a topical quinolone antibiotic (ciprofloxacin) with a cheaper topical antiseptic (boric acid) for treating chronic suppurative otitis media in children.

Risk Factors for Hearing Loss in Children following Bacterial Meningitis in a Tertiary Referral Hospital

Objective. This study aimed to examine hearing function in children admitted with bacterial meningitis to determine the risk factors for sensorineural hearing loss. Setting. The study was conducted in the audiology unit and paediatric wards of Kenyatta National Hospital. Subjects and Methods. The study involved 83 children between the ages of six months and twelve years admitted with bacterial meningitis. The median age for the children examined was 14. On discharge they underwent hearing testing to evaluate for presence and degree of hearing loss. Results. Thirty six of the 83 children (44.4%) were found to have at least a unilateral mild sensorineural hearing loss during initial audiologic testing. Of the children with hearing loss, 22 (26.5%) had mild or moderate sensorineural hearing loss and 14 (16.9%) had severe or profound sensorineural hearing loss. Significant determinants identified for hearing loss included coma score below eight, seizures, cranial nerve neuropathy, positive CSF culture, and fever above 38.7 degrees Celsius. Conclusions. Sensorineural hearing loss was found to be highly prevalent in children treated for bacterial meningitis. There is need to educate healthcare providers on aggressive management of coma, fever, and seizures due to their poor prognostic value on hearing.

Cigarette Smoking and Alcohol Ingestion as Risk Factors for Laryngeal Squamous Cell Carcinoma at Kenyatta National Hospital, Kenya

Laryngeal squamous cell carcinoma (SCC) is strongly linked to cigarette smoking. It is estimated to account for more than 70% of laryngeal SCCs and up to 89% in combination with alcohol. We wished to determine the prevalence of cigarette smoking and alcohol ingestion among patients with laryngeal squamous cell carcinoma and estimate risk attributed to cigarette smoking and alcohol ingestion. Fifty experimental group patients and fifty controls were recruited of matching age, sex and region of residence. History of smoking and alcohol intake was taken and analyzed to estimate the relative strengths of these exposures. Cessation of smoking was associated with reduced risk of SCC. Smokers had increased risk compared to controls. Those who smoked only had a higher glottic cancer risk. Those who smoked and drank alcohol had a higher supraglottic cancer risk. Being a current smoker and long duration of smoking were independent risk factors of laryngeal SCC.

Demography and histologic pattern of laryngeal squamous cell carcinoma in kenya.

Background. Laryngeal squamous cell carcinoma is a common head and neck cancer worldwide. Objective. To determine the demographic characteristics of patients with laryngeal cancer, establish their tumor characteristics and relate it to their smoking and alcohol ingestion habits. Methods. Fifty cases and fifty controls were recruited of matching age, sex, and region of residence. History and pattern of cigarette smoking and alcohol ingestion was taken and analyzed. Results. 33 (66%) of the cases and 3 (6%) among controls were current cigarette smokers. 74% had smoked for more than 30 years, P < 0.0001 OR 21.3 (95% CI: 2.6–176.1). There was a male predominance (96%) and most cases (62%) were from the ethnic communities in the highland areas of Kenya predominantly in Central and Eastern provinces. Very heavy drinkers had increased risk of P < 0.0001 OR, 6.0 (95% CI: 1.957–18.398) and those who smoked cigarettes and drank alcohol had poorly differentiated tumors G3, P < 0.001, OR 11.652 (95% CI 2.305–58.895), and G4, P=0.52 OR 7.286 (95% CI 0.726–73.075). They also presented with advanced disease (73.6%). Conclusion. Cigarette smoking and alcohol ingestion are strong risk factors for development of late stage and poorly differentiated laryngeal squamous cell carcinoma in Kenya.

Prevalence and Predictors of Malnutrition in Nasopharyngeal Carcinoma

We assessed the prevalence and predictors of malnutrition in patients with nasopharyngeal carcinoma. Sixty cases and 123 controls matched for age and gender were included. Bio-data, dietary history, height, weight, body mass index (BMI), ideal body weight, and serum albumin levels were recorded. Pretreatment weight loss of >5% was present in 35% of subjects (P < 0.0001). A BMI of < 18.5 kg/m2 was present in 13.3% (P < 0.001), percent ideal body weight of <90% was present in 30% (P < 0.001), and serum albumin levels < 30 g/dL was present in 23.3% (P < 0.001) of cases. Nasopharyngeal carcinoma increased the likelihood of having a BMI < 18.5 kg/m2 (odds ratio, 9.3 (3.4–25.3) P ≤ 0.001). Logistic regression shows that stage IV disease was associated with a decrease in all parameters except protein-calorie intake. Stage IV nasopharyngeal carcinoma is a predictive marker for weight loss and low serum albumin levels. Nutritional management is important for ensuring the patients’ ability to withstand chemoradiation and thus improve survival and quality of life.