Objectives 1.) To measure prevalence of hearing impairment (HI) in schoolchildren living in poverty in Peru. 2.) To identify risk factors for HI and assess its impact on academic performance. Study design Cross-sectional. Setting Elementary schools in an “asentimiento humano” (shantytown) near Lima, Peru, October 2008–March 2009. Subjects Schoolchildren (n=335), ages 6–19 years. Methods Audiologic health was assessed with pure-tone audiometry, tympanometry and otoscopy. The primary outcome was HI, defined as average threshold >25dB HL for 0.5, 1, 2, and 4 kHz, in one or both ears (per World Health Organization/International Organization for Standardization). A questionnaire on health history was administered to parents. Statistical analysis included univariate analysis for chi-squared values and odds ratios, and multivariate logistic regression. Results HI prevalence: 6.9% (95%CI 4.2–9.6%). Risk factors for HI (OR 95%CI, p-value): neonatal jaundice (5.59, 1.63–19.2, 0.015), seizure (7.31, 2.50–21.4, 0.0013), trauma-related hospitalization (5.80, 1.66–20.3, 0.003), recurrent otitis media(5.06, 1.98–12.9, 0.002), past otorrhea (4.70, 1.84–12.0, 0.003), family history of HI at <35 years (2.91, 1.19–7.14, 0.026), TM abnormality (13.8, 4.48–42.7, <0.001), cerumen impaction (15.8, 4.71–53.1, <0.001) and Eustachian tube dysfunction (4.87, 1.74–13.7, <0.001). HI was an independent predictor of academic failure (3.36, 1.15–9.82, 0.03). Conclusions Impoverished Peruvian schoolchildren were 4-7 times more likely to experience HI than children living in higher-income countries. Untreated middle-ear disease in the context of limited access to pediatric care was a major risk factor for HI. Furthermore, HI was associated with worse scholastic achievement. These results support prioritization of pediatric ear health as an essential component of the global health agenda, especially in resource-poor countries.

The detection of virus is used to diagnose human immunodeficiency virus type 1 (HIV-1) infection in infants due to the persistence of maternal antibodies for a year or more. An HIV-1 DNA PCR assay with simple specimen collection and processing was developed and evaluated. Whole blood was collected on filter paper that lysed cells and bound the DNA, eliminating specimen centrifugation and extraction procedures. The DNA remained bound to the filter paper during PCR amplification. Assays of copy number standards showed reproducible detection of 5 to 10 copies of HIV-1 in 5 l of whole blood. The sensitivity of the assay did not decrease after storage of the standards on filter paper for 3 months at room temperature or after incubation at 37 or 45°C for 20 h. The primers used for nested PCR of the HIV-1 pol gene amplified templates from a reference panel of multiple HIV-1 subtypes but did not amplify a subtype A or a subtype C virus from children living in Seattle. The assay had a sensitivity of 98.4% and a specificity of 98.3% for testing of 122 specimens from 35 HIV-1-infected and 16 uninfected children and 43 seronegative adults living in Washington. The assay had a sensitivity of 99% and a specificity of 100% for testing of 102 HIV-1-positive (as determined by enzyme immunoassay) Peruvian women and 6 seropositive and 34 seronegative infants. This assay, with adsorption of whole blood to filter paper and no specimen processing, provides a practical, economical, sensitive, and specific method for the diagnosis of HIV-1 subtype B infection in infants.

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Objectives To measure the prevalence and to identify risk factors of hearing impairment in human immunodeficiency virus-infected children living in Peru. Study design Cross-sectional observational study. Setting Two public hospitals and 1 nonprofit center in Lima, Peru, between August 2009 and April 2010. Subjects A total of 139 HIV-infected children, ages 4 to 19 years. Methods Hearing impairment and otologic health were assessed with pure tone audiometry, tympanometry, and otoscopy. The primary outcome was hearing loss, defined as average threshold >25dB for 0.5, 1, 2, and 4 kHz, in one or both ears. Historical and socioeconomic information was obtained through parental survey and medical chart review. Statistical analysis included univariate analysis and multivariate logistic regression. Results Fifty-four (38.8%) of 139 children had hearing impairment. On multivariate analysis, risk factors included: tympanic membrane perforation (odds ratio [OR] 7.08; 95% confidence interval [CI], 1.65-30.5; P = .01), abnormal tympanometry (OR 2.71; 95% CI, 1.09-6.75; P = .03), cerebral infection (OR 11.6; 95% CI, 1.06-126; P = .05), seizures (OR 5.20; 95% CI, 1.21-22.4; P = .03), and CD4 cell count <500 cells/mm3 (OR 3.53; 95% CI, 1.18-10.5; P = .02). Conclusions The prevalence of hearing impairment in HIV-infected children in Lima, Peru was 38.8%. Middle ear disease, prior cerebral infection, and low CD4 cell count were significantly associated with hearing impairment. The high prevalence of hearing impairment emphasizes the need for periodic hearing assessment in the routine clinical care of HIV-infected children.

HIV infection was related both to women's own risk behaviors and to the perceived risk behaviors of their sexual partners. Underlying societal factors related to heterosexual HIV infection, including deferral of marriage, warrant further study.