Early onset of otitis media is a strong predictor of subsequent disease in urban Aboriginal infants: Djaalinj Waakinj cohort study

Abstract

Aim Australian Aboriginal and/or Torres Strait Islander children in rural/remote areas suffer high rates of persistent otitis media (OM) from early infancy. We aimed to determine the proportion of Aboriginal infants living in an urban area who have OM and investigate associated risk factors. Methods Between 2017 and 2020, the Djaalinj Waakinj cohort study enrolled 125 Aboriginal infants at 0–12 weeks of age in the Perth South Metropolitan region, Western Australia. Proportion of children with OM based on tympanometry at ages 2, 6 and 12 months was evaluated, type B tympanogram indicating middle ear effusion. Potential risk factors were investigated by logistic regression with generalised estimating equations. Results The proportion of children with OM was 35% (29/83) at 2 months, 49% (34/70) at 6 months and 49% (33/68) at 12 months of age. About 70% (16/23) of those with OM at ages 2 and/or 6 months had OM at 12 months compared with 20% (3/15) if no prior OM (relative risk = 3.48, 95% confidence interval (CI): 1.22–40.1). On multivariate analysis, infants living in houses with ≥1 person/room were at increased risk of OM (odds ratio = 1.78, 95% CI: 0.96–3.32). Conclusion Approximately half of Aboriginal infants enrolled into the South Metropolitan Perth project have OM by the age of 6 months and early onset of disease strongly predicts subsequent OM. Early surveillance for OM in urban areas is needed for early detection and management to reduce the risk of long‐term hearing loss which can have serious developmental, social, behavioural, educational and economic consequences.

Development of the national consensus statement on ear health and hearing check recommendations for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: systematic scoping review and e-Delphi

“…In the absence of rapid improvement in the social and environmental factors that lead to ear infections in more than one in three [ 1 , 2 ] Aboriginal and Torres Strait Islander children, it is imperative that we succeed at identifying persistent ear and hearing problems in children’s first years of life and provide effective, holistic care to the child, and clear, practical information to their family. To assist with early identification, we developed strong recommendations for ear health and hearing checks through a systematic scoping review and a large, national e-Delphi consensus process.…”

“…Otitis media (OM) or middle ear infection/inflammation continues to be prevalent among young Aboriginal and Torres Strait Islander children. Up to one in two children aged younger than 3 years in urban areas, and up to nine in ten in remote areas, experience the condition [ 1 – 4 ]. Children whose first episode commences prior to 6 months of age are more likely to develop persistent forms of OM [ 1 , 4 ].…”

“…Up to one in two children aged younger than 3 years in urban areas, and up to nine in ten in remote areas, experience the condition [ 1 – 4 ]. Children whose first episode commences prior to 6 months of age are more likely to develop persistent forms of OM [ 1 , 4 ]. Relative to non-Indigenous Australian children, presentations of OM in Aboriginal and Torres Strait Islander children are typically more severe and persistent, start earlier and last longer, and have greater impact on hearing [ 5 , 6 ].…”

INdigenous Systems and Policies Improved and Reimagined for Ear and hearing care (INSPIRE): a multi-method study protocol

“… 4 12 Prevalence rates vary, however, recent literature indicates that up to 35% of Aboriginal and Torres Strait Islander children in urban areas present with otitis media at 2 months, increasing to 49% at 6 and 12 months. 13 Wicked problems are often multi-causal, socially complex issues, requiring coordinated efforts from multiple agencies across multiple sectors and levels of government. 11 Further, health determinants, the underlying cause of the disease, remain poorly addressed.…”