Description
Introduction
An estimated one million Rohingya live in the world’s largest and most densely populated refugee camp in Cox’s Bazar, Bangladesh. This population has limited access to healthcare, largely delivered by primary care doctors in the camp. Alongside other health issues, doctors tell of high prevalence of chronic suppurative otitis media (CSOM). The disorder is globally prevalent in socioeconomically deprived populations, affects hearing (and consequently education and employability), and the ear discharge can be socially embarrassing and stigmatising.
Prevalence surveys show that the global burden of illness from CSOM involves 65–330 million individuals with draining ears, 60% of whom (39–200 million) suffer from significant hearing impairment. Over 90% of the burden is borne by countries in the South-east Asia and Western Pacific regions, Africa, and several ethnic minorities in the Pacific
Surveys of rural Bangladeshi populations show 5-6% of adults and children have CSOM, however there is no literature on the prevalence in the Rohingya refugees. The objective is to conduct the first prevalence survey in this population, and the lived experience of Rohingya children and adults with CSOM.
Specifically, we seek to understand the impact of ear disease on their socialisation, employability, mental health and decision-making ability, and exploring their healthcare seeking behaviours. Currently there is also no information on perceived or actual barriers to accessing care from both the population and provider perspective.
Methods
The sample size was 290 participants based on a true prevalence of 0.05. The first stage was a convenience sampling with household visits to identify an estimated prevalence using digital otoscopy. The participants with perforated tympanic membranes were invited to have a pure tone air conduction audiometry, questionnaire on impact on quality of life and semi-structured interviews to investigate lived experience.
Results
Of the 290 participants, 53% were male and 47% had no formal education. Ear discharge and hearing loss was reported by 31% and 26%, respectively. Digital otoscopy revealed a perforated membrane in 15%, of which 5% were bilateral, and 8% were children. Continuous discharge was reported by 28% and 45% reported a frequency of >3 times per year. Social interaction was affected as a result of this by 83%. Based on the World Health Organisation classification of hearing loss, 33% had moderate-profound hearing loss.
The qualitative results showed most commonly reported impact on daily life were due to the physical symptoms of chronic ear disease (73%) and the effect these had on mental health (51%), difficulty in socialising (48%) and employability and education (43%). There was much heterogeneity amongst the group regarding prior access to services with some patients having never sought medical assistance prior to the camp, and others who had visited several health facilities.
Conclusion
This is the first study estimating the prevalence of CSOM which is significantly higher than the host population. Our findings also report the impact on mental health, social life, employability and education. These results are critical in understanding and strategising health services to address this burden of ear disease in refugees.
| Contact Geneva Health Forum | I would like to receive information about the GHF 2024 conference and other GHF activities / Je souhaite recevoir des informations sur la conférence GHF 2024 et d'autres activités du GHF. |
|---|
