Hearing Lossin resource-limited settings: The Silent Overlooked Epidemic In Sub-Saharan African Children

Hearing Impairment is the most common disability reported worldwide and its consequences profoundly affect quality of life while impacting heavily on the economy. Despite this acknowledgement, priorities for healthcare in developing countries fall heavily on conditions such as malaria, tuberculosis and HIV, thus shifting attention away from other diseases and disabilities. The objective of this review was to outline key priority areas that should inform drafting policies for hearing impairment in developing countries. We undertook a literature search on PubMed, Google scholar, HINARI and Web of Science for publications discussing hearing loss in low- and middle-income countries. Search terms included “hearing loss”, “primary ear hearing care”, “hearing loss policies”, “hearing loss prevention”, “hearing loss causes” and “hearing loss detection”. We did not limit the publication period. However, we excluded all publications whose content did not contribute to the objective of our work. Our findings are discussed and recommendations given_________________________________________________________________________Keywords: Hearing loss, Sub - Saharian African, Childre

Indications and immediate outcomes of tracheostomy in Rwanda

Introduction: Tracheostomy is performed as an alternative to the natural breathing airways for upper airway obstruction, pulmonary toilet or for protecting the larynx. It is a common procedure in surgical departments.Objectives: The study aimed at evaluating the immediate outcomes of tracheostomy and the incidence of immediate complications associated with tracheostomy.Methods: Using a questionnaire, prospective data was collected from patients, who presented in Ear, Nose and Throat department at the Kigali University Teaching Hospital (KUTH).Results: 29 patients underwent a tracheostomy. The age rang was 4 to 77 years, mean of 37 years, 82.8% were aged above 18 years. Male to female ratio was 3.8:1. The incidence of tracheostomy was 9.5%. The most common indication was prolonged intubation accounting for 55.2% of cases. No intra -operative complications were noted. No tracheostomy related mortality occurred within 24 hours after the procedure. 86.2% patients were clinically stable after the procedure while 13.8% were unstable due to their primary medical conditions.Conclusion: Prolonged intubation is the most common indication for tracheostomy, most of the times performed as an elective procedure. The procedure is safe for all patients even in resource poor settings and post-operative complications are minimal.Keywords: Tracheostomy, Indications, Immediate outcome, Complications, Rwand

Knowledge and care seeking practices for ear infections among parents of under five children in Kigali, Rwanda : a cross-sectional study

Background: Infections affecting the middle ear are a common childhood occurrence. Some cases may present with ear discharge through a tympanic membrane perforation which may heal spontaneously. However, up to 5% or more cases of those affected have persistent ear discharge. A number of barriers contribute towards delayed presentation at health facilities for treatment of ear infections. We conducted a study to evaluate parents’ and caregivers’ knowledge and care seeking practices for ear infections in children under five in Gasabo district in Kigali, Rwanda. Methods: Parents/guardians (n = 810) were interviewed using a structured questionnaire to elicit their knowledge of ear infections in children under five and their attitude to seeking care for their children. Results: The mean age of the respondents was 31.27 years (SD = 7.88, range 17–83). Considering an average of knowledge parameters which included causes, symptoms, prevention, treatment and consequences of ear infections, we found that 76.6% (622) of respondents were knowledgeable about ear infections. We defined a positive practice as seeking medical treatment (community health workers or health facility) and this was found in 89.1% (722) respondents. Correlating knowledge with choice of seeking treatment, respondents were 33% less likely to practice medical pluralism (OR = 0.33, CI 0.11–0.97, P = 0.043) if they were familiar with infections. Moreover, urban dweller were 1.7 times more likely to know ear infections compared to rural dwellers (OR = 1.70, CI 1.22–2.38, P = 0.002). Conclusion: The majority of respondents had good knowledge and positive attitudes and practices about ear infection. However, medical pluralism was common. There is need to improve the community’s awareness and access to primary health care facilities for the care of ear infections especially in rural areas of Rwanda

Causes of Delayed Care Seeking for Chronic Suppurative Otitis Media at a Rwandan Tertiary Hospital

Background. Chronic suppurative otitis media causes serious lifelong consequences when treatment is delayed. Early detection and effective treatment result in a good outcome and possible complications are thus avoided. The aim of this study was to determine the factors resulting in delayed care seeking for treatment of CSOM. Method and Patient. The study was a cross-sectional survey conducted at a tertiary teaching hospital in Rwanda. A questionnaire was used to collect data of patients diagnosed with CSOM who attended ENT Department during the study period. We defined delayed care seeking as seeking treatment 6 months after onset of symptoms. Data was entered and analysed using SPSS 16.0. Result. This study enrolled 109 patients, 97 (88.9%) of whom had delays in care seeking. Majority were young adults ranging between 21 and 30 years (39.2%) while 58.8% were rural residents. Fifty-eight patients (56.9%) of those with delayed presentation used traditional medicine. The main reason for delayed care seeking was low knowledge of CSOM reported by 88 (90.7%) patients. Conclusion. This study shows that majority of patients with delayed care seeking are young adult patients. There is low knowledge concerning this disease and this significantly contributes to delayed care seeking

Prevalence of Middle Ear Infections and Associated Risk Factors in Children under 5 Years in Gasabo District of Kigali City, Rwanda

Middle ear infections are common in children, and delay in diagnosis and treatment may result in complications such as delays in speech and language development and deafness. The aim of this study was to determine the prevalence and care seeking behaviour for middle ear infections in children under five years in Kigali city. We conducted a cross-sectional study among 810 children aged 6–59 months in Gasabo district of Kigali city, Rwanda. The prevalence of middle ear infections was 5.8%, of whom 4% had chronic suppurative otitis media. A child was less likely to develop middle ear infections if they lived in an urban setting (OR = 0.52, 95% CI: 0.285–0.958) but more likely to develop middle ear infections if exposed to household smoke (OR = 2.54, 95% CI: 1.18–5.46). Parents were unlikely to know that their child had an ear infection (OR: 0.15, 95% CI: 0.06–0.34). Middle ear infection remains a public health problem in Rwanda but many parents were not aware of its presence in the affected children. There is a need to raise awareness of parents about ear infection and to promote early care seeking from qualified health workers

ENT Outreach in Africa: Rules of Engagement

To address inequality of access to ear, nose, and throat (ENT) care, there must be significant and sustained investment in education and training of surgeons, audiologists, speech therapists, clinical officers, anesthetists, and specialized nurses engaged in ENT in sub-Saharan Africa and other developing nations. Outreach by ENT surgeons from developed countries is essential if we are to address the critical lack of access to ENT care in SSA. However, it should be based on mutual respect, shared values, aspirations, a desire to create a durable and sustainable impact, and internationally accepted best practice. In this article, we propose rules of engagement for outreach projects in SSA and other developing countries to optimize their contributions by making them useful, sustainable, productive, and developmental. These proposed rules of engagement are based on our personal experiences and observations—good and bad—of outreach activities in our countries