The Kalgoorlie Otitis Media Research Project: rationale, methods, population characteristics and ethical
Deborah Lehmann1, Ashwini Arumugaswamy, Dimity Elsbury
1Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, West Perth, WA, Australia. deborahl@ichr.uwa.edu.au
Insights
Otitis media (OM) is common in Aboriginal children, leading to hearing loss. This study identified interacting risk factors, emphasizing the need for comprehensive interventions to reduce OM
Area of Science:
- Paediatrics
- Epidemiology
- Public Health
Background:
- Otitis media (OM) is a prevalent childhood illness, particularly affecting Australian Aboriginal children from infancy.
- Hearing loss resulting from OM significantly impacts educational attainment and overall quality of life.
- The multifactorial nature of OM necessitates understanding complex causal pathways rather than single risk factors.
Purpose of the Study:
- To identify key risk factors for otitis media in Aboriginal and non-Aboriginal children.
- To investigate the interaction of these risk factors within complex causal pathways.
- To inform the development of effective interventions for reducing the burden of OM.
Main Methods:
- A longitudinal study followed 100 Aboriginal and 180 non-Aboriginal children from birth to 2 years in Western Australia.
- Data collection included demographic, socio-economic, environmental, breast milk, and biological samples (nasopharyngeal, saliva).
- Ear health was assessed using clinical examination, tympanometry, transient evoked otoacoustic emissions, and audiometry, with adherence to ethical guidelines for Indigenous research.
Main Results:
- Otitis media was diagnosed in 55% of Aboriginal children versus 26% of non-Aboriginal children at 12 months.
- Aboriginal mothers exhibited younger age, lower education levels, lower employment rates, and higher household crowding.
- Exposure to environmental tobacco smoke was higher in Aboriginal (64%) and non-Aboriginal (40%) infants.
Conclusions:
- High rates of otitis media in Aboriginal children are linked to socio-economic and environmental factors, including tobacco smoke exposure.
- Effective otitis media prevention and management strategies require a holistic approach addressing multiple interacting risk factors.
- Community consultation and collaboration with Indigenous peoples are crucial for ethical and successful research in this area.
Abstract:
Otitis media (OM) is one of the most common paediatric illnesses for which medical advice is sought in developed countries. Australian Aboriginal children suffer high rates of OM from early infancy. The resultant hearing loss can affect education and quality of life. As numerous factors contribute to the burden of OM, interventions aimed at reducing the impact of single risk factors are likely to fail. To identify key risk factors and understand how they interact in complex causal pathways, we followed 100 Aboriginal and 180 non-Aboriginal children from birth to age 2 years in a semi-arid zone of Western Australia. We collected demographic, obstetric, socio-economic and environmental data, breast milk once, and nasopharyngeal samples and saliva on seven occasions. Ear health was assessed by clinical examination, tympanometry, transient evoked otoacoustic emissions and audiometry. We considered the conduct of our study in relation to national ethical guidelines for research in Aboriginal and Torres Strait Islander health. After 1 year of community consultation, the study was endorsed by local committees and ethical approval granted. Fieldwork was tailored to minimise disruption to people's lives and we provided regular feedback to the community. We saw 81% of non-Aboriginal and 65% of Aboriginal children at age 12 months. OM was diagnosed on 55% and 26% of routine clinical examinations in Aboriginal and non-Aboriginal children respectively. Aboriginal mothers were younger and less educated, fewer were employed and they lived in more crowded conditions than non-Aboriginal mothers. Sixty-four per cent of Aboriginal and 40% of non-Aboriginal babies were exposed to environmental tobacco smoke. Early consultation, provision of a service while undertaking research, inclusion of Aboriginal people as active members of a research team and appropriate acknowledgement will assist in ensuring successful completion of the research.
Related Concept Videos
01:56Ethics in Research
01:15Bioavailability Study Design: Healthy Subjects Versus Patients