SITUATIONAL ASSESSMENT OF THE EAR DISEASE BURDEN AND HEALTH SERVICES IN KIGEZI REGION, SOUTH WESTERN UGANDA. (EHESA-PROJECT)

Description

Problem statement: Ear disease affects both adults and children. Although literature reports high variability in prevalence of the different ear diseases, the four most common are; cerumen impaction, ear infections, hearing impairment and foreign body impaction in no particular order.

Ear disease and its resultant HI have for long been recognized as public health problems in Uganda despite the paucity of recent data on their burden in both adults and children. Earlier studies reported a high prevalence of disabling HI of 11.7% and 10.2% among Ugandan adults and children respectively. It was noted that correctable ear diseases such as infections and cerumen impaction accounted for 17% of adult and 41% of pediatric disabling HI in Uganda (Westerberg, Lee et al. 2008). A recent urban-based study done at Mbarara regional referral hospital, a south-western district in Uganda reported a 9.3% prevalence of pediatric HI (Nakku, Nyaiteera et al. 2017). In as much as this study demonstrated the high-burden of HI in children, its findings cannot be generalized to other rural-based primary health facilities which are the first points of access to healthcare for many patients with ear disease in the same region. We feel that the true burden of ear disease and HI is generally unknown in South-western Uganda.

Although 60% of HI is due to preventable causes and majority of the ear diseases are medically and/or surgically reversible, over 90% of those affected by ear disease live in low-middle-income countries which also suffer acute shortages of physicians and where access to specialized otolaryngology services which are crucial for prevention and treatment of ear disease and HI is very limited (Hancock, Hoa et al. 2018, WHO 2020). Early recognition and treatment of ear disease can aid the prevention of HI and its consequences. In Kabale district, the specialized otolaryngology services are only available at Kabale regional referral hospital (KRRH) which has one surgeon and one clinical officer. It is expected that patients reporting to lower primary health care centres (PHCs) (District hospitals, HC IV & HC III) should be managed for mild-to-moderate ear disease while those with severe disease that requires specialized care are referred to the regional referral hospital. Given the limited human resource at the regional referral hospitals, a decentralized model of care should be more preferred over a centralized one.  For this to happen, there is need to ensure that adequate ear healthcare is offered at the lower PHCs so as to avoid unnecessary referrals, delayed referrals, and onset of ear complications. Today, there is paucity of information on the diagnostic and management capacity, and referral processes at lower PHCs and at Kabale regional referral hospital so as to demonstrate the gaps that could be leveraged in order to improve the organization and quality of ear healthcare services in the district.

In this study we aim at establishing the prevalence of ear disease, the diagnostic and management capacity for ear disease among patients presenting to KRRH and other selected lower PHCs and district hospitals between January 2019 and December 2021, and to document the treatment and referral practices for patients with ear disease in Kigezi region.