High rates of suppurative otitis media among children attending urban clinics in Goroka, Eastern Highlands Province, Papua New Guinea: a cross-sectional study

Background: Otitis media (OM) is the leading cause of childhood hearing loss but its burden in low-middle-income countries like Papua New Guinea (PNG) is poorly understood. We aimed to determine the proportion of children aged ≤15 years attending clinics in Goroka, Eastern Highlands Province, PNG with OM and associated risk factors. Methods: In 2021–2022 any child attending outpatient clinics because they were sick or for ear screening or immunisation and accompanying siblings were eligible for enrolment into this cross-sectional study. Clinical and risk factor data were collected, ears examined by trained research nurses using otoscopy and tympanometry and findings independently reviewed by Australia-based audiologists. A child-level diagnosis was made based on the worst affected ear. Findings: Of 498 enrolled children, 68.1% attended for treatment, 15.3% for immunisation, 1.2% for ear screening and 15.5% were siblings. The proportion of children with any OM was similar among those attending because they were sick and other reasons (75.5% vs 71.4%) but suppurative OM (acute OM with/without perforation and chronic suppurative OM) was more common in children attending because they were sick (47.4% vs 16.9%). A tympanic membrane perforation was present in 22.1% of children. OM affected 79.0% of children <6 months; 45.4% of 1–2–year-olds had suppurative OM. Maternal smoking was associated with increased risk of any OM (adjusted odds ratio [aOR] 1.80, 95% CI: 1.08–3.00). Suppurative OM was associated with antibiotic use in preceding 30 days (aOR 1.78, 95% CI: 1.04–3.06). Interpretation: Children in the PNG highlands have among the world's highest burden of OM. Urgent public health action is required, including health worker training, regular ear screening, and strategies to prevent this under-reported disease in PNG. Funding: This project was funded by a Wesfarmers Centre for Vaccines and Infectious Diseases Deborah Lehmann Research Award.