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A case–control study of nutritional factors associated with chronic suppurative otitis media in yemeni children
  1. M A Elemraid1,
  2. I J Mackenzie1,
  3. W D Fraser2,
  4. G Harper1,
  5. B Faragher1,
  6. Z Atef3,
  7. N Al-Aghbari3,
  8. B J Brabin1,4,5
  1. 1WHO Collaborating Centre for Prevention of Deafness, Child Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2Department of Musculoskeletal Biology, Institute of Aging and Chronic Disease, Liverpool, UK
  3. 3Department of Child Health, Al-Thawra General Hospital, Sana'a, Yemen
  4. 4Global Child Health Group, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
  5. 5Department of Community Child Health, Royal Liverpool Children's NHS Trust, Liverpool, UK


Background Undernutrition and chronic suppurative otitis media (CSOM) in children are common in low resource settings but there are few studies of their interactions.

Objective The purpose of this study was to determine nutritional factors associated with CSOM in Yemeni children.

Methods A case–control study of 75 children with CSOM and 74 healthy controls. Assessment included dietary history, anthropometry, haemoglobin, and serum analytes zinc, copper, selenium, iron, calcium, phosphate and total 25-hydroxy vitamin D (25(OH)D).

Results Cases had lower mean z scores for weight-for-age, weight-for-height, body mass index and mid-upper arm circumference (MUAC) (all p<0.05), and lower mean haemoglobin (p=0.003), serum zinc (p=0.002), and selenium (p<0.001) concentrations. There was high prevalence of low serum zinc concentration (≥90%), and vitamin D deficiency in both cases (80%) and controls (96%). Duration of ear discharge was negatively correlated with total 25(OH)D (p=0.028), adjusted calcium for albumin (p<0.001), phosphate (p=0.002), transferrin receptor/ferritin ratio (p=0.004) and copper (p<0.001), and positively correlated with child age and MUAC (p<0.001).

Conclusions Children with CSOM were more undernourished than controls with lower mean serum zinc and selenium concentrations. Vitamin D deficient and iron replete children had longer duration of infection and severe disease. Trials evaluating specific micronutrients are required to assess specific nutrient-infection interactions in CSOM.

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