Out of 350 total respondents, 191(54.6%) were males and 159(45.5%) were females; 228(65.1%) belonged to rural areas, whereas 12(34.9%) belonged to urban areas; 173(49.4%) were unemployed and 177(50.6%) were employed. Majority of the study participants were Hindus 311(88.9%), whereas 21(6%) were Muslims, 18(5.1%) were Christians. Significantly large portion of the respondents belonged to Class 2 [112(32%)] and Class 3 [138(39.4%)] of B.G. Prasad Socioeconomic Classification. (Figure I &II)
Regarding education, more respondents were better educated [high school education 88 (25.1%), graduation/diploma 84(24%), higher secondary 65(18.6%) and middle school 59(16.9%)] than those who were less or not educated (Figure III).
Among 176 employed respondents, majority were coming under the categories of Skilled Labourers 58(32.9%), Professionals 35(19.9%), and Shop/business owner13(7.5%).(Figure IV).
The majority of the respondents [311(88.9%)] did not have any ear problems. Family members of 339(96.9%)] respondents did not have any history of ear surgeries. Past history of any ear surgery was not present in 337(96.3%) respondents.
Category 1: General perceptions about ear infections: (Table I)
Among 350 respondents, relationship of bottle feeding to ear infections were disregarded by 232(66.3%) respondents and 258(73.7%) respondents did not consider smoking as one of the factors related to ear diseases. More than half of the respondents [188(53.7%)] felt that ear infections cannot occur in young children.
Category 2: Perceptions of respondents about cholesteatoma: (Table II)
The majority of the respondents [230(65.7%)] were not aware of a disease like cholesteatoma with bone eroding properties occurring inside the ear, and [224(64%)] respondents opined that it cannot be present inside the ear as a disease without any visible symptoms. While itching in the ear was identified by 219(62.6%)] respondents as a symptom of ear disease, giddiness was disregarded by majority of the respondents [228(65.1%)] as related to ear infections.
Category 3: Common symptoms of midde ear infections:
The majority of respondents correctly identified common symptoms of ear infections like ear pain [326(93.1%)], ear discharge [324(92.6%)], hearing loss [308(88%)].
Ringing sensation in the ear was identified less frequently [239(68.3%)] by the respondents.
Category 4: Uncommon symptoms of middle ear infections:
Itching in the ear was identified less frequently [219(62.6%)], as a symptom of middle ear infections. Giddiness was disregarded by the majority of the participants [228(65.1%)] as a symptom of ear infections.
Category 5: Knowledge regarding the intratemporal complications (Table III)
A large number of respondents disregarded the possibility of spread of ear infections outside the ear - to the bone around the ear [175(50%)], to the nerve causing permanent hearing loss [152(43.4%)], to the neck causing neck swellings [197(56.3%)], to cause deviation of the angle of mouth [244(69.7%)], to cause eye problems like blurring of vision/ double vision [229(65.4%)], to cause severe giddiness [192(54.9%)].
Category 6: Knowledge regarding intracranial complications (Table IV)
More than half of the respondents disregarded that general body symptoms could be related to complications of untreated ear infections; like difficulty in balance while walking or standing, weakness of limbs, etc. [219(62.6%)] fits/convulsions 260(74.3%), etc. A significant portion of respondents also didn’t know that ear infections can spread to the inside of the skull[248(70.9%)], spread to the brain [235(67.1%)], complications can itself may lead to death [291(83.1%)].
Category 7: Harmful practices considered safe by respondents in CSOM patients: (Table V)
Many harmful practices were considered safe for patients with ear infections by a large number of respondents like cleaning the ear with ear buds 168(48%), cleaning the ear with mineral (bottled) water 139(39.7%), Taking head bath as usual (without precautions) 133(38%), putting herbal medicines into the ear 124(35.4%), putting oil into the ear 121(34.6%), cleaning the ear with tap water 115(32.9%), swimming as usual (without precautions) 108(30.9%), getting the ear cleaned by other people 103(29.4%), Cleaning the ear with safety pins/ match sticks 99(28.3%), Self medication with any ear drops from local pharmacy 70(20%). (Figure V)
Compilation of various knowledge, attitude and practices related aspects into good and poor levels in each of the 7 categories. (Table VI)
Among 350 respondents, majority exhibited poor level of knowledge/awareness about CSOM, especially Cholesteatoma; with regards to knowledge categories “Category 1 - “General perceptions about ear infections” [295(84.3%)]; “Category 2 - Perceptions about Cholesteatoma [246(70.3%)]; “Category 5- Knowledge about locoregional/Intratemporal complications [244(69.7%)];“Category 6- Knowledge about General body complaints/ Intracranial complications [247(70.6%)]; “Category 7- Harmful practices considered safe by participants in CSOM patients”[279(79.7%)].
A good level of knowledge was exhibited by respondents for symptoms of CSOM only in two categories; “Category 3- Knowledge about common ear symptoms in CSOM”[313(89.4%)], and “Category 4- Knowledge about Less commonly reported symptoms of CSOM” [258(73.7%)].
Bivariate and multivariate analysis of the data: (Table VII)
The bivariate analysis gave rise to the following significant findings:
a. Those respondents with education of middle school and below were 2.03 times more prone for having less overall knowledge on ear disease related factors (this association was also statistically significant (p<0.05) than those with higher education. In contrary to the applied assumption, those with unskilled jobs or no occupation were less likely (OR = 0.56) to have poor overall ear disease knowledge than those with skilled or professional jobs (and this was also statistically significant).j
b. Those with no history of ear surgeries were found to be 1.68 times more likely to have less knowledge on ear disease than those who have had ear surgeries, but this was not statistically significant (p>0.05) and more over, the confidence interval of ODDS ratio included zero also.
The Multivariate analysis:
The Multivariate analysis (where the possible confounding factors were adjusted for) of same sociodemograhic and ear disease related history with overall knowledge on ear disease gave rise to two interesting findings:
a. Those with less education were found to be less likely (OR = 0.49) to have poor knowledge on ear disease and was statistically significant, this is in contrary to applied assumption and to the findings of bivariate analysis. Similarly the finding of bivariate analysis that unskilled and unemployed being protected from less knowledge on ear disease was proved wrong in multivariate analysis; where they were found to be 1.76 times more likely to have poor ear disease knowledge than those who are skilled or professionals and this finding was statistically significant.
b. Those from rural area and those without any history of ear disease were found to be 1.69 and 1.35 times more likely to have less ear disease knowledge than their counterparts, but these associations were not statistically significant (p>0.05) and more over, the confidence interval of ODDS ratio included zero also.