Observations on the relation of environmental and behavioral factors to the occurrence of otitis media among Indian children.

Studies were conducted to assess the relation of environmental and behaviora factors to occurrence of acute suppurative otitis media (ASOM) among four populations of Indian children in Arizona. Episodes of ASOM were recorded for 1,428 children observed during the first year of life. Data obtained on the households and premises of these children included number of persons in the household, number of sleeping rooms, type of water supply and sewage disposal, type of heating and cooling, availability of electricity, method of infant feeding, distance to a health facility, and mother's education. The rates of ASOM for the four populations ranged from 1.1 to 2.2 attacks per child and differed significantly from each other, with one exception. The differences between populations apparently were not related to any of the factors evaluated. Additional analyses to evaluate the association of each factor with occurrence of ASOM included (a) a comparison of rates among children living in homes having each factor with rates among children living in homes lacking the factor, (b) a comparison of the frequency of each factor in homes of children who had no recorded attacks of ASOM with the frequency in homes of children who had three or more attacks (high-risk children), and (c) an evaluation of the relation between frequency of encounters for ASOM and the environmental factors. Results did not indicate that any environmental or behavioral factor observed was consistently or strongly associated with either the incidence of ASOM or the frequency of attacks. Similarly, no differences were apparent in the frequency of adverse environmental conditions in homes of infants with contrasting rates of ASOM. Rates of ASOM during the first year of life were not associated with either the presence or the absence of adverse environmental conditions.