Barriers to Care for Chronic Suppurative Ear Disease in Cambodia: A Mixed Methods Study

Background: Chronic suppurative otitis media is a major global disease, disproportionately affecting those in low- and middle-income countries. Access to ear specialist care however, is limited due to cultural, financial, or structural barriers. Few studies have explored barriers to care for those with ear and hearing disorders. In a charity hospital in Cambodia, one of very few centres in the country resourced to provide specialist ear services, we carried out a study to explore potential barriers to care. Methods: A mixed method study incorporated patients presenting with ear disease to the Children’s Surgical Centre (CSC) Hospital in Cambodia with three arms: 1) A questionnaire survey of 114 patients, 2) Quantitative analysis and correlation of markers of disease severity to distance from hospital in 407 patients who underwent tympanoplasty and 173 who underwent mastoidectomy, 3) Semi-structured in-depth interviews of 20 patients. Findings: Patients presented with advanced ear disease, with associated hearing loss amongst the highest per capita levels globally. Travel distance was a commonly cited barrier, however, we found no statistical relationship between distance to the hospital and markers of disease severity. Multiple barriers to care included a lack of awareness of ear disease, lack of availability of quality ear specific services, fear of treatment, direct and indirect costs, and sociocultural barriers. Interpretation: Our research highlights several potential barriers to access for people experiencing chronic middle ear disease in Cambodia; the association between such barriers, the duration and severity of disease, and the lack of adequate services poses a significant public health challenge. Funding Statement: Nil. Declaration of Interests: No conflicting interests to declare. Ethics Approval Statement: Approval was granted by the University of Melbourne School of Health Sciences Human Ethics Sub Committee (Ethics ID 1852982·1 and 1853407·1) and the Institutional Review Board of the Children’s Surgical Centre.