Ear, Nose, and Throat (ENT) health is a critical component of overall well-being, particularly during pregnancy when physiological and hormonal changes increase susceptibility to ENT-related issues. Pregnancy-related changes such as increased vascularity, mucosal edema, and immune modulation can predispose women to conditions like rhinitis, sinusitis, otitis media, hearing impairments, and voice disturbances. Despite the significant impact of ENT disorders on maternal health and quality of life, awareness regarding these conditions remains low, particularly in rural settings where healthcare access is limited [1-4].

In Himachal Pradesh, including Chamba and Hamirpur districts, healthcare infrastructure remains underdeveloped, and women often rely on traditional beliefs or home remedies rather than seeking timely medical intervention. Limited awareness about ENT complications during pregnancy may lead to delayed diagnosis and inadequate management, increasing the risk of chronic infections, hearing deficits, or complications affecting maternal and fetal health. Moreover, misconceptions and a lack of structured antenatal ENT screening contribute to the underreporting of symptoms, preventing early intervention and effective treatment [5-8].

While maternal health programs emphasize conditions like gestational diabetes, hypertension, and anemia, ENT health remains a neglected area. Untreated ENT infections during pregnancy can lead to complications such as hearing loss, chronic sinusitis, or respiratory issues, which can further affect maternal well-being and fetal development. Given the unique geographical and socioeconomic challenges of rural Himachal Pradesh, evaluating awareness levels of pregnant women regarding ENT health is crucial to identifying knowledge gaps and improving healthcare strategies [9-12].

This study aims to assess the awareness and knowledge of ENT health among pregnant women in Chamba and Hamirpur districts of Himachal Pradesh. By identifying common misconceptions, healthcare-seeking behavior, and gaps in knowledge, the findings will contribute to designing targeted awareness programs and integrating ENT screening into maternal healthcare. Improved awareness and early diagnosis can significantly enhance maternal health outcomes and ensure comprehensive prenatal care for women in rural communities.

Research Design

This study employed a descriptive, cross-sectional research design to evaluate the knowledge, awareness, and healthcare-seeking behavior of pregnant women regarding ENT health in Chamba and Hamirpur districts of Himachal Pradesh. A structured online questionnaire-based survey was used as the primary data collection tool, focusing on knowledge of ENT disorders, symptoms, risk factors, and barriers to healthcare access. The cross-sectional approach was chosen to provide a comprehensive snapshot of the awareness levels and practices related to ENT health among pregnant women in this rural setting.

Study Area and Population

The study was conducted in Chamba and Hamirpur districts of Himachal Pradesh, known for its challenging geographic terrain and limited access to specialized healthcare. The population in this region largely relies on primary healthcare centers, traditional medicine, and community health workers, often leading to delays in seeking medical intervention for ENT-related issues. The study population comprised pregnant women residing in Chamba and Hamirpur districts ensuring a representative sample to assess knowledge gaps and healthcare accessibility.

Study Duration

The research was conducted over a three-month period, from October to December 2024. This timeline allowed for adequate data collection and ensured participation from a diverse group of pregnant women across different socio-demographic backgrounds.

Sample Size and Sampling Technique

A total of 400 participants were included in the study. The sample size was determined using a 95% confidence level, an assumed awareness rate of 50% regarding ENT health, and a 5% margin of error. An additional 5% of responses were considered to account for incomplete or inconsistent data. A convenience sampling technique was used, leveraging digital platforms such as WhatsApp, Facebook, and community-based WhatsApp groups for pregnant women, Accredited Social Health Activists (ASHAs), and maternal healthcare workers. This approach ensured easy accessibility for participants while capturing responses from different rural regions of Chamba.

Inclusion and Exclusion Criteria

Inclusion criteria:

• Pregnant women residing in Chamba and Hamirpur districts of Himachal Pradesh

• Women aged 18 years or older

• Those with access to a smartphone or computer and internet connectivity to complete the survey

• Participants willing to provide informed consent

Exclusion criteria:

• Women with pre-existing diagnosed ENT disorders unrelated to pregnancy

• Those unwilling to participate

• Respondents with incomplete or inconsistent survey responses

Study Tool: Structured Online Questionnaire

A pre-validated, structured questionnaire was designed and administered using Google Forms as the primary data collection tool. The questionnaire was developed with input from ENT specialists, maternal health experts, and public health professionals to ensure scientific validity. It consisted of three major sections:

• Socio-Demographic Information: This section collected details on age, education level, occupation, income, and access to healthcare facilities

• Knowledge and Awareness Assessment: A set of 20 multiple-choice questions evaluating participants’ understanding of ENT disorders during pregnancy, symptoms, risk factors, and available treatments

• Healthcare-Seeking Behavior and Practices: This section examined whether participants had experienced ENT symptoms during pregnancy, their healthcare-seeking patterns, preferences for treatment (allopathic, ayurvedic, home remedies), and barriers to accessing ENT care

The questionnaire was available in both Hindi and English to accommodate different literacy levels and ensure accessibility across diverse participant groups.

Scoring Criteria

To assess knowledge and awareness levels, responses from the knowledge assessment section were scored and categorized into four levels:

• Very Good Knowledge: ≥80% correct responses

• Good Knowledge: 60%–79% correct responses

• Fair Knowledge: 41%–59% correct responses

• Poor Knowledge: <40% correct responses

This classification helped identify specific knowledge gaps and populations requiring targeted educational interventions.

Data Collection Procedure

The online survey was made available for responses over three months, allowing participants to complete it at their convenience. The questionnaire included an introductory message explaining the study’s objectives and emphasizing voluntary participation. Electronic informed consent was obtained before participants could proceed with the survey. To maximize participation, reminders were periodically sent via WhatsApp, maternal healthcare groups, and community networks.

Data Analysis

Data collected through Google Forms were exported to Microsoft Excel for initial cleaning and verification. The dataset was then analyzed using SPSS software version 26.0. Descriptive statistics (frequencies, percentages) were used to summarize socio-demographic characteristics, knowledge levels, and healthcare-seeking behaviors. The chi-square test was applied to assess associations between demographic variables and awareness levels, with a p-value of <0.05 considered statistically significant.

Ethical Considerations

All participants provided informed consent before taking part in the study. The research adhered to strict ethical guidelines, ensuring confidentiality and anonymity of all responses. No personally identifiable information was collected, and data were securely stored for research purposes only.

The socio-demographic profile of the study participants highlights the diversity of the surveyed population. The majority of respondents (34.1%) were between the ages of 26–35 years, representing a key reproductive age group vulnerable to pregnancy-related ENT issues. Gender distribution was nearly balanced, with 50.8% males and 49.2% females, ensuring a representative sample. Educational attainment varied, with most participants having completed secondary education (31.5%) or holding an undergraduate degree (33.0%), suggesting a population with moderate literacy levels capable of understanding health information. The occupational distribution showed that homemakers (31.0%) and agricultural workers (21.5%) were the most represented groups, emphasizing the rural focus of the study. Additionally, a significant proportion (59.5%) of respondents resided in rural areas, underscoring the need for targeted healthcare awareness programs in less urbanized regions. Among employed respondents, a majority had 6–10 years of work experience (34.3%), suggesting a stable working population with potential exposure to occupational health challenges affecting ENT health (Table 1).

Table 1: Socio-Demographic Characteristics of Participants

The awareness and knowledge assessment revealed mixed levels of understanding regarding ENT health among pregnant women in rural Himachal Pradesh. While 78.0% correctly identified ENT as referring to "Ear, Nose, and Throat," some misconceptions were prevalent. Knowledge of pregnancy-related nasal congestion was strong (71.8%), but only 64.0% recognized vitamin B12 deficiency as a contributor to hearing issues. A majority of participants (77.3%) correctly identified the need for an ENT consultation in cases of sudden hearing loss, while 79.8% were aware that staying hydrated benefits ENT health. However, some participants were uncertain about the management of conditions such as sinusitis, with only 68.3% correctly recognizing that antibiotics should only be used if the cause is bacterial. Similarly, knowledge about managing nosebleeds (66.0%) and understanding the risks of untreated strep throat during pregnancy (66.5%) were moderate, indicating gaps in first-aid knowledge and pregnancy-related ENT health risks. Encouragingly, 86.0% correctly identified an otolaryngologist as the specialist for ENT concerns, demonstrating a relatively good understanding of whom to consult for such issues (Table 2).

Table 2: Awareness and Knowledge of ENT Health Among Pregnant Women

The classification of participants based on their ENT health awareness scores shows that while a significant proportion had good knowledge, substantial gaps remain. A total of 37.8% of respondents scored in the "Very Good" category (≥80% correct responses), indicating strong awareness levels. The largest group (39.8%) fell within the "Good" category (60%–79%), suggesting that while participants had a basic understanding of ENT health, misconceptions about specific pregnancy-related ENT issues persisted. Meanwhile, 17.3% of respondents had only fair knowledge (41%–59%), highlighting the need for targeted health education efforts, particularly in rural areas. Alarmingly, 5.3% of participants exhibited poor awareness  (<40%),  demonstrating  a  critical  knowledgedeficit that could contribute to inadequate healthcare-seeking behavior and reliance on ineffective home remedies. The findings emphasize the need for structured awareness programs, particularly for rural pregnant women, to improve knowledge about ENT conditions, their risks, and proper management strategies (Table 3).

Table 3: Knowledge Score Classification

This study provides crucial insights into the awareness and knowledge of ENT health among pregnant women in Chamba and Hamirpur districts of Himachal Pradesh. The findings underscore the presence of significant knowledge gaps, healthcare-seeking behaviors, and misconceptions regarding ENT disorders during pregnancy. Given the physiological and hormonal changes that occur during pregnancy, women are at an increased risk of developing ENT conditions such as nasal congestion, sinusitis, ear infections, and voice changes. Despite the impact of these conditions on maternal well-being, they remain underreported and often overlooked in maternal health programs, particularly in rural areas where healthcare access is limited. This study emphasizes the urgent need for targeted awareness campaigns and healthcare interventions to improve recognition, early diagnosis, and effective management of ENT conditions in pregnant women, ensuring better maternal and fetal outcomes.

The socio-demographic characteristics of the study participants provide a comprehensive understanding of the factors influencing awareness of ENT health among pregnant women in Chamba and Hamirpur districts of Himachal Pradesh. The largest proportion of respondents (34.1%) belonged to the 26–35 age group, which represents a key reproductive demographic. Given that pregnancy-related ENT complications are most prevalent in this age group, it is critical that these women receive accurate health information and timely interventions. The gender distribution of the study was nearly balanced, with 50.8% male and 49.2% female participants, highlighting the importance of involving not just women but also their families in maternal health awareness programs, as family members often influence healthcare decisions in rural communities.

The educational background of participants indicates a relatively literate population, with most respondents having secondary education (31.5%) or holding an undergraduate degree (33.0%). While this suggests that women are capable of understanding health-related information, it also highlights that formal education alone does not necessarily translate into increased awareness about ENT health. Occupational data revealed that homemakers (31.0%) and agricultural workers (21.5%) formed the largest groups, reflecting the rural setting of the study. Given the physically demanding nature of these occupations and the potential exposure to environmental allergens and infections, it is essential to raise awareness about preventive ENT healthcare among these populations.

Another key finding is that 59.5% of respondents resided in rural areas, reinforcing the need for targeted community-based health initiatives. The limited availability of specialized healthcare facilities, long travel distances to hospitals, and reliance on traditional medicine in these regions may contribute to delays in seeking ENT care. Among employed respondents, the majority had 6–10 years of work experience (34.3%), indicating a stable working population that may be balancing employment with pregnancy-related health concerns. These findings highlight the necessity of incorporating ENT education into existing maternal health programs and workplace health initiatives.

The assessment of knowledge and awareness revealed a spectrum of understanding regarding ENT health in pregnancy. While general awareness of ENT health was moderate to good, significant gaps existed in knowledge of pregnancy-specific ENT conditions. Encouragingly, 78.0% of participants correctly identified the meaning of ENT as “Ear, Nose, and Throat,” and 71.8% recognized nasal congestion as a common ENT issue in pregnancy. However, only 64.0% of respondents were aware that vitamin B12 deficiency can contribute to hearing issues, indicating a substantial gap in understanding the nutritional factors affecting ENT health.

Similarly, while 77.3% of participants correctly identified the need for an ENT consultation in cases of sudden hearing loss, only 68.3% recognized that antibiotics should be used for sinusitis only if the cause is bacterial. This finding suggests a lack of awareness about appropriate medication use during pregnancy, potentially leading to the misuse of antibiotics or ineffective self-medication. Furthermore, misconceptions were evident in the understanding of strep throat complications, with only 66.5% correctly identifying that untreated strep throat during pregnancy can lead to preterm labor. These gaps in knowledge may contribute to delays in seeking medical care, thereby increasing the risk of complications for both mother and baby.

Interestingly, 79.8% of participants were aware that staying hydrated is beneficial for ENT health, demonstrating a fair understanding of general preventive measures. However, knowledge about pregnancy-specific ENT conditions remained inconsistent. For example, only 66.0% of respondents knew the correct first-aid steps for managing nosebleeds, and 69.8% correctly identified fluid buildup as a common cause of ear infections during pregnancy. Additionally, 75.5% of respondents acknowledged that pregnancy hormones could worsen allergies, yet only 72.0% understood that these hormonal changes also affect the sense of smell. The lack of awareness regarding the broader effects of pregnancy on ENT health suggests a need for comprehensive educational initiatives that address both general and pregnancy-related ENT concerns.

Furthermore, 86.0% of respondents correctly identified an otolaryngologist as the appropriate specialist for ENT concerns, which is a positive indicator of general health literacy. However, knowledge about when to seek medical attention remained variable. For example, while 71.8% recognized persistent ear pain as a symptom requiring immediate consultation, a significant proportion of women were unaware of the risks associated with untreated ENT infections. These findings suggest that many pregnant women might be relying on home remedies or delaying medical consultation, increasing the risk of complications. Strengthening antenatal counseling sessions to include ENT health education could improve knowledge and encourage timely healthcare-seeking behavior.

The study also explored healthcare-seeking behaviors and the barriers that pregnant women face in accessing ENT care. While most participants demonstrated an awareness of basic ENT health concepts, their actual healthcare-seeking patterns suggest that knowledge does not always translate into action. A key concern is that even though 77.3% of participants knew they should visit an ENT specialist for sudden hearing loss, a significant portion of women in rural settings might still delay seeking professional care due to logistical challenges, cultural beliefs, or financial constraints.

Rural areas like Chamba and Hamirpur districts, faces several healthcare access issues, including long travel distances to specialized hospitals, limited availability of ENT specialists, and a strong reliance on primary healthcare workers who may lack the expertise to diagnose and manage ENT conditions effectively. Additionally, socioeconomic barriers and traditional beliefs may contribute to the underreporting of ENT symptoms during pregnancy. Many women may not perceive ENT issues as serious compared to other maternal health concerns such as hypertension or gestational diabetes, leading to delays in diagnosis and treatment.

Furthermore, the reliance on home remedies and traditional medicine remains prevalent in rural communities. While some traditional practices may provide symptomatic relief, they may also lead to mismanagement of ENT conditions if they delay timely medical intervention. Addressing these challenges through community outreach programs, improved healthcare infrastructure, and telemedicine services could help bridge the gap between awareness and action.

The classification of knowledge scores provides further insight into the variations in awareness among pregnant women. A significant proportion (37.8%) demonstrated very good knowledge (≥80% correct responses), while 39.8% fell into the "Good" category (60%–79%). While these figures are encouraging, they also indicate that a substantial proportion of participants lack comprehensive knowledge of ENT health, particularly in relation to pregnancy. Meanwhile, 17.3% of respondents had only fair knowledge (41%–59%), and 5.3% had poor awareness (<40%), highlighting a subset of the population that remains particularly vulnerable to misinformation and inadequate healthcare-seeking behavior.

The presence of knowledge gaps among nearly one-fourth of respondents suggests that many pregnant women may not recognize early symptoms of ENT issues, increasing the risk of untreated infections or complications. These findings underscore the importance of integrating ENT health education into routine antenatal care visits. Developing culturally appropriate educational materials, conducting awareness workshops, and training rural healthcare workers in ENT health management could significantly enhance awareness levels and improve healthcare-seeking behavior [13-17].

Recommendations for Improving ENT Health Awareness:

• Integration into Maternal Health Programs: ENT health education should be included in routine antenatal check-ups to ensure that pregnant women receive timely information on ENT conditions, risk factors, and treatment options

• Community-Based Awareness Campaigns: Conducting health education sessions in rural healthcare centers, Anganwadi centers, and self-help groups can help improve knowledge and encourage timely medical consultation

• Training of Primary Healthcare Workers: Midwives, ASHAs, and rural healthcare providers should be trained to identify ENT-related complications and refer cases to specialists when necessary

• Telemedicine and Mobile Health Services: Establishing teleconsultation services and mobile health clinics in remote areas could improve access to ENT care and reduce delays in seeking medical intervention

• Development of Educational Materials: Distributing health booklets, posters, and mobile-based awareness modules in local languages could enhance outreach efforts and ensure that accurate health information reaches rural communities

This study underscores the critical need for improved awareness and education regarding ENT health among pregnant women in Chamba and Hamirpur districts of Himachal Pradesh. While general knowledge was moderate, significant gaps persisted in understanding pregnancy-related ENT disorders, their risks, and appropriate medical interventions. Integrating ENT health awareness into routine antenatal care, enhancing healthcare provider training, and leveraging digital health platforms can bridge these gaps, ensuring timely diagnosis and management. Strengthening community-based health initiatives will be essential in improving maternal health outcomes and preventing long-term complications associated with untreated ENT conditions during pregnancy.

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