BackgroundMillions of people across the world suffer from disabling hearing loss. Appropriate interventions lead to improved speech and language skills, educational advancement, and improved social integration. A major limitation to improving care is identifying those with disabling hearing loss in low-resource countries.ObjectivesThis review article summarises information on currently available hearing screening platforms and technology available from published reports and the authors’ personal experiences of hearing loss identification in low-resource areas of the world. The paper reviews the scope and capabilities of portable hearing screening platforms, including the pros and cons of each technology and how they have been utilised in low-resource environments.ConclusionPortable hearing screening tools are readily available to assess hearing loss in low-resource areas. Each technology has advantages and limitations that should be considered when identifying the optimal methods to assess needs in each country.
Dizziness is a common clinical problem that is challenging to diagnose and treat. One of a subset of symptoms that fall under the encompassing term of dizziness is vertigo, which is the subjective experience of hallucination of movement, often associated with vestibular disorders. While dizziness has a broad range of causes, the association between vestibular disturbance, and its attendant vertigo, and anxiety is well established. The Vertigo Symptom Scale (VSS) is a questionnaire that assesses aspects of vertigo and vertigo-related anxiety. The aim of this study was twofold. In phase 1, a translation of the VSS into Afrikaans was evaluated using the Delphi consensus technique and two panels of participants. Panel 1 comprised first-language Afrikaans speakers who commented on the language, grammar and vocabulary of the items. Panel 2 were bilingual health care practitioners with either a psychology background or a special interest in vertigo. After two rounds of consultation, consensus was achieved and the final translation of the Afrikaans Vertigo Symptom Scale (AVSS) was agreed upon, as well as a list of Afrikaans words descriptive of vertigo. Phase 2 used a descriptive, correlational design. The aim was to pilot the AVSS with a sample of vertiginous and control participants to establish its ability to differentiate between the two groups and to explore experiences of vertigo and anxiety within the two embedded subscales. The results of the pilot study yielded significant statistical differences (p<0.001) between the groups on both subscales of the tool. Preliminary results suggest that the AVSS is able to identify patients with vertiginous disturbance and anxiety. The AVSS presents with good sensitivity and specificity as measured by the receiver-operating characteristic (ROC) curve.Afrikaans is the home language of almost 6 million people in South Africa. The translation of the VSS into Afrikaans presents health care professionals with a tool with which to assess vertigo and vertigo-related anxiety in this population.
Hearing screening for newborn babies is an established protocol in many high-income countries. Implementing such screening has yielded significant socioeconomic advantages at both an individual and societal level. This has yet to permeate low/middle-income countries (LMIC). Here, we illustrate how newborn hearing screening needs to be contextually adapted for effective utilisation and implementation in an LMIC. Specifically, this advocates the use of auditory brainstem testing as the first-line approach. We propose that such adaptation serves to maximise clinical efficacy and community participation at a reduced cost.
Understanding mother’s knowledge, attitude and practice (KAP) of permanent childhood hearing impairment (PCHI) is essential for the success of universal newborn hearing screening (UNHS) as poor compliance and follow-up remains a global challenge. To determine content area for a questionnaire that measures PCHI-related KAP in rural mothers, we trained moderators who interviewed 145 pregnant women (17 groups) from 5 ante-natal clinics. Interviews were recorded, transcribed, summarised and analysed using thematic framework analysis. Four knowledge themes were identified: 1) PCHI was perceived as the malfunction of hearing leading to disability; 2) a poorly-responsive/communicative child may have PCHI; 3) lifestyle, hereditary and environmental factors are significant causes of PCHI; 4) medical management of PCHI was doubted, with some advocating birth and ancestral rituals. Two themes were identified for attitude: 1) beliefs that PCHI was emotionalised due to the negative lifelong impact on the child and family; 2) UNHS processes were favourable though some preferred other belief systems. Three themes were identified for practice: 1) doctors were the first choice followed by traditional healers; 2) willingness to continue follow-up although challenges exist; 3) minimal family support during consultation. The contextualised KAP of women regarding UNHS processes and PCHI provided content area for the design of a KAP tool.
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