Objective: This study investigated the reliability, accuracy, and time efficiency of automated hearing assessment using a computer-based telemedicine-compliant audiometer. Materials and Methods: Thirty normal-hearing subjects and eight hearing-impaired subjects were tested with pure-tone air conduction audiometry (125-8,000 Hz) in a manual and automated configuration in a counterbalanced manner. For the normal-hearing group each test was repeated to determine test-retest reliability and recording time, and preference for threshold-seeking method (manual vs. automated) was documented. Results: Test-retest thresholds were not significantly different for manual and automated testing. Manual audiometry test-retest correspondence was 5 dB or less in 88% of thresholds compared to 91% for automated audiometry. Thresholds for automated audiometry did not differ significantly from manual audiometry with 87% of thresholds in the normal-hearing group and 97% in the hearingimpaired group, corresponding within 5 dB or less of each other. The largest overall average absolute difference across frequencies was 3.6 -3.9 dB for the normal-hearing group and 3.3 -2.4 for the hearing-impaired group. Both techniques were equally time efficient in the normal-hearing population, and 63% of subjects preferred the automated threshold-seeking method. Conclusions: Automated audiometry provides reliable, accurate, and time-efficient hearing assessments for normal-hearing and hearing-impaired adults. Combined with an asynchronous telehealth model it holds significant potential for reaching underserved areas where hearing health professionals are unavailable.
On 5 March 2020, South Africa recorded its first case of imported COVID-19. Since then, cases in South Africa have increased exponentially with significant community transmission. A multisectoral approach to containing and mitigating the spread of SARS-CoV-2 was instituted, led by the South African National Department of Health. A National COVID-19 Command Council was established to take government-wide decisions. An adapted World Health Organiszion (WHO) COVID-19 strategy for containing and mitigating the spread of the virus was implemented by the National Department of Health. The strategy included the creation of national and provincial incident management teams (IMTs), which comprised of a variety of work streams, namely, governance and leadership; medical supplies; port and environmental health; epidemiology and response; facility readiness and case management; emergency medical services; information systems; risk communication and community engagement; occupational health and safety and human resources. The following were the most salient lessons learnt between March and September 2020: strengthened command and control were achieved through both centralised and decentralised IMTs; swift evidenced-based decision-making from the highest political levels for instituting lockdowns to buy time to prepare the health system; the stringent lockdown enabled the health sector to increase its healthcare capacity. Despite these successes, the stringent lockdown measures resulted in economic hardship particularly for the most vulnerable sections of the population.
Between 2020 and 2021, the COVID-19 pandemic severely strained health systems across countries, leaving millions without access to essential healthcare services. Immunization programs experienced a ‘double burden’ of challenges: initial pandemic-related lockdowns disrupted access to routine immunization services, while subsequent COVID-19 vaccination efforts shifted often limited resources away from routine services. The latest World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) estimates suggest that 25 million children did not receive routine vaccinations in 2021, six million more than in 2019 and the highest number witnessed in nearly two decades. Recovering from this sobering setback requires a united push on several fronts. Intensifying the catch-up of routine immunization services is critical to reach children left behind during the pandemic and bridge large immunity gaps in countries. At the same time, we must strengthen the resilience of immunization systems to withstand future pandemics if we hope to achieve the goals of Immunization Agenda 2030 to ensure vaccinations are available for everyone, everywhere by 2030. In this article, leveraging the key actions for sustainable global immunization progress as a framework, we spotlight examples of strategies used by five countries—Cambodia, Cameroon, Kenya, Nigeria, and Uganda—who have exhibited exemplar performance in strengthening routine immunization programs and restored lost coverage levels in the last two years of the COVID-19 pandemic. The contents of this article will be helpful for countries seeking to maintain, restore, and strengthen their immunization services and catch up missed children in the context of pandemic recovery and to direct their focus toward building back a better resilience of their immunization systems to respond more rapidly and effectively, despite new and emerging challenges.
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