Background The rising prevalence of hearing loss is a global health concern. Professional hearing services are largely absent within low- and middle-income countries where appropriate skills are lacking. Task-shifting to community healthcare workers (CHWs) supported by mHealth technologies is an important strategy to address the problem. Objective To evaluate the feasibility of a community-based rehabilitation model providing hearing aids to adults in low-income communities using CHWs supported by mHealth technologies. Method Between September 2020 and October 2021, hearing aid assessments and fittings were implemented for adults aged 18 and above in two low-income communities in the Western Cape, South Africa, using trained CHWs. A quantitative approach with illustrative open-ended questions was utilised to measure and analyse hearing aid outcomes. Data were collected through initial face-to-face interviews, telephone interviews, and face-to-face visits post-fitting. Responses to open-ended questions were analysed using inductive thematic analysis. The International Outcome Inventory – Hearing Aids questionnaire determined standardised hearing aid outcomes. Results Of the 152 adults in the community who self-reported hearing difficulties, 148 were successfully tested by CHWs during home visits. Most had normal hearing (39.9%), 24.3% had bilateral sensorineural hearing loss, 20.9% had suspected conductive hearing loss, and 14.9% had unilateral hearing loss, of which 5.4% had suspected conductive loss. Forty adults met the inclusion criteria to be fitted with hearing aids. Nineteen of these were fitted bilaterally. Positive hearing aid outcomes and minimal device handling challenges were reported 45 days post-fitting and were maintained at six months. The majority (73.7%) of participants fitted were still making use of their hearing aids at the six-month follow-up. Conclusions Implementing a hearing healthcare service-delivery model facilitated by CHWs in low-income communities is feasible. mHealth technologies used by CHWs can support scalable service-delivery models with the potential for improved access and affordability in low-income settings.

Objective: Postnatal visits at community-based midwife obstetric units (MOUs) have been proposed as an alternative primary healthcare screening platform in South Africa. This study evaluated the outcomes of distortion product otoacoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) screening conducted by a dedicated nonprofessional screener at a community-based MOU in the Western Cape, South Africa.Methods: Universal newborn hearing screening (UNHS) at a community-based MOU was evaluated over a 16-month period. A dedicated non-professional screener was trained to follow a two-stage screening protocol targeting bilateral hearing loss. A two group comparative design was used alternating AABR (Maico MB11 BERAphone TM) and DPOAE (Bio-logic AuDX I) technology on a daily basis. Infants referring the initial screen received a follow-up appointment in two days' time and were rescreened with the same technology used at their first screen.Those referring the second stage were booked for diagnostic assessments.Results: 7452 infants were screened including 47.9% (n=3573) with DPOAE and 52.1% (n=3879) with AABR technology. Mean age at first stage screen was 6.1 days. The initial bilateral referral rate was significantly lower for AABR (4.6%) compared to DPOAE (7.0%) and dropped to 0.3% and 0.7% respectively following the second stage screenings. First rescreen and initial diagnostic follow-up rates of 90% and 92.3% were obtained for the DPOAE group and 86.6% and 90% for the AABR group. Follow-up rates showed no significant difference between technology groups. Diagnostic assessment revealed a higher prevalence rate for bilateral sensorineural hearing loss among the AABR group (1/1000) compared to the DPOAE group (0.3/1000). Screening technology had no significant influence on daily screening capacity (23 AABR/day; 24 DPOAE/day). 3Conclusions: Postnatal visits at community-based MOUs create a useful platform for hearing screening and follow-up. AABR technology with negligible disposable costs provides opportunity for AABR screening to be utilised in community-based programmes. AABR screening offers lower initial referral rates and a higher true positive rate compared to DPOAE.

(1) Hearing health training and promotion is a priority for early childhood development (ECD) practitioners, but training opportunities are limited, especially in low- and middle-income countries (LMIC). mHealth (mobile health) has the potential to deliver scalable ear and hearing training to ECD practitioners. (2) This study investigated the effect of an mHealth training intervention program for ECD practitioners to improve knowledge and perceptions of hearing health in young children. An experimental one-group, pre-post-test study included ECD practitioners working with children between birth and 6 years old across 31 neighbouring communities in the Western Cape Province, South Africa. Hearing health training was provided using WhatsApp messages that encompassed infographics and voice notes. Knowledge and perceptions regarding hearing and hearing-related problems in children were surveyed pre-training, directly post training, and 6 months post training. (3) ECD practitioners (N = 1012) between 17 and 71 years of age received the mHealth training program and completed both the pre-and post-training surveys. Overall, knowledge scores indicated a significant improvement from pre- to post training (Z = −22.49; p < 0.001). Six-month post-training knowledge scores were sustained. Content analysis of ECD practitioners’ application of the training information 6 months post training indicated improved awareness, practical application, better assistance for hearing problems, and widespread advocacy. (4) The mHealth training program supports improved knowledge and perceptions of ECD practitioners regarding hearing health for young children. With improved knowledge scores maintained 6 months post training, mHealth hearing health training is an effective intervention. An mHealth training program for ECD practitioners provides a scalable, low-cost intervention for primary and secondary prevention in childhood hearing loss, especially in LMICs.

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