Decentralising paediatric hearing services through district healthcare screening in Western Cape province, South Africa

Abstract

Background: Childhood hearing loss is a global epidemic most prevalent in low- and middle-income countries where hearing healthcare services are often inaccessible. Referrals for primary care services to central hospitals add to growing lists and delays the time-sensitive treatment of childhood hearing loss.Aim: To compare a centralised tertiary model of hearing healthcare with a decentralised model through district hearing screening for children in the Western Cape province, South Africa.Setting: A central paediatric tertiary hospital in Cape Town and a district hospital in the South Peninsula region.Methods: A pragmatic quasi-experimental study design was used with a 7-month control period at a tertiary hospital (June 2019 to December 2019). Decentralising was measured by attendance rates, travelling distance, number of referrals to the tertiary hospital and hearing outcomes. There were 315 children in the tertiary group and 158 in the district group. Data were collected from patient records and an electronic database at the tertiary hospital.Results: Attendance rate at the district hospital was significantly higher (p 0.001). Travel distance to the district hospital was significantly shorter (p 0.001). Number of referrals to the tertiary hospital decreased significantly during the intervention period (p 0.001). Most children in both the tertiary and district groups (78.7% and 80.4%, respectively) passed initial hearing screening bilaterally.Conclusion: Hearing screening should be conducted at the appropriate level of care to increase access, reduce patient travelling distances and associated costs and reduce the burden on tertiary-level hospitals.

Implementation of a decentralised clinical training programme (DCTP) at a university of technology in South Africa: Implications for health science education and clinical practice

“…to suggest that other health professionals such as nurses, occupational therapists, physiotherapists and audiologists have also been taught using this approach at certain universities in SA, [18][19][20] there is a paucity of data on the models and approaches to DCTP implementation among these health science disciplines, particularly in SA. [21] Data on DCTP implementation approaches also suggest a lack of clarity regarding the teaching philosophy within these programmes. [14] Gaede [2] argues that DCTP is an essential component in the endeavour to increase graduate output and improve graduate competencies of health professionals.…”