Estimating Need for Glasses and Hearing Aids in The Gambia: Results from a National Survey and Comparison of Clinical Impairment and Self-Report Assessment Approaches

Abstract

Few estimates are available of the need for assistive devices (ADs) in African settings. This study aimed to estimate population-level need for glasses and hearing aids in The Gambia based on (1) clinical impairment assessment, and (2) self-reported AD awareness, and explore the relationship between the two methods. The Gambia 2019 National Eye Health Survey is a nationally representative population-based sample of 9188 adults aged 35+ years. Participants underwent standardised clinical vision assessments including the need for glasses (distance and near). Approximately 25% of the sample underwent clinical assessment of hearing and hearing aid need. Data were also collected on self-reported awareness, need and access barriers to vision and hearing ADs. Overall, 5.6% of the study population needed distance glasses (95% CI 5.0–6.3), 45.9% (95% CI 44.2–47.5) needed near glasses and 25.5% (95% CI 22.2–29.2) needed hearing aids. Coverage for each AD was very low (<4%). The agreement between self-report and clinical impairment assessment for AD need was poor. In conclusion, there is high prevalence and very low coverage for distance glasses, near glasses and hearing aids in The Gambia. Self-report measures alone will not provide an accurate estimate of AD need.

Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys

“…Specifically, our study explored Mactaggart et al’s recommendation to use a WG cut-off of “some difficulty or worse” as first-stage screening followed by clinical impairment assessment in the same functional domain to identify people with disabilities, based upon a moderate+ impairment threshold [ 10 ]. Though our overall findings were congruent with the general recommendation to use “some difficulty or worse” cut-off, Mactaggart et al’s research anticipated that at least 80% of people with disabilities would be identified using this method, whereas our study found much fewer people with impairment (44–79%) and people with service/AP needs (60–82%) would be identified using updated recommended mild+ impairment thresholds [ 2 , 12 , 13 , 14 , 27 , 43 , 44 ]. Therefore, it appears use of this screening recommendation might not be transferrable to a mild+ impairment threshold.…”

“…This study uses data from five cross-sectional surveys undertaken in Cameroon, Chile, India, The Gambia and Turkey between 2013 and 2020 ( Table 1 ) [ 12 , 13 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Four were regional/district surveys (Cameroon, Chile, India and Turkey) and one was a national survey (The Gambia).…”

“…Clinical impairment assessment is time consuming, requires trained clinicians, is expensive, and often focuses on just one ICF component (impairment), lacking a broader assessment of the individual’s functioning. However, this method provides a more accurate assessment of the need for rehabilitation and AP than self-report alone [ 9 , 12 , 13 ]. Recently, more “rapid” population-based clinical impairment assessment survey methodologies integrating mobile health technology have been developed which overcome some of the disadvantages of traditional clinician-led measures; for example, the Rapid Assessment of Hearing Loss (RAHL) [ 14 ] uses the mobile audiometry tool HearTest together with a clinical examination of the ear [ 15 ].…”

“…A combination of both self-report and broader clinical assessment is required to obtain more holistic estimates of functioning across multiple domains [ 2 , 12 , 13 ]. Previous research suggested that a first stage screening using the WG questions, followed by clinical impairment assessment on people who reported “some difficulty” or worse in the corresponding functional domain, would identify the majority of people with impairments and activity limitations [ 10 ].…”

Measuring Access to Assistive Technology using the WHO rapid Assistive Technology Assessment (rATA) questionnaire in Guatemala: Results from a Population-based Survey

“…It also, importantly, incorporates consumer choice, and individuals' understanding of their need, uptake and benefit from AT which is crucial for developing AT services (Zhang et al, 2021). However, there are limitations of this approach, with evidence suggesting it can both under-and over-estimate AT need (Mactaggart, Kuper, Murthy, Oye & Polack, 2016;Boggs et al, 2019Boggs et al, , 2020Boggs et al, , 2021bBoggs, Polack, Kuper & Foster, 2021c). Consumer choice and participation are undeniably important.…”