Hearing and vision screening for preschool children using mobile technology, South Africa

Abstract

ObjectiveTo implement and evaluate a community-based hearing and vision screening programme for preschool children in the Western Cape, South Africa, supported by mobile health technology (mHealth) and delivered by community health workers (CHWs).MethodsWe trained four CHWs to provide dual sensory screening in preschool centres of Khayelitsha and Mitchells Plain during September 2017–December 2018. CHWs screened children aged 4–7 years using mHealth software applications on smartphones. We used logistic regression analysis to evaluate the association between screening results and age, sex and test duration, and, for hearing, excessive background noise levels.ResultsCHWs screened 94.4% (8023/10 362) of eligible children at 271 centres at a cost of 5.63 United States dollars per child. The number of children who failed an initial hearing and visual test was 435 (5.4%) and 170 (2.1%), respectively. Hearing test failure was associated with longer test times (odds ratio, OR: 1.022; 95% confidence interval, CI: 1.021–1.024) and excessive background noise levels at 1 kilohertz (kHz) (e.g. OR for left ear: 1.688; 95% CI: 1.198–2.377). Visual screening failure was associated with longer test duration (OR: 1.003; 95% CI: 1.002–1.005) and younger age (OR: 0.629; 95% CI: 0.520–0.761). Of the total screened, 111 (1.4%) children were diagnosed with a hearing and/or visual impairment.ConclusionmHealth-supported CHW-delivered hearing and vision screening in preschool centres provided a low-cost, acceptable and accessible service, contributing to lower referral numbers to resource-constrained public health institutions.

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

“…A high follow-up attendance rate (89.4%) for hearing screening was also found in a recent South African community-based study when the rescreening was conducted at a communitylevel as opposed to a public healthcare institution. 29 Patients who needed referral to the tertiary hospital for specialised diagnostic assessment had an attendance rate of 73.3%, which is in line with a previous South African community-based hearing screening study that found an attendance rate for diagnostic assessments of 75.8%. 29 Patient travelling distance was significantly shorter to the district hospital as opposed to the tertiary hospital.…”

“…29 Patients who needed referral to the tertiary hospital for specialised diagnostic assessment had an attendance rate of 73.3%, which is in line with a previous South African community-based hearing screening study that found an attendance rate for diagnostic assessments of 75.8%. 29 Patient travelling distance was significantly shorter to the district hospital as opposed to the tertiary hospital. Access to services is one of the leading barriers to hearing healthcare in underserved communities.…”

“…This percentage is higher than the reported referral rate of a South African community-based hearing and vision screening study of 5.4%, which utilised smartphone-based pure tone audiometry screening. 29 A possible reason for the higher referral rate is the method of screening. Otoacoustic emissions screening is sensitive to middle ear pathology and it is more likely to fail in the presence of abnormal middle ear function.…”

Applied tele-audiology research in clinical practice during the past decade: a scoping review

“…These studies described results of audiologists along with trained facilitators at remote sites that provided hearing screening services for infants and children. Eksteen et al (2019) reported that use of minimally trained community care workers (CCW) to screen for both hearing and vision was affordable (estimated cost $5.63 USD per child) and provided a scalable service delivery model. Monica et al (2017) assessed the feasibility of synchronous remote tele-hearing screening using audiometry and distortion product otoacoustic emissions (DPOAE) on a small group of school children (n ¼ 31) in India.…”

Health system requirements for hearing care services

“…13,14 This issue also suggests potential solutions that seek to integrate ear and hearing care within the overall spectrum of services provided through health systems, and focuses on building capacity of health-care providers in ear and hearing care. 10,11 Papers present technological solutions that can improve access to hearing care and facilitate its integration into health systems 15,16 and provide examples of innovative policies that could serve as models for improving access to services in underserved areas of the world. 6,12 The theme issue sets the stage for the First Membership Assembly of the World Hearing Forum, which will take place this December at WHO headquarters in Geneva, Switzerland.…”