Prevalence and characteristics of hearing and vision loss in preschool children from low income South African communities: results of a screening program of 10,390 children

Abstract

Background The majority of children with sensory impairments live in low- and middle-income countries. More studies of hearing and vision impairment prevalence are needed, in order to generate more accurate estimates of trends in sensory impairments. This study aimed to estimate the prevalence and describe the characteristics of hearing and vision loss among preschool children (4–7 years) in an underserved South African community following community-based mobile health (mHealth) supported hearing and vision services. Methods A screening program of sensory impairments was undertaken of children attending preschools in the communities of Khayelitsha and Mitchell’s Plain, Cape Town, from September 2017 until June 2019. Hearing and vision screening were done by trained community health workers using mHealth technology. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were conducted using smartphones that host point-of-care validated and calibrated hearing and vision testing applications (hearTest app, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). Descriptive statistical analysis and logistic regression analysis were conducted after extracting data from a secure cloud-based server (mHealth Studio, hearX Group) to Microsoft Excel (2016). Results A total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6 and 4.4% of children failed hearing and vision screening respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of children of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was done on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.05), but not for hearing loss (p = 0.06). Gender was not a significant predictor of hearing (p = 0.22) or vision loss (p = 0.20). Conclusions Hearing loss is prevalent in at least 22 per 1000 and vision loss in at least 23 per 1000 preschool children in an underserved South African community. Timely identification of sensory losses can be facilitated through community-based hearing and vision services supported by mHealth technology.

Combined hearing and vision screening programs: A scoping review

“…The first three to four years of life are critical for optimal neuroplasticity for cognitive development, including the sensory systems ( 49 , 50 ). Therefore, combined screening programs can facilitate early detection and intervention of hearing and vision impairments to support early childhood development with long-term benefits for socio-emotional, academic, and vocational outcomes ( 6 , 11 , 20 , 37 , 51 – 55 ).…”

“…Only Bright and colleagues ( 19 ) demonstrated the potential cost-benefit of separate vs. combined screening as part of population-based surveys for hearing and vision. The economic benefit of combined screening can also impact public health services as unnecessary referrals and/or follow-up appointments can be reduced ( 37 , 40 ).…”

“…All studies involving adults were conducted in home-based settings, facilitated mainly by healthcare professionals (e.g., nurses, doctors, and audiologists) [e.g., ( 43 , 48 , 61 )]. Most studies involving children were conducted in school settings ( 11 , 20 , 36 , 37 , 39 , 41 , 42 , 45 – 47 ). These studies demonstrate the potential for decentralized combined hearing and vision screening in adults and children using community-based service delivery models.…”

“…These studies demonstrate the potential for decentralized combined hearing and vision screening in adults and children using community-based service delivery models. Community-based models offer greater accessibility, especially in lower income or resource-constrained communities where access to such services might otherwise be unattainable ( 11 , 20 , 37 , 42 ), and demonstrate improved follow-up rates ( 37 ). Furthermore, a decentralized service also supports economic benefit to community members and parents/caregivers of infants and children due to limited travel costs and less time from work ( 36 ).…”

Causes of Hearing Impairment Observed in Clinical/Hospital Setting

“…Previous study presented same results. [15] The only thing that can be done to stop hearing loss is to spread awareness about the issues that contribute to it and how they may be fixed. For instance, maternal infection is avoidable through immunisation, and the use of ototoxic medicines should be discouraged.…”