The role of community health workers in addressing the global burden of ear disease and hearing loss: a systematic scoping review of the literature

Abstract

IntroductionCommunity health workers (CHWs) have the potential to improve access to ear and hearing services for people across low-income or middle-income countries, remote, underserved, or resource-poor areas of the world. We performed a systematic scoping review to identify evidence on how CHWs are currently deployed in the prevention, screening, diagnosis, treatment and management of ear disease and hearing loss; methods to train and support CHWs in this context; and cost-effectiveness of CHWs.MethodsWe performed a systematic search of the literature from September 1978 to 18 March 2018 from 11 major databases and the grey literature.ResultsWe identified 38 original studies that met the inclusion criteria, taking place across South Asia (n=13), Oceania (n=7), North America (n=7), South America (n=6) and Africa (n=5). 23 studies showed CHWs can increase community participation in screening. They can conduct screening using whispered voice tests, noisemakers for neonatal screening, automated audiological tests and otoscopy. Eight studies focused specifically on the evaluation of programmes to train CHWs, and three provided a general programme description. Three studies documented a role of CHWs in the treatment of ear disease or hearing loss, such as performing ear washouts, instillation of topical antibiotics or fitting of hearing aids. Only one study provided an indepth cost-utility analysis regarding the use of CHWs to conduct hearing screening, and no studies commented on the role of CHWs in the prevention of hearing loss.ConclusionCHWs have been employed in diverse ways to address the global burden of ear disease and hearing loss. Future research needs to explore the role of CHWs in preventative strategies, identify optimum methods to train and support CHWs, and explore their cost-effectiveness.

Training for hearing care providers

“…These manuals have been used in several countries to train community health workers, including Brazil, Burkina Faso, China, Colombia, Fiji, Kenya, Malawi and Nigeria. 16 Other regional or national resources for training community health workers are available, for example the Aboriginal and Torres Strait Islander ear health manual 17 from Australia, and the Chinese ear and hearing care training manual. 18 Training programmes to date have reported learner outcomes of community health workers in terms of short-term improvements in knowledge, 16 rather than ability to independently assess or manage ear and hearing disorders.…”

“…Other studies suggest that community health workers can acquire sufficient practical skills to assess and manage patients. 16 Community health workers in India were able to perform a whispered voice test to screen for hear-ing loss in adults, 19 and in Malawi they could identify patients with potential hearing problems. 20 Several studies have shown that community health workers are able to capture images on digital otoscopy.…”

“…20 Several studies have shown that community health workers are able to capture images on digital otoscopy. 16 In all these initiatives, however, the community health workers sent captured data for expert assessment and did not personally instigate diagnosis, management or intervention.…”

“…A literature review found several studies reporting that community health workers were able to perform pure tone audiometry, the basic test of adult hearing, but details of the training given or the accuracy of the results were lacking in such studies. 16 A study from the Dominican Republic reported that a charity developed a 3-month training programme for staff with at least secondary school education to perform basic hearing tests. 26 Again, detailed methods or outcomes were not reported.…”

Impact of Community Oriented Ear Care (COEC) on national programme for control of deafness in India: A critical look

“…The worldwide weight of crippling hearing misfortune is most extreme (80%) in those living in low-salary or center pay nations (LMICs). Additionally there is a de iciency of expert ear care experts in LMICs, so the job of network arranged ear care arrangement at PHC level become crucial [3]. CHWs at PHC level can assume a major job in improving access to ear and hearing administrations, for example, screening and raising network awareness [3].…”