Community-based hearing screening for young children using an mHealth service-delivery model

Abstract

Background: Hearing loss is one of the most common developmental disorders identifiable at birth with its prevalence increasing throughout school years. However, early detection programs are mostly unavailable in low- and middle-income countries (LMICs) where more than 80% of children with hearing loss reside.Objective: This study investigated the feasibility of a smartphone-based hearing screening program for preschool children operated by community healthcare workers (CHWs) in community-based early childhood development (ECD) centers.Method: Five CHWs were trained to map ECD centers and conduct smartphone-based hearing screenings within a poor community in South Africa over a 12-month period. The hearScreenTM smartphone application employed automated test protocols operating on low-cost smartphones. A cloud-based data management and referral function allowed for remote monitoring for surveillance and follow up.Results: 6424 children (3–6 years) were screened for hearing loss with an overall referral rate of 24.9%. Only 39.4% of these children attended their follow-up appointment at a local clinic, of whom 40.5% referred on their second screening. Logistic regression analysis indicated that age, gender and environmental noise levels (1 kHz) had a significant effect on referral rates (p < 0.05). The quality index reflecting test operator test quality increased during the first few months of testing.Conclusion: Smartphone-based hearing screening can be used by CHWs to detect unidentified children affected by hearing loss within ECD centers. Active noise monitoring, quality indices of test operators and cloud-based data management and referral features of the hearScreenTM application allows for the asynchronous management of hearing screenings and follow-ups.

Community health worker‐based hearing screening on a mobile platform: A scalable protocol piloted in Haiti

“…Recently, mobile technologies have been utilized to extend the reach of existing hearing health services in LMICs . Programs using calibrated headphones, tablet computers, and smartphones have been clinically validated in collecting accurate audiometric thresholds in pediatric populations .…”

Smartphone Apps in the Context of Tinnitus: Systematic Review

“…The final developed mobile device-based screening system (PASS Speech Audiometry Version 2) suggests that smartphone-based audiometry can be easily adopted to prevent and manage hearing loss. Furthermore, smartphone-based hearing testing can also be a viable and cost-effective solution for accurately conducting audiometry in community-based early childhood development centers, particularly in poor communities [83]. To add to this, smartphone-based audiometry can also be used to estimate pure-tone thresholds [84].…”

Hearing care across the life course provided in the community

“…Validated mHealth technologies 34 allow hearing screening to be done in primary care clinics 35 , 36 using automated testing and a smartphone interface. These technologies enable personnel to provide reliable remote hearing screening for high-risk children 25 – 27 . Beginning in the early 2000s, South African CHWs, using mHealth technologies, have also delivered hearing screening to children in a variety of community settings, including home visits and early childhood development facilities 26 , 27 .…”

“…These technologies enable personnel to provide reliable remote hearing screening for high-risk children 25 – 27 . Beginning in the early 2000s, South African CHWs, using mHealth technologies, have also delivered hearing screening to children in a variety of community settings, including home visits and early childhood development facilities 26 , 27 . Evaluations of these models demonstrate that CHWs can be trained to screen children in a reliable and time-efficient manner 26 , 27 .…”

“…Beginning in the early 2000s, South African CHWs, using mHealth technologies, have also delivered hearing screening to children in a variety of community settings, including home visits and early childhood development facilities 26 , 27 . Evaluations of these models demonstrate that CHWs can be trained to screen children in a reliable and time-efficient manner 26 , 27 . After identifying a child with hearing problems, mHealth systems allow CHWs to facilitate further intervention by notifying families and caregivers about nearby clinics for advanced hearing care 25 .…”