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

Abstract

Objective: To establish the feasibility of a systematic, community health worker (CHW)-based hearing screening program that gathers Health Insurance Portability and Accountability Act-compliant electronic data (otoscopic images of tympanic membrane and audiometric evaluation) on a smartphone in an effort to streamline treatment options in resource-limited communities.Methods: This is a cross-sectional study in which four schools were screened in Portau-Prince, Haiti, during in April 2018. A total of 122 subjects (61% female) aged 5-17 years underwent an initial brief audiometric screen followed by a more comprehensive air conduction audiometric evaluation if they failed their initial screen. Participants with more than 35-dB loss in any frequency on their comprehensive audiometric evaluation received endoscopic otoscopy.Results: Seventy-five percent of subjects (91/122) passed their initial screen. Of those who failed, 9% (4/44 ears) had a severe or profound hearing loss on comprehensive evaluation. Abnormal otoscopic findings (11/36 ears, 31%) included are cerumen impaction (n = 6), myringosclerosis (n = 3), tympanic membrane perforation (n = 1), and tympanic membrane retraction (n = 1). The average duration of the initial testing was 100 seconds (SD = 74 seconds), whereas the duration of comprehensive testing was 394 seconds (SD = 175 seconds). Extrapolating from these data, we estimate that a group of seven trained CHWs could gather formal audiologic and otologic data points for 100 children per hour using this protocol.

Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies

“…LHWs are essential, when implementing a sustainable community-led hearing and vision screening programme (Eksteen et al, 2019;Jayawardena et al, 2020;Rono et al, 2018;. The use of LHWs kept costs low, compared to the use of hearing health professionals (audiologist/ENT) or eye health professionals (optometrist/ophthalmologist), and this has also been demonstrated by other researchers (Bright et al, 2019;Eksteen et al, 2019;Mahomed-Asmail, et al, 2016;Rono et al, 2018;.…”

“…Some of these barriers can be overcome by employing novel mobile health (mHealth) technologies for sensory screening, which enable new service delivery models where services are delivered by persons with minimal training, including by school staff (Bernstein, Besser, Maidment, & Swanepoel, 2018;Bright, McComrick, Phiri, Mulwafu, Burton, Polack, Mactaggart, Yip, Swanepoel & Kuper, 2020, Bright, Mulwafu, Phiri, Ensink, Smith, Yip, Mactaggart & Polack, 2019Jayawardena, Nassiri, Levy, Valeriani, Kemph, Kahue, Segaren, Labadie, Bennett, Elisée & Netterville, 2020;Morjaria, & Bastawrous, 2017;Reddy & Bassett, 2017;Rono et al, 2018;Shinn, Zuniga, Macharia, Reppart, Netterville & Jayawarenda, 2019;Swanepoel, 2017). Smartphonebased applications (apps) have been used in previous studies to successfully screen the hearing of preschool (Yousuf Hussien, and school-aged (Jayawardena et al, 2020;Mahomed-Asmail, et al, 2016) children.…”

“…Automated test protocols and intuitive user interfaces on these smartphone screening apps allow lay health workers (LHWs) or community health workers (CHWs) to facilitate hearing and vision testing (Bright et al, 2020;Eksteen et al, 2019;Jayawardena et al, 2020;Rono et al, 2018;Yousuf Hussein et al, 2016;. A recent study confirmed that training CHWs in primary ear and hearing care identification can be feasible and accurate (Bright et al, 2019).…”

Referral Criteria for Preschool Hearing Screening in Resource-Constrained Settings: A Comparison of Protocols

“…Employing validated mHealth technologies that support CHWs, government and community screening programs can improve capacity for effective large-scale hearing screening Jayawardena et al, 2020;Shinn et al, 2019;Suen et al, 2019;Swanepoel, 2020). In order for CHWs to deliver such care with new technologies, it is important that screening protocols are selected appropriately to maximize true positives and minimize excessive referral rates tailored to contextual health care system capacity.…”

“…As a consequence, children in resource-constrained settings are rarely screened for hearing loss (Harris & Dodson, 2017;Levy et al, 2018;Mulwafu et al, 2016;Swanepoel & Clark, 2019;Wilson et al, 2017). Some of these challenges may be overcome by incorporating mobile health (mHealth) technologies and community-delivered hearing health care as these have the potential to decentralize and increase access to services in resource-constrained settings Jayawardena et al, 2020;Manus et al, 2021;Suen et al, 2019;Swanepoel, 2020;van Wyk et al, 2019;World Health Organization [WHO], 2021;Yancey et al, 2019). mHealth technology, such as the validated hearScreen application (hearX Group), offers an inexpensive and mobile alternative to conventional evaluations by utilizing calibrated headphones on low-cost smartphones, employing a simple user interface (Mahomed-Asmail et al, 2016;Sandström et al, 2016;Swanepoel, 2020;Swanepoel & Clark, 2019;van Tonder et al, 2017;Yousuf Hussein et al, 2016.…”