Reasons for low uptake of referrals to ear and hearing services for children in Malawi

Bright, Tess; Mulwafu, Wakisa; Thindwa, Richard; Zuurmond, Maria; Polack, Sarah

doi:10.1371/journal.pone.0188703

Cited by 32 publications

(36 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There was reluctance from many community members to travel to the local or regional health centre to seek care, given the long distances and costs involved, uncertainty about whether they would receive high quality treatment from the staff posted there, and competing health needs such as disease due to HIV. These factors mirror findings from a study in Malawi, where of 150 children referred to specialist ear and hearing services, over 97% failed to attend citing a lack of finance, transport, and/or understanding about the importance of the referral [35]. This questions if addressing ear and hearing disorders is better integrated into broad ranging health services delivered by CHWs, in contrast to vertical, disease specific approaches which have been the mainstay of community health interventions in the past [36].…”

Section: Demand-side Barrierssupporting

confidence: 51%

Exploring perceptions, barriers, and enablers for delivery of primary ear and hearing care by community health workers: a photovoice study in Mukono District, Uganda

O’Donovan

Namanda²,

Hamala³

et al. 2020

Int J Equity Health

View full text Add to dashboard Cite

Background: Hearing loss is a prevalent but neglected disease, especially in low-or middle-income countries. The role of Community Health Workers (CHWs) to deliver primary ear and hearing care has been explored in several studies from a technical standpoint, but understanding perceptions, barriers, and enablers of such an approach from the perspective of CHWs themselves through a health equity lens has been less well documented. Methods: This qualitative study used photovoice to explore the views and experiences of CHWs in the Seeta Nazigo Parish of Mukono District in the delivery of ear and hearing care in the community. CHWs were trained in ear and hearing care, and provided with digital cameras to capture photographs related to their work in the community over the following 3 months. Individual interviews regarding the photographs were held at the end of each month, in addition to one focus group discussion. A community workshop was convened at the end of the study to display the photos. Thematic analysis of photographs was conducted using Braune and Clarkes six-step framework. We also used the data to explore potential roles for key stakeholders in primary ear and hearing care, and how photovoice may facilitate their engagement. Results: 13 CHWs participated in the study. Several themes were generated from analysis. CHWs perceived a high burden of ear and hearing disorders in their community and recognised the role they could play in tackling that burden. Potential barriers identified included a lack of equipment, training, and supervision of CHWs; logistical, financial, or psychological barriers to community participation; and the widespread use of traditional medicine. CHWs identified roles for the government and NGO bodies to enable and support delivery of ear and hearing care in the community. The community workshop was a useful method to engage key stakeholders in this topic.

show abstract

Section: Demand-side Barrierssupporting

confidence: 51%

Exploring perceptions, barriers, and enablers for delivery of primary ear and hearing care by community health workers: a photovoice study in Mukono District, Uganda

O’Donovan

Namanda²,

Hamala³

et al. 2020

Int J Equity Health

View full text Add to dashboard Cite

show abstract

“…Prior evidence suggests that despite the formal stipulations of government policies, important barriers to adequate health service utilization for people in need persist. Specifically, the existing literature has identified the presence of financial barriers imposed by informal payments and travel costs [12][13][14][15]; quality of care barriers, related to drug stock-outs, chronic shortage of highly-qualified staff, and users' lack of information on probable medical benefits [9,[13][14][15][16][17][18]; distance to health facilities, due to an uneven geospatial distribution of healthcare providers across regions [13,15,17]; and cultural barriers, related to low educational levels, traditional beliefs, and fear of stigma [12,13,15,16].…”

Section: Introductionmentioning

confidence: 99%

Determinants of healthcare seeking and out-of-pocket expenditures in a “free” healthcare system: evidence from rural Malawi

et al. 2020

View full text Add to dashboard Cite

Background: Monitoring financial protection is a key component in achieving Universal Health Coverage, even for health systems that grant their citizens access to care free-of-charge. Our study investigated out-of-pocket expenditure (OOPE) on curative healthcare services and their determinants in rural Malawi, a country that has consistently aimed at providing free healthcare services. Methods: Our study used data from two consecutive rounds of a household survey conducted in 2012 and 2013 among 1639 households in three districts in rural Malawi. Given our explicit focus on OOPE for curative healthcare services, we relied on a Heckman selection model to account for the fact that relevant OOPE could only be observed for those who had sought care in the first place. Results: Our sample included a total of 2740 illness episodes. Among the 1884 (68.75%) that had made use of curative healthcare services, 494 (26.22%) had incurred a positive healthcare expenditure, whose mean amounted to 678.45 MWK (equivalent to 2.72 USD). Our analysis revealed a significant positive association between the magnitude of OOPE and age 15-39 years (p = 0.022), household head (p = 0.037), suffering from a chronic illness (p = 0.019), illness duration (p = 0.014), hospitalization (p = 0.002), number of accompanying persons (p = 0.019), wealth quartiles (p 2 = 0.018; p 3 = 0.001; p 4 = 0.002), and urban residency (p = 0.001). Conclusion: Our findings indicate that a formal policy commitment to providing free healthcare services is not sufficient to guarantee widespread financial protection and that additional measures are needed to protect particularly vulnerable population groups.

show abstract

“…We suspect that this rate was affected by a long waiting period before follow-up appointments, parents changing their mobile phone number and not notifying the ECD center, and difficulties with taking leave from work, which may result in loss of income for informal workers. Other reasons that may account for non-attendance include lack of transportation, fear and uncertainty about the referral clinic, lack of education regarding hearing loss, and a lack of visibility of services [35]. More precise reasons for non-attendance should be investigated in future studies.…”

Section: Discussionmentioning

confidence: 99%

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

Hussein

Swanepoel

Mahomed

et al. 2018

Global Health Action

View full text Add to dashboard Cite

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.

show abstract

Reasons for low uptake of referrals to ear and hearing services for children in Malawi

Cited by 32 publications

References 22 publications

Exploring perceptions, barriers, and enablers for delivery of primary ear and hearing care by community health workers: a photovoice study in Mukono District, Uganda

Exploring perceptions, barriers, and enablers for delivery of primary ear and hearing care by community health workers: a photovoice study in Mukono District, Uganda

Determinants of healthcare seeking and out-of-pocket expenditures in a “free” healthcare system: evidence from rural Malawi

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

Contact Info

Product

Resources

About