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 hearScreen^TM 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 hearScreen^TM application allows for the asynchronous management of hearing screenings and follow-ups.

KEYWORDS:

• Smartphone
• hearing screening
• early childhood development
• mobile health
• community healthcare workers

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

We would like to thank all the participants involved with this study, including the team leaders and community health workers of the community of Mamelodi.

Author contributions

All authors listed have met all the International Committee of Medical Journal Editors (ICMJE) criteria for authorsip and have contributed equally to this work.

Disclosure statement

The hearScreen™ application is intellectual property owned, patented, and trademarked by the University of Pretoria. The product has been developed for commercialization. More information is available at www.hearscreen.co.za.

Ethics and consent

Ethical clearance for this study was obtained from the Ethics Committee, University of Pretoria, South Africa. Assent of participants and consent from their parent/caregiver was obtained prior to any data collection.

Paper context

Childhood hearing screening programs within low- and middle-income countries are few, due to limited financial and human resources. This study investigated the feasibility of a low-cost smartphone-based hearing-screening program for preschool children operated by non-specialist healthcare workers. Such programs can successfully aid in prevention, early identification and treatment of disabling hearing loss prior to school entry. Additionally, features such as automated test sequences, integrated noise monitoring and cloud-based data management allow for asynchronous point-of-care diagnostics in difficult to reach populations.

Additional information

Funding

The financial assistance of the National Institute for the Humanities and Social Sciences (NIHSS), in collaboration with the South African Humanities Deans Association (SAHUDA), towards this research is hereby acknowledged. Opinions expressed and conclusions arrived at are those of the authors and are not necessarily to be attributed to the NIHSS and SAHUDA.