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

Laryngoscope Investigative Otolaryngology

article

Asitha D. L. Jayawardena¹  Ashley M. Nassiri¹  Dylan A. Levy²  Vienna Valeriani³  Alison J. Kemph⁴  Charissa N. Kahue¹  Nathaniel Segaren³  Robert F. Labadie¹  Marc L. Bennett¹  Carl A. Elisée⁵  James L. Netterville¹ 

[1] Department of Otolaryngology, Vanderbilt University Medical Center;Frank H. Netter MD School of Medicine, Quinnipiac University;Caris Foundation Haiti;Department of Hearing and Speech Sciences, Vanderbilt University Medical Center;Department of Otolarhinolaryngology, Hopital de L'Universite d'Etat d'Haiti

关键词: community health workers;    global health;    hearing screening;    low- and middle-income countries;    mobile technology;    pediatric audiology;    public health;    scalable hearing screening;   

DOI  :  10.1002/lio2.361

学科分类：环境科学（综合）

来源: Wiley

【 摘 要 】

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.Conclusions: A systematic approach that utilizes local resources (CHWs) and existing infrastructure (cell phones and the Internet) can significantly reduce the burden of hearing healthcare specialists while simultaneously facilitating early diagnosis and management of disabling hearing loss in low-resourced settings.

【 授权许可】

CC BY|CC BY-NC-ND