Abstract
ObjectiveTo assess the outcomes of children diagnosed with hearing impairment 3 years earlier in terms of referral uptake, treatment received and satisfaction with this treatment, and social participation.MethodsWe conducted a population-based longitudinal analysis of children with a hearing impairment in two rural districts of Malawi. Key informants within the community identified the cohort in 2013 (baseline). Informants clinically screened children at baseline, and by questionnaires at baseline and follow-up in 2016. We investigated associations between sociodemographic characteristics and outcomes by multivariate logistic regression.ResultsWe diagnosed 752 children in 2013 as having a hearing impairment and traced 307 (40.8%) children of these for follow-up in 2016. Referral uptake was low (102/184; 55.4%), more likely among older children (odds ratio, OR: 3.5; 95% confidence interval, CI: 1.2–10.2) and less likely for those with an illiterate caregiver (OR: 0.5; 95% CI: 0.2–0.9). Few of the children who attended hospital received any treatment (33/102; 32.4%) and 63.6% (21/33) of caregivers reported satisfaction with treatment. Difficulty making friends and communicating needs was reported for 10.0% (30/299) and 35.6% (107/301) of the children, respectively. Lack of school enrolment was observed for 29.5% (72/244) of children, and was more likely for older children (OR: 28.6; 95% CI: 10.3–79.6), girls (OR: 2.4; 95% CI: 1.2–4.8) and those with an illiterate caregiver (OR: 2.1; 95% CI: 1.0–4.1).ConclusionMore widespread and holistic services are required to improve the outcomes of children with a hearing impairment in Malawi.
Highlights
466 million people live with disabling hearing loss globally, including 34 million children, and most of these live in low- and middle-income countries.[1]
There was no significant difference between the groups included at baseline and at follow-up, except that children aged 15–18 years were slightly more likely to be included in the follow-up (OR: 1.7; 95% confidence intervals (CI): 1.1– 2.8), demonstrating that those followed up were relatively representative of the baseline group (Table 1)
After eliminating non-significant variables, referral uptake was lower among children living in Ntcheu district and among those with caregivers who were illiterate
Summary
466 million people live with disabling hearing loss globally, including 34 million children, and most of these live in low- and middle-income countries.[1] Unaddressed hearing loss has a negative impact on language development, school performance, employment opportunities, psychosocial well-being and aspects of family life, with an estimated annual global cost to society of 750 billion United States dollars.[2] Hearing loss often goes unnoticed and unaddressed, and its impact has not been explored adequately in low- and middleincome countries.[3,4]. Treatment and rehabilitation are important to mitigate some of these negative effects and maximize functioning for affected individuals. In many low- and middle-income countries there is a shortage of good-quality ear and hearing services,[6] and even when services are available utilization remains low.[7,8] At national and regional levels, data are currently lacking on the need for ear and hearing services that would help to advocate for, plan and implement these programmes
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