Abstract
BackgroundChildhood hearing loss is a global epidemic most prevalent in low- and middle-income countries where hearing healthcare services are often inaccessible. Referrals for primary care services to central hospitals add to growing lists and delays the time-sensitive treatment of childhood hearing loss.AimTo compare a centralised tertiary model of hearing healthcare with a decentralised model through district hearing screening for children in the Western Cape province, South Africa.SettingA central paediatric tertiary hospital in Cape Town and a district hospital in the South Peninsula region.MethodsA pragmatic quasi-experimental study design was used with a 7-month control period at a tertiary hospital (June 2019 to December 2019). Decentralising was measured by attendance rates, travelling distance, number of referrals to the tertiary hospital and hearing outcomes. There were 315 children in the tertiary group and 158 in the district group. Data were collected from patient records and an electronic database at the tertiary hospital.ResultsAttendance rate at the district hospital was significantly higher (p < 0.001). Travel distance to the district hospital was significantly shorter (p < 0.001). Number of referrals to the tertiary hospital decreased significantly during the intervention period (p < 0.001). Most children in both the tertiary and district groups (78.7% and 80.4%, respectively) passed initial hearing screening bilaterally.ConclusionHearing screening should be conducted at the appropriate level of care to increase access, reduce patient travelling distances and associated costs and reduce the burden on tertiary-level hospitals.
Highlights
Hearing loss is the second most prevalent developmental disability, affecting approximately 15.5 million children under the age of 5 years globally.[1]
No audiological services are available at any of the primary healthcare clinics or maternity and obstetric units (MOU) in this area, which result in referrals for initial hearing screening of older children based on risk factors or concerns for hearing loss
An attendance rate of 83.2% (158/190) was found during the 7-month intervention period for patients attending the district hearing screening project, which was significantly higher than the attendance rate of 70.2% (315/449) for patients from the district hospital catchment area who were seen for initial hearing screening at the tertiary hospital during the control period (p < 0.001)
Summary
Hearing loss is the second most prevalent developmental disability, affecting approximately 15.5 million children under the age of 5 years globally.[1]. Hearing healthcare services in LMICs are not prioritised by health systems overwhelmed by lifethreatening diseases.[5] Identification of hearing loss in children is often impeded in LMICs because of the absence of well-managed hearing screening programmes, the impact of poverty and malnutrition on hearing and the lack of public and professional awareness of hearing loss and its devastating effects in children.[6] In addition, poor hearing health infrastructure and resources (personnel and equipment) and geographical barriers such as distance, lead to limited accessibility of hearing healthcare services.[5,6] Children born into a lower socioeconomic status have considerably http://www.phcfm.org. Referrals for primary care services to central hospitals add to growing lists and delays the time-sensitive treatment of childhood hearing loss
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