Hearing and vision screening for preschool children using mobile technology, South Africa.

Susan Eksteen,De Wet Swanepoel,Andrew Bastawrous,Robert H Eikelboom,Hannah Kuper,Stefan Launer

doi:10.2471/blt.18.227876

Abstract

ObjectiveTo implement and evaluate a community-based hearing and vision screening programme for preschool children in the Western Cape, South Africa, supported by mobile health technology (mHealth) and delivered by community health workers (CHWs).MethodsWe trained four CHWs to provide dual sensory screening in preschool centres of Khayelitsha and Mitchells Plain during September 2017–December 2018. CHWs screened children aged 4–7 years using mHealth software applications on smartphones. We used logistic regression analysis to evaluate the association between screening results and age, sex and test duration, and, for hearing, excessive background noise levels.ResultsCHWs screened 94.4% (8023/10 362) of eligible children at 271 centres at a cost of 5.63 United States dollars per child. The number of children who failed an initial hearing and visual test was 435 (5.4%) and 170 (2.1%), respectively. Hearing test failure was associated with longer test times (odds ratio, OR: 1.022; 95% confidence interval, CI: 1.021–1.024) and excessive background noise levels at 1 kilohertz (kHz) (e.g. OR for left ear: 1.688; 95% CI: 1.198–2.377). Visual screening failure was associated with longer test duration (OR: 1.003; 95% CI: 1.002–1.005) and younger age (OR: 0.629; 95% CI: 0.520–0.761). Of the total screened, 111 (1.4%) children were diagnosed with a hearing and/or visual impairment.ConclusionmHealth-supported CHW-delivered hearing and vision screening in preschool centres provided a low-cost, acceptable and accessible service, contributing to lower referral numbers to resource-constrained public health institutions.

Highlights

Detection of sensory impairments is essential for facilitating early childhood development, socioemotional well-being and academic success,[1,2,3,4] as well as the sustainable development goals related to education.[5]
54 children with hearing impairment, who receive interventions, and 5 children awaiting confirmation of diagnosis mHealth: mobile health technology age, sex and test duration for both vision and hearing screening; for hearing, we evaluated the association between test outcome and excessive noise levels at each frequency
The 271 preschool centres participating in our study included a total of 10 362 children

Summary

Introduction

Sensory inputs of hearing and vision during early childhood development support the achievement of optimal language, speech and educational outcomes.[1,2] Early detection of sensory impairments is essential for facilitating early childhood development, socioemotional well-being and academic success,[1,2,3,4] as well as the sustainable development goals related to education.[5]Hearing and vision impairments are the most common global developmental disabilities in children younger than 5 years, affecting 15.5 and 25.2 million, respectively,6 95% of whom live in low- and middle-income countries.[6,7,8] Services are usually unavailable or inaccessible in these countries because of an absence of systematic screening programmes for children, prohibitive equipment cost and a shortage of trained personnel.[2,9,10,11] An awareness and knowledge of sensory impairments, their potential impact on a child’s development and potential rehabilitative solutions are poor among early childhood practitioners in underprivileged communities.[12]The evidence base on the value of community-based programmes incorporating mobile health technology (mHealth) for hearing and vision loss is growing.[13,14,15] Community health workers (CHWs)[16] play an important role in improving access to hearing services, including in screening and raising community awareness.[15,17] mHealth has been recognized as increasingly important in supporting the achievement of the sustainable development goals[18] and addressing access and affordability in underserved populations;[8,19] it has the potential to improve health system efficiency, quality of preventative care and health outcomes.[20,21] Validated smartphone applications (apps), including automated tests for hearing and vision screening, pre-specified screening protocols for result interpretation, cloud-based data management for surveillance of programme performance and geolocation-based referral, allow CHWs to undertake decentralized screening and identify cases for referral.[8,13,14,15,22,23,24] CHWs have reported such apps as user-friendly and efficient.[8,12,22]. The evidence base on the value of community-based programmes incorporating mobile health technology (mHealth) for hearing and vision loss is growing.[13,14,15] Community health workers (CHWs)[16] play an important role in improving access to hearing services, including in screening and raising community awareness.[15,17] mHealth has been recognized as increasingly important in supporting the achievement of the sustainable development goals[18] and addressing access and affordability in underserved populations;[8,19] it has the potential to improve health system efficiency, quality of preventative care and health outcomes.[20,21] Validated smartphone applications (apps), including automated tests for hearing and vision screening, pre-specified screening protocols for result interpretation, cloud-based data management for surveillance of programme performance and geolocation-based referral, allow CHWs to undertake decentralized screening and identify cases for referral.[8,13,14,15,22,23,24] CHWs have reported such apps as user-friendly and efficient.[8,12,22]

Methods

Results

Discussion

Conclusion