Abstract
BackgroundIn an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic ABR testing; one using a tele-medicine approach and the other a traditional in-person testing at a tertiary care hospital.MethodsVillage health workers (VHWs) underwent a five day training program on conducting Distortion Product Oto Acoustic Emissions (DPOAE) screening and assisting in tele-ABR. VHWs conducted DPOAE screening in 91 villages and hamlets in two administrative units (blocks) of a district in South India. A two-step DPOAE screening was carried out by VHWs in the homes of infants and children under five years of age in the selected villages. Those with ‘refer’ results in 2nd screening were recommended for a follow-up diagnostic ABR testing in person (Group A) at the tertiary care hospital or via tele-medicine (Group B). The overall outcome of the community-based hearing screening program was analyzed with respect to coverage, refer rate, follow-up rate for 2nd screenings and diagnostic testing. A comparison of the outcomes of tele-versus in-person diagnostic ABR follow-up was carried out.ResultsSix VHWs who fulfilled the post training evaluation criteria were recruited for the screening program. VHWs screened 1335 children in Group A and 1480 children in Group B. The refer rate for 2nd screening was very low (0.8%); the follow-up rate for 2nd screening was between 80 and 97% across the different age groups. Integration of tele-ABR resulted in 11% improvement in follow-up compared to in-person ABR at a tertiary care hospital.ConclusionsNon-availability of audiologists and limited infrastructure in rural areas has prevented the establishment of large scale hearing screening programs. In existing programs, considerable challenges with respect to follow-up for diagnostic testing was reported, due to patients being submitted to traveling long distance to access services and potential wage losses during that time. In this program model, integration of a tele-ABR diagnostic follow-up improved follow-up in comparison to in-person follow-up. VHWs were successfully trained to conduct accurate screenings in rural communities. The very low refer rate, and improved follow-up rate reflect the success of this community-based hearing screening program.
Highlights
In an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic auditory brainstem response (ABR) testing; one using a tele-medicine approach and the other a traditional in-person testing at a tertiary care hospital
In an attempt to reach rural areas, this study explores the combination of a community-based pediatric hearing screening program in remote rural villages integrating two models of diagnostic auditory brainstem response (ABR)2 testing; i) using tele-medicine approach ii) in-person at a tertiary care hospital
Outcomes of training Evaluation of knowledge A benchmark criteria of 80% scores in knowledge assessment was set for recruiting Village health worker (VHW) for the screening program
Summary
In an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic ABR testing; one using a tele-medicine approach and the other a traditional in-person testing at a tertiary care hospital. Diagnostic evaluations and management of children referred from the community and school screenings were carried out by an ENT specialist, audiologist or audiometrician at a district hospital [14] This program integrated primary ear care with primary and district health systems, having the potential to reach both urban and rural populations. Impact assessments suggests that lack of infrastructural facilities, as well as shortages of audiologists and equipment in district hospitals plagued the program in several states [16, 17] Such shortcomings in human resources and infrastructure at rural centres makes newborn hearing screening unviable, as parents are unlikely to travel to distant centres for diagnostic testing, due to transportation costs, lost wages or for cultural reasons
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