Abstract
BackgroundThe majority of children with sensory impairments live in low- and middle-income countries. More studies of hearing and vision impairment prevalence are needed, in order to generate more accurate estimates of trends in sensory impairments. This study aimed to estimate the prevalence and describe the characteristics of hearing and vision loss among preschool children (4–7 years) in an underserved South African community following community-based mobile health (mHealth) supported hearing and vision services.MethodsA screening program of sensory impairments was undertaken of children attending preschools in the communities of Khayelitsha and Mitchell’s Plain, Cape Town, from September 2017 until June 2019. Hearing and vision screening were done by trained community health workers using mHealth technology. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were conducted using smartphones that host point-of-care validated and calibrated hearing and vision testing applications (hearTest app, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). Descriptive statistical analysis and logistic regression analysis were conducted after extracting data from a secure cloud-based server (mHealth Studio, hearX Group) to Microsoft Excel (2016).ResultsA total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6 and 4.4% of children failed hearing and vision screening respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of children of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was done on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.05), but not for hearing loss (p = 0.06). Gender was not a significant predictor of hearing (p = 0.22) or vision loss (p = 0.20).ConclusionsHearing loss is prevalent in at least 22 per 1000 and vision loss in at least 23 per 1000 preschool children in an underserved South African community. Timely identification of sensory losses can be facilitated through community-based hearing and vision services supported by mHealth technology.
Highlights
The majority of children with sensory impairments live in low- and middle-income countries
Follow‐up hearing test Follow-up hearing tests at the preschools were done on 88.5% (514) of children of whom 240 children (54.2% female) presented with hearing loss (Table 1 and Fig. 1)
They were referred to the health care clinic for further tests, but they were not included as children with a hearing loss in this study
Summary
The majority of children with sensory impairments live in low- and middle-income countries. The majority of children (80 to 90%) with sensory impairments live in low- and middle-income countries (LMICs) [2, 4, 10, 12] where services are usually unavailable or inaccessible, because of an absence of systematic screening programmes for children, prohibitive equipment cost and a shortage of trained personnel [11, 17, 18]. The prevalence of hearing and vision loss for children aged between 5 and 9 years are estimated at 4.5 and 3.1% respectively in sub-Saharan Africa in contrast to 2.2 and 1.3% respectively in high-income North America, demonstrating the need for attention to sensory impairment in LMICs [2]. Most cases of childhood hearing and vision loss have preventable causes that are common in low-to-middle-income countries (LMICs) and is often related either to infection or nutrition [8,9,10, 16, 19]. Children with disabilities in LMICs have considerably limited access to non-emergency health resources [11, 19] and are prone to be left behind under the SDGs era without timely and appropriate intervention from early childhood [2, 16, 20]
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