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de Cates C, Jashek-Ahmed F, Bohara RB, Salter C, Youngs R. How chronic ear disease affects quality of life: a qualitative research study in Nepal. J Laryngol Otol 2023; 137:390-397. [PMID: 35485736 DOI: 10.1017/s0022215122001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hearing loss is the third leading cause globally for 'years lived with disability'. The majority of those affected live in low and middle-income countries. METHOD This study used qualitative research methods to explore the impact of chronic ear disease on quality of life in Nepal. Twenty face-to-face semi-structured interviews were conducted during a visiting ear camp at the Britain Nepal Otology Service Ear Care Centre in Nepal. Interviews were recorded, transcribed and translated with thematic content analysis performed manually by two researchers. RESULTS Chronic ear disease has a significant impact on social interactions, emotional well-being and functionality. Barriers to surgery are cost, accessibility, reputation, gender and fear of complications. CONCLUSION This study provided valuable new insight into patient perspectives on living with chronic ear disease in Nepal. Patients with chronic ear disease experience discrimination and stigmatisation across all levels of personal, family and social life, with their function across all domains being directly limited by symptoms.
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Affiliation(s)
- C de Cates
- Department of Otolaryngology, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
| | - F Jashek-Ahmed
- West Middlesex Hospital, Chelsea & Westminster NHS Foundation Trust, London, UK
| | - R B Bohara
- Britain Nepal Otology Service Ear Care Centre, Nepalgunj, Nepal
| | - C Salter
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - R Youngs
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
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Coco L, Carvajal S, Navarro C, Piper R, Marrone N. Community Health Workers as Patient-Site Facilitators in Adult Hearing Aid Services via Synchronous Teleaudiology: Feasibility Results from the Conexiones Randomized Controlled Trial. Ear Hear 2023; 44:28-42. [PMID: 36253920 PMCID: PMC9780168 DOI: 10.1097/aud.0000000000001281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the feasibility of Community Health Workers (CHWs) as patient-site facilitators in teleaudiology-facilitated hearing aid services to improve hearing aid rehabilitation outcomes for older Hispanic/Latino adults in a medically underserved, rural, US-Mexico border community. DESIGN A total of 28 adults (aged 55 to 89) with bilateral hearing loss participated in this study. Individuals were randomized to one of two teleaudiology intervention arms that differed at the level of the patient-site facilitator. Participants in the experimental group were assisted locally by trained CHW facilitators. Participants in the control group were assisted locally by trained university student facilitators. Synchronous (real-time) teleaudiology hearing aid services took place with participants located at a rural community health center and the clinician located a university 70 miles away. The results of this feasibility study are presented within the reach, effectiveness, adoption, implementation fidelity, and maintenance implementation framework. RESULTS Regarding reach, the participants in this study population are historically under-represented in research (primarily low-income Hispanic/Latino older adults). A total of 57 individuals were recruited, 47 were consented and assessed for eligibility and 28 individuals met inclusion criteria and were randomized. The average age of participants was 73.9 years, (range: 55 to 89 years) and most individuals were female (75%). Most participants (86%) reported having incomes less than $20,000 annually. Effectiveness results (via the Self Efficacy for Situational Communication Management Questionnaire) showed that both groups (CHW and control) significantly improved listening self-efficacy from pre-fitting baseline and no difference between groups was observed. Regarding datalogging, at the short-term follow-up, participants in the CHW group wore their hearing aids for more hours/day on average compared with participants in the control group. Implementation fidelity was high for both groups. Long-term maintenance of CHW-supported teleaudiology appears feasible given that training and institutional support is in place. CONCLUSIONS Teleaudiology-delivered hearing aid services were feasible when facilitated locally by trained CHWs. Future efficacy and effectiveness research is warranted with CHWs and teleaudiology, potentially leading to a significant reduction in barriers for rural and medically under-resourced communities.
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Affiliation(s)
- Laura Coco
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson, AZ
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA
| | - Scott Carvajal
- Health Behavior Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | | | - Rosie Piper
- Mariposa Community Health Center, Nogales, AZ
| | - Nicole Marrone
- Department of Speech, Language, and Hearing Sciences, College of Science, University of Arizona, Tucson, AZ
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Coco L, Piper R, Marrone N. Feasibility of community health workers as teleaudiology patient-site facilitators: a multilevel training study. Int J Audiol 2021; 60:663-676. [PMID: 33403874 PMCID: PMC8628855 DOI: 10.1080/14992027.2020.1864487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We evaluated the feasibility of a multi-level teleaudiology patient-site facilitator training program for Community Health Workers (CHWs) at a partnering health centre in southern Arizona. DESIGN Three levels were offered: Introductory, with basic information on hearing loss and teleaudiology; Intermediate, on technology, team roles, and access issues; and Facilitator, on further knowledge and hands-on skills to serve as patient-site facilitators in synchronous hearing aid service delivery. Six domains of feasibility were addressed using a mixed-methods design. Quantitative data included survey responses and observation of hands-on skills. Qualitative data included field notes from group discussion and open-ended survey questions, and were analysed using CHW core competencies. STUDY SAMPLE Twelve CHWs participated in the introductory training, ten moved on to intermediate, and three continued to the facilitator. RESULTS Quantitative outcomes indicated that the trainings were feasible according to each of the six domains. CHWs in the facilitator training passed the practical hands-on skill assessment. Qualitative analyses revealed CHWs comments addressed eight of the ten possible CHW core competencies, and focussed on service coordination/navigation, and capacity building. CONCLUSIONS Teleaudiology trainings for CHWs were feasible, increasing service capacity for a potential pathway to improve access to hearing health care in low-resource areas.
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Affiliation(s)
- Laura Coco
- University of Arizona, College of Science, Department of Speech, Language, and Hearing Sciences, Tucson, Arizona, USA
| | - Rosie Piper
- Mariposa Community Health Center, Nogales, Arizona, USA
| | - Nicole Marrone
- University of Arizona, College of Science, Department of Speech, Language, and Hearing Sciences, Tucson, Arizona, USA
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Kumar S, Aramani A, Mathew M, Bhat M, Rao VV. Prevalence of hearing impairment amongst school going children in the rural field practice area of the institution. Indian J Otolaryngol Head Neck Surg 2019; 71:1567-1571. [PMID: 31750218 DOI: 10.1007/s12070-019-01651-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/05/2019] [Indexed: 12/12/2022] Open
Abstract
Worldwide, over 275 million people are estimated to have moderate to profound hearing loss in both ears. Children with hearing impairment often experience delayed development of speech and cognitive skills, which may result in slower learning and difficulty in progressing at school. Adequate hearing is one of the main factors for good psychosocial development, by which individuals may express their thoughts, feelings, and wishes, and acquire life experience and knowledge. Therefore, hearing impairment needs to be diagnosed early for prompt therapy. Primary objectives of this study was to know prevalence of hearing impairment amongst primary school children and secondary objective was to identify the common causes of hearing impairment amongst primary school children. The cross sectional study was conducted in the government and private schools of our rural field practice area in 2013-2014 for the duration of 4 months from November 2013 to February 2014. Prevalence of Hearing loss was 8.8%. Most common cause of Hearing loss was Impacted wax and Retracted Tympanic membrane. Otological conditions-Wax followed by otitis media with effusion and chronic suppurative otitis media were the common ear problems found in our study.
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Affiliation(s)
- Saurabh Kumar
- 1Department of Community Medicine, Father Muller Medical College, Mangalore, India
| | - Anita Aramani
- 2Department of Otorhinolaryngology and Head and Neck Surgery, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka 575002 India
| | - Minton Mathew
- Specsavers Hearing Care Limited, Cowley, Oxford, UK.,Department of Speech and Hearing, Father Muller College of Speech and Hearing, Mangalore, India
| | - Mahesh Bhat
- 2Department of Otorhinolaryngology and Head and Neck Surgery, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka 575002 India
| | - Vinay V Rao
- 2Department of Otorhinolaryngology and Head and Neck Surgery, Father Muller Medical College Hospital, Kankanady, Mangalore, Karnataka 575002 India
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O'Donovan J, Verkerk M, Winters N, Chadha S, Bhutta MF. The role of community health workers in addressing the global burden of ear disease and hearing loss: a systematic scoping review of the literature. BMJ Glob Health 2019; 4:e001141. [PMID: 30899572 PMCID: PMC6407559 DOI: 10.1136/bmjgh-2018-001141] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Community health workers (CHWs) have the potential to improve access to ear and hearing services for people across low-income or middle-income countries, remote, underserved, or resource-poor areas of the world. We performed a systematic scoping review to identify evidence on how CHWs are currently deployed in the prevention, screening, diagnosis, treatment and management of ear disease and hearing loss; methods to train and support CHWs in this context; and cost-effectiveness of CHWs. Methods We performed a systematic search of the literature from September 1978 to 18 March 2018 from 11 major databases and the grey literature. Results We identified 38 original studies that met the inclusion criteria, taking place across South Asia (n=13), Oceania (n=7), North America (n=7), South America (n=6) and Africa (n=5). 23 studies showed CHWs can increase community participation in screening. They can conduct screening using whispered voice tests, noisemakers for neonatal screening, automated audiological tests and otoscopy. Eight studies focused specifically on the evaluation of programmes to train CHWs, and three provided a general programme description. Three studies documented a role of CHWs in the treatment of ear disease or hearing loss, such as performing ear washouts, instillation of topical antibiotics or fitting of hearing aids. Only one study provided an indepth cost-utility analysis regarding the use of CHWs to conduct hearing screening, and no studies commented on the role of CHWs in the prevention of hearing loss. Conclusion CHWs have been employed in diverse ways to address the global burden of ear disease and hearing loss. Future research needs to explore the role of CHWs in preventative strategies, identify optimum methods to train and support CHWs, and explore their cost-effectiveness.
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Affiliation(s)
- James O'Donovan
- Department of Education, University of Oxford, Oxford, UK.,Division of Research and Health Equity, Omni Med, Mukono, Uganda
| | - Misha Verkerk
- Department of Otolaryngology, King's College Hospital NHS Foundation Trust, London, UK
| | - Niall Winters
- Department of Education, University of Oxford, Oxford, UK
| | - Shelly Chadha
- WHO Programme for Prevention of Deafness and Hearing Loss, World Health Organization, Geneva, Switzerland
| | - Mahmood F Bhutta
- Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Bhutta MF. Models of service delivery for ear and hearing care in remote or resource-constrained environments. J Laryngol Otol 2019; 133:39-48. [DOI: 10.1017/s0022215118002116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractBackgroundThere is poor availability of ear and hearing services globally, because of a lack of infrastructure, funding, equipment and appropriately trained personnel. When deciding upon delivery of ear and hearing services, an approach based upon community assessment is advocated, with subsequent asset mapping and acquisition.ObjectivesSome of the challenges to delivery of care in resource-constrained or remote environments are acknowledged, with discussion of several existing models of service delivery, and their advantages and disadvantages. Public health and telehealth are also mentioned. This article may assist those trying to set up new programmes in ear and hearing health.
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Samelli AG, Rabelo CM, Sanches SGG, Martinho AC, Matas CG. Tablet-based tele-audiometry: Automated hearing screening for schoolchildren. J Telemed Telecare 2018; 26:140-149. [PMID: 30269641 DOI: 10.1177/1357633x18800856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction To assess the performance of a tablet-based tele-audiometry method for automated hearing screening of schoolchildren through a comparison of the results of various hearing screening approaches. Methods A total of 244 children were evaluated. Tablet-based screening results were compared with gold-standard pure-tone audiometry. Acoustic immittance measurements were also conducted. To pass the tablet-based screening, the children were required to respond to at least two out of three sounds for all the frequencies in each ear. Several hearing screening methods were analysed: exclusively tablet-based (with and without 500 Hz checked) and combined tests (series and parallel). The sensitivity, specificity, positive and negative predictive values and accuracy were calculated. Results A total of 9.43% of children presented with mild to moderate conductive hearing loss (unilateral or bilateral). Diagnostic values varied among the different hearing screening approaches that were evaluated: sensitivities ranged from 60 to 95%, specificities ranged from 44 to 91%, positive predictive values ranged from 15 to 44%, negative predictive values ranged from 95 to 99%, accuracy values ranged from 49 to 88%, and area under curve values ranged from 0.690 to 0.883. Regarding diagnostic values, the highest results were found for the tablet-based screening method and for the series approach. Discussion Compared with the results obtained by conventional audiometry and considering the diagnostic values of the different hearing screening approaches, the highest diagnostic values were generally obtained using the automated hearing screening method (including 500 Hz). Thus, this application, which was developed for the tablet computer, was shown to be a valuable hearing screening tool for use with schoolchildren. Therefore, we suggest that this hearing screening protocol has the potential to improve asynchronous tele-audiology service delivery.
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Affiliation(s)
| | | | | | - Ana C Martinho
- School of Medicine, University of São Paulo (FMUSP), Brazil
| | - Carla G Matas
- School of Medicine, University of São Paulo (FMUSP), Brazil
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Skilton MK, Poole N, Metcalfe CW, Martin TP, Smith MC. The impact of ear disease and hearing impairment on the lives of Nepali patients in Pokhara: a qualitative study. Int Health 2015; 8:101-7. [DOI: 10.1093/inthealth/ihv052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/17/2015] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To compare the efficacy and feasibility of teleaudiometry with that of sweep audiometry in elementary school children, using pure-tone audiometry as the gold standard. METHODS A total of 243 students with a mean age of 8.3 years participated in the study. Of these, 118 were boys, and 125 were girls. The following procedures were performed: teleaudiometry screening with software that evaluates hearing at frequencies of 1,000, 2000 and 4000 Hz at 25 dBHL; sweep audiometry screening in an acoustic booth (20 dBHL at the same frequencies); pure-tone audiometry thresholds in an acoustic booth (frequencies of 500, 1000, 2000 and 4000 Hz); and acoustic immittance measurements. RESULTS The diagnostic capacities of the teleaudiometry/sweep audiometry screening methods were as follows: sensitivity ϝ 58%/65%; specificity ϝ 86%/99%; positive predictive value ϝ 51%/91%; negative predictive value ϝ 89%/92%; and accuracy ϝ 81%/92%. Teleaudiometry and sweep audiometry showed moderate agreement. Furthermore, the use of these methods in series with immittance testing improved the specificity, whereas parallel testing improved the sensitivity. CONCLUSION Teleaudiometry was found to be reliable and feasible for screening hearing in school children. Moreover, teleaudiometry is the preferred method for remote areas where specialized personnel and specific equipment are not available, and its use may reduce the costs of hearing screening programs.
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Affiliation(s)
- Maine Botasso
- Faculdade de Medicina da Universidade de São Paulo, Department of Physiotherapy, Communications Sciences and Disorders and Occupacional Therapy, São Paulo/SP, Brazil
| | - Seisse Gabriela Gandolfi Sanches
- Faculdade de Medicina da Universidade de São Paulo, Department of Physiotherapy, Communications Sciences and Disorders and Occupacional Therapy, São Paulo/SP, Brazil
| | - Ricardo Ferreira Bento
- Faculdade de Medicina da Universidade de São Paulo, Department of Ophthalmology and Otorhinolaryngology, São Paulo/SP, Brazil
| | - Alessandra Giannella Samelli
- Faculdade de Medicina da Universidade de São Paulo, Department of Physiotherapy, Communications Sciences and Disorders and Occupacional Therapy, São Paulo/SP, Brazil
- E-mail:
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Youngs R, Fisher E. ENT's part in the UK's ‘Medical Oscars’. J Laryngol Otol 2013; 127:535-535. [DOI: 10.1017/s0022215113001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gopalan SS, Mohanty S, Das A. Assessing community health workers' performance motivation: a mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme. BMJ Open 2012; 2:e001557. [PMID: 23019208 PMCID: PMC3488714 DOI: 10.1136/bmjopen-2012-001557] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/15/2012] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE This study examined the performance motivation of community health workers (CHWs) and its determinants on India's Accredited Social Health Activist (ASHA) programme. DESIGN Cross-sectional study employing mixed-methods approach involved survey and focus group discussions. SETTING The state of Orissa. PARTICIPANTS 386 CHWs representing 10% of the total CHWs in the chosen districts and from settings selected through a multi-stage stratified sampling. PRIMARY AND SECONDARY OUTCOME MEASURES The level of performance motivation among the CHWs, its determinants and their current status as per the perceptions of the CHWs. RESULTS The level of performance motivation was the highest for the individual and the community level factors (mean score 5.94-4.06), while the health system factors scored the least (2.70-3.279). Those ASHAs who felt having more community and system-level recognition also had higher levels of earning as CHWs (p=0.040, 95% CI 0.06 to 0.12), a sense of social responsibility (p=0.0005, 95% CI 0.12 to 0.25) and a feeling of self-efficacy (p=0.000, 95% CI 0.38 to 0.54) on their responsibilities. There was no association established between their level of dissatisfaction on the incentives (p=0.385) and the extent of motivation. The inadequate healthcare delivery status and certain working modalities reduced their motivation. Gender mainstreaming in the community health approach, especially on the demand-side and community participation were the positive externalities of the CHW programme. CONCLUSIONS The CHW programme could motivate and empower local lay women on community health largely. The desire to gain social recognition, a sense of social responsibility and self-efficacy motivated them to perform. The healthcare delivery system improvements might further motivate and enable them to gain the community trust. The CHW management needs amendments to ensure adequate supportive supervision, skill and knowledge enhancement and enabling working modalities.
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Affiliation(s)
| | | | - Ashis Das
- The World Bank, NW Washington DC, USA
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Samelli AG, Rabelo CM, Pereira MB, Portela MN, Sanches SGG, Neves-Lobo IF. Comparison of screening methods for conductive hearing loss identification in children: low-cost proposal. J Med Screen 2012; 19:1-7. [DOI: 10.1258/jms.2012.011051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the effectiveness of two screening methods (imitanciometry screening and questionnaire) to identify children at risk for conductive hearing loss, comparing this data with complete audiologic evaluation. Methods Of 507 children aged between three and six, 111 completed all procedures. The observational methods used were: imitanciometry screening, a questionnaire to identify risk factors for hearing loss and complete audiologic evaluation. Results obtained in the first two instruments were compared with results from complete audiologic evaluation (gold standard). From these comparisons, sensitivity and specificity, accuracy, positive and negative predictive values, and odds ratio were determined for the two screening methods and for the combination of both methods. Results The two methods applied in series (questionnaire and after imitanciometry screening) showed a greater odds ratio and better correlation between sensitivity and proportion of false-positives (ROC curve). Conclusion Combining the two tests in series improved screening accuracy. This combination was the best tool for identifying children at risk for conductive hearing loss.
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Affiliation(s)
- A G Samelli
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - C M Rabelo
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M B Pereira
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M N Portela
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - S G G Sanches
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - I F Neves-Lobo
- Department of Physical Therapy, Speech-language Pathology and Audiology, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Samelli AG, Rabelo CM, Vespasiano APC. Development and analysis of a low-cost screening tool to identify and classify hearing loss in children: a proposal for developing countries. Clinics (Sao Paulo) 2011; 66:1943-8. [PMID: 22086526 PMCID: PMC3203968 DOI: 10.1590/s1807-59322011001100015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 08/08/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE A lack of attention has been given to hearing health in primary care in developing countries. A strategy involving low-cost screening tools may fill the current gap in hearing health care provided to children. Therefore, it is necessary to establish and adopt lower-cost procedures that are accessible to underserved areas that lack other physical or human resources that would enable the identification of groups at risk for hearing loss. The aim of this study was to develop and analyze the efficacy of a low-cost screening tool to identify and classify hearing loss in children. METHODS A total of 214 2-to-10 year-old children participated in this study. The study was conducted by providing a questionnaire to the parents and comparing the answers with the results of a complete audiological assessment. Receiver operating characteristic (ROC) curves were constructed, and discriminant analysis techniques were used to classify each child based on the total score. RESULTS We found conductive hearing loss in 39.3% of children, sensorineural hearing loss in 7.4% and normal hearing in 53.3%. The discriminant analysis technique provided the following classification rule for the total score on the questionnaire: 0 to 4 points - normal hearing; 5 to 7 points - conductive hearing loss; over 7 points - sensorineural hearing loss. CONCLUSION Our results suggest that the questionnaire could be used as a screening tool to classify children with normal hearing or hearing loss and according to the type of hearing loss based on the total questionnaire score.
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Affiliation(s)
- Alessandra Giannella Samelli
- Centro de Docência e Pesquisa em Fonoaudiologia, Fisioterapia e Terapia Ocupacional, Universidade de São Paulo, São Paulo, Brazil.
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Youngs R, Weir N, Tharu P, Bohara RB, Bahadur D. Diagnostic otoscopy skills of community ear assistants in Western Nepal. J Laryngol Otol 2011; 125:27-9. [DOI: 10.1017/s0022215110001891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:Deafness is a major problem in developing countries. Rural communities tend to be affected more than urban ones, and chronic otitis media is common. The World Health Organization has proposed primary ear care as a method of providing otological services in developing countries. This study aimed to assess the diagnostic otoscopy skills of community ear assistants in rural Western Nepal.Materials and methods:Community ear assistants undertook the pre-operative evaluation of 92 patients selected for middle-ear surgery in an ‘ear camp’ setting. The otoscopy skills of community ear assistants were also assessed by means of an otoscopy quiz. Consultant otologists and trainee otolaryngologists underwent an identical assessment.Results:The community ear assistants' selection of patients for middle-ear surgery concurred with the consultant otologists' opinion in 87 of 92 patients (94.5 per cent). The level of community ear assistants' otoscopy skills was between that of junior and senior otolaryngology trainees.Conclusions:With intensive training, medically unqualified community ear assistants can develop otoscopy skills comparable to those of medically qualified otolaryngology trainees. These results support the development of primary ear care in poorer countries where access to specialist otological services is difficult or impossible.
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Glenton C, Scheel IB, Pradhan S, Lewin S, Hodgins S, Shrestha V. The female community health volunteer programme in Nepal: decision makers' perceptions of volunteerism, payment and other incentives. Soc Sci Med 2010; 70:1920-1927. [PMID: 20382464 DOI: 10.1016/j.socscimed.2010.02.034] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 01/29/2010] [Accepted: 02/08/2010] [Indexed: 11/29/2022]
Abstract
The Female Community Health Volunteer (FCHV) Programme in Nepal has existed since the late 1980s and includes almost 50,000 volunteers. Although volunteer programmes are widely thought to be characterised by high attrition levels, the FCHV Programme loses fewer than 5% of its volunteers annually. The degree to which decision makers understand community health worker motivations and match these with appropriate incentives is likely to influence programme sustainability. The purpose of this study was to explore the views of stakeholders who have participated in the design and implementation of the Female Community Health Volunteer regarding Volunteer motivation and appropriate incentives, and to compare these views with the views and expectations of Volunteers. Semi-structured interviews were carried out in 2009 with 19 purposively selected non-Volunteer stakeholders, including policy makers and programme managers. Results were compared with data from previous studies of Female Community Health Volunteers and from interviews with four Volunteers and two Volunteer activists. Stakeholders saw Volunteers as motivated primarily by social respect, religious and moral duty. The freedom to deliver services at their leisure was seen as central to the volunteer concept. While stakeholders also saw the need for extrinsic incentives such as micro-credit, regular wages were regarded not only as financially unfeasible, but as a potential threat to the Volunteers' social respect, and thereby to their motivation. These views were reflected in interviews with and previous studies of Female Community Health Volunteers, and appear to be influenced by a tradition of volunteering as moral behaviour, a lack of respect for paid government workers, and the Programme's community embeddedness. Our study suggests that it may not be useful to promote a generic range of incentives, such as wages, to improve community health worker programme sustainability. Instead, programmes should ensure that the context-specific expectations of community health workers, programme managers, and policy makers are in alignment if low attrition and high performance are to be achieved.
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Affiliation(s)
- Claire Glenton
- Department of Global Health and Welfare, SINTEF Society and Technology, P.O. Box 124 Blindern, Oslo 0314, Norway.
| | - Inger B Scheel
- Department of Global Health and Welfare, SINTEF Society and Technology, P.O. Box 124 Blindern, Oslo 0314, Norway
| | | | - Simon Lewin
- Norwegian Knowledge Centre for the Health Services, Norway; Medical Research Council of South Africa, Cape Town, South Africa
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Olusanya BO, Somefun AO. Place of birth and characteristics of infants with congenital and early-onset hearing loss in a developing country. Int J Pediatr Otorhinolaryngol 2009; 73:1263-9. [PMID: 19540001 DOI: 10.1016/j.ijporl.2009.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 05/20/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the characteristics of infants with sensorineural hearing loss (SNHL) and the relationship with place of birth. METHODS Subjects were drawn from hospital-based and community-based universal infant hearing screening programs concurrently conducted from May 2005 to April 2008 in Lagos, Nigeria. Maternal and infant characteristics of children born in hospitals and detected with SNHL were compared with those born outside hospitals. Each program consisted of a first-stage screening with transient-evoked otoacoustic emissions (TEOAE) followed by second-stage automated auditory brainstem response (AABR). Hearing status was confirmed by diagnostic auditory brainstem response, tympanometry and visual response audiometry. RESULTS A total of 4718 infants were screened under the hospital-based program out of which 12 (0.3%) infants were confirmed with SNHL whereas 71 (1.0%) of the 7179 infants screened under the community-based program were confirmed with SNHL. Of all infants with SNHL 39 (47.0%) were born in hospitals suggesting that 27 (38.0%) of infants under the community-based program were born in hospitals. Prevalence of SNHL ranged from 4.0 per 1000 among infants born in government hospitals to 23 per 1000 among those born in family homes. Mothers of those born outside hospitals were significantly likely to belong to the Yoruba tribe (p<0.001), use herbal medications in pregnancy (p<0.001), deliver vaginally (p=0.004) but without skilled attendants at delivery (p<0.001). There were no significant differences among the infants themselves except that those born outside hospitals were significantly likely to be detected in the first 3 months of life compared to those born in hospitals (p<0.001). CONCLUSIONS A significant proportion of infants with SNHL in many developing countries are likely to be born outside hospitals thus underscoring the need for community-oriented UNHS to facilitate early detection and intervention. Conventional risk factors for SNHL are unlikely to discriminate across places of birth. Pediatricians and otolaryngologists should consider a more active role in fostering community-oriented delivery of primary ear care services in this and similar settings in the developing world.
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Affiliation(s)
- Bolajoko O Olusanya
- Maternal and Child Health Unit, Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria.
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Abstract
BACKGROUND Parental support for infant hearing loss is essential for a successful infant screening programme. However, in developing countries where unfavourable customs and beliefs towards childhood disabilities have been reported, parental support towards infant screening is uncertain and there is presently no published evidence on the subject. OBJECTIVE To elicit the views of mothers and would-be mothers in order to ascertain their knowledge on infant hearing loss and their attitudes towards infant hearing screening. METHODS A structured questionnaire consisting of 15 questions was administered to 101 mothers (mean age 31.6+/-7.3 years, range: 21-55 years) attending two community hospitals in Lagos, Nigeria. The responses were evaluated by descriptive statistics, factor analysis of the principal components and multiple regression analysis. The reliability of the two main domains (knowledge and attitude) was tested for internal consistency by Cronbach's alpha coefficient. RESULTS Maternal knowledge was highest for measles (73%; mean score 2.54) and ear discharge (73%; mean score 2.51) but low for birth asphyxia (37%; mean score 1.90), traditional medicine (42%; mean score 2.03) and jaundice (47%; mean score 2.09) as causes of hearing loss. Attitude towards neonatal screening was positive in majority of mothers (92%; mean score 2.84) and there was a high acceptance of hearing aids as an early intervention option (84%; mean score 2.70). Five factors (eigenvalue>1) were extracted after principal component analysis with the attitude variables loading highly and exclusively on one factor. Age was the only demographic variable that was associated with a domain (knowledge) after multiple regression analysis. The component scales for the two domains were highly internally consistent (alpha coefficients of 0.84 and 0.83). CONCLUSIONS Contrary to the concerns often expressed about parental support for infant hearing screening programmes in developing countries, this study suggests that current parental knowledge and attitude favour early detection and intervention of childhood hearing impairment.
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Affiliation(s)
- B O Olusanya
- Academic Unit of Audiological Medicine, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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