Implementation and evaluation of a rural community-based pediatric hearing screening program integrating in-person and tele-diagnostic auditory brainstem response (ABR)

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Abstract

Background

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.

Methods

Village 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.

Results

Six 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.

Conclusions

Non-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.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3827-x) contains supplementary material, which is available to authorized users.

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Most cited references 31

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A mobile telemedicine-enabled ear screening service for Indigenous children in Queensland: activity and outcomes in the first three years.

Chris Perry, Anthony Smith, Xiao-wei Wu … (2012)

A mobile ear-screening service was established in an Aboriginal community in central Queensland. Telemedicine allowed ear nose and throat (ENT) specialists at the tertiary children's hospital in Brisbane to assess children at a distance using pre-recorded information comprising video-otoscopic images and the results of tympanometry and audiometry. During the first three years, 1053 children were registered with the service. A total of 2111 screening assessments were carried out at 21 schools in the region. The average screening rate achieved in the community was 85%. More than half of all assessments resulted in a referral to the ENT specialist (for online assessment) or local doctor (for treatment). Twenty specialist ENT online clinics were conducted during which 415 patients were reviewed. Over half of all online review cases (55%) resulted in appointments at the next ENT outreach clinic for further review and/or surgery. The community-based screening service led by local Indigenous health workers, and linked to a tertiary children's hospital by telemedicine, was an effective method for routine screening of children at risk of hearing impairment.

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Progress towards early detection services for infants with hearing loss in developing countries

Bolajoko O Olusanya, De Wet Swanepoel, Mônica Chapchap … (2007)

Background Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region. Methods A cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline. Results Pilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes. Conclusion Lack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery.

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Evaluating loss to follow-up in newborn hearing screening in Massachusetts.

R MacNeil, Michael Farrell, Wanda Barfield … (2008)

The purpose of this work was to examine loss to follow-up on the use of diagnostic or intervention services for Massachusetts infants and children screened or diagnosed with hearing loss and risk factors for becoming lost to follow-up. We used data from the Massachusetts Childhood Hearing Data System and Early Intervention Information System. We calculated the percent use of audiologic evaluation for Massachusetts infants born in 2002-2003 who did not pass hearing screening and Early Intervention services for those with hearing loss. We generated crude and adjusted relative risks, as well as confidence intervals, to estimate associations of maternal and infant factors with the use of audiologic evaluation and early intervention services. Factors evaluated included child's birth weight and hearing screening or diagnostic results and maternal age, race or ethnicity, marital status, smoking status during pregnancy, educational attainment, health insurance, and residence region. In 2002-2003, 11% of Massachusetts children who did not pass hearing screening became lost to follow-up on the audiologic evaluation, and 25% of those with hearing loss did not receive early intervention services. Children were at higher risk of becoming lost to follow-up on audiologic evaluation if their mothers were nonwhite, covered by public insurance, smokers during pregnancy, or residing in western, northeastern, or southeastern Massachusetts compared with those in the Boston region. Of children with hearing loss, those with a unilateral or mild or moderate degree of hearing loss, normal birth weight, or living in the southeastern or Boston region were more likely to go without early intervention services. Massachusetts has excellent follow-up rates overall. Our analyses allow the program to prioritize limited resources to subgroups of infants who are at high risk of becoming lost to follow-up.

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Author and article information

Contributors

Vidya Ramkumar: vidya.ramkumar@sriramachandra.edu.in , vidya.ramkumar@gmail.com

Roopa Nagarajan: roopanagarajan@sriramachandra.edu.in

Vanaja C. Shankarnarayan: csvanaja@gmail.com

Selvakumar Kumaravelu: selvaneuro@yahoo.co.in

James W. Hall: jwhall3phd@gmail.com

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 3 January 2019

Publication date PMC-release: 3 January 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 1

Affiliations

[1 ]Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Na du-400116 India

[2 ]ISNI 0000 0004 0503 0903, GRID grid.411681.b, Department of Audiology & Speech Language Pathology, , Bharati Vidyapeeth Deemed University, ; Pune, India

[3 ]Department of Neurosurgery, Chairman Telemedicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India

[4 ]ISNI 0000 0001 2168 8324, GRID grid.261241.2, Department of Audiology, , Nova Southeastern University, ; Fort Lauderdale, USA

[5 ]ISNI 0000 0001 2107 2298, GRID grid.49697.35, Department of Communication Pathology, , University of Pretoria, ; Pretoria, South Africa

Article

Publisher ID: 3827

DOI: 10.1186/s12913-018-3827-x

PMC ID: 6318860

PubMed ID: 30606168

SO-VID: f2450f8c-c4d1-4efc-a928-e88e4d4b1609

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 8 May 2018

Date accepted : 17 December 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001411, Indian Council of Medical Research;

Award ID: 5/8/10-4 (Oto)/2010-NCD-I

Award Recipient : Selvakumar Kumaravelu

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ScienceOpen disciplines: Health & Social care

Keywords: community-based program,paediatric hearing screening,tele-audiology,tele-auditory brainstem response

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ScienceOpen disciplines: Health & Social care

Keywords: community-based program, paediatric hearing screening, tele-audiology, tele-auditory brainstem response

Implementation and evaluation of a rural community-based pediatric hearing screening program integrating in-person and tele-diagnostic auditory brainstem response (ABR)

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Most cited references 31

A mobile telemedicine-enabled ear screening service for Indigenous children in Queensland: activity and outcomes in the first three years.

Progress towards early detection services for infants with hearing loss in developing countries

Evaluating loss to follow-up in newborn hearing screening in Massachusetts.

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