Early hearing detection and intervention in South Africa: Exploring factors compromising service delivery as expressed by caregivers

Barriers and facilitators influencing hearing help-seeking behaviors for adults in a peri-urban community in South Africa: a preventive audiology study

Objective

This study aims to examine the barriers and facilitators to accessing ear and hearing care experienced by adults with hearing impairment in a developing South African context.

Methods

A total of 23 participants were recruited through purposive sampling from an audiology department of a public hospital in peri-urban South Africa. Individual semi-structured interviews were conducted to capture a broad range of perspectives. Data were analyzed through thematic analysis.

Results

Socio-economic factors acted as the primary barrier while structural and health system factors were the main facilitator in influencing participants' journeys toward hearing help-seeking.

Conclusion

Help-seeking decisions made by adults with hearing impairment are impacted by numerous factors. Individual, providers, and environmental factors combine to play a significant role in resolving ear and hearing complaints. Socio-economic and healthcare level gaps reveal the inequalities that affect help-seekers, which, therefore, need to be addressed. The provision of equitable audiology services within hearing health policy is critical for the prevention of severe consequences of hearing impairment. Plans to implement universal healthcare through the National Health Insurance (NHI) by the South African government must include the universal access to preventive audiology services.

Modeling Lost to Intervention in Early Hearing Detection and Intervention: A Modified eDelphi Study

PURPOSE

The purpose of this study was to develop a functional model of the drivers behind why families may decline early intervention services following the identification of a child as D/deaf or hard of hearing.

METHOD

This model was developed using a modified eDelphi method. Invited experts (N = 155) were provided proposed models of why families may decline early intervention services in accordance with current literature. In the first phase of feedback, participants (n = 23) provided changes they would make to the model to be more in line with their perceptions of lost to intervention. These changes were implemented, and a second phase of feedback with participants (n = 25) moved to accept the model as presented.

RESULTS

Agreement was reached on five main barriers to early intervention access for children who have been identified as D/deaf or hard of hearing (family experience, family culture, perceived vulnerability, perceived benefits, and perceived barriers). Each of these main barriers has associated examples of how they may manifest across different early intervention programs and situations.

CONCLUSIONS

This is the first theoretical model of why loss to intervention happens within early hearing detection and intervention. Having a model provides the opportunity for future work to implement novel approaches to support families during the early intervention enrollment process.

Assessment of Hearing Impairment in Sick Newborns: A Prospective Observational Study

BACKGROUND

 Undiagnosed neonatal hearing loss causes severe language, cognitive, and behavioral problems in children. Sick newborns who spend 48 hours in the neonatal intensive care unit (NICU) have a 10- to 20-fold increased risk of permanent hearing loss. The aim of this study is to identify hearing impairment in high-risk sick newborns who spend at least 48 hours in the NICU.

METHODS

 The present prospective observational study was conducted at a single center. All sick neonates admitted to the NICU for a minimum of 48 hours at the JK Lon Hospital, Zanana Hospital, and Mahila Chikitsalaya, Sawai Man Singh (SMS) Medical College, Jaipur, Rajasthan, India, from June 2017 to May 2018 were considered eligible for the study. The primary outcome was the assessment of hearing loss of high-risk newborns using otoacoustic emissions at the time of discharge, six weeks of age, and automated auditory brainstem response (AABR) at three months of chronological age. The secondary outcome was to analyze the association of hearing loss with different risk factors in high-risk neonates.

RESULTS

 A total of 150 infants who had one or more risk factors were studied, 60 were female and 90 were male. No statistically significant difference in hearing loss was observed based on birth weight, sex, and gestational age. The first distortion-product otoacoustic emission (DPOAE) screening was done on infants at the time of discharge from the NICU. Eighty-three infants (55.33%) had "refer" on the first DPOAE and the remaining 67 (44.67%) were passed results at the time of discharge. At six weeks of life, on repeat screening with a second DPOAE test, 36% "refer" on the first screen had a "refer" result on the second DPOAE. However, 4.4% "pass" on the first screen turned out to be "refer" on the second screen. These 33 infants who had "refer" results on the second screen were subjected to testing. At 10 weeks of life, AABR was performed on 33 infants. Eleven infants out of 33 had sensorineural hearing loss (SNHL) on AABR. Hearing impairment with the DPOAE test was observed with risk factors neonatal hyperbilirubinemia (NHH), hypoxic ischemic encephalopathy (HIE), and very low birth weight (VLBW) and was statistically significant among all risk factors. But, no such association (between hearing impairment and risk factors) was observed with the AABR test. In our study, we found that the duration of mechanical ventilation in mean days 7.67±6.24 had statistically significant SNHL compared to the lesser duration of mechanical ventilation (p<0.001).

CONCLUSION

Two-stage DPOAE done prior to AABR is helpful in the early detection of hearing loss.

Barriers to access to ear and hearing care services in low- and middle- income countries: A scoping review

People living in low- and middle- income countries (LMICs) meet significant challenges in accessing ear and hearing care (EHC) services. We conducted a scoping review to identify and summarise such barriers, to recognise gaps in the literature, and to identify potential solutions. Reviewers independently screened titles, abstracts and full-text articles and charted data. We undertook thematic analysis of supply and demand side dimensions of access, and summarised findings mapped against the Levesque framework. Of 3048 articles screened, 62 met inclusion criteria for review. Across the five access dimensions, supply-side constraints were more frequently described, the most common being a shortage of EHC workforce or appropriate facilities, despite high demand. We identified a thin geographical spread of literature on barriers to accessing EHC services in LMICs, reflecting low availability of such services. LMICs face a diverse range of demand and supply side challenges including workforce, equipment and resource shortages, and challenges for the majority of the population to pay for such services. There is a need for many LMICs to develop health policy and programmes in EHC, including integration into primary care, scaling up the EHC workforce through increased training and education, and improving EHC literacy through public health measures.

A proposed artificial intelligence-based real-time speech-to-text to sign language translator for South African official languages for the COVID-19 era and beyond: In pursuit of solutions for the hearing impaired

Background

The emergence of the coronavirus disease 2019 (COVID-19) pandemic has resulted in communication being heightened as one of the critical aspects in the implementation of interventions. Delays in the relaying of vital information by policymakers have the potential to be detrimental, especially for the hearing impaired.

Objectives

This study aims to conduct a scoping review on the application of artificial intelligence (AI) for real-time speech-to-text to sign language translation and consequently propose an AI-based real-time translation solution for South African languages from speech-to-text to sign language.

Methods

Electronic bibliographic databases including ScienceDirect, PubMed, Scopus, MEDLINE and ProQuest were searched to identify peer-reviewed publications published in English between 2019 and 2021 that provided evidence on AI-based real-time speech-to-text to sign language translation as a solution for the hearing impaired. This review was done as a precursor to the proposed real-time South African translator.

Results

The review revealed a dearth of evidence on the adoption and/or maximisation of AI and machine learning (ML) as possible solutions for the hearing impaired. There is a clear lag in clinical utilisation and investigation of these technological advances, particularly in the African continent.

Conclusion

Assistive technology that caters specifically for the South African community is essential to ensuring a two-way communication between individuals who can hear clearly and individuals with hearing impairments, thus the proposed solution presented in this article.

Analysis of barriers and facilitators to early hearing detection and intervention in KwaZulu-Natal, South Africa

Background

Objectives

Method

Results

Conclusion

Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review

Background: Neurological impairments (NI) and disability are common among older children in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical and rehabilitative care by children and adolescents with NI in LMICs.

Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all studies reporting on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches.

Results: Our literature searches identified 3,258 reports of which 20 were included in the final analysis. Fifteen studies (75.0%) originated from diverse settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=17, 85.0%), geographical and physical inaccessibility (N=14, 70.0%), inadequate healthcare resources (N=14, 70.0%), prohibitive culture and beliefs (N=12, 60.0%), and inadequate education/awareness (N=11, 55.0%). Factors reported in <50% of the studies included competing domestic roles (N=4, 20%) and a lack of confidentiality for personal information (N=2, 10.0%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level.

Conclusions: Financial constraints, geographic and physical inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs.

PROSPERO registration: CRD42020165296 (28/04/2020)

Contextually appropriate school entry hearing screening protocol for low- and middle-income countries: A scoping review

BACKGROUND

In low- and middle-income countries (LMICs), where universal newborn hearing screening programmes are often not available, school entry hearing screening programmes serve as a safeguard for early detection and intervention for hearing loss in school learners.

OBJECTIVE

To determine a contextually appropriate school entry hearing screening protocol for LMICs.

METHODS

A scoping review was utilised to comprehensively search for relevant publications in the following electronic databases: Africa-Wide Information, CINAHL, Health Source: Nursing/Academic Edition, Cochrane Library, Pubmed, Scopus, and Web of Science. Studies included those that investigated school-based hearing screening protocols or programmes for LMICs among learners aged five to twelve years. The review was conducted and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.

RESULTS

The search yielded 1863 studies, and after removing duplicates and ineligible studies, 19 studies were selected for data extraction. Pure tone audiometry screening was the most frequently used age-appropriate hearing screening test in the reviewed studies (n = 17). Conducting pure tone audiometry screening using 1, 2, and 4 kHz frequency combination resulted in referral rates ranging from 3.2% to 21%. In studies that included 0.5 kHz to the screening frequencies, referral rates ranged from 5.8% to 56%. Screening at 25 dB HL intensity level yielded referral rates ranging from 3.2% to 10.3%. Immediate rescreening reduced overall referral rates for learners referred for audiological diagnostic testing by up to 57%. Ambient noise levels were controlled by conducting screening in quiet rooms (n = 14) and utilising screening equipment that allows for monitoring and reducing environmental noise (n = 3).

CONCLUSION

An ideal school entry hearing screening protocol in LMIC contexts could potentially utilise pure tone audiometry screening at 1, 2, and 4 kHz, using 25 dB HL screening intensity level with an immediate rescreen for learners with a refer result. School entry hearing screening should be conducted in a quiet room, preferably using hearing screening equipment capable of monitoring ambient noise levels to reduce false positive referrals.

Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review

Background: Neurological impairments (NI) and disability are common among survivors of childhood mortality in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all reports on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches, and we report a synthesized analysis of the barriers identified in the primary studies. Results: Our literature searches identified 3,074 reports of which 16 were included in the final analysis. Fourteen studies (87.5%) originated from rural settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=15, 93.8%), geographical inaccessibility (N=11, 68.8%), inadequate healthcare resources (N=11, 68.8%), inadequate education/awareness (N=9, 56.3%), and prohibitive culture/beliefs (N=9, 56.3%). Factors reported in <50% of the studies related to the attitude of the patient, health worker, or society (N=7, 43.8%), poor doctor-patient communication (N=5, 31.3%), physical inaccessibility (N=3, 18.8%), and a lack of confidentiality for personal information (N=2, 12.5%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020)

What are the current practices employed by audiologists in early hearing detection and intervention in the South African healthcare context?

BACKGROUND

Universal access to early hearing detection and intervention (EHDI) forms part of the audiology community's goal. Evidence on current practices employed by South African audiologists in EHDI in order to ensure this universal access and success for children with hearing impairment is therefore required, hence this study.

METHODS

A quantitative survey research methodology with a cross-sectional design was employed. An online survey was completed by 49 qualified audiologists and dually qualified speech therapists and audiologists. Data were analysed using descriptive statistics.

RESULTS

Results identified gaps in the implementation of EHDI within the South African context. A total of 83.7% of the participants were involved in newborn hearing screening (NHS), with over half adopting the targeted screening approach instead of universal NHS services (UNHS). Capacity versus Demand challenges play a significant role in the lack of successful implementation of NHS with over 60% of the audiologists in the sample reporting that NHS is and should only be conducted by audiologists only; with minimal evidence of task shifting found. No standardised screening protocol was found, with challenges around budget allocation for EHDI revealed.

CONCLUSIONS

Although progress has been noted, a) gaps between public and private healthcare sector resources allocations and availability, b) limited contextually responsive strategic planning, as well as c) lack of translation of knowledge, policies and guidelines into practice, are glaring areas that require attention by the South African audiology community.

Community-Based Hearing and Vision Screening in Schools in Low-Income Communities Using Mobile Health Technologies

Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening (OR = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening (OR = 0.87, 95% CI [0.79, 0.96]). A third (32.5%) of referred cases followed up for air-conduction threshold audiometry, and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%, 19/26) or vision loss (57.8%, 26/45). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.

El impacto de las tecnologías educativas en la formación de profesionales a cargo de la atención neonatal

Introducción: Se observa el avance existente en la producción de tecnologías educativas para facilitar el aprendizaje, la formación y la solución a las necesidades que surgen del proceso de trabajo de los profesionales que prestan servicios en las unidades neonatales. Objetivo: Evaluar el impacto de las tecnologías educativas utilizadas en la formación de profesionales a cargo de la atención neonatal. Materiales y métodos: Se llevó a cabo una revisión integradora de la literatura en PubMed, CINAHL, Scopus, Web of Science, ScienceDirect y LILACS en el periodo entre agosto y septiembre de 2017. Se cruzaron los descriptores de aplicaciones móviles “personal de salud, niños, recién nacidos, multimedia, aprendizaje, salud móvil, aplicaciones, neonatos y educación sanitaria” y se analizaron 12 artículos en total. Resultados: En los estudios se utilizaron diferentes tecnologías de enseñanza, desde las metodologías tradicionales hasta las metodologías activas, con la exposición de materiales educativos impresos junto con las tecnologías de la información y la comunicación. La mayoría de los estudios mostraron una mejora en el conocimiento, las habilidades y el cumplimiento de las directrices relacionadas con el cuidado crítico del recién nacido. Discusión: Las tecnologías educativas de corta y mediana duración que se emplearon para la atención neonatal permitieron ampliar los conocimientos y las habilidades profesionales. Las tecnologías impresas favorecieron el desarrollo de un enfoque comunicativo horizontal, lo que repercutió en el empoderamiento y la autonomía de los participantes. Los dispositivos móviles, por su parte, brindaron un apoyo inmediato al cuidador mediante el acceso a una gran diversidad de contenidos educativos desde cualquier lugar, lo que ayudó a aclarar las dudas relacionadas con la aplicación de procedimientos. Conclusión: Las tecnologías educativas utilizadas en la formación de los profesionales se encuentran diversificadas y son aplicables en diferentes escenarios de la atención neonatal, lo que repercute en el aprendizaje y los resultados en materia de salud del recién nacido Como citar este artículo: Balbino, Aldiania Carlos; Silva, Amanda Newle Sousa; Queiroz, Maria Veraci Oliveira. O impacto das tecnologias educacionais no ensino de profissionais para o cuidado neonatal. Revista Cuidarte. 2020; 11(2): e954. http://dx.doi.org/10.15649/cuidarte.954