Vision, hearing loss screened by phone
HEALTHY hearing and vision in early childhood are the foundation for success at school. Hearing and vision difficulties are the most common developmental disabilities in children younger than 5 years, with more than 40 million affected globally.
More than 90% of children with hearing or vision loss live in low and middle-income countries where early detection services are unavailable.
Often called invisible disabilities, hearing and vision loss cannot be identified without conducting a test. These tests, especially for hearing, have traditionally needed expensive equipment and trained audiologists.
Without systematic screening, hearing losses go undetected until children reach school age. This often has a devastating impact on their development and academic outcomes.
Over the past six years, I’ve been working with colleagues around the world to develop and evaluate hearing care models that can be delivered in poor communities using smartphone technologies and facilitated by minimally trained people.
The minimally trained people included lay community members, health workers, care workers, and even teachers. They provided hearing screenings and diagnostics.
In 2016, we introduced vision screening in a pilot project. Our most recent implementation study in the Western Cape evaluates a screening project in low-income communities by community members using mobile health (mHealth) technologies.
This is the first report in the world of combined hearing and vision screening for young children.
Our findings show that a mobile health supported service-delivery system can dramatically increase access to hearing and vision services for the poor. We introduced a screening programme in preschools in Khayelitsha and Mitchells Plain. We trained unemployed community members as lay health workers to provide hearing and vision screenings at preschool centres.
We gave the community health workers smartphones with pre-installed applications. The mobile health technology used was from hearX Group, a digital health company started from our work at the University of Pretoria.
The hearScreen app provided a quick and reliable hearing check. The vision was checked using the Peek Acuity app provided by UK partner Peek Vision.
Preschool children who failed the initial hearing screening were screened a second time a week later. It included an otoscopy – examining the inner ear. Children who failed this screening were referred to public audiology services. Children who failed the initial vision screening and re-screening were referred to primary health care facilities for optometry evaluation.
All follow-up services and interventions were provided by public health services, for example, hearing aids or spectacles. The results from the first 8023 children screened across 271 preschools show hearing and vision ability was accurately assessed at low cost. Average test time for hearing and vision in our programme was just over 2 minutes, cutting typical test times in half. The tests were done for $5.63 (R83.63). More than a 100 children were diagnosed for the very first time and are now receiving treatment.