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Implementation and evaluation of a rural community-based pediatric hearing screening program integrating in-person
Vidya Ramkumar1, Roopa Nagarajan2, Vanaja C Shankarnarayan3
1Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Na, du-400116, India.
Insights
This study successfully trained village health workers to conduct pediatric hearing screenings in rural India using tele-medicine and in-person diagnostic auditory brainstem response (ABR) testing. Tele-ABR significantly improved follow-up rates, enhancing access to care for children in remote areas.
Area of Science:
- Public Health
- Audiology
- Telemedicine
Background:
- Rural areas face challenges in pediatric hearing healthcare due to limited infrastructure and audiologist availability.
- Community-based programs are essential to overcome geographical barriers and improve access to care.
Purpose of the Study:
- To evaluate a community-based pediatric hearing screening program in rural villages.
- To compare the effectiveness of tele-medicine versus in-person diagnostic auditory brainstem response (ABR) testing for follow-up care.
Main Methods:
- Village health workers (VHWs) were trained to conduct Distortion Product Oto Acoustic Emissions (DPOAE) screening and assist with tele-ABR.
- A two-step DPOAE screening was performed in homes for children under five.
- Children with 'refer' results received diagnostic ABR testing either in-person or via tele-medicine.
Main Results:
- Six VHWs screened 1335 children (in-person ABR group) and 1480 children (tele-ABR group).
- The refer rate for the second screening was low (0.8%), with high follow-up rates (80-97%).
- Tele-ABR integration improved follow-up rates by 11% compared to in-person ABR.
Conclusions:
- A community-based model with trained VHWs and tele-ABR is effective for pediatric hearing screening in underserved rural areas.
- Tele-ABR significantly enhances follow-up rates, addressing challenges of distance and potential wage loss for families.
- The program demonstrated success through a low refer rate and improved follow-up, highlighting its scalability.
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.
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