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Hearing and vision screening for preschool children using mobile technology, South Africa
Susan Eksteen1, Stefan Launer2, Hannah Kuper3
1Department of Speech-Language Pathology and Audiology, University of Pretoria, c/o Lynnwood and University Roads, Hatfield, Pretoria 0002, South Africa.
Insights
Community health workers used mobile health technology to screen preschool children for hearing and vision impairments. This low-cost program successfully identified children needing further assessment, improving early detection rates.
Area of Science:
- Public Health
- Global Health
- Health Technology
Background:
- Preschool children require early detection of hearing and vision impairments for optimal development.
- Access to screening services can be limited in resource-constrained settings.
Purpose of the Study:
- To implement and evaluate a community-based hearing and vision screening program for preschool children in South Africa.
- To assess the effectiveness of mobile health technology (mHealth) and community health workers (CHWs) in delivering dual sensory screening.
Main Methods:
- Four CHWs were trained to conduct hearing and vision screenings in preschools using mHealth applications on smartphones.
- Screening covered children aged 4-7 years in Khayelitsha and Mitchells Plain from September 2017 to December 2018.
- Logistic regression analyzed associations between screening results and factors like age, sex, test duration, and background noise.
Main Results:
- 94.4% of eligible children were screened at 271 centers, costing $5.63 per child.
- 5.4% failed hearing tests and 2.1% failed vision tests; 1.4% were diagnosed with impairments.
- Hearing and vision test failures were associated with longer test durations; hearing failure also linked to background noise, and vision failure to younger age.
Conclusions:
- mHealth-supported CHW-delivered screening is a low-cost, acceptable, and accessible service for preschool children.
- The program effectively identified children with potential hearing and visual impairments, reducing referrals to overburdened health institutions.
Objective:
To implement and evaluate a community-based hearing and vision screening programme for preschool children in the Western Cape, South Africa, supported by mobile health technology (mHealth) and delivered by community health workers (CHWs).
Methods:
We trained four CHWs to provide dual sensory screening in preschool centres of Khayelitsha and Mitchells Plain during September 2017-December 2018. CHWs screened children aged 4-7 years using mHealth software applications on smartphones. We used logistic regression analysis to evaluate the association between screening results and age, sex and test duration, and, for hearing, excessive background noise levels.
Results:
CHWs screened 94.4% (8023/10 362) of eligible children at 271 centres at a cost of 5.63 United States dollars per child. The number of children who failed an initial hearing and visual test was 435 (5.4%) and 170 (2.1%), respectively. Hearing test failure was associated with longer test times (odds ratio, OR: 1.022; 95% confidence interval, CI: 1.021-1.024) and excessive background noise levels at 1 kilohertz (kHz) (e.g. OR for left ear: 1.688; 95% CI: 1.198-2.377). Visual screening failure was associated with longer test duration (OR: 1.003; 95% CI: 1.002-1.005) and younger age (OR: 0.629; 95% CI: 0.520-0.761). Of the total screened, 111 (1.4%) children were diagnosed with a hearing and/or visual impairment.
Conclusion:
mHealth-supported CHW-delivered hearing and vision screening in preschool centres provided a low-cost, acceptable and accessible service, contributing to lower referral numbers to resource-constrained public health institutions.
