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.
