Abstract:
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 : Health-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.
