BACKGROUND : Hearing loss is one of the most common developmental disorders identifiable
at birth with its prevalence increasing throughout school years. However, early detection
programs are mostly unavailable in low- and middle-income countries (LMICs) where more
than 80% of children with hearing loss reside.
OBJECTIVE : This study investigated the feasibility of a smartphone-based hearing screening
program for preschool children operated by community healthcare workers (CHWs) in
community-based early childhood development (ECD) centers.
METHOD : Five CHWs were trained to map ECD centers and conduct smartphone-based
hearing screenings within a poor community in South Africa over a 12-month period. The
hearScreenTM smartphone application employed automated test protocols operating on lowcost
smartphones. A cloud-based data management and referral function allowed for remote
monitoring for surveillance and follow up.
RESULTS : 6424 children (3–6 years) were screened for hearing loss with an overall referral rate
of 24.9%. Only 39.4% of these children attended their follow-up appointment at a local clinic,
of whom 40.5% referred on their second screening. Logistic regression analysis indicated that
age, gender and environmental noise levels (1 kHz) had a significant effect on referral rates
(p < 0.05). The quality index reflecting test operator test quality increased during the first few
months of testing.
CONCLUSION : Smartphone-based hearing screening can be used by CHWs to detect unidentified
children affected by hearing loss within ECD centers. Active noise monitoring, quality
indices of test operators and cloud-based data management and referral features of the
hearScreenTM application allows for the asynchronous management of hearing screenings