PURPOSE : This study has two main objectives: 1) to assess the value of combining the rapid assessment of avoidable blindness (RAAB) and the recently developed rapid assessment of hearing loss (RAHL) based on existing population-based data from Cameroon and India; 2) to test the feasibility of a combined RAAB-RAHL protocol. METHODS : A secondary data analysis of population-based disability surveys in India and Cameroon (in 2013–2014) was conducted, focussing on people aged 50+. Hearing impairment (HI) was defined as pure tone average of 41dB (better ear).Visual impairment (VI) was defined as presenting visual acuity of <6/18 (better eye). The relationship between HI and VI was examined. The feasibility of a combined RAAB-RAHL survey was assessed within a RAHL conducted among adults aged 50+ in Malawi in 2018. Outcomes included: time taken, costs, number of people examined in a day, and qualitative feedback from participants and field teams. RESULTS : The prevalence of combined VI and HI among people aged 50+ was 4.4% (95% confidence interval (CI) 3.0, 6.4) in India and 4.8% (95%CI 3.0, 8.0) in Cameroon. Among participants with VI, approximately a third in India (29.3%) and Cameroon (35.1%) also had HI. A quarter of participants in India (25.4%) and Cameroon (26.9%) who had HI also had VI. In Malawi, the total time taken to complete both RAAB and RAHL assessments was approximately 27 minutes per participant. It was feasible to complete 30 participants per day for a team of four people. The estimated cost of a combined RAAB-RAHL approach in comparison to two separate impairment surveys is up to 37% less depending on the method of combination. CONCLUSION : The substantial overlap between VI and HI supports a combined rapid survey of the two impairments. The pilot study of a combined RAAB-RAHL survey demonstrates feasibility and lower cost compared to conducting two standalone impairment surveys. A combined RAAB-RAHL approach could maximize limited resources to increase prevalence data for both vision and hearing impairment.
S1 File. Rapid Assessment of Hearing Loss questionnaire—Malawi.
S2 File. Rapid Assessment of Avoidable Blindness questionnaire.
S3 File. Population-based survey of disability questionnaire India (Mahabubnagar District).
S4 File. Population-based survey of disability questionnaire Cameroon (Fundong Health
This research has been made possible through the hard work of many individuals and organisations.
Firstly, we would like to thank the study participants for their generous time in taking
part in the study. Secondly, we recognise the efforts of the village leaders from Malawi for their
assistance in coordinating the survey. We would also like to thank GV Murthy and Joseph Oye
for coordinating the fieldwork in India and Cameroon respectively. We thank hearX and colleagues
for their support in the use of hearTest and integration of ODK with hearTest. Finally,
we thank colleagues from the International Centre for Evidence in Disability for their input in
to the survey protocol development. Electronic data solutions were provided by LSHTM Open
Research Kits (odk.lshtm.ac.uk).