Community-based hearing and vision screening at schools in a low-resourced community : an evaluation study

Abstract

Hearing and vision loss in children pose significant academic, social, and developmental challenges. Currently, there are limited studies on dual sensory screening programmes. This study aimed to describe a dual sensory screening programme for school-aged children using mHealth technology facilitated by lay health workers (LHWs).

During the duration of the programme, six LHWs (but only three LHWs were employed at any given time) were trained to provide hearing and vision screening using validated smartphone applications (apps) for hearing screening (hearScreen™), air conduction threshold audiometry (hearTest™) and vision screening (PEEK™ acuity) which was conducted between September 2017 to April 2019. LHWs evaluated children with a mean age of 6.0 years (0.9 SD) and 5.8 years (0.9 SD), for hearing and vision screening, respectively. Programme performance was evaluated, and logistic regression analysis was used to determine the effect of age, gender, and noise levels on hearing screening outcomes. Logistic regression analysis was also used to identify the effects of gender and age on vision acuity screening outcomes.

A total of 4888 participants underwent the hearing screening (49.7% female) and 4933 underwent the vision screening (50.2% female). The duration of screenings was 105.1 seconds (+/-102.5 SD) for hearing screening and 111.0 seconds (+/- 60.5 SD) for vision screening. Overall, 1.6% of participants referred the hearing screening and 3.6% referred vision screening. Logistic regression showed that females were more likely to pass hearing screening (OR:1.61; 95% CI: 1.11-2.54) while older children were less likely to pass visual acuity screening [OR: (0.87, 95% CI:0.79-0.96). A third (32.5%) of referred cases followed up for air conduction threshold audiometry and one in four (25.1%) followed up for diagnostic vision testing. A high proportion of these cases were confirmed to have hearing (73.1%; 19/26) or vision loss (57.8%; 26/45). The logistic regression analysis showed that gender was a significant predictor for hearing screening outcomes and age was a significant predictor for vision screening outcomes. Exceeded permissible noise levels during hearing screening were minimal and did not significantly influence outcomes.

Community-based smartphone sensory screening facilitated by LHWs provided hearing and vision services to schools in a low-income community. Those children who attended follow-up services and were identified with potential sensory deficits were referred to a secondary hospital or private facility for diagnostic testing. Follow-up rates were low but the screening programme was cost-effective.