Hussein, Shouneez YousufSwanepoel, De WetMahomed-Asmail, FaheemaBiagio-de Jager, Leigh2019-10-072019-10-072018Hussein, S.Y., Swanepoel, D.W., Mahomed, F. et al. 2018, 'Community-based hearing screening for young children using an mHealth service-delivery model', Global Health Action, vol. 11, no. 1467077, pp. 1-7.1654-9716 (print)1654-9880 (online)10.1080/16549716.2018.1467077http://hdl.handle.net/2263/71600BACKGROUND : 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 and follow-ups.en© 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/).SmartphoneHearing screeningMobile health (mHealth)Early childhood development (ECD)Community health worker (CHW)Preschool childrenArticle