Pediatric hearing screening in low-resource settings: Incorporation of video-otoscopy and an electronic medical record

Abstract

Objective: To develop a sustainable, comprehensive, intervention-based approach to pediatric hearing care in low- and middle income countries (LMICs) where global hearing loss is most heavily concentrated.

Methods: Community health workers (CHWs) in Kilifi county, Kenya were trained to conduct hearing screening and video-otoscopy via a unified, smartphone-based platform using mobile electronic medical record (EMR) generation for children diagnosed with hearing loss or other pathology. Among at-risk students pre-selected by their teachers, the frequency of hearing loss and pathology in children with and without hearing loss was measured.

Results: Of the 155 screened, 16 (10%) children were found to have hearing loss. 12 (5.9%) children with normal hearing had the following pathology: perforation (N = 5 ears), effusion (N = 9), retraction (N = 6), and infections (N = 7). CHWs were also adept at EMR creation without significant delay in workflow. Out of all those screened, 28 (18%) children were found to have hearing loss or other pathology and were referred to follow up. All 28 of 28 children referred were successfully entered into the EMR.

Conclusions: CHWs with little to no prior medical experience can provide a much needed public health service - hearing screening in LMICs where access to health care is limited. The incorporation of video-otoscopy provides a more comprehensive approach to hearing care by not only helping identify etiologies of existing hearing disability but also conditions that predispose to future hearing loss. It can easily be performed in conjunction with hearing screenings via the use of a unified, mobile platform. The addition of EMR supports follow-up and allows remote consultation.

Keywords: Community health workers; Data management; Hearing loss; Hearing screening; Mobile health; Otoscopy; Public health; Telehealth; Video-otoscopy.