Mulwafu Wakisa, Kuper Hannah, Viste Asgaut, Goplen Frederik K
Department of Surgery, College of Medicine Blantyre Malawi, Blantyre, Malawi.
Department of Clinical Research, The London School of Hygiene & Tropical Medicine, London, UK.
BMJ Open. 2017 Oct 11;7(10):e016457. doi: 10.1136/bmjopen-2017-016457.
To assess the feasibility and acceptability of training community health workers (CHWs) in ear and hearing care, and their ability to identify patients with ear and hearing disorders.
Cluster randomised controlled trial (RCT).
Health centres in Thyolo district, Malawi.
Ten health centres participated, 5 intervention (29 CHWs) and 5 control (28 CHWs).
Intervention CHWs received 3 days of training in primary ear and hearing care, while among control CHWs, training was delayed for 6 months. Both groups were given a pretest that assessed knowledge about ear and hearing care, only the intervention group was given the posttest on the third day of training. The intervention group was given 1 month to identify patients with ear and hearing disorders in their communities, and these people were screened for hearing disorders by ear, nose and throat clinical specialists.
Primary outcome measure was improvement in knowledge of ear and hearing care among CHWs after the training. Secondary outcome measures were number of patients with ear or hearing disorders identified by CHWs and number recorded at health centres during routine activities, and the perceived feasibility and acceptability of the intervention.
The average overall correct answers increased from 55% to 68% (95% CI 65 to 71) in the intervention group (p<0.001). A total of 1739 patients with potential ear and hearing disorders were identified by CHWs and 860 patients attended the screening camps, of whom 400 had hearing loss (73 patients determined through bilateral fail on otoacoustic emissions, 327 patients through audiometry). Where cause could be determined, the most common cause of ear and hearing disorders was chronic suppurative otitis media followed by impacted wax. The intervention was perceived as feasible and acceptable to implement.
Training was effective in improving the knowledge of CHW in ear and hearing care in Malawi and allowing them to identify patients with ear and hearing disorders. This intervention could be scaled up to other CHWs in low-income and middle-income countries.
Pan African Clinical Trial Registry (201705002285194); Results.
评估培训社区卫生工作者（CHW）开展耳科及听力保健工作的可行性和可接受性，以及他们识别耳科和听力障碍患者的能力。
整群随机对照试验（RCT）。
马拉维蒂约洛区的卫生中心。
10个卫生中心参与研究，5个干预组（29名CHW）和5个对照组（28名CHW）。
干预组的CHW接受了为期3天的初级耳科及听力保健培训，而对照组的CHW培训延迟6个月。两组均进行了关于耳科及听力保健知识的预测试，仅干预组在培训第三天进行了后测。干预组有1个月时间在其社区识别耳科和听力障碍患者，这些人由耳鼻喉临床专家进行听力障碍筛查。
主要观察指标是培训后CHW耳科及听力保健知识的改善情况。次要观察指标是CHW识别出的耳科或听力障碍患者数量以及在日常活动中卫生中心记录的患者数量，以及干预措施的感知可行性和可接受性。
干预组平均总体正确答案从55%提高到68%（95%可信区间65至71）（p<0.001）。CHW共识别出1739名可能患有耳科和听力障碍的患者，860名患者参加了筛查营地，其中400名有听力损失（73名通过耳声发射双侧未通过确定，327名通过听力测定确定）。在能够确定病因的情况下，耳科和听力障碍最常见的病因是慢性化脓性中耳炎，其次是耵聍栓塞。该干预措施被认为实施起来可行且可接受。
培训有效提高了马拉维CHW的耳科及听力保健知识，并使他们能够识别耳科和听力障碍患者。这种干预措施可扩大到低收入和中等收入国家的其他CHW。
泛非临床试验注册中心（201705002285194）；结果
