Yancey Kristen L, Cheromei Loyce J, Muhando Jackie, Reppart Jim, Netterville James L, Jayawardena Asitha D L
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
Malindi District Hospital, Malindi, Kenya.
Int J Pediatr Otorhinolaryngol. 2019 Nov;126:109633. doi: 10.1016/j.ijporl.2019.109633. Epub 2019 Aug 10.
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.
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.
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.
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.
在全球听力损失最为集中的低收入和中等收入国家（LMICs），开发一种可持续、全面、基于干预的儿童听力保健方法。
肯尼亚基利菲县的社区卫生工作者（CHWs）接受培训，通过一个统一的基于智能手机的平台进行听力筛查和视频耳镜检查，并为被诊断患有听力损失或其他病变的儿童生成移动电子病历（EMR）。在教师预先选定的高危学生中，测量有听力损失和无听力损失儿童的听力损失和病变发生率。
在155名接受筛查的儿童中，16名（10%）被发现有听力损失。12名（5.9%）听力正常的儿童有以下病变：穿孔（N = 5耳）、积液（N = 9）、内陷（N = 6）和感染（N = 7）。社区卫生工作者也擅长创建电子病历，且工作流程没有明显延迟。在所有接受筛查的儿童中，28名（18%）被发现有听力损失或其他病变，并被转诊进行随访。所有28名被转诊的儿童都成功录入了电子病历。
几乎没有或没有医疗经验的社区卫生工作者可以在医疗服务获取有限的低收入和中等收入国家提供急需的公共卫生服务——听力筛查。视频耳镜检查的纳入为听力保健提供了一种更全面的方法，不仅有助于识别现有听力残疾的病因，还能识别易导致未来听力损失的状况。通过使用统一的移动平台，它可以很容易地与听力筛查同时进行。电子病历的添加支持随访并允许远程会诊。
