Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.
International School for Eye Health, London School of Hygiene and Tropical Medicine, United Kingdom.
Lang Speech Hear Serv Sch. 2021 Apr 20;52(2):568-580. doi: 10.1044/2020_LSHSS-20-00089. Epub 2021 Jan 26.
Introduction Globally, more than 50 million children have hearing or vision loss. Most of these sensory losses are identified late due to a lack of systematic screening, making treatment and rehabilitation less effective. Mobile health (mHealth), which is the use of smartphones or wireless devices in health care, can improve access to screening services. mHealth technologies allow lay health workers (LHWs) to provide hearing and vision screening in communities. Purpose The aim of the study was to evaluate a hearing and vision school screening program facilitated by LHWs using smartphone applications in a low-income community in South Africa. Method Three LHWs were trained to provide dual sensory screening using smartphone-based applications. The hearScreen app with calibrated headphones was used to conduct screening audiometry, and the Peek Acuity app was used for visual acuity screening. Schools were selected from low-income communities (Gauteng, South Africa), and children aged between 4 and 9 years received hearing and vision screening. Screening outcomes, associated variables, and program costs were evaluated. Results A total of 4,888 and 4,933 participants received hearing and vision screening, respectively. Overall, 1.6% of participants failed the hearing screening, and 3.6% failed visual acuity screening. Logistic regression showed that female participants were more likely to pass hearing screening ( = 1.61, 95% CI [1.11, 2.54]), while older children were less likely to pass visual acuity screening ( = 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). Conclusions mHealth technologies can enable LHWs to identify school-age children with hearing and/or vision loss in low-income communities. This approach allows for low-cost, scalable models for early detection of sensory losses that can affect academic performance.
简介
在全球范围内，有超过 5000 万儿童存在听力或视力损失。由于缺乏系统的筛查，这些感官损失大多发现较晚，导致治疗和康复效果不佳。移动医疗（mHealth）是指在医疗保健中使用智能手机或无线设备，可以改善筛查服务的可及性。mHealth 技术使初级卫生保健工作者（LHWs）能够在社区中提供听力和视力筛查。
目的
本研究旨在评估在南非低收入社区中，由 LHWs 使用智能手机应用程序进行的听力和视力学校筛查项目。
方法
培训了 3 名 LHWs 使用基于智能手机的应用程序进行双重感官筛查。使用校准耳机的 hearScreen 应用程序进行听力筛查，使用 Peek Acuity 应用程序进行视力筛查。从低收入社区（南非豪登省）中选择学校，对 4 至 9 岁的儿童进行听力和视力筛查。评估了筛查结果、相关变量和项目成本。
结果
共有 4888 名和 4933 名参与者分别接受了听力和视力筛查。总体而言，有 1.6%的参与者未通过听力筛查，有 3.6%的参与者未通过视力筛查。逻辑回归显示，女性参与者更有可能通过听力筛查（ = 1.61，95%CI [1.11，2.54]），而年龄较大的儿童不太可能通过视力筛查（ = 0.87，95%CI [0.79，0.96]）。有三分之一（32.5%）的转介病例接受了空气传导阈值听力测试，四分之一（25.1%）的病例接受了诊断性视力测试。其中很大一部分病例被确诊为听力（73.1%，19/26）或视力损失（57.8%，26/45）。
结论
mHealth 技术可以使 LHWs 在低收入社区中识别出学龄期儿童的听力和/或视力损失。这种方法允许以低成本、可扩展的方式进行早期检测，以发现可能影响学业表现的感官损失。
