Community-based hearing screening for young children using an mHealth service-delivery model

Background: 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 hearScreen(TM) smartphone application employed automated test protocols operating on low-cost 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 hearScreen(TM) application allows for the asynchronous management of hearing screenings and follow-ups.