The Role of Community Health Workers in Addressing the Global Burden of Ear Disease and Hearing Loss: a Systematic Scoping Review of the Literature

Overview

Journal BMJ Glob Health

Specialty Public Health

Date 2019 Mar 23

PMID 30899572

Citations 20

Authors

James ODonovan

Misha Verkerk

Niall Winters

Shelly Chadha

Mahmood F Bhutta

Affiliations

Soon will be listed here.

Abstract

Introduction: Community health workers (CHWs) have the potential to improve access to ear and hearing services for people across low-income or middle-income countries, remote, underserved, or resource-poor areas of the world. We performed a systematic scoping review to identify evidence on how CHWs are currently deployed in the prevention, screening, diagnosis, treatment and management of ear disease and hearing loss; methods to train and support CHWs in this context; and cost-effectiveness of CHWs.

Methods: We performed a systematic search of the literature from September 1978 to 18 March 2018 from 11 major databases and the grey literature.

Results: We identified 38 original studies that met the inclusion criteria, taking place across South Asia (n=13), Oceania (n=7), North America (n=7), South America (n=6) and Africa (n=5). 23 studies showed CHWs can increase community participation in screening. They can conduct screening using whispered voice tests, noisemakers for neonatal screening, automated audiological tests and otoscopy. Eight studies focused specifically on the evaluation of programmes to train CHWs, and three provided a general programme description. Three studies documented a role of CHWs in the treatment of ear disease or hearing loss, such as performing ear washouts, instillation of topical antibiotics or fitting of hearing aids. Only one study provided an indepth cost-utility analysis regarding the use of CHWs to conduct hearing screening, and no studies commented on the role of CHWs in the prevention of hearing loss.

Conclusion: CHWs have been employed in diverse ways to address the global burden of ear disease and hearing loss. Future research needs to explore the role of CHWs in preventative strategies, identify optimum methods to train and support CHWs, and explore their cost-effectiveness.

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References

Bennett K, Haggard M, Silva P, Stewart I . Behaviour and developmental effects of otitis media with effusion into the teens. Arch Dis Child. 2001; 85(2):91-5. PMC: 1718889. DOI: 10.1136/adc.85.2.91. View

Shrestha R, Baral K, Weir N . Community ear care delivery by community ear assistants and volunteers: a pilot programme. J Laryngol Otol. 2002; 115(11):869-73. DOI: 10.1258/0022215011909314. View

Couzos S, Lea T, Mueller R, Murray R, Culbong M . Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community-based, multicentre, double-blind randomised controlled trial. Med J Aust. 2003; 179(4):185-90. DOI: 10.5694/j.1326-5377.2003.tb05496.x. View

Pirozzo S, Papinczak T, Glasziou P . Whispered voice test for screening for hearing impairment in adults and children: systematic review. BMJ. 2003; 327(7421):967. PMC: 259166. DOI: 10.1136/bmj.327.7421.967. View

Eikelboom R, Weber S, Atlas M, Dinh Q, Mbao M, Gallop M . A tele-otology course for primary care providers. J Telemed Telecare. 2004; 9 Suppl 2:S19-22. DOI: 10.1258/135763303322596156. View

Lewin S, Dick J, Pond P, Zwarenstein M, Aja G, van Wyk B . Lay health workers in primary and community health care. Cochrane Database Syst Rev. 2005; (1):CD004015. DOI: 10.1002/14651858.CD004015.pub2. View

Couzos S, Lea T, Murray R, Culbong M . 'We are not just participants--we are in charge': the NACCHO ear trial and the process for Aboriginal community-controlled health research. Ethn Health. 2005; 10(2):91-111. DOI: 10.1080/13557850500071038. View

Berg A, Papri H, Ferdous S, Khan N, Durkin M . Screening methods for childhood hearing impairment in rural Bangladesh. Int J Pediatr Otorhinolaryngol. 2005; 70(1):107-14. DOI: 10.1016/j.ijporl.2005.05.029. View

Boutayeb A . The double burden of communicable and non-communicable diseases in developing countries. Trans R Soc Trop Med Hyg. 2005; 100(3):191-9. DOI: 10.1016/j.trstmh.2005.07.021. View

10.

Roy E, Hasan K, Haque F, Siddique A, Sack R . Acute otitis media during the first two years of life in a rural community in Bangladesh: a prospective cohort study. J Health Popul Nutr. 2008; 25(4):414-21. PMC: 2754010. View

11.

Kokesh J, Ferguson A, Patricoski C, Koller K, Zwack G, Provost E . Digital images for postsurgical follow-up of tympanostomy tubes in remote Alaska. Otolaryngol Head Neck Surg. 2008; 139(1):87-93. DOI: 10.1016/j.otohns.2008.04.008. View

12.

Alvarenga K, Bevilacqua M, Martinez M, Melo T, Blasca W, Taga M . Training proposal for community health agents in hearing health. Pro Fono. 2008; 20(3):171-7. DOI: 10.1590/s0104-56872008000300006. View

13.

Olusanya B, Wirz S, Luxon L . Community-based infant hearing screening for early detection of permanent hearing loss in Lagos, Nigeria: a cross-sectional study. Bull World Health Organ. 2009; 86(12):956-63. PMC: 2649576. DOI: 10.2471/blt.07.050005. View

14.

Olusanya B, Akinyemi O . Community-based infant hearing screening in a developing country: parental uptake of follow-up services. BMC Public Health. 2009; 9:66. PMC: 2656536. DOI: 10.1186/1471-2458-9-66. View

15.

Stevenson J, McCann D, Watkin P, Worsfold S, Kennedy C . The relationship between language development and behaviour problems in children with hearing loss. J Child Psychol Psychiatry. 2009; 51(1):77-83. DOI: 10.1111/j.1469-7610.2009.02124.x. View

16.

Melo T, Alvarenga K, Blasca W, Taga M . Community health agents training on hearing health: effectiveness of videoconference. Pro Fono. 2010; 22(2):139-45. DOI: 10.1590/s0104-56872010000200012. View

17.

Youngs R, Weir N, Tharu P, Bohara R, Bahadur D . Diagnostic otoscopy skills of community ear assistants in Western Nepal. J Laryngol Otol. 2010; 125(1):27-9. DOI: 10.1017/S0022215110001891. View

18.

Elliott G, Smith A, Bensink M, Brown C, Stewart C, Perry C . The feasibility of a community-based mobile telehealth screening service for Aboriginal and Torres Strait Islander children in Australia. Telemed J E Health. 2010; 16(9):950-6. DOI: 10.1089/tmj.2010.0045. View

19.

Frenk J, Chen L, Bhutta Z, Cohen J, Crisp N, Evans T . Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 376(9756):1923-58. DOI: 10.1016/S0140-6736(10)61854-5. View

20.

Solheim J, Kvaerner K, Falkenberg E . Daily life consequences of hearing loss in the elderly. Disabil Rehabil. 2011; 33(23-24):2179-85. DOI: 10.3109/09638288.2011.563815. View