Original Research

Decentralising paediatric hearing services through district healthcare screening in Western Cape province, South Africa

Silva Kuschke, Talita le Roux, Alex J. Scott, Daniel C. d.W. Swanepoel
African Journal of Primary Health Care & Family Medicine | Vol 13, No 1 | a2903 | DOI: https://doi.org/10.4102/phcfm.v13i1.2903 | © 2021 Silva Kuschke, Talita le Roux, Alex J. Scott, Daniel C. d.W. Swanepoel | This work is licensed under CC Attribution 4.0
Submitted: 12 January 2021 | Published: 29 June 2021

About the author(s)

Silva Kuschke, Department of Audiology, Faculty of Allied Health – Communication Sciences, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
Talita le Roux, Department Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
Alex J. Scott, Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
Daniel C. d.W. Swanepoel, Department Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa; and, Department Ear Science Centre, School of Surgery, University of Western Australia, Nedlands, Australia; and, Ear Science Institute, Subiaco, Australia


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Abstract

Background: Childhood hearing loss is a global epidemic most prevalent in low- and middle-income countries where hearing healthcare services are often inaccessible. Referrals for primary care services to central hospitals add to growing lists and delays the time-sensitive treatment of childhood hearing loss.

Aim: To compare a centralised tertiary model of hearing healthcare with a decentralised model through district hearing screening for children in the Western Cape province, South Africa.

Setting: A central paediatric tertiary hospital in Cape Town and a district hospital in the South Peninsula region.

Methods: A pragmatic quasi-experimental study design was used with a 7-month control period at a tertiary hospital (June 2019 to December 2019). Decentralising was measured by attendance rates, travelling distance, number of referrals to the tertiary hospital and hearing outcomes. There were 315 children in the tertiary group and 158 in the district group. Data were collected from patient records and an electronic database at the tertiary hospital.

Results: Attendance rate at the district hospital was significantly higher (p < 0.001). Travel distance to the district hospital was significantly shorter (p < 0.001). Number of referrals to the tertiary hospital decreased significantly during the intervention period (p < 0.001). Most children in both the tertiary and district groups (78.7% and 80.4%, respectively) passed initial hearing screening bilaterally.

Conclusion: Hearing screening should be conducted at the appropriate level of care to increase access, reduce patient travelling distances and associated costs and reduce the burden on tertiary-level hospitals.


Keywords

childhood hearing loss; decentralisation; hearing healthcare; low- and middle-income countries; otoacoustic emissions

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