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

Glob Health Action. 2018;11(1):1467077. doi: 10.1080/16549716.2018.1467077.


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 hearScreenTM 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 hearScreenTM application allows for the asynchronous management of hearing screenings and follow-ups.

Keywords: Smartphone; community healthcare workers; early childhood development; hearing screening; mobile health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care Facilities
  • Child
  • Child, Preschool
  • Community Health Services / organization & administration*
  • Community Health Workers / organization & administration
  • Early Diagnosis
  • Hearing Loss / diagnosis*
  • Humans
  • Mass Screening / organization & administration*
  • Referral and Consultation
  • Smartphone*
  • South Africa
  • Telemedicine / organization & administration*

Grants and funding

The financial assistance of the National Institute for the Humanities and Social Sciences (NIHSS), in collaboration with the South African Humanities Deans Association (SAHUDA), towards this research is hereby acknowledged. Opinions expressed and conclusions arrived at are those of the authors and are not necessarily to be attributed to the NIHSS and SAHUDA.