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The role of community health workers in addressing the global burden of ear disease and hearing loss: a systematic scoping review of the literature

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.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1136/bmjgh-2018-001141

Authors


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Role:
Author
ORCID:
0000-0002-7248-5436
More by this author
Institution:
University of Oxford
Department:
Education
Oxford college:
Kellogg College
Role:
Author
ORCID:
0000-0001-8597-2914


Publisher:
BMJ Publishing Group
Journal:
BMJ Global Health More from this journal
Volume:
4
Issue:
2
Article number:
e001141
Publication date:
2019-03-01
Acceptance date:
2019-01-25
DOI:
EISSN:
2059-7908
Pmid:
30899572


Language:
English
Keywords:
Pubs id:
pubs:982165
UUID:
uuid:72155961-6ade-46f8-b27b-402174632c66
Local pid:
pubs:982165
Source identifiers:
982165
Deposit date:
2019-04-16

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