Access to surgical care for hearing loss in Africa: a systematic review across African settings and a qualitative study of ENT care providers in Nigeria

Thesis

Hearing loss is a major cause of disability globally and disproportionately affects populations in Africa. Surgery plays an important role in preventing, treating and restoring hearing, yet there are significant challenges in accessing surgical hearing care in many African settings. Although it has been recognised as a public health priority, barriers and facilitators influencing access to hearing loss surgery have not been comprehensively explored nor has the evidence been systematically synthesised. This thesis investigates barriers and facilitators that affect access to surgery for hearing loss in Africa through a systematic review and survey of Ear, Nose and Throat (ENT) care providers in Nigeria.

The systematic review evaluates existing literature on barriers and facilitators to surgical hearing care access in Africa, mapping these factors to an access framework. Seventeen studies were eligible for inclusion. Barriers related to workforce capacity, infrastructure and surgical equipment availability were the most frequently reported. Financial burden, ruralurban disparities and delays in surgical pathway were also common. Facilitators were less frequently described and were primarily focused on workforce strengthening and service expansion.

The survey of ENT care providers yielded 71 respondents. Financial barriers were perceived as major challenges to accessing surgery for hearing loss in Nigeria. Like the systematic review, respondents proposed service availability interventions, including improving specialist training, equipment provision and workforce development as priority interventions to improve access in this context.

Access to surgical care for hearing loss in Africa is influenced by challenges that interconnect. Addressing these barriers requires a multifaceted approach to achieve equitable access. Future research should evaluate the efficacy of these interventions and explore differences in access pathways across populations and settings.

Authors: Jonah, S

• DOI: 10.5287/ora-kzeo1gbp6
• Type of award: MSc by Research
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: hearing loss; Africa; access to surgery; Nigeria
• Subjects: Surgery; global surgery; Otolaryngology