Assessment of knowledge, attitude and practice for oxygen therapy among medical staff at the Colonial War Memorial Hospital in Fiji.

BACKGROUND: Oxygen therapy (OT) is a commonly prescribed essential medicine for people of all ages in the management of hypoxia. The adverse effects of inappropriate OT supplementation may be underestimated by health professionals and lead to poor health outcomes among hospitalised patients. Knowledge, attitude and practice (KAP) assessments of medical staff members to OT guidelines are essential to ensure optimal patient care. AIMS: To perform a KAP assessment of OT administration among doctors and nurses employed at the national hospital of Fiji in 2021. METHODS: Prospective cross-sectional study design. KAP assessment was performed with an online questionnaire and clinical observation. RESULTS: The study population (N = 116) consisted of doctors (20.7%) and nurses (79.3%) representing the acute medical, burns, cardiac care, intensive care, surgical and postanaesthetic recovery units. Overall, the proportion of participants who obtained a good score (>70%) was 87% for knowledge, 87.93% for attitudes and 84% for practice. Best knowledge scores were obtained for general OT indications (71%) and scenarios where immediate oxygen application is required (70%). Lowest knowledge scores were for OT contraindications (14%) and oxygen saturation for acute myocardial infarction (32%), asthma (36%) and healthy newborns (43%). The most positive attitudes were in response to the statement that OT guidelines are essential (96%). A total of 78 (80.4%) patients were being cared for with good OT practice. CONCLUSIONS: Good KAP scores were obtained for medical staff in Fiji regarding OT administration. Ongoing professional education activities should include updated training of OT contraindications and optimal oxygen saturation levels for special patient groups.

Development of a Risk-Factor Questionnaire for the Infant Ear and Hearing Program in Samoa.

PURPOSE: Congenital hearing loss is the most common sensory disorder present at birth. While universal newborn hearing screening is the standard for most high-income countries, alternative models are under consideration for most low and middle-income countries. The Pacific Islands have among the highest rates of paediatric ear disease and deafness in the world, and an interim Infant Ear and Hearing Program is currently being developed for the Polynesian nation of Samoa. The inclusion of a routine risk-factor questionnaire for childhood deafness in the Infant Ear and Hearing Program package is a feasible alternative for well-baby clinics in Samoa. DESCRIPTION: The World Health Organisation advocates that all member states should implement newborn and infant hearing screening. This includes a risk-factor questionnaire developed from the joint committee on infant hearing risk-factors, as well as additional risk-factors unique to low and middle income countries. The present paper examines all known risk-factors for childhood deafness to develop an appropriate and evidence-based questionnaire for inclusion in the Samoan Child Health Book and Infant Ear and Hearing Program package. ASSESSMENT: From a starting point of 19 risk-factors, 11 risk-factors were included with no changes; 5 risk-factors were modified to align with current health service availability in Samoa; 2 risk-factors were excluded due to cultural inappropriateness and irrelevance for Samoa; and 1 risk-factor was added for our Samoan and Pacific Island context. CONCLUSION: There are 17 items on the final risk-factor questionnaire for childhood deafness developed for Samoa. The Infant Ear and Hearing Program package will also include ear examinations and monitoring of hearing developmental milestones. The risk-factor questionnaire will be reviewed again in 5 years' time for the next edition of the Samoan Child Health Book.

Ethical considerations for universal newborn hearing screening in the Pacific Islands: a Samoan case study.

Permanent congenital and early-onset hearing impairment (PCEOHI) is the most common sensory disorder among newborns. The WHO recommends newborn and infant hearing screening for all member states to facilitate early identification and intervention for children with PCEOHI. Ethical implications of newborn/infant hearing screening in low-income and middle-income countries should be considered. Although the Pacific Island region is estimated to have among the highest global burden of hearing loss, hearing health services are limited and virtually non-existent in Pacific Island countries. The aim of this brief report is to consider the ethical implications of implementing hospital-based universal newborn hearing screening (UNHS) in Samoa. Based on well-acknowledged screening principles, this report found that the Samoan context does not satisfy the screening principles for such a programme, and that the implementation of UNHS would, therefore, be unethical. This conclusion was reached even after considering the hypothetical provision of necessary screening and diagnostic audiology equipment from external donors. We recommend that current efforts should be directed towards the wider professional community involved in the daily care of children with a permanent hearing loss. Given the high prevalence of paediatric ear disease in the Pacific Islander population, an interim ear and hearing programme could be considered at the community level. These strategies should provide the infrastructure and referral pathways required in the advent of UNHS in Samoa.

Ethical issues for large-scale hearing aid donation programmes to the Pacific Islands: a Samoan perspective.

The Pacific Islands are estimated to have among the highest global burdens of hearing loss, however, hearing health services are limited throughout this region. The provision of hearing aid is desirable, but should be delivered in accordance with WHO recommendations of appropriate and locally sustainable services. Large-scale hearing aid donation programmes to the Pacific Islands raise ethical questions that challenge these recommendations.The aim of this paper is to consider the ethical implications of large-scale hearing aid donation programmes to Samoa, a nation of the Pacific Islands. Evaluation of both 'Western' and 'Pacific Island' perspectives reveals important cross-cultural differences regarding attitudes to donation programmes. We attempt to offer possible solutions that satisfy both ethical frameworks, and which should enable us to deliver an effective hearing health service for Samoa. These solutions may be translational and benefit other Pacific Island nations in a similar context.

Prevalence and Pattern of Ear Disease Among Primary School Students in Samoa: Preliminary Results from ENT Clinic Outreach to Urban, Rural and Remote Settings.

Objectives: To assess the prevalence and pattern of ear disease among students attending primary school in urban, rural, and remote regions of Samoa in order to develop an evidence-based national school ear and hearing health program. Methods: Retrospective clinical data review of all primary school students seen by the Ear, Nose & Throat Clinic of Samoa during school-based outreach visits from March 2022 to April 2024. A purposefully designed spreadsheet was created to extract the following information from the clinical records: school location (urban, rural, remote), gender (male, female), age (years), age category (0-4, 5-9, 10-14, 15+ years), right ear diagnosis, left ear diagnosis. Data were entered into the SPSS statistical software package for descriptive statistical analysis and association tests of significance. Results: A total of 1491 primary school students were seen for ear health examinations (51.1% male, 48.9% female), with a mean age of 9.1 years (SD = 2.3). Five primary schools were included, representing urban (n = 865), rural (n = 258), and remote (n = 368) settings. Overall, 682 (45.7%) students had normal ear examination results for both ears, 237 (15.9%) had an ear pathology in 1 ear only, and 568 (38.1%) had ear pathology in both ears. Bilateral ear pathology was significantly higher among students who were in the 5 to 9 age group (P < .00001), female (P = .035), and from rural settings (P = .0001). The most common pathology was impacted cerumen (36.8%), followed by otitis media with effusion (7.5%). Overall prevalence of chronic suppurative otitis media (CSOM) was 2.6% (n = 39 students). Following the school visits, no further intervention was required for 1180 students (79%), mostly due to successful cerumen and foreign body removals for 468 students (31.4%). Conclusion: Impacted cerumen is a significant issue among Samoan school-aged students, and future school-based ear health programs should include staff members trained in cerumen removal. CSOM prevalence suggests an avoidable burden of disease that must be addressed.

Characteristics of patients admitted to the intensive care unit during the 2019 measles epidemic in Samoa: A retrospective clinical case series.

Our report describes the characteristics of patients admitted to the intensive care unit of the National Hospital of Samoa during the 2019-2020 measles epidemic. The study design was a retrospective review of clinical records; the age range was 2 months to 51 years, with the majority of cases in the 2-23 month age group (71%). Vaccination status was unknown or unrecorded for 17 (24%). Of the 54 (75%) who were not fully vaccinated, 35 (65%) did not survive. Almost all (98%) presented with multiple complications on admission, mostly pneumonia (91%). The mortality rate was 61%, implying a low survival rate particularly among young infants and toddlers, even when optimal care was available and administered.

Service delivery approaches related to hearing aids in low- and middle-income countries or resource-limited settings: A systematic scoping review.

Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing aids do not receive them, in part due to challenges in accessing hearing aids and related services, which are most salient in low- and middle-income countries (LMIC) and other resource-limited settings. Innovative approaches for hearing aid service delivery can overcome many of the challenges related to access, including that of limited human resources trained to provide ear and hearing care. The purpose of this systematic scoping review is to synthesize evidence on service delivery approaches for hearing aid provision in LMIC and resource-limited settings. We searched 3 databases (PubMed, Scopus, Ovid MEDLINE) for peer-reviewed articles from 2000 to 2022 that focused on service delivery approaches related to hearing aids in LMIC or resource-limited settings. Fifteen peer-reviewed articles were included, which described hospital-based (3 studies), large-scale donation program (1 studies), community-based (7 studies), and remote (telehealth; 4 studies) service delivery approaches. Key findings are that hearing aid services can be successfully delivered in hospital- and community-based settings, and remotely, and that both qualified hearing care providers and trained non-specialists can provide quality hearing aid services. Service delivery approaches focused on community-based and remote care, and task sharing among qualified hearing care providers and trained non-specialists can likely improve access to hearing aids worldwide, thereby reducing the burden of untreated hearing loss.

High Levels of Satisfaction Among Hearing Aid Users in a Pilot Study for Sustainable Low-Cost Auditory Rehabilitation Services in Samoa.

The provision of locally sustainable hearing aid device services is desirable in the Pacific Islands. The aim of the present study was (1) To assess the suitability of low-cost pre-programmable hearing aids in Samoa, a Polynesian nation of the Pacific Islands, and (2) To develop translations of established auditory rehabilitation questionnaires into the FaaSamoan language for clinical, public health, and research applications. A cross-over trial of 2 low-cost pre-programmable hearing aids among 20 adults in Samoa was conducted as part of a larger UN-funded global audiology study. The International Outcome Inventory for Hearing Aids, the International Outcome Inventory for Hearing Aids for Significant Others, and the Revised Hearing Handicap Inventory questionnaires were translated into the FaaSamoan language to assess the self-reported outcomes of study participants. Overall, high scores were measured for the self-reported outcome measures, suggesting good levels of use and satisfaction with the hearing aid devices. Overall, results found that once a hearing aid was fitted that 67.6% of participants reported no hearing handicap, 32.4% reported a mild to moderate hearing handicap, and no participant reported a significant hearing handicap.

Knowledge and attitudes of female caregivers in Samoa to childhood hearing loss and hearing services.

OBJECTIVES: To assess the knowledge and attitudes of 150 female caregivers in Samoa to childhood hearing loss and hearing services, and to compare findings between urban (n = 100) and rural-dwelling (n = 50) caregivers. METHODS: A semi-structured interview using a 26-item questionnaire was administered to participants in the Samoan language. Participants were required to respond "yes", "no", or "unsure". RESULTS: Highest awareness of aetiology of childhood hearing loss was found for otitis media (88.7%), followed by noise exposure (64.7%) and family history (38%). Highest awareness of public health measures that may prevent/reduce otitis media was found for routine childhood immunizations (74.7%) and breast-feeding for first 6 months of life (69.3%). Overall, 40% of Samoan caregivers agreed that curses may cause childhood hearing loss. There was overwhelming support for community-based hearing services for newborns/infants (98%) and school students (97.3%). CONCLUSIONS: There is positive support for community-based hearing health services for children among female caregivers of Samoa. There was high awareness of otitis media as a major cause of childhood hearing loss, as well as good knowledge of public health measures that reduce/minimise the risk of otitis media.

Access block and overcrowding at the emergency department at Tupua Tamasese Meaole Hospital in Samoa.

BACKGROUND: Access block and overcrowding are known to adversely impact on patient outcomes, service delivery, and patient experiences within emergency departments (ED) worldwide. There are no studies on access block or overcrowding from the Pacific Islands. The aim of the present study is to provide preliminary data on access block and overcrowding in the ED of the national tertiary hospital of Samoa. METHODS: Mixed methods study design. Data collection was performed in March 2020. The quantitative strand calculated (1) the point prevalence of patients impacted by access block in the ED, and (2) the ED bed occupancy rate to assess for overcrowding. The qualitative strand used thematic analysis of two focus group interviews exploring access block and overcrowding with ED medical and nursing staff members. RESULTS: On the day of data collection, a total of 60 patients presented through the ED triage system. Of the 20 patients who were admitted into ED, 80% were triaged as 'see without delay' (CAT1), 'emergency' (CAT2) or 'urgent' (CAT3). For patients requiring admission to hospital wards, 100% waited 4 + h in ED, and 100% waited 8 + h, suggesting the presence of access block. Overcrowding in the ED setting was also evident, with an ED bed occupancy rate of 0.95, and an adjusted bed occupancy rate of 1.43. The major themes emerging from the ED staff focus groups and individual in-depth interviews were (1) the adverse impacts of access block and overcrowding, i.e., violence towards ED staff members, (2) the preventable contributing factors, i.e., lack of physical beds in the ED, and (3) practical recommendations to improve patient flow through the ED, i.e., improved collaboration between ED, outpatient services, and the hospital wards. CONCLUSIONS: Preliminary evidence suggested the presence of access block and overcrowding in the ED of the national tertiary hospital of Samoa. ED staff interviews provided insight into the ED frontline challenges and offered practical recommendations for ED health service improvement.

Knowledge and attitudes of school principals towards childhood hearing loss and hearing services: A cross-sectional survey to support the implementation of inclusive education in Samoa.

Objectives: To assess the knowledge and attitudes among school principals towards childhood hearing loss and hearing services to support the implementation of inclusive education in Samoa. Educators are uniquely positioned to advocate for inclusive education in their classrooms, and may be among the first professionals to suspect hearing loss in their young students. Given the well-known impacts of childhood hearing loss on learning and development, educators therefore play a vital role in referring students for an ear and hearing health assessment. Methods: A cross-sectional convenience sampling design and bilingual questionnaire were used (English/Samoan). School principals attending the annual conference for educators of Samoa over 4 days in June 2022 were invited to anonymously complete a 23-item questionnaire on childhood hearing loss and hearing services. Participants were required to respond to each statement with either 'yes', 'no' or 'unsure'. The questionnaire investigated general knowledge of healthy hearing and hearing loss, knowledge of causes and risk factors of hearing loss, knowledge of identification and intervention for hearing loss and the attitudes towards students with hearing loss. Results: 95.4% of the 109 participants agreed that healthy hearing is important, and 97.2% felt that childhood hearing loss is an important problem in Samoa. Participants agreed that hearing loss adversely impacts the interaction with peers (95.4%), listening in the classroom (94.5%), speech and language development (93.6%), classroom behaviour (88.1%) and reading skills (85.3%). 97.2% of participants felt that students with hearing loss should have the same opportunities as their normal-hearing counterparts, and 92.7% would include students with hearing loss in their classroom. 94.5% were keen to learn more about childhood hearing loss. There were no significant differences in response proportions between variable subgroups. Conclusion: Overall, the results displayed high levels of knowledge and very positive attitudes among school principals in Samoa towards their students with hearing loss.

Awareness and Perceptions of University Nursing Students in Samoa Towards Childhood Hearing Impairment and Hearing Healthcare: A Cross-Sectional Study.

Introduction: Pacific Islands have among the highest prevalence of pediatric hearing impairment in the world. Given the limited availability of ear and hearing specialists in the Pacific region, the broader health professional community plays a vital role in the prevention of avoidable pediatric hearing impairment. Nurses emerge as one of the ideal candidates for task-sharing in the administration of ear and hearing care at the public and primary healthcare levels. Objectives: The aim of this study is to evaluate the awareness and perceptions of university nursing students in Samoa to pediatric hearing impairment and hearing healthcare. Methods: This study employed a cross-sectional study design. A 10-item questionnaire was administered to university nursing students in Samoa (N = 100). The statements aimed to evaluate perceptions towards childhood hearing impairment, as well as awareness of causal factors of permanent childhood hearing loss and available hearing healthcare. Participants were required to provide a response based on the five-point Likert scale "Strongly Agree," "Agree," "Neutral/Don't know," "Disagree," and "Strongly Disagree." Results: Overall, 79% of participants responded "Disagree/Strongly Disagree" to the item "Hearing loss is not that important because it does not kill." Overall, 52% of respondents were aware of hearing impairment as a public health concern in Samoa. Early identification and intervention services for newborns with hearing impairment are nonexistent in Samoa, and awareness was low for the importance of early detection (62%) and amplification suitability for babies (49%). Overall, awareness was also low for causal factors of permanent sensorineural hearing loss. Conclusions: A borderline neutral/positive perception was found among our future nursing professionals to engage with pediatric hearing impairment in Samoa. Awareness regarding the causes of permanent childhood hearing impairment, as well as early identification and intervention services, could be integrated in the university curriculum.

Sensitivity and specificity of the Alvarado Score for the timely differential diagnosis of acute appendicitis for a case series in Samoa.

BACKGROUND: Timely diagnosis of acute appendicitis (AA) is essential for optimal management of abdominal pain emergency presentations. Improved diagnostic procedures should minimise progression to complicated appendicitis, as well as reduce the number of unwanted surgical interventions. The Alvarado Score is an important tool to assist with the management of AA based on clinically predictive values. The aim of the present study was to evaluate the sensitivity and specificity of the Alvarado Score as an instrument for the diagnosis of AA in our low-resourced context of Samoa. MATERIALS AND METHODS: The lead investigator performed a retrospective clinical data review design of all patients admitted to the Tupua Tamasese Meaole Hospital Surgical Unit for AA from January 2015 to December 2016. Exclusion criteria were appendiceal abscess and/or mass, and final diagnosis 'not acute appendicitis'. Age, sex, village, Alvarado Score, Ultrasound Scan Result, surgical management, and histopathology result were the main variables entered into the SPSS statistical software package for analysis. RESULTS: Of the 225 patients (2-86 years) admitted for AA, 67.1% (N = 151) underwent appendicectomy, and the remaining 32.9% (N = 74) were treated with antibiotics. An Alvarado Score (≥5) showed 91.7% sensitivity and 50% specificity for AA. There was a significant relationship between the Alvarado Score and the Ultrasound Scan for AA (p < 0.05). Histology results showed complicated AA in 68.6% (N = 94) of cases. The negative appendicectomy rate was 2.6%. CONCLUSIONS: The Alvarado Score is an effective tool for the timely differential diagnosis of AA in our Samoan context. The high rate of complicated acute appendicitis warrants investigation to further improve the management of AA in the Pacific Island setting.

Acute Kidney Injury: Incidence, aetiology, management and outcome measures of a Samoan case series.

BACKGROUND: Acute Kidney Injury (AKI) is a major and under-recognised cause of morbidity and mortality worldwide. Low and middle-income countries bear the greatest burden of AKI (85%). There is currently no published literature on AKI from the Pacific Islands. The aim of the present study was to report the incidence, aetiology, management and outcomes measures of AKI from the tertiary referral hospital of Samoa. MATERIALS AND METHODS: Single-centre prospective observational study. Participants were recruited by the lead investigator from the hospital patient information system. The inclusion criteria for participation was (1) adults (>18 years) admitted to general wards of Tupua Tamasese Meaole (TTM) Hospital with a diagnosis of AKI between December 1, 2019 and May 31, 2020, and (2) serum creatinine level of >200 µmol/L, and (3) compliance with the current Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI diagnosis. The data collection form was adapted from the International Society for Nephrology - Global Snapshot Project, and recorded demographic and baseline characteristics, precipitating causes of AKI, treatment/management, and outcomes measures. RESULTS: There was a total of 114 AKI admissions over the study period corresponding to a hospital-based AKI incidence of 26.8 per 1000 admissions per 6 months. 75% of AKI cases were community acquired. The leading causes of AKI were dehydration (79%) and sepsis (64%). More than 40% of cases presented with two or more Non-Communicable Disease co-morbidities. The in-patient mortality rate was 20.2%. In the 3 months following discharge from hospital, 25% of AKI cases had completely resolved, 25% of patients had died, and 18.7% of AKI cases had progressed to chronic kidney disease. The leading causes of mortality were cardiovascular events (35%) and sepsis (35%). CONCLUSIONS: The hospital-based incidence and unfavourable outcomes of AKI are high in Samoa. Greater awareness of this under-recognised condition is warranted among the public, government officers, and health professionals.

Knowledge and Attitudes of Pacific Islander Doctors and Medical Students to Childhood Hearing Loss and Hearing Services: Results of a Structured Questionnaire Survey in SAMOA.

The Pacific Islands have among the highest global rates of childhood hearing loss in the world. Given the scarcity of ENT Specialists and audiologists in the region, the role of the wider health professional community in addressing preventable childhood hearing loss is crucial. A 10-item 5-point Likert scale questionnaire was administered to medical officers and medical students in Samoa. The statements aimed to investigate knowledge and attitudes to childhood hearing loss and hearing services. Overall, 95.8% of participants selected "Disagree/Strongly Disagree" in response to the statement "Hearing loss is not that important because it does not kill." There was good knowledge regarding early detection and intervention services for infant hearing assessments (73.6%) and amplification suitability for babies (69.4%-72.2%). Highest knowledge of causes of childhood sensorineural hearing loss was measured for neonatal meningitis/seizures (55.6%), followed by intra-uterine infections (52.8%), and aminoglycosides (52.8%). Knowledge was lowest for jaundice (33.3%) and birth asphyxia (38.9%).

A call to action for the inclusion of ENT/Audiology services in the public health approach to addressing non-communicable diseases in the Pacific Islands.

•Non-Communicable Diseases (NCDs): a public health crisis in the Pacific Islands.•Hearing loss is a silent disability associated with NCDs.•Hearing disability secondary to NCDs may be prevented/minimised.•Inclusion of ear/hearing health in NCD public heath agenda is advocated.•Ear/hearing health support should positively impact NCD outcomes.

A preliminary report of the pattern of ear disease among students attending a school for people with disabilities in Samoa.

OBJECTIVES: The Ear, Nose, and Throat Department of Samoa is developing a school outreach service, and the aim of this study is to determine the pattern of ear disease among students attending a school for people with disabilities in Samoa. METHODS: The study design is a prospective study of a 2-day outreach visit to a school for people with disabilities by the Samoan Ear, Nose, and Throat team who recorded their clinical findings (N = 28). Two Ear, Nose, and Throat Specialists performed ear examinations for each student and recorded their diagnosis and recommendations as per routine Ear, Nose, and Throat Clinic protocols on a purposefully designed form based on the World Health Organization Ear and Hearing Survey. This information was entered into an Excel spreadsheet for descriptive statistical analysis. RESULTS: Results showed that 39% (n = 11) of students passed their initial ear examination, while 61% (n = 17) of students presented with at least one ear condition requiring Ear, Nose, and Throat intervention. The most common pathology was impacted wax (n = 15 ears). Following the Ear, Nose, and Throat Clinic outreach visit, 21 students (75%) no longer required Ear, Nose, and Throat or medical services, five students (18%) required a medical prescription for the treatment of ear disease, and two students (7%) were referred to the Ear, Nose, and Throat Department for further review. CONCLUSION: Students attending schools for people with disabilities are a priority population for the Ear, Nose, and Throat Clinical service outreach programme.

Knowledge and attitudes of schoolteachers in the Pacific Islands to childhood hearing loss and hearing services: A national survey protocol for Samoa.

OBJECTIVES: The Pacific Island region is estimated to have among the highest rates of childhood ear disease and hearing loss in the world. The adverse effects of childhood hearing loss include delayed speech/language development, learning difficulties, and reduced social-emotional well-being. Schoolteachers and early childhood educators are among the first professionals who may suspect hearing loss in their young students, and they are well-placed to initiate referrals to appropriate health services. Given the current efforts to implement Inclusive Education in the Pacific Islands, teachers are also uniquely positioned to positively influence, support, and advocate for a child with hearing loss in their classroom. There are no previous studies on this topic from the Pacific Island region. METHODS: The study will use a national survey and convenience sampling design. Teachers attending the Annual Teachers Conference in Samoa will be invited to independently and anonymously completed a 23-item questionnaire on childhood hearing loss and hearing services. Questions are in English, with a Samoan translation provided. The participating teachers will be required to respond with "yes," "no," or "unsure," and to mark their response on the questionnaire. The questions assess knowledge of biomedical etiology of hearing impairment, knowledge of the adverse impacts of hearing loss on childhood development, knowledge of hearing loss identification and intervention, and attitudes toward children with a hearing impairment. RESULTS: Not applicable for a study protocol. CONCLUSION: We publish these protocols to facilitate similar studies in other low- and middle-income countries, and especially among our Pacific Island neighbors.

Maternal knowledge and attitudes to childhood hearing loss and hearing services in the Pacific Islands: A cross-sectional survey protocol for urban and rural/remote Samoa.

Introduction: The successful implementation of ear and hearing health services for children depends on the support and engagement of primary caregivers. The World Health Organization recommends childhood hearing screening programs for all member states to enable early detection and intervention for children with hearing loss. Ear and hearing specialists are limited in the Pacific Islands, a region with one of the highest global rates of ear disease and hearing loss. Given that a significant proportion of childhood hearing loss is preventable through public health measures, collaboration with health promotion activities is recommended to improve primary caregiver knowledge of avoidable ear and hearing disorders among infants and young children. Previous work has examined the knowledge and attitudes of parents in an urban Pacific Island settings, and this study will investigate for differences between urban and rural/remote Pacific Island populations. Study design: Cross-sectional survey. Methods: Questionnaire administered to mothers attending immunization clinics with their infants in urban (Apia) and rural/remote (Savai'i) Samoa. A 25-item questionnaire was formally translated from the original English into Samoan by an accredited translator in collaboration with an Ear, Nose and Throat registered nurse. It will be administered in a semi-structured interview style by a Health Promotion Officer in Samoan. The participating mothers are required to respond with 'yes,' 'no,' or 'unsure.' The questions assess knowledge of biomedical etiology of hearing impairment (9 questions), beliefs regarding non-biomedical etiology of hearing impairment (2 questions), knowledge of otitis media and its risk factors (5 questions), knowledge of hearing loss identification and intervention (4 questions), and attitudes towards hearing services for children (6 questions). Results: Not applicable. Data to be collected. Conclusion: We publish these protocols to facilitate similar studies in other Low- and Middle-Income Countries, and especially among our Pacific Island neighbours.

Knowledge and attitudes of university health students in the Pacific Islands towards childhood hearing loss and hearing services: a Samoan survey study protocol.

Introduction: The Pacific Islands have among the highest rates of ear disease and hearing loss in the world, especially among children. Given that Ear, Nose and Throat (ENT)/audiology specialists are limited in the region, the successful implementation of ear and hearing health services will depend on the participation and support of the wider community of health professionals. There are currently no studies from the Pacific Islands investigating the knowledge and attitudes of either health students or health professionals towards childhood hearing loss and hearing services. Methods and analysis: Survey of medical and nursing students (n=370) currently enrolled at the National University of Samoa. Students will independently and anonymously complete a 10-item questionnaire. The questions assess attitudes to childhood hearing loss (two questions), knowledge of aetiology of childhood hearing loss (three questions), and knowledge of identification and interventions for children with hearing loss (five questions). Responses are based on a 5-point Likert scale (Strongly agree/Agree/Neutral/Disagree/Strongly disagree). Discussion/conclusion: We publish these protocols to facilitate similar studies in other low-income and middle-income countries, and especially among our Pacific Island neighbours.