Implementation and evaluation of a rural community-based pediatric hearing screening program integrating in-person and tele-diagnostic auditory brainstem response (ABR).

BACKGROUND: In an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic ABR testing; one using a tele-medicine approach and the other a traditional in-person testing at a tertiary care hospital. METHODS: Village health workers (VHWs) underwent a five day training program on conducting Distortion Product Oto Acoustic Emissions (DPOAE) screening and assisting in tele-ABR. VHWs conducted DPOAE screening in 91 villages and hamlets in two administrative units (blocks) of a district in South India. A two-step DPOAE screening was carried out by VHWs in the homes of infants and children under five years of age in the selected villages. Those with 'refer' results in 2nd screening were recommended for a follow-up diagnostic ABR testing in person (Group A) at the tertiary care hospital or via tele-medicine (Group B). The overall outcome of the community-based hearing screening program was analyzed with respect to coverage, refer rate, follow-up rate for 2nd screenings and diagnostic testing. A comparison of the outcomes of tele-versus in-person diagnostic ABR follow-up was carried out. RESULTS: Six VHWs who fulfilled the post training evaluation criteria were recruited for the screening program. VHWs screened 1335 children in Group A and 1480 children in Group B. The refer rate for 2nd screening was very low (0.8%); the follow-up rate for 2nd screening was between 80 and 97% across the different age groups. Integration of tele-ABR resulted in 11% improvement in follow-up compared to in-person ABR at a tertiary care hospital. CONCLUSIONS: Non-availability of audiologists and limited infrastructure in rural areas has prevented the establishment of large scale hearing screening programs. In existing programs, considerable challenges with respect to follow-up for diagnostic testing was reported, due to patients being submitted to traveling long distance to access services and potential wage losses during that time. In this program model, integration of a tele-ABR diagnostic follow-up improved follow-up in comparison to in-person follow-up. VHWs were successfully trained to conduct accurate screenings in rural communities. The very low refer rate, and improved follow-up rate reflect the success of this community-based hearing screening program.

Tele-ABR using a satellite connection in a mobile van for newborn hearing testing.

We assessed the feasibility of conducting Auditory Brainstem Response (ABR) testing in a mobile van with satellite connectivity, with the help of trained health workers. ABR recordings in newborn babies made by telemedicine were compared with recordings made face to face. The auditory evoked response equipment was controlled by an audiologist at a nearby hospital. Videoconferencing was used during the testing process to monitor patient preparation by the village health worker. A total of 24 newborns (13 male and 11 female) aged 8-30 days underwent ABR in face-to-face and tele-mode. There was no significant difference between peak V latency measured at three intensity levels in the two modes. Agreement between the two methods of measurement was examined with a Bland-Altman plot. Almost all points were within the limits of agreement, suggesting no bias in the telemedicine measurements. Real-time tele-ABR testing as a component of newborn hearing screening is feasible in a mobile van using satellite link with the assistance of village health workers.