Parental awareness of hearing impairment in their school-going children and healthcare seeking behaviour in Kisumu district, Kenya
Introduction
Childhood hearing impairment (HI) is a significant public health condition associated with long-term academic and communicative difficulties. Causes can be congenital or acquired. Nearly half of the known causes can be prevented by primary public health methods [1], [2]. Early identification and prompt intervention are crucial for improved outcomes. Efficient test measures to facilitate early detection of HI are not universally available in the developing countries owing to their high costs and lack of skills [3]. Besides, concerns about their potential benefits to the society, persist [4]. This implies that their application for mass screening cannot be reasonably cost effective [5]. Parental awareness of their child's hearing disability consequently is a valuable primary resource for early detection and intervention.
Early identification of childhood hearing impairment (defined as identification by 6 months after birth) and appropriate intervention is critical for normal speech, language, cognitive and social development [6], [7], [8]. Screening/surveillance tests and systems for children are essential primary public health strategies whose aims would be: to ensure all children have opportunity to realize their full potential in terms of good health, well-being and development; and to identify and manage as early as possible remediable disorders to minimize their impact [1]. In developing countries early detection poses significant practical challenge. Many pediatric health care providers feel inadequately trained in assessing children's developmental status, or are often too busy to conduct the elaborate developmental screening tests during the regular clinics [9]. The level of parental involvement, quality, quantity and timing of care services children receive are essential to their psychosocial and academic development and ultimately the quality of life they achieve [10], [11], [12]. Although the severity of HI relates inversely to the age at detection, less is known of the bearing of socioeconomic status and demographic factors on the age of diagnosis and the impact of parental awareness on care seeking.
Section snippets
Epidemiology of childhood HI
The prevalence of childhood HI varies widely across different age groups, social classes and even within individuals [13], [14]. It is estimated that about 440 million children worldwide have hearing loss above 85 decibels (dB) but this increases to about 800 million when threshold is reduced to 50 dB. In Kenya, the mean prevalence of childhood HI varies between 2.3% and 5.6% [3], [15]. The actual prevalence of mild and moderate HI is difficult to assess because test environments typically have
Study area
The study was carried out in Kisumu district in western Kenya. It covers an area of 918.55 km2 within the Lake Basin on the Winam Gulf with a population of 539,966 [37], [38]. Poor infrastructure is a major concern affecting socioeconomic activities in the district. The main economic activity is subsistence agriculture and service industries. Leading causes of childhood morbidity include malaria, acute respiratory illnesses, diarrhea diseases and anemia. There are 49 health facilities, most of
Demographic characteristics
Of the pupils screened, 2.48% (35/1411) had hearing impairment (BEHL0.5–4 kHz ≥ 25 dB HL) in either one or both ears. Their age range was 6–14 years while the mean age was 9.5 (S.D. 2.21) compared to 8.7 years (S.D. 1.34) of the target population (t = 12.903, p = 0.001). Nearly half (57.1%) resided in the periurban zone, while 65.7% were from low socioeconomic strata (Table 1). Majority of them (85.7%) had thresholds above 39 dB (Fig. 1). Unilateral moderate to severe hearing impairment (HI) was
Discussion
This current study was carried out in an area of diverse geographical and socioeconomic background. However, majority of the index population was from low socioeconomic strata. The observed HI prevalence of 2.48% is comparable to that reported by Newton et al. [3]. The average detection time was 5.5 years. This prevalence demonstrates a heavy disability burden due to HI, while service provision and use remains dismal.
Most parents were both aware of and the first to suspect the reduced hearing
Conclusion
Childhood hearing impairment is an important problem in this community. While most parents are aware of their children's hearing limitations, they detect them late and their level of service demand and uptake is still low. Prioritizing issues of access to and utilization of the care facilities, the organizational factors and poverty alleviation can harness the benefits of parental awareness for early intervention in ear care programs. Reasons for late identification and lack of demand for care
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