Parental awareness of hearing impairment in their school-going children and healthcare seeking behaviour in Kisumu district, Kenya

Summary

Background

Hearing-impaired children who are identified early and appropriately managed have improved outcomes in speech, language, cognitive and social development. Enhanced parental awareness of their child's hearing disability, behavioral, developmental and psychosocial limitations is essential to sustaining timely detection and appropriate intervention. Additionally, availability of services for diagnosis, treatment and habilitation would improve the demand for pedaudiological care in this community.

Objective

To describe level of parental awareness of childhood HI and the pattern of access to and utilization of ambulatory care services.

Subjects

Thirty-three parents of lower primary school-going children who failed audiometric screening from sampled schools in Kisumu district, western Kenya.

Main outcome measures

First person to detect HI, age of child at first suspicion of HI, source of ambulatory health care and use of the health care facilities.

Results

The prevalence of HI was 2.48%. Most parents/guardians (69.7%) were aware of their child's hearing impairment. Of these, 63.6% were first to detect HI in the pupils, while 30.3% were detected by screen. Most children (57.2%) were first recognized with (HI) after age 2 years. The mean age at identification was 5.5 years. The median travel distance to the preferred health care facility was 2 km (IQR 1–2.5). Parents seldom sought or lacked help for their hearing-impaired children. Of 27.3% who asked for hearing assessment, 9.1% received some counsel on HI and 12.1% received medication, one (3%) was referred for audiological assessment and none used a hearing aid. Use of health facilities for maternal care was (65.7%) and immunization (62.9%).

Conclusions

Despite adequate parental awareness of chronic childhood disability, health facilities were underutilized. This indicates the need to further stimulate and maintain a desirable level of uptake of services for diagnosis, treatment and habilitation of childhood HI, while sustaining delivery of effective and acceptable high quality paediatric care.

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.