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Service delivery approaches related to hearing aids in low- and middle-income countries or resource-limited settings
(Public Library of Science, 2024-01-24) Dillard, Lauren K.; Der, Carolina M.; Laplante-Levesque, Ariane; Swanepoel, De Wet; Thorne, Peter R.; McPherson, Bradley; De Andrade, Victor; Newall, John; Ramos, Hubert D.; Kaspar, Annette; Nieman, Carrie L.; Clark, Jackie L.; Chadha, Shelly
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.
Trends in body mass index for people with and without HIV : pooled analysis of nationally-representative health surveys from 10 countries and 173,800 adults in Africa
(Public Library of Science, 2024-09-17) Carrillo-Larco, Rodrigo M.; Bulstra, Caroline A.; Manne-Goehler, Jennifer; Siedner, Mark J.; Johnson, Leslie C.M.; Marconi, Vincent C.; Chung, Michael H.; Venter, Willem Daniel Francois; Kocher, Erica; Lalla-Edward, Samanta; Chandiwana, Nomathemba C.; Kariuki, Jacob K.; Ali, Mohammed K.
It remains unclear if and how body mass index (BMI) levels have changed over time in HIV endemic regions. We described trends in mean BMI and prevalence of overweight between 2003–2019 in 10 countries in Africa including people living with (PLWH) and without (PLWoH) HIV. We pooled Demographic and Health Surveys (DHS) from countries where ≥2 surveys >4 years apart were available with height/weight measurements and HIV tests. HIV status was ascertained with a finger-prick dried blood spot (DBS) specimen tested in a laboratory. The DBS is taken as part of the regular DHS procedures. We summarized age and socioeconomic status standardized sex-specific mean BMI (kg/m2) and prevalence of overweight (BMI ≥25 kg/m2) by HIV status. We fitted country-level meta-regressions to ascertain if changes in ART coverage were correlated with changes in BMI. Before 2011, women LWH (22.9 [95% CI: 22.2–23.6]) and LWoH (22.6 [95% CI: 22.3–22.8]) had similar mean BMI. Over time, mean BMI increased more in women LWH (+0.8 [95% CI: 0.7–0.8] BMI units) than LWoH (+0.2 [95% CI: 0.2–0.3]). Before 2013, the mean BMI was similar between men LWH (21.1 (95% CI: 20.3–21.9)) and LWoH (20.8 (95% CI: 20.6–21.1)). Over time, mean BMI increased more in men LWoH (+0.3 [95% CI: 0.3–0.3]) than LWH (+0.1 [95% CI: 0.1–0.1]). The same profile was observed for prevalence of overweight. ART coverage was not strongly associated with BMI changes. Mean BMI and prevalence of overweight were similar in PLWH and PLWoH, yet in some cases the estimates for PWLH were on track to catch up with those for PLWoH. BMI monitoring programs are warranted in PLWH to address the rising BMI trends.
Tuberculin skin test surveys and the annual risk of Tuberculous infection in school children in Northern KwaZulu-Natal
(Public Library of Science, 2024-06-18) Yates, Tom A.; Cebekhulu, Siphiwe; Mthethwa, Mumsy; Fourie, Petrus Bernardus; Newell, Marie-Louise; Abubakar, Ibrahim; Tanser, Frank
Tuberculin skin test surveys in primary school children can be used to quantify Mycobacterium tuberculosis transmission at community level. KwaZulu-Natal province, South Africa, is home to 11.5 million people and suffers a burden of tuberculosis disease that is among the highest in the world. The last tuberculin survey in the province was undertaken in 1979. We performed a tuberculin skin test survey nested within a demographic and health household surveillance programme in Northern KwaZulu-Natal. We enrolled children aged between six and eight years of age attending primary schools in this community. Mixture analysis was used to determine tuberculin skin test thresholds and the Annual Risk of Tuberculous Infection derived from age at testing and infection prevalence. The Community Infection Ratio, a measure of the relative importance of within-household and community transmission, was calculated from data on tuberculin positivity disaggregated by household tuberculosis contact.
Between June and December 2013, we obtained tuberculin skin test results on 1240 children. Mixture analysis proved unstable, suggesting two potential thresholds for test positivity. Using a threshold of 10mm or treating all non zero reactions as positive yielded estimates of the Annual Risk of Tuberculous Infection of 1.7% (1.4–2.1%) or 2.4% (2.0–3.0%). Using the same thresholds and including children reported to be receiving TB treatment as cases, resulted in estimates of 2.0% (1.6–2.5%) or 2.7% (2.2–3.3%). The Community Infection Ratio was 0.58 (0.33–1.01). The force of infection in this community is lower than that observed in Western Cape province, South Africa, but higher than that observed in community settings in most other parts of the world. Children in this community are commonly infected with Mycobacterium tuberculosis outside the home. Interventions to interrupt transmission are urgently needed.
Frontline support : responding to the COVID-19 mental health crisis in South Africa through online arts and music therapy
(Approaches, 2024-12-23) Lotter, Carol Barbara; Mattison, Nethaniëlle; Schroeder, Calsey; Pollard, Anja; carol.lotter@up.ac.za
COVID-19 rendered South Africa reeling from the ramifications of the pandemic. Lockdown restricted movement, placed significant strain on healthcare workers, and profoundly impacted the socio-economic state of the country. Increased unemployment, reports of gender-based violence and suicide threats were among some indications of a resultant mental health crisis. In response, Frontline Support (FS), a collaborative volunteer-based arts therapy initiative was established. This report presents the documented process of establishing and implementing FS. The concept and structure of the organisation as well as the triage and treatment intervention are described. Descriptive statistics drawn from triage data, a client evaluation, and a therapist survey, as well as the themes emerging from the thematic analysis thereof are presented. The inclusion of two vignettes, drawn from documented clinical case studies, illustrate the online therapeutic offering of FS. A summary of quantitative data includes: the triage allocation, number of clients accessing FS, breakdown of sessions and geographical reach for the period March 2020 to July 2021. The thematic analysis of the client evaluation yielded five themes: i) Perceived personal gains through online therapy, ii) Enhanced personal insight, iii) Clients’ experience of the therapist, iv) Difficulties experienced by clients, and v) Reflections and recommendations. The therapist survey yielded the following six themes: i) Access and awareness, ii) Client access to and engagement with therapeutic arts resources, iii) Possibilities and restrictions of the Online Platform (OLP), iv) Arts therapies techniques adapted for the OLP, v) Therapists’ challenges, and vi) Establishing and maintaining the therapeutic relationship. The discussion reflects on the benefits, challenges and learnings of FS, and concludes with recommendations for its ongoing development, sustainability and accessibility within South Africa.
Investigating the Internet skills of older adults in South Africa
(CHRIST University, 2024-10-10) Gwala, Nkonzwenhle; Mawela, Tendani; tendani.mawela@up.ac.za
The older adult population is growing in South Africa. However, it is reported that approximately only 3.6% of older adults use the Internet. Using information technology resources and the internet can enable older adults to be independent for longer, and the internet may improve older adults’ quality of life. Additionally, access to technology and the internet supports access to information and digital inclusion. This study investigated older adults’ level of internet skills in South Africa and their experiences regarding internet use. The research followed a positivist, quantitative approach and used online questionnaires for data collection. The results showed that older adults appear to be lacking in internet skills in South Africa. The overall mean scores were low, where mobile skills seemed to be the lowest-rated skill for the respondents. The evaluation also showed that online operational and creativity skills appeared low for older adults.