Diagnostic accuracy of non‐specialist versus specialist health workers in diagnosing hearing loss and ear disease in Malawi

Tropical Medicine and International Health - Tập 24 Số 7 - Trang 817-828 - 2019
Tess Bright1, Wakisa Mulwafu2,3, Mwanaisha Phiri2, R.J.H. Ensink4, Andrew Smith1, Jennifer Yip1, Islay Mactaggart1, Sarah Polack1
1International Centre for Evidence in Disability London School of Hygiene & Tropical Medicine London UK
2Audiology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
3Department of Surgery, University of Malawi, Blantyre, Malawi
4Department of Oto-rhino-laryngology, Gelre Hospitals, Zutphen, The Netherlands

Tóm tắt

AbstractObjectiveTo determine whether a non‐specialist health worker can accurately undertake audiometry and otoscopy, the essential clinical examinations in a survey of hearing loss, instead of a highly skilled specialist (i.e. ENT or audiologist).MethodsA clinic‐based diagnostic accuracy study was conducted in Malawi. Consecutively sampled participants ≥ 18 years had their hearing tested using a validated tablet‐based audiometer (hearTest) by an audiologist (gold standard), an audiology officer, a nurse and a community health worker (CHW). Otoscopy for diagnosis of ear pathologies was conducted by an ENT specialist (gold standard), an ENT clinical officer, a CHW, an ENT nurse and a general nurse. Sensitivity, specificity and kappa (κ) were calculated. 80% sensitivity, 70% specificity and kappa of 0.6 were considered adequate.ResultsSix hundred and seventeen participants were included. High sensitivity (>90%) and specificity (>85%) in detecting bilateral hearing loss was obtained by all non‐specialists. For otoscopy, sensitivity and specificity were >80% for all non‐specialists in diagnosing any pathology except for the ENT nurse. Agreement in diagnoses for the ENT clinical officer was good (κ = 0.7) in both ears. For other assessors, moderate agreement was found (κ = 0.5).ConclusionA non‐specialist can be trained to accurately assess hearing using mobile‐based audiometry. However, accurate diagnosis of ear conditions requires at least an ENT clinical officer (or equivalent). Conducting surveys of hearing loss with non‐specialists could lower costs and increase data collection, particularly in low‐ and middle‐income countries, where ENT specialists are scarce.

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Tropical Medicine and International Health

Tập 24 Số 7

817-828

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