In this study, researchers estimated that hearing loss is the most common sensory disability and its prevalence is increasing globally with population ageing.  They had estimated 360 million people, or 5.3% of the world’s population, are living with disabling hearing impairment.  The leading causes of hearing impairment in sub-Saharan Africa are believed to be middle ear disease and impacted wax, and are therefore easily amenable to treatment and prevention.

The high prevalence of ear diseases and hearing loss in sub-Saharan Africa is at least partly due to the severe shortage of health workers including audiologists and of resources for hearing aid provision, support and aural rehabilitation programmes. The primary ear and hearing training increased the knowledge and confidence of CHWs in ear and hearing care, an area of healthcare in which they had not previously been trained.

The trained CHW demonstrated their ability to identify patients with ear and hearing disorders, both through outreach and as part of routine practice. They identified 1739 people with potential ear or hearing disorders of whom 860 attended a screening, and almost half (400) had significant hearing loss and a further 115 had unilateral hearing loss.

There was little change, however, in the patients with ear and hearing disorders recorded at the health centres after the intervention. Successful integration of ear and hearing care into primary healthcare requires resources, to raise awareness, train CHWs and provide equipment and medications at the health centre.

Important lessons can also be learnt from the study and the existing literature in considering whether and how to scale up the primary ear and hearing training. In summary, in line with the Malawi Government guidelines on task shifting to CHWs, the following tasks in ear and hearing care are recommended for CHWs.

There are (1) information, education and communication on ear and hearing disorders; (2) identification of cases for referral, (3) follow-up of cases for treatment adherence; (4) support and counselling of families on ear and hearing disorders. All these tasks assume that the CHWs have been trained in ear and hearing care and that equipment like otoscopes are made available to them.

The training was effective in improving the knowledge of CHW in ear and hearing care in Malawi and allowing them to identify people in the community requiring ENT services.

In future studies, author gave training of CHWs and their identification of patients with ear and hearing disorders could be scaled up in Malawi and tested in other low-income and middle-income countries.