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The role of community health workers in addressing the global burden of ear disease and hearing loss: a systematic scoping review of the literature
  1. James O'Donovan1,2,
  2. Misha Verkerk3,
  3. Niall Winters1,
  4. Shelly Chadha4,
  5. Mahmood F Bhutta5
  1. 1 Department of Education, University of Oxford, Oxford, UK
  2. 2 Division of Research and Health Equity, Omni Med, Mukono, Uganda
  3. 3 Department of Otolaryngology, King's College Hospital NHS Foundation Trust, London, UK
  4. 4 WHO Programme for Prevention of Deafness and Hearing Loss, World Health Organization, Geneva, Switzerland
  5. 5 Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr James O'Donovan; james.odonovan{at}


Introduction Community health workers (CHWs) have the potential to improve access to ear and hearing services for people across low-income or middle-income countries, remote, underserved, or resource-poor areas of the world. We performed a systematic scoping review to identify evidence on how CHWs are currently deployed in the prevention, screening, diagnosis, treatment and management of ear disease and hearing loss; methods to train and support CHWs in this context; and cost-effectiveness of CHWs.

Methods We performed a systematic search of the literature from September 1978 to 18 March 2018 from 11 major databases and the grey literature.

Results We identified 38 original studies that met the inclusion criteria, taking place across South Asia (n=13), Oceania (n=7), North America (n=7), South America (n=6) and Africa (n=5). 23 studies showed CHWs can increase community participation in screening. They can conduct screening using whispered voice tests, noisemakers for neonatal screening, automated audiological tests and otoscopy. Eight studies focused specifically on the evaluation of programmes to train CHWs, and three provided a general programme description. Three studies documented a role of CHWs in the treatment of ear disease or hearing loss, such as performing ear washouts, instillation of topical antibiotics or fitting of hearing aids. Only one study provided an indepth cost-utility analysis regarding the use of CHWs to conduct hearing screening, and no studies commented on the role of CHWs in the prevention of hearing loss.

Conclusion CHWs have been employed in diverse ways to address the global burden of ear disease and hearing loss. Future research needs to explore the role of CHWs in preventative strategies, identify optimum methods to train and support CHWs, and explore their cost-effectiveness.

  • Community Health Worker (CHW)
  • hearing
  • audiology
  • hearing-loss
  • ear disease
  • hearing screening

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  • Handling editor Seye Abimbola

  • Contributors Activities undertaken by the authors were as follows: establishment of research question(s) and development of search strategy: JOD, NW, MFB; background framing: JOD, MFB, NW; database search and record screening: JOD and MV; extraction of primary studies from the included reviews: JOD and MV; discussion and conclusions: JOD, NW, MV, SC, MFB. All authors agree to take public responsibility for the paper’s content and have approved the final paper prior to submission.

  • Funding JOD is a DPhil candidate at the University of Oxford supported by a grant from the Economic and Social Research Council (ES/P000649/1) and The British Medical Association Charitable Arm.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Since this was a systematic scoping literature review of existing data, ethical approval was not sought.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are contained within the main body of the text and in the online supplementary material.