BARRIERS TO EARLY DETECTION OF PEDIATRIC HEARING LOSS IN LOW-RESOURCE SETTINGS: A COMMUNITY BASED STUDY

Abstract

Early identification of pediatric hearing loss is critical for optimizing language, cognitive, and social development, yet 70% of caregivers in our low-resource study settings exhibited limited awareness (mean awareness score = 3.2 ± 1.1), and only 45% understood the importance of newborn screening. To elucidate context-specific impediments, we conducted a community-based, mixed-methods study involving semi-structured interviews and focus groups with 200 caregivers and 50 community health workers, a structured caregiver survey (n = 200), and cross-sectional audits of 40 primary health centers. Qualitative analysis identified five major barrier themes—awareness, cost, distance, stigma, and training—while quantitative data revealed that 65% of caregivers reported prohibitive travel times (mean = 45 ± 20 min) and out-of-pocket costs (mean = 150 ± 60 local units). Facility audits showed that fewer than half of centers possessed functional otoacoustic emission or auditory brainstem response devices, only 35% had adequately trained personnel, and just 30% maintained clear referral pathways. By integrating thematic frequencies with prevalence metrics, we developed an evidence matrix yielding impact scores (accessibility = 4.2; cost = 3.9 on a 1–5 scale) that pinpoint the most critical failure points in the screening cascade. Correlation analysis demonstrated a positive relationship between caregiver education level and awareness (r = 0.78, p < 0.01). Temporal screening trends and pilot outreach data further suggested that mobile unit deployment and CHW-led education in high-need seasons increased screening uptake by 35%. These findings underscore the necessity of decentralized, subsidized screening models, integration of hearing checks into routine maternal–child health visits, and targeted health literacy campaigns. Implementing such community-driven interventions could substantially reduce diagnostic delays and improve developmental outcomes for children with hearing loss in resource-constrained environments.