Inclusive Hearing Care for School Children in Tanzania

Our Vision is to enable equitable access to Inclusive Education (IE) and participation for children with hearing loss (HL), in Tanzania and Ethiopia, thus contributing to UN Sustainable Development Goals (SDG) 3, 4, 10, 17 and 1. WHO states that to fight poverty, we need to include persons with disabilities. We aim to contribute to UNs strategy: "Leave No One Behind". Project partners: SINTEF, NTNU (Norwegian University of Science and Technology), The Open University of Tanzania and Patandi Teachers College in Tanzania and Jimma University in Ethiopia. Kilimanjaro Christian Medical Centre (KCMC) is local partner in Tanzania. WHO reports that nearly 80% of persons with disabling hearing loss (HL) live in low- and middle-income countries (LMICs) and it is estimated that 34 million children have HL. Furthermore, 60% of HL in children is due to avoidable causes that can be prevented. Traditionally, hearing care are specialised services provided at centralised clinics, at high cost, making services inaccessible for most people in LMICs. Innovative technology and capacity building facilitating task-shifting might enable hearing care services to be available in local communities. Loss of hearing affects children's development of speech, language and cognitive skills and may impact negatively on school attendance. In many LMICs, children with HL are vulnerable to dropping out of school or never going to school and girls are more likely to drop out or never attend school (WHO, 2021, UNICEF, 2018). Children with HL are reported to have lower school performance than children without HL. Lack of education will affect adult life with respect to employment and participation. Our objective is to develop a model for local hearing care services in primary school and implement innovative technology adapted to the local context. Furthermore, to document the prevalence and cause of HL, build capacity, create awareness, establish collaboration between education and health and pilot innovative solutions in local schools. The project has developed an automatic game-based hearing test using tablets and headphones and dedicated software that can be downloaded via the internet. The children can sit together in the classroom, and they enjoy the computer game. Children and teachers have participated in the development of the game. The first pilot study documented that 7-17% of the children had HL. The main reasons were earwax blocking the ear canal and untreated infections, that can be prevented and treated locally, if detected. Status: Field work has been conducted (WP1 & WP2), which includes hearing testing of 1,000 children in grade 2 and 3 in Arusha, Tanzania and the corresponding 500 children in Jimma, Ethiopia. We are currently analysing data documenting the prevalence and cause of HL and following up and treating the children with HL locally. Health personnel and ENT specialists participated, removing earwax and providing medicine for ear infections. Children with HL were followed up 1-2 times during 2023. The fieldwork also includes collection of data on children's quality of life and school performance. Both quantitative and qualitative data are collected through questionnaires and interviews with the children, teachers, and relatives. Additional follow-up of the children will be carried out first half of 2024, to document any long term-effect. Testing of selected hearing devices will be conducted during 2024. Education for audiologists do not exist in Tanzania and Ethiopia. The project have drafted a curriculum for Diploma in Audiology and Speech-Language Pathology (DASLP) at KCMC, Tanzania. The curriculum is submitted to Tanzanian Commission for Universitites (TCU) for approval. The project has conducted digital online training of ten nurses from Jimma University Medical Center's, in Ethiopia, and teachers at the involved schools have received knowledge and awareness about children with HL. NTNU has created a network collaboration with University of Colorado School of Medicine, Denver, USA and European Federation of Audiology Societies. One Master student from NTNU has finished her Master in Global Health as part of I Hear You2. The project organize annually a one-day event in Tanzania on World Hearing Day as part of the annual global WHO event. The activities include hearing tests and awareness in society. The events are registered and reported to WHO. Three scientific publications are in the process for publication during 2024. The project is shortlisted for The Zero Project Award on Inclusive Education, and Information and Communication Technology (ICT) for 2024 (No 5097 from OUT). Shortlisted projects are invited to the Zero Project Conference and price giving event at UNs office, Vienna, Austria, Feb 21 -23, 2024. The project has received ethical approval from the National Institute of Medical Research, Tanzania, the Institutional Review Board, Jimma University Institute of Health, Ethiopia, and REK, Norway.

Our Vision is to enable equitable access to Inclusive Education (IE) and participation for children with hearing loss, thus contributing to reduce poverty and "Leaving No One Behind". SINTEF, NTNU, The Open University of Tanzania, Patandi Teachers College and Jimma University are collaborating partners. Globally, there are about 466 million people (6.1 % of the world’s population) with hearing loss, whereof approximately 34 million are children (WHO, 2020). Nearly 90 % of people with hearing loss live in low- and middle-income countries (LMICs), which often lack the resources and services to address hearing loss (WHO, 2018). Traditionally, hearing care services are specialised services provided at centralised clinics, at high cost, making the services inaccessible for most of the population in LMICs. Innovative technology and targeted capacity building might enable hearing care services to be available in local communities. The loss of hearing affects children's development of speech, language and cognitive skills and impact negatively on school attendance. In many low-income countries, children with hearing loss and deafness are vulnerable to dropping out of school or never going to school and girls are most likely to drop out or never attend school (WHO, 2020; UNICEF, 2018). Children with hearing loss are reported to have lower school performance than children without hearing loss. Lack of education will affect adult life with respect to employment and participation. The objective is to develop a model for local hearing care services in primary school that will enable equitable access to Inclusive Education for children with hearing loss. Prevalence and cause of hearing loss will be surveyed in Tanzania and Ethiopia, medical and technical hearing care interventions will be performed at local schools in Tanzania, technology will be adapted to the local context and hearing care services piloted in Tanzania.