Andrew Whiteley Smith

• BSc, MSc, MB BS, MRCP, DRCOG, DCH
• Professor at London School of Hygiene and Tropical Medicine

Objective To 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). Methods A clinic‐based diagnostic accuracy study was conducted in Malawi. Consecutively sampled participan...

In a cross-sectional study to determine the magnitude of dual sensory impairment (DSI-combined hearing and vision loss) in children in single-disability special education schools, children in schools for the blind and schools for the deaf in four states in South-East Nigeria were examined by an ophthalmologist and otorhinolaryngologist to determine...

Solomon and colleagues inappropriately label our analysis of trachoma control erroneous, but their comments are largely related to methodological issues in (standardised WHO-CHOICE) cost effectiveness analysis and present gaps in knowledge.1 2 Firstly, mass treatment with antibiotics of all residents is probably more effective and costly than trea...

Objective To determine the relative costs, effects, and cost effectiveness of selected interventions to control cataract, trachoma, refractive error, hearing loss, meningitis and chronic otitis media. Design Cost effectiveness analysis of or combined strategies for controlling vision and hearing loss by means of a lifetime population model. Setti...

General appendix (referred to by all the papers in this cluster)

Appendices A–C: Details of (A) definitions of interventions, disease models, and resource use patterns; (B) costs, health effects, and cost effectiveness of all interventions; (C) probabilistic uncertainty analyses for interventions

Hearing impairment is a leading cause of disease burden, yet studies of its prevalence are rare. We present estimates of the global prevalence of hearing impairment generated for the Global Burden of Disease 2010 study. We estimated that 1.2% (0.8%-1.8%) of children under age 15, 9.8% (7.7%-13.2%) of females over age 15, and 12.2% (9.7%-16.2%) of m...

Few of the low and middle income countries have national plans or programmes forprevention of hearing loss. WHO believes that strong national plans need to be alignedwith its own programmes and policies in order to achieve people-centred care deliveredthrough strong integrated health systems. It has followed up this ideal with the setting ofindicat...

Prevention is an action to stop a disease or disability from occurring or progressingin an individual or in a population. Large public health initiatives only began in the 19th century, when it was realized that the health of individual members of society isprofoundly influenced by society's collective characteristics. Primordial preventiontargets...

Hearing loss is a chronic and often lifelong disability that can cause profound damage to the development of speech, language, and cognitive skills in children, especially when commencing before the critical period of language development in infancy. That damage, in turn, affects the child's progress in school and, later, his or her ability to obta...

The problem of deafness or hearing loss is increasing world-wide. In countries rich and poor, people are living longer, and presbyacusis, the deafness of old age, is becoming more frequent. Hearing loss is a chronic and often life-long disability that, depending on the severity and the frequencies affected, can cause profound damage to the developm...

A data bank of prevalence of hearing impairment for monitoring and implementation of programmes at national or global level and for the estimate of the global burden has been established. A systematic search was conducted of random-sample population-based studies of bilateral hearing impairment with clearly defined hearing threshold levels. Fifty-t...

The purpose of this paper was to present estimates of costs and effects of selected interventions for hearing impairment in Africa and Asia. The method used mathematical simulation models on the basis of WHO burden of disease information, and WHO-CHOICE costing databases. Findings showed that in both regions, screening strategies for hearing impair...

Although the loss of vision and hearing has multiple causes, and the burden of these diseases is complex, three major points emerge from the outset: Impairments of the essential senses of vision and hearing contribute to early demise and are important causes of morbidity for individuals who are blind or deaf. Cost-effective interventions are availa...

This paper gives an overview of WHO activities in the global campaign for the prevention of deafness and hearing impairment, focusing particularly on children. It discusses the size of the problem and the causes and consequences of deafness and hearing impairment. It emphasizes the inadequate state of our knowledge of this subject in developing cou...

Antibiotic ear drops can clear up children's suppurative otitis media (glue ear), but antiseptics and oral or injected antibiotics may not work as well Chronic suppurative otitis media is a very serious infection deep in the ear. The ear leaks pus, and infection can damage the bones inside the ear and cause hearing loss. It usually affects small ch...

The WHO Programme for Prevention of Deafness and Hearing Impairment (PDH) is especially targeted at developing countries where there is a serious lack of accurate population-based data on the prevalence and causes of deafness and hearing impairment, including noise-induced hearing loss. However, opportunities exist for prevention of noise-induced h...

Chronic suppurative otitis media (CSOM) is a serious bacterial infection of the middle ear that can follow untreated acute otitis media. To assess the effects of different treatments for CSOM. We searched Medline from 1966 to 1996 and a bibliographic collection of the Hearing Impairment Research Group in Liverpool, UK. We handsearched two otolaryng...

The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled tr...

Information on the prevalence of hearing impairment and related ear pathologies in children in sub-Saharan Africa is scarce. A pilot study for a clinical trial of simple treatments for chronic suppurative otitis media (CSOM) in school children in Kiambu district, Kenya, provided information on the prevalence of hearing impairment and ear pathologie...

Researchers have conducted few population-based studies on the prevalence of deafness or hearing impairment in sub-Saharan Africa. The few studies that do exist focus on children attending schools for the deaf or special clinics, but they do not uncover the mild and moderate cases of hearing impairment, those who face the stigma of deafness or hear...

Routine screening for hearing impairment in childhood is now widespread in industrial countries, although there is considerable controversy over the most efficient techniques and procedures. In most developing countries, however, routine screening programmes for hearing impairment do not currently exist. The problems involved in implementing screen...

In order to determine whether giving iron to iron-deficient children increases their susceptibility to malaria, 213 Gambian children aged between 6 months and 5 years with iron-deficiency anaemia were randomized to receive either oral iron or placebo during the rainy season when malaria transmission is maximal. Haematological and iron measurements...

Haematological and iron parameters, measured in 907 children aged from 6 months to 5 years in rural Gambia at the start of the rainy season, differed from those in American reference populations as follows: mean haemoglobin levels were much lower at ages 1 and 2 years and mean levels of mean corpuscular volume (MCV) were lower at all ages (at age 1...

A comparison has been made of Lapudrine® (chlorproguanil) and Maloprim® (pyrimethamine +dapsone) as malaria chemoprophylactics when given every two weeks for 3 years to Gambian children under the age of 5 years. Both drugs produced falls in spleen and malaria parasite rates and an increase in packed cell volume. Maloprim, but not chlorproguanil, si...

In order to determine whether giving iron to iron-deficient children increases their susceptibility to malaria, 213 Gambian children aged between 6 months and 5 years with iron-deficiency anaemia were randomized to receive either oral iron or placebo during the rainy season when malaria transmission is maximal. Haematological and iron measurements...

Audiological and other long-term neurological sequelae were determined in 157 cases and their controls matched for age, sex and village 6 to 12 months after an epidemic of group A meningococcal meningitis in rural West Africa. 19 cases (12.1%) and 3 controls (1.9%) had moderate or severe neurological sequelae of any type (P less than 0.001); 6 case...

Mortality from meningococcal disease was determined during an epidemic in a rural area of The Gambia with few medical resources, but where a system of registration of births and deaths had been established before the introduction of a primary health care programme. 33 deaths were recorded among 127 patients, a case mortality rate of 26%. 84% of dea...

Enzyme-linked immunosorbent asays (ELISAs) are described for determining levels of dapsone and pyrimethamine in urine. Both assays have a sensitivity of about 20 mug/l and are reproducible, but each produces some false positives. The problem of false positive reactions was partially obviated by requiring positive results in both assays. In a pilot...