northern

Northern Uganda’s only hope to fight a silent ‘pandemic’

Gulu, April 17, 2023:  More than 5 percent of the world’s 7 billion population – or 430 million people require rehabilitation to address their ‘disabling’ hearing loss.

Today, there are 432 million adults and 34 million children globally with hearing impairment.

It is estimated that by 2050, more than 700 million people – or one in every 10 people will have disabling hearing loss.

In Uganda, an estimated 2 million Ugandans are living with permanent hearing loss or some kind of impairment. Studies conducted within the country have found road crashes as one of the major causes of injury to the ear.

And, as the world deals with the socio-economic impact of the “silent pandemic”, there is hope, especially with the acquisition and installation of the new ultramodern ear-testing equipment at St Philip Health Centre III at Michan village, Bardege-Layibi Division in Gulu City.

The machine, which cost approximately shs110 million, can provide services such as ear checkups, hearing aids programming and fitting, hearing aid repair and maintenance, as well as audio-speech therapy for people with cochlear implants.

This machine is the only operating ear-treatment equipment in the sub-region after the one recently installed at Gulu Regional Referral Hospital broke down.

According to Dr. Isaac Ojok, an audiologist at the facility, samples of 250 students in two schools in Gulu City alone discovered that up to 55 of them had defects in their ears that required treatment and corrections, and this number would make you wonder about the situation among adults.

Dr. Ojok called upon individuals with hearing problems, organizations, and bodies that work with children such as schools and other institutions to prioritize ear checkups and testing.

“The Centre has acquired ultramodern ear testing equipment which is among some of the best in the industry. Now that the Centre is fully-equipped, we will be able to identify, diagnose, and rehabilitate hearing problems,” Dr. Ojok said.

According to Ojok, hearing defects are a significant problem in Northern Uganda and yet remain untackled by health facilities and stakeholders.

Dr. Julius Omoding, an ENT (Ear, Nose, and Throat) specialist disclosed that causes of hearing impairment can be divided into congenital and acquired causes. He says congenital causes may lead to hearing loss being present at or acquired soon after birth and hearing loss can be caused by genetic factors or complications during pregnancy and childbirth.

Dr. Josephine Likichoru, an audiologist says some children are born with underdeveloped ears, especially premature babies. Even head injury or lack of oxygen to the brain can cause hearing impairment.

On the other hand, acquired causes may lead to hearing loss at any age. Such causes include infectious diseases such as meningitis, measles, and mumps; chronic ear infections and the use of certain drugs that damage the inner ear such as some antibiotics and anti-malarial.

Other causes are continuous exposure to excessive noise, which damages the delicate hair cells in the inner ear. This damage often results in permanent hearing loss and tinnitus (ringing in the ears).

She, however, disclosed that the treatment for hearing impairment is prescribed depending on the type and cause. If the cause is an infection, the patient is put on antibiotics and it clears. She adds that if the patient has mild hearing loss, he or she is given a hearing aid to amplify the sound and enable him or her to hear properly.

“The aids are sometimes given out free of charge at government health facilities if available and in private facilities, a hearing aid costs about shs8 million and if the condition cannot be corrected, a patient is referred to the school of the deaf to learn sign language,” she explains.

Prevention

Dr. Likichoru says half of all causes of hearing loss can be prevented through primary prevention. Some simple strategies for prevention include immunizing children against childhood diseases such as measles, meningitis, rubella, and mumps.

“Adolescent girls and women of reproductive age should also be immunized against rubella before pregnancy. Pregnant women should also be screened for and treated for diseases such as syphilis, which might cause hearing loss in an unborn child,” explains Likichoru.

Dr. Hillary Ogutti, an ENT surgeon at Arua Hospital, warned people against using sharp objects such as matchsticks to clean their ears, saying they could damage the eardrums, leading to hearing loss.

“Don’t have your television, radio, or music on too loud. This is particularly important if you have young children because their ears are more delicate than those of an adult. When listening to radio or television, the safe volume should be at a level whereby one can comfortably have a conversation with someone who is two meters away,” explains Ogutti.

He also urges people to get examined if they experienced dull hearing or ringing in the ears after listening to music.

“We believe more in prevention rather than treatment. This is why we encourage people to go for regular check-ups to find out about the functioning of their ears,” Ogutti emphasizes.

The government of Uganda through the Ministry of Health has adopted several other strategies to improve hearing health such as enhancing the supply of ear drop medicines by the National Medical Stores, construction of ear/nose/throat (ENT) departments in various regional hospitals of Mbarara, Kabale, Arua, Soroti, and Jinja.

There are also medium-sized departments in Moroto, Fort-portal, Hoima, and Mubende.

During the commemoration of The World Hearing Day on March 3, 2019, at Kampala Capital City Authority Upper Gardens, Joyce Moriku Kaducu, the then minister of state for primary health care disclosed that most of the people suffering from hearing loss live in developing countries of which Uganda is one.

“The ENT department at Mulago National Referral Hospital is undergoing expansions under the rehabilitation of the entire hospital complex,” Moriku said.

The government has also implemented the Deaf-Blind Project in collaboration with Sense International in the Wakiso district, aimed at reducing the prevalence of deaf-blindness and offering specialized rehabilitative health care to the affected children.

Technological efforts to address hearing loss have a long history. Early hearing trumpets and other “hearing aids” focused on increasing the volume and directionality of sound.

With a series of advances in technology (carbon transmitters in the late 1800s, vacuum tubes in the early 1900s, transistors beginning in the 1920s and in more common use in the 1950s, microprocessors in the 1970s and 1980s, and digitalization of sound in the 1980s and 1990s), the size of hearing aids has decreased, while the capabilities to provide clearer sound have greatly improved.

Details can be found in Mills, 2011Mudry and Dodele, 2000Washington University School of Medicine, 2016.

In addition, advances in signal processing and other technologies, improvements in battery capabilities, and the advent of wireless access have made it possible for hearing aids to include telecoils (for coupling with compatible electronic products), directional microphones, noise reduction circuitry, direct audio input, and processing algorithms that are intended to minimize background noise and maximize conversational sound, and capabilities for wireless signal reception for interactions with televisions, phones, computers, and tablets, and other communication and hearing assistive technologies.

The extent to which these components (and other innovations) are included in specific hearing aid products varies across the range of basic to premium-level aids.

Upgrades and variations include the extent and nature of Bluetooth capability, the inclusion of a telecoil, the number of channels, automatic switching among programs, feedback reduction, and smartphone applications to program or personalize the device Consumer Reports, 2015HLAA, 2016Mamo et al., 2016McCormack and Fortnum, 2013.

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