Ear health services in remote NT communities

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    On Country training program.
  • Aboriginal child having her ear checked.
    Ear check.
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By
Jiunn-Yih Su, Amanda Leach, Alan Cass, Peter Morris, Sean Taylor, Kelvin Kong, Amelia McCullough, Tarrant Tolotta, Tess Riethmuller, Emily Websdale, Sandra Godfrey
The Hearing for Learning Initiative - Menzies School of Health Research
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A recent evaluation of the quality of ear health services provided to Aboriginal children living in remote Northern Territory (NT) communities has revealed a large room for improvement.

In remote Aboriginal communities in the NT, many children suffer otitis media (infection of the middle ear, OM) from when they are just a few months of age. This infection can occur to them repeatedly and frequently. If undetected, left untreated, or inadequately treated, it can become progressively worse and lead to serious complications, and the most common complication is hearing impairment.

As young children need to hear to learn to speak and communicate, the hearing impairment caused by OM has been shown in local studies to negatively impact Aboriginal children’s early childhood development, school participation and academic performance, and is also associated with a higher risk of child maltreatment and youth offense.

Over the last few decades, various interventions have been conducted in the NT to control the high rates of OM among Aboriginal children, including vaccines targeting the most common pathogens, evidence-based effective treatment and easily accessible treatment guidelines. However, recent community surveys found that the high rates still persist, although there is a shift of the dominant disease types to the milder ones. Given that OM affects Aboriginal children early in life, vaccines cannot prevent all infections, and there is effective treatment, it is essential to conduct ear examinations to detect OM in time and to treat it to prevent its worsening and the associated hearing impairment.

The Hearing for Learning Initiative (HfLI) has been established as a community-based service enhancement program with a combined funding of $7.9m from the Federal Department of Health, NT Health and the Balnaves Foundation. It aims to integrate locally based ear health facilitators into the existing health clinics to assist Aboriginal children with ear and hearing problems, increase the awareness of the prevalent OM and improve ear health services. The goal is to work with communities to establish reliable, sustainable, culturally appropriate services that ensure every ear of every child is healthy and hearing every day.

As part of the HfLI program, a study was conducted to evaluate the baseline data for ear health services provided to Aboriginal children aged 0-16 years living in remote NT communities for the period of 2016-2020. The study (recently published here) found that, on average, of children aged 0-16 years, only 57% had received one or more ear examination in a six-month period. In the most at-risk and the most critical age groups for language development, namely, under 2 and 2-4 years of age, only between 70-80% of children had ever received ear check-ups in a six-month period. This means up to 30% of these young Aboriginal children could have undetected OM and hearing impairment that affected their learning to speak and learn.

In addition, the study also found that among the children whose ears were checked, about 40% had OM and, of those diagnosed with OM, fewer than one in four were treated or followed up in accordance with the local guidelines.

These findings reveal many missed opportunities to control high rates of OM and to reduce Aboriginal children’s risk of hearing impairment and the associated negative outcomes later in life. Given the large room for improvement, it is crucial to increase ear examinations, improve the effectiveness in diagnosing OM and enhance compliance with OM management guidelines. It is hoped that the HfLI program currently conducted will be able to show the approach of training and employing locally based ear health facilitators in remote health clinics can bring improvement to all these aspects.

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