STATUSOF EARAND EARING CAREIN SOUTH EAST ASIA...
Transcript of STATUSOF EARAND EARING CAREIN SOUTH EAST ASIA...
STATUS OF EAR AND HEARING
CARE IN SOUTH EAST ASIA
REGION
Dr. Suneela Garg
Director Professor,
Department of Community Medicine,
Maulana Azad Medical College, New Delhi, India
Director - Society for Sound Hearing International
GLOBAL BURDEN OF DISEASE DUE TO
DEAFNESS AND HEARING LOSS
� Hearing loss most frequent sensory deficit in humanpopulation
� WHO estimates (2012) about 360 million peoplesuffering from disabling hearing loss� Around 5.3% of the global population
� Approximately 32 million children <15 years
� 7.5 million younger than 5 years
� Burden greatest in Southern Asia (27%), Asian Pacificregion (10%) & Sub-Saharan Africa (9%)
� Globally, there is paucity of data with regard toepidemiological studies
0
50
100
150
200
250
300
350
400
1985 1995 2005 2012
More developed/ High income countries
Less developed/ LMI countries
TOTAL
42m
TRENDS IN WHO GLOBAL ESTIMATES OF
DISABLING HEARING LOSS:1985 - 2012
Millions with disabling
hearing loss
360m
278m
120m
HEARING LOSS- DALYS (000S)
22076
1935 2502
7013
26261314
6549
15862
1360 1792
4930
2269
899
4518
0
5000
10000
15000
20000
25000
Global African Region Region of the
Americas
South East Asia
Region
European
Region
Eastern
Mediterranean
Region
Western Pacific
Region
2012 DALYs (000s) 2000 DALYs (000s)
Hearing Loss is responsible for 22, 076,000 DALYs
LEADING CAUSE OF SENSORY ORGAN
DISEASE BURDEN (DALYS) AMONG ADULTS
WORLDWIDE, 2012
2%
13%
26%
3%
14%
42%
0%
Glaucoma
Cataracts
Refractive errors
Macular degeneration
Other vision loss
Hearing loss
Sense organ disorders
PREVALENCE OF MODERATE TO SEVERE
HEARING LOSS (%) IN SEAR COUNTRIES
Data from DPR Korea & Maldives not available.
Source: Status of ear and hearing care in the South-East Asia Region, WHO
publication, 2007 (Brown), Data reported by country representatives (Annexure) (Blue)
& Data provided by both sources (Red)
0
2
4
6
8
10
12
14
16
18 16.6
119.6 9 8.6
6.3 6
4.2
0.03
Pre
va
len
ce o
f d
ea
fne
ss &
HL
SEAR Countries
HUMAN RESOURCES FOR EAR CARE IN
SOUTH EAST ASIA REGION
� ENT specialists
� Primary care providers
� Audiologists
� Audiometricians
� Speech therapists
� Teachers for the deaf
� Sign language interpreters
•Shortage of ear
professionals in
SEAR
•Skewed
geographical
distribution
NUMBER OF ENT SURGEONS IN SEAR
COUNTRIES (PER MILLION POPULATION)
Data from DPR Korea not available.
Source: Status of ear and hearing care in the South-East Asia Region, WHO
publication, 2007 (Brown) & Data reported by country representatives (Annexure)
(Blue) (Data per thousand population is very meagre)
0
5
10
15
20
25
30 26.8
9.5 8.8
6.34.2 3.2 3 2.6 2.2
0.9
EN
T s
urg
eo
ns
pe
r m
illio
n p
op
ula
tio
n
SEAR Countries
NUMBER OF AUDIOLOGISTS IN SEAR
COUNTRIES (PER MILLION POPULATION)
0.1
2.7
3.1
0.3
0.1
0.4
0.7
3.0
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5
Bangladesh
Bhutan
India
Indonesia
Myanmar
Nepal
Sri Lanka
Thailand
Number of audiologists per million population
SE
AR
co
un
trie
s
Data from DPR Korea and Maldives not available, No audiologist in Timor- Leste.
India data includes Speech therapists
Source: Data reported by country representatives (Annexure)
(Data per thousand population is very meagre)
NUMBER OF AUDIOMETRICIANS IN SEAR
COUNTRIES (PER MILLION POPULATION)
1.4
1.3
2.1
0.1
0.2
1.9
2.6
1.4
0.0 0.5 1.0 1.5 2.0 2.5 3.0
Bangladesh
Bhutan
India
Indonesia
Myanmar
Sri Lanka
Timor- Leste
Thailand
Number of audiometricians per million population
SE
AR
co
un
trie
s
Data from DPR Korea, Maldives and Nepal not available
Source: Status of ear and hearing care in the South-East Asia Region, WHO publication,
2007 (Brown) & Data reported by country representatives (Annexure) (Blue)
(Data per thousand population is very meagre)
NUMBER OF SPEECH THERAPISTS IN SEAR
COUNTRIES (PER MILLION POPULATION)
Data from DPR Korea not available. No speech therapist in Myanmar, Nepal & Timor
Leste. India data includes audiologists
Source: Status of ear and hearing care in the South-East Asia Region, WHO publication,
2007 (Brown) & Data reported by country representatives (Annexure) (Blue)
(Data per thousand population is very meagre)
0.6
1.4
3.2
2.9
3.3
5.2
0.7
0.0 1.0 2.0 3.0 4.0 5.0 6.0
Bangladesh
Bhutan
India
Indonesia
Maldives
Sri Lanka
Thailand
Number of speech therapists per million population
SE
AR
co
un
trie
s
AVAILABILITY OF EAR CARE SERVICES IN
SEA REGION
Ear Care Services
Public
Primary Secondary
Private
Tertiary
EAR CARE SERVICES AT THE PRIMARY
HEALTH CARE LEVEL
•Primary ear care services areprovided exclusively by generalphysicians posted at primary healthcentres
Bangladesh
•Trained nurses provide basic ear care servicesBhutan
•At village level in rural India, basic ear care services are provided by MPWs under IMNCI and awareness creation by ASHA & AWW
India
•Primary ear care services are provided exclusively by general physicians posted at primary health centres
Indonesia
EAR CARE SERVICES AT THE PRIMARY
HEALTH CARE LEVEL
• Trained nurses provide basic ear careservicesMaldives
• Nurses provide primary ear care services inrural areas.
• Otologist assistants are present in EasternNepal
• NGO sector is very active
Nepal
• General physician posted at primary healthcentres gives first line of treatment topersons suffering from any ear ailment
Sri Lanka
• Nurses provide basic ear care serviceThailand
• Primary ear care is provided by special ENT nurses
• NGO sector is very active (Uma Ita Nian, ATLASS II, Agape school for the deaf)
Timor Leste
SERVICES AVAILABLE AT THE PRIMARY-LEVEL
CENTRES
General Physical diagnosis BAN, BHU, IND, INO, MAL, MMR, NPL, SRL,
THA
Tuning fork test BHU
Hearing Screening BHU, MMR
Cleaning of cerumen BAN, BHU
Ear examination with otoscope MAL, SRL, THA, INO, IND*
Prescribe medicine on ear drops BAN, INO, NPL, SRL, THA, BHU, MMR, MAL
Dispense Medicines BAN, IND, MAL, SRL, THA, MMR, BHU
Refer to appropriate centre BAN, IND, INO, MAL, SRL, THA, MMR, BHU,
NPL
Source: Status of ear and hearing care in the South-East Asia Region, WHO publication,
2007
*Otoscopes are being provided to PHCs in a phased manner
DISEASES TREATED AT THE PRIMARY-
LEVEL CENTRE
BAN BHU IND INO MAL NPL SRL THA TL
ASOM* ASOM ASOM ASOM ASOM ASOM AOM+ ASOM ASOM
CSOM++ CSOM CSOM CSOM CSOM CSOM CSOM CSOM CSOM
Cerumen# Cerumen Cerumen Cerumen Cerumen Cerumen Cerumen Cerumen Cerume
n
Otitis Otitis Otitis Otitis Otitis Otitis Otitis Otitis Otitis
Externa Externa Externa Externa Externa Externa Externa Externa Externa
*ASOM – Acute Suppurative Otitis Media
+AOM – Acute Otitis Media
++CSOM – Chronic Serous Otitis Media
#Cerumen – Medical treatment of cerumen only
Source: Status of ear and hearing care in the South-East Asia Region, WHO publication,
2007. Data from Timor Leste reported by country representative
EAR CARE SERVICES AT PRIMARY
HEALTH CARE LEVEL
Country Number of health centers/ 100,000
population
Bangladesh 13
Bhutan 2
DPR Korea 26 polyclinics
India 2.8 (Primary health centers and Community
Health centers)
Indonesia 10 (Primary health centers and sub-centers)
Myanmar 0
Nepal 7
Sri Lanka 35
Timor- Leste 17
Thailand 1
Data from Maldives not available.
Source: Data reported by country representatives (Annexure)
EAR CARE SERVICES AT SECONDARY
HEALTH CARE LEVEL
Country Number and types of health centers
providing secondary ear care/
100,000 population
Bangladesh 0.01(Secondary hospitals)
Bhutan 0.27(Regional referral hospitals)
DPR Korea 0.12 (District hospitals)
India 0.05 (District Hospitals)
Indonesia 6.3 (CHCs in 1999)
Maldives 19.7 (General hospitals)
Myanmar 0.08(Hospitals)
Nepal 0.06(District hospitals)
Sri Lanka 0.07
Timor- Leste 5.9(5 District Health Centers , 66
community health centers)
Thailand 0.01 (General Hospitals)
Source: Data reported by country representatives (Annexure)
EAR CARE SERVICES AT TERTIARY HEALTH
CARE LEVEL
Country Number of health
facilities/ 1,000,000
population
Remarks
Bangladesh 0.02
Bhutan 0.14 1 National referral hospital
DPR Korea 3.2 800 hospitals
India 0.03 398 teaching institutions having
ENT depart, around half are private
teaching hospitals
Indonesia 0.004 Limited audiological facilities
Myanmar .009
Nepal .07 All with audiological services
Sri Lanka .22 Government hospitals
Timor-Leste .25 1 National Hospital at Dilli
Thailand .14 All with audiology and microsurgery
facilities
Data from Maldives not available.
Source: Data reported by country representatives (Annexure)
NATIONAL POLICIES AND LEGISLATION FOR
EAR CARE IN SEAR
� National programme/ strategy for prevention of
deafness and hearing impairment
� Bangladesh (2011), India (2006), Indonesia (2007),
Sri Lanka (2012) and Thailand
� No programme in
� Bhutan, Maldives, Nepal and Timor Leste
NATIONAL COMMITTEES FOR EAR &
HEARING CARE
� Seven of eleven
� Bangladesh
� India
� Indonesia
� Myanmar
� Nepal
� Sri Lanka
� Thailand
LEGISLATION ON NOISE
� Legislation on environmental and workplace
noise levels formulated in:
� Bangladesh
� India
� Indonesia
� Thailand
WAY FORWARD
� Each country in region must have database on
prevalence of hearing loss, its causes, available
infrastructure and manpower
� Data to be periodically updated and used as
evidence by National Committees for developing
effective strategies for prevention and control of
deafness.
� This should be used as tool to sensitize policy
makers, programme managers & other stakeholders
for improved hearing care.
NATIONAL POLICIES AND LEGISLATION FOR EAR
CARE IN SEAR
Country Programme/
Strategy/ Policy/
Committee
Focal person in
the Ministry
of Health (MoH)
Year of
initiation
Coverage of the policy
Bangladesh National Strategy for
Prevention of
Deafness & Hearing
Impairment
Director-General
of Health
Services, Ministry
of Health
2011 National survey on prevalence
of hearing impairment
completed in 2013. National
Institute of ENT established in
Dhaka
India National Programme
for
Prevention and
Control of
Deafness
Director-General
of Health
Services, Ministry
of Health and
Family Welfare
(MoHFW)
2006 281 districts (out of 640
districts) across 29 States and
7 Union Territories
Indonesia National Strategy
Plan for Prevention
and Management of
Hearing Impairment
and Deafness
Ministry of Health 2007 48 regional committees
covering 19 (out of 33)
provinces and 29 (out of 463)
districts/ cities
NATIONAL POLICIES AND LEGISLATION
Myanmar Committee of
Prevention and
Control of Deafness
Secretary-
Director General,
Department of
Health
(chairperson)
Nepal National
Committee on
Prevention and
Control of Deafness
Secretary-
Ministry of Health
and Population
(chairperson)
2012 Progress status not available
Sri Lanka National
Programme for
Prevention and
Control of
Deafness
Secretary-
Ministry of Health
2012 Programme is in pilot phase
and is being implemented
across four districts
Thailand Policy for
Prevention and
Control of
Deafness in place
Country Programme/
Strategy/ Policy/
Committee
Focal person in
the Ministry
of Health (MoH)
Year of
initiation
Coverage of the policy
ANNEXURE- DATA REPORTED BY
COUNTRIES
� Bangladesh- Dr. Kamrul Hassan Tarafder and Prof. Md Abul Hasan
Joarder
� Bhutan-Dr. Tika Ram Adhikari
� India- Dr A.K. Agarwal, Mr Suman Kumar, Dr S R Savithri and Dr. Ritu
Gupta
� Indonesia- Dr Bulantrisna Djelantik, Dr Upik Rukmini, Dr. Ronny
Swento and Mr Sharad Adhikary
� Myanmar- Dr Than Than Htay
� Nepal- Dr Lal Kishore Yadav
� Sri Lanka- Dr Chandra Jayasuriya
� Thailand- Dr. Suchitra Prasansuk
� Timor Leste- Dr Rajesh Pandav