Screening procedure

The screening procedure was organised in 3 segments or stations as follows:

i) Station 1 : An entry point, where all clerical work was done, i.e. monitoring the failing/following register, vetting the incoming child’s eligibility for a screening and allocating an identity number (ID No). The clerk then directed the child and her/his mother or carer to station 2.

ii) Station 2: The questionnaire screening point, where the screener receives the child and his/her mother or carer. The screener asks the mother or carer the set of questions on the questionnaire and performs some auditory acuity detection tasks with the child. They then record all the responses and their observations and summarise the outcome o f the screen on the top copy o f the questionnaire. The child and their parent or carer is sent to station 3 where the audiologist performs a pure-tone audiometric screening.

iii) Station 3: the child goes into a room with a battery-powered audiometer, which has recently been calibrated. The audiologist performs the pure-tone

audiometric screening without any background information on how the child performed on the questionnaire screen. Four frequencies are selected and used throughout the screening exercise viz.: 0.5 kHz, 1 kHz, 2 kHz and 4 kHz. Initially as far as possible, it was planned to obtain the lowest hearing threshold from each screened child, but the ambient noise made it impossible to read the 30dBHL screen. It was then set at SOdBHL for all the children.

After the day’s work, one person collected questionnaires from stations 2 and 3, usually the person positioned at station 1. The questionnaires and audiograms were filed immediately in separate files and were kept by the person manning station 1 (usually by the researcher or the other person appointed by him to work on station 1 during his absence). There was tight security around the files and no one except the station 1 clerk had access to the questionnaires and the audiograms from stations 2 and 3.

Before the team retired to bed they met to discuss and record the general observations noted during the day, such as:

i) The attendance of children at the screen. ii) Recording important events in the community. iii) Recording the weather pattern of the day.

iv) Discussing the general public health status o f the community members especially children, e.g. food security, nutritional activities (e.g. gardening for personal food growing and rain fed crops grown by the community for cash and subsistence).

v) Recording the referrals done by the hearing screening team to other institutions, such as the clinic, hospital and local school.

vi) Also, recording children above and under the target group (36 - 72 month olds) screened by the team during the day.

A field diary was maintained, which recorded observations at each screening and provided this study with a record of summarised events and general community observations.

3.6.4 “Questionnaire” screen interviews

Seven hundred and forty-seven (747) “Failing” and Follow ing” children recruited in the study were screened by use o f the “Q uestionnaire” screen that was directed to mothers or carers o f children attending the screen. This was a high com pliance rate o f 0.90. The 87 children who were not screened dropped from the study for various reasons, amongst which were: away for holidays, illness and mothers or carers unable to attend for reasons such as being busy with household chores or too old to walk to the screening venues.

Village community workers visited house-to-house reminding mothers or carers to attend hearing screening interview sessions on specified dates. See Picture 3.4 some o f the 747 children brought by their mothers or carers for screening.

Picture 3.4: M others bringing their children for screening

On the due date, mothers or carers brought their children to a screening venue. The screening venues were at selected schools or clinics. At a screening venue, the screening team o f 4 people stood ready for mothers or carers to arrive as early as 07.30 hours. As the child and their mother or carer arrived at the venue, they were received by the study administrator/receptionist, who made sure they were both settled. They explained the purpose o f the screen and what the m other or carer’s participation was going to contribute to the overall aim o f the study.

See some children waiting for their turn for screening in Picture 3.5.

Picture 3.5: Children waiting for a screen with pre-school teachers

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The consent of the mother or carer to participate in the study was verbally requested. After making the mother or carer settled she or he was given the “Questionnaire” marked with the allocated identity number on which was written the child’s name. The mother or carer and child were directed to the other room or shady place where an interview was conducted by a Tonga language fluent interviewer.

The interviewer received the mother and child. They made them comfortable and explained in brief how they would conduct the interview. The mother or carer was told the time the interview would last. Then the interviewer requested the mother or carer to hand-in the questionnaire given to her at the reception. The mother or carer’s permission to proceed with answering some questions was requested and granted.

The interview session proceeded by going through questions on Part 1 of the “Questionnaire” screen (for every child), which collected some demographic data about the child (see Picture 3.6, one of the field workers interviewing the mother or carer).

Picture 3.6: Interviewing the mother

After the questions on “Part 1” of the “Questionnaire” screen had been asked and the answers recorded, the interviewer seleeted an age specific section from “Part 2” of the “Questionnaire” screen. They then asked the mother or carer the questions in this section. Some of the questions required playing a game of naming body parts with the child. The child was expected to imitate or point to the part of their body mentioned in a quiet voice by the mother or carer and the interviewer. The responses given by the mother or carer and the child were recorded on the “Questionnaire” screen.

The interview session ended with the interviewer thanking the mother or carer and his or her child for participating in the session and it was explained to the mother or carer that she or he was expected to attend the next session in another room where the child’s hearing was to be evaluated by use of a machine (audiometer) by an audiologist.