Data from: Reasons for low uptake of referrals to ear and hearing services for children in Malawi

Background: Early detection and appropriate intervention for children with
hearing impairment is important for maximizing functioning and quality of
life. The lack of ear and hearing services in low income countries is a
significant challenge, however, evidence suggests that even where such
services are available, and children are referred to them, uptake is low.
The aim of this study was to assess uptake of and barriers to referrals to
ear and hearing services for children in Thyolo District, Malawi. Methods:
This was a mixed methods study. A survey was conducted with 170 caregivers
of children who were referred for ear and hearing services during
community-based screening camps to assess whether they had attended their
referral and reasons for non-attendance. Semi-structured interviews were
conducted with 23 caregivers of children who did not take up their
referral to explore in-depth the reasons for non-uptake. In addition, 15
stakeholders were interviewed. Thematic analysis of the interview data was
conducted and emerging trends were analysed. Results: Referral uptake was
very low with only 5 out of 150 (3%) children attending. Seven main
interacting themes for non-uptake of referral were identified in the
semi-structured interviews: location of the hospital, lack of transport,
other indirect costs of seeking care, fear and uncertainty about the
referral hospital, procedural problems within the camps, awareness and
understanding of hearing loss, and lack of visibility and availability of
services. Conclusion: This study has highlighted a range of interacting
challenges faced by families in accessing ear and hearing services in this
setting. Understanding these context specific barriers to non-uptake of
ear and hearing services is important for designing appropriate
interventions to increase uptake.