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.

背景：听力障碍儿童的早期发现与恰当干预，对实现其功能最大化发挥与生活质量提升具有重要意义。低收入国家普遍存在耳部与听力医疗服务供给不足的问题，这是一项严峻挑战；但现有研究证据显示，即便此类服务已实现可及且儿童获得转诊资格，其就诊率仍处于低位。本研究旨在评估马拉维蒂约洛区儿童耳部与听力服务转诊的就诊率及其阻碍因素。

方法：本研究为混合方法研究。针对社区筛查活动中已获得耳部与听力服务转诊资格的170名儿童照护者开展问卷调查，以评估其是否完成转诊就诊及未就诊的具体原因。针对23名未完成转诊的儿童照护者开展半结构化访谈，以深入探究其未就诊的根本原因。此外，本研究还对15名利益相关方进行了访谈。对访谈数据开展主题分析，并对研究中涌现出的趋势进行解读。

结果：本次研究的转诊就诊率极低，150名获得转诊的儿童中仅5名（3%）完成了就诊。半结构化访谈共识别出7项与转诊未就诊相关的核心交互主题：转诊医院的地理位置偏远、交通资源匮乏、就医间接成本高昂、对转诊医院存在恐惧与不确定感、社区筛查活动存在流程问题、对听力损失的认知与理解不足，以及服务可见性与可及性缺失。

结论：本研究明确了该地区家庭在获取耳部与听力医疗服务过程中面临的一系列交互关联的挑战。深入理解该特定场景下导致耳部与听力服务就诊率低下的情境障碍，对设计针对性干预措施以提升就诊率具有重要的指导意义。