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 human population WHO estimates (2012) about 360 million people suffering 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 Pacific region (10%) & Sub-Saharan Africa (9%) Globally, there is paucity of data with regard to epidemiological studies
TRENDS IN WHO GLOBAL ESTIMATES OF DISABLING HEARING LOSS:1985-2012 Millions with disabling hearing loss 400 350 300 250 200 150 100 50 0 360m 278m 120m 42m 1985 1995 2005 2012 More developed/ High income countries Less developed/ LMI countries TOTAL
HEARING LOSS- DALYS (000S) 25000 22076 20000 15862 15000 10000 7013 6549 5000 1935 1360 2502 1792 4930 2626 2269 1314 899 4518 0 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 0% 2% 42% 14% 13% 3% 26% Glaucoma Cataracts Refractive errors Macular degeneration Other vision loss Hearing loss Sense organ disorders
GLOBAL DISTRIBUTION OF DEAFNESS ACROSS DIFFERENT WHO REGIONS
PREVALENCE OF MODERATE TO SEVERE HEARING LOSS (%) IN SEAR COUNTRIES 18 16.6 16 Prevalence of deafness & HL 14 12 10 8 6 4 2 0 11 9.6 9 8.6 6.3 6 4.2 0.03 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)
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) ENT surgeons per million population 30 25 20 15 10 5 0 26.8 9.5 8.8 6.3 4.2 3.2 3 2.6 2.2 0.9 SEAR Countries 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)
NUMBER OF AUDIOLOGISTS IN SEAR COUNTRIES (PER MILLION POPULATION) Thailand 3.0 Sri Lanka 0.7 SEAR countries Nepal Myanmar Indonesia India 0.1 0.3 0.4 3.1 Bhutan 2.7 Bangladesh 0.1 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Number of audiologists per million population 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) Thailand 1.4 Timor- Leste 2.6 SEAR countries Sri Lanka Myanmar Indonesia India 0.1 0.2 1.9 2.1 Bhutan Bangladesh 1.3 1.4 0.0 0.5 1.0 1.5 2.0 2.5 3.0 Number of audiometricians per million population 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) Thailand 0.7 Sri Lanka 5.2 SEAR countries Maldives Indonesia India 2.9 3.2 3.3 Bhutan 1.4 Bangladesh 0.6 0.0 1.0 2.0 3.0 4.0 5.0 6.0 Number of speech therapists 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)
AVAILABILITY OF EAR CARE SERVICES IN SEA REGION Ear Care Services Public Private Primary Secondary Tertiary
EAR CARE SERVICES AT THE PRIMARY HEALTH CARE LEVEL Bangladesh Primary ear care services are provided exclusively by general physicians posted at primary health centres Bhutan Trained nurses provide basic ear care services India Indonesia At village level in rural India, basic ear care services are provided by MPWs under IMNCI and awareness creation by ASHA & AWW Primary ear care services are provided exclusively by general physicians posted at primary health centres
EAR CARE SERVICES AT THE PRIMARY HEALTH CARE LEVEL Maldives Trained nurses provide basic ear care services Nepal Sri Lanka Nurses provide primary ear care services in rural areas. Otologist assistants are present in Eastern Nepal NGO sector is very active General physician posted at primary health centres gives first line of treatment to persons suffering from any ear ailment Thailand Nurses provide basic ear care service Timor Leste Primary ear care is provided by special ENT nurses NGO sector is very active (Uma Ita Nian, ATLASS II, Agape school for the deaf)
SERVICES AVAILABLE AT THE PRIMARY-LEVEL CENTRES General Physical diagnosis Tuning fork test Hearing Screening Cleaning of cerumen Ear examination with otoscope Prescribe medicine on ear drops Dispense Medicines Refer to appropriate centre BAN, BHU, IND, INO, MAL, MMR, NPL, SRL, THA BHU BHU, MMR BAN, BHU MAL, SRL, THA, INO, IND* BAN, INO, NPL, SRL, THA, BHU, MMR, MAL BAN, IND, MAL, SRL, THA, MMR, BHU BAN, IND, INO, MAL, SRL, THA, MMR, BHU, NPL *Otoscopes are being provided to PHCs in a phased manner Source: Status of ear and hearing care in the South-East Asia Region, WHO publication, 2007
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 India Indonesia Myanmar 0 Nepal 7 Sri Lanka 35 Timor- Leste 17 Thailand 1 26 polyclinics Data from Maldives not available. Source: Data reported by country representatives (Annexure) 2.8 (Primary health centers and Community Health centers) 10 (Primary health centers and sub-centers)
EAR CARE SERVICES AT SECONDARY HEALTH CARE LEVEL Country Number and types of health centers providing secondary ear care/ 100,000 population Bangladesh Bhutan DPR Korea India 0.01(Secondary hospitals) 0.27(Regional referral hospitals) 0.12 (District hospitals) 0.05 (District Hospitals) Indonesia 6.3 (CHCs in 1999) Maldives Myanmar Nepal Sri Lanka 0.07 19.7 (General hospitals) 0.08(Hospitals) 0.06(District hospitals) 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 Bangladesh 0.02 Remarks 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.
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Annexure
NATIONAL POLICIES AND LEGISLATION FOR EAR CARE IN SEAR Country Programme/ Strategy/ Committee Policy/ Focal person in the Ministry of Health (MoH) Year of initiation Coverage of the policy Bangladesh India National Strategy for Prevention of Deafness & Hearing Impairment National Programme for Prevention and Control of Deafness Indonesia National Strategy Plan for Prevention and Management of Hearing Impairment and Deafness Director-General of Health Services, Ministry of Health Director-General of Health Services, Ministry of Health and Family Welfare (MoHFW) 2011 National survey on prevalence of hearing impairment completed in 2013. National Institute of ENT established in Dhaka 2006 281 districts (out of 640 districts) across 29 States and 7 Union Territories Ministry of Health 2007 48 regional committees covering 19 (out of 33) provinces and 29 (out of 463) districts/ cities
NATIONAL POLICIES AND LEGISLATION Country Programme/ Strategy/ Policy/ Committee Focal person in the Ministry of Health (MoH) Year of initiation Coverage of the policy Myanmar Committee of Prevention and Control of Deafness Nepal Sri Lanka National Committee on Prevention and Control of Deafness National Programme for Prevention Control of Deafness and Thailand Policy for Prevention and Control of Deafness in place Secretary- Director General, Department of Health (chairperson) Secretary- Ministry of Health and Population (chairperson) Secretary- Ministry of Health 2012 Progress status not available 2012 Programme is in pilot phase and is being implemented across four districts
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
EAR DISEASES THAT CAN LEAD TO HEARING LOSS Preventable/ Modifiable Earwax Chronic otitis media Serous otitis media Dry perforation of tympanic membrane Others Congenital Age-related