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

GLOBAL DISTRIBUTION OF DEAFNESS

ACROSS DIFFERENT WHO REGIONS

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.

Thank You!

TO BECOME A MEMBER OF SSHI

Please visit our website

www.soundhearing2030.org

Annexure

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

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