ESTRATEGIAS GLOBALES PARA LA PREVENCION DE LA PERDIDA DE LA AUDICION – Perspectiva de la Organizacion Mundial de la Salud
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Este documento de la Organización Mundial de la Salud presenta estrategias globales para la prevención de la pérdida auditiva. Describe el tamaño del problema de la pérdida auditiva a nivel mundial y sus efectos en individuos y sociedades. También analiza desafíos clave como la falta de conciencia, la necesidad de un enfoque de salud pública y la importancia de intervenciones rentables.
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ESTRATEGIAS GLOBALES PARA LA PREVENCION DE LA PERDIDA DE LA AUDICION – Perspectiva de la Organizacion Mundial de la Salud
- 1. ESTRATEGIAS GLOBALES PARA LA PREVENCION DE LA PERDIDA DE LA AUDICION – Perspectiva de la Organizacion Mundial de la Salud Dr Andrew Smith Oficial Medico Prevencion de la Sordera y el Deterioro de la Audicion Academia Americana de Otorrinolaringologia – Cirugia de Cabeza y Cuello Reunion Anual, 16 al 19 de Septiembre del 2007, Washington DC.
- 6. Desafios Claves para la Prevencion del Deterioro de la Audicion 1. El tamaño del problema
- 8. Grados de Deterioro de la Audicion Grado 0 25 dB o < No / problemas leves ninguno escucha susurros Grado 1 26 - 40 dB Escucha / repite palabras leve con voz normal a 1 m. Grado 2 Niños 31 - 60 dB Escucha / repite palabras Moderado Adultos 41 - 60 dB con voz alta a 1 m. Grado 3 61 - 80 dB Escucha palabras gritadas Severo en el mejor oido Grado 4 81 dB o > No puede escuchar o Profundo comprender voz gritada [Promedio 0.5, 1, 2, 4 kHz en el mejor oido] Alteracion Auditiva Inhabilitante
- 9. Prevalencia global del deterioro de la audicion, 2005 Deterioro de la Audicion deshabilitante
- 10. 42m 120m 278m Cambios en la estimacion de la OMS sobre el deterioro deshabilitante de la audicion desde 1985 Razones Probables: Envejecimiento de la poblacion, mejor identificacion e incremento en la incidencia
- 11. Prevalencia Global estimada del deterioro de la audicion, por sexo y nivel de severidad, 2005
- 14. Principales Causas Globales de Disabilidad (AVD) y Carga Global de Enfermedad, 2005 Nueva evaluacion de Enfermedades de Carga Global se inicia en el 2007
- 15. Midiendo el tamaño del problema
- 17. Encuesta OMS Oidos & Transtornos de la Audicion (5) Diagnostico de enfermedad del oido & Causa del transtorno de la audicion (6) Accion necesaria (4) Examen del oido (3) Prueba de audicion (2) Demografia & historia (1) Muestra de grupo aleatorio de la poblacion
- 18. Medida del tamaño del problema en Madagascar
- 19. Encuesta en sitios de 4 provincias propuestas en China CBM support
- 20. Progreso de las encuestas basadas en poblacion usando el Software de la OMS para encuestar acerca del oido y los deterioros auditivos OMAN: Nacional (con ceguera) 2.1% NIGERIA 3 Regiones 4.4, 6.1, 7.6% MADAGASCAR Tana Provincia 6.9% CHINA:Jiangsu 5.3 % Sechuan 4.9%, Guizhou 6.1%, Jilin 4.5% (con % de prevalencia del deterioro deshabilitante de la audicion) 10 Paises que han completado encuestas Paises con encuestas en progreso VIETNAM: Norte: 7.8% Sur: 4.7% 4 SEARO surveys (4.6 - 8.8%) BRAZIL Canoas (parte) 6.8%
- 21. VENTAJAS DEL PROTOCOLO DE LA OMS Informacion precisa en cuanto a tamaño, causas y necesidades Datos estandarizados para la comparacion de tiempo/lugar Basado en la poblacion
- 22. Usando resultados de encuestas: Conociendo la prevalencia por causa puede llevar a la accion
- 23. DETERIORO DESHABILITANTE DE LA AUDICION EN 3 ESTADOS NIGERIANOS Kebbi Akwa Ibom Sokoto Katsina Niger Kaduna Kwara Kogi FCT Yobe Kano Jigawa Bauchi Plateau Taraba Borno Adamawa Oyo Ogun Lagos Osun Ondo Edo Delta Benue Cross River Rivers Enugu Anambra Imo Abia Nassarawa Zamfara Gombe Ebony Bayeisa Ekiti KATSINA 7.6% BENUE 6.1% AKWA IBOM 4.4%
- 25. El cinturon de meningitis en Africa sub-Sahariana
- 26. COMO AYUDARAN ESTOS DATOS? OMS Encuestas de servicios de salud & infraestructura DETERMINAR PRIORIDADES SELECCIONAR ESTRATEGIAS PARA PREVENCION PREDECIR NECESIDADES INCREMENTO DEL CONOCIMIENTO AYUDAR A MEDIR LA CARGA DE LA ENFERMEDAD y EL ANALISIS ECONOMICO
- 27. Datos globales disponibles de Sordera y Deterioro Auditivo del 2007 Dr. Donatella Pascolini Dr. Andrew Smith Programa de la OMS para la Prevencion de la Ceguera y la Sordera Genova, 2008 . Desarrollo de la base de datos global
- 28. USA7 N/A N/A 0.7** >20 dB HL ambos oidos 0.5,1,2,4 kHz 4-14 15890 R escuela Agencia de escuelas de asuntos induess, Reserva Navaja 1980 USA6 N/A N/A 0.4** 0.7** > 26 dB HL ambos oidos 0.5,1,2,3 kHz > 26 dB HL ambos oidos 3,4,6 kHz 6-19 6166 N PBS 3 grupos etnicos: no-Hispanos, blancos, no-Hispanos, negros, Mexicanos Americanos 1988-94 USA5 Africanos Am 0.78-- Cubanos Am 1.21-- Mexicanos Am 0.6-- PuertoRiqueños 0.95-blancos no Hispanos 0.38 >30 dB HL 0.5,1,2 kHz Africanos Am 0.94-- Cubanos Am 5.75-- Mexicanos Am 2.12-- PuertoRiqueños 4.78--blancos, no Hispanos 1.18 16-30 dB HL 0.5,1,2 kHz 6-19 7888 N PBS 5 grupos etnicos en estados del sur oeste, Florida, NewYork City area 1982-84 USA4 N/A N/A 47** >25 dB HL 0.5,1,2,4 kHz 57-89 2293 D PBS Framingham, Massachussets 1979 USA3 N/A N/A 35.1** > 25 dB HL 1,2,4 kHz 55-74 2506 N PBS Todo el pais 1975 USA2 N/A N/A 32.4** >25 dB HL 48-92 3753 D PBS Beaver Dam, Wisconsin 1993-95 USA1 0.11 > 40 dB HL 0.5,1,2 kHz N/A N/A 3-10 263400 D lista Atlanta metropolitana 1991-93 USA CRI1 N/A N/A 3.25** >25 dB HL 0.5,1,2,4 kHz 8 12612 N esuela Todas las 7 provincias 1996 Costa Rica BRA1 6.8 > 31 dB HL (4-15y) > 41 dB HL (15+ y) 0.5,1,2,4 kHz 19.2 26-30 dB HL (4-15y) 26-40 dB HL (15+ y) 0.5,1,2,4 kHz 4 y > 2427 D PBS Canoas, metropolitan Porto Allegre; protocolo de la OMS usado en todo el estudio 2003 Brazil fuente Prevalencia DA deshabilitante Definicion DA deshabilitante prevalencia leve o todo(**) DA Definicion leve o todo DA Edad del grupo Tamaño de la muestra Nivel de estudio Tipo de estudio Localizacion Año de estudio pais OMS Region de las Americas
- 29. Desafios Claves para la Prevencion del Deterioro Auditivo 2. Efectos en la sociedad
- 31. Desafios Claves para la Prevencion del Deterioro Auditivo 3. Efectos en los individuos
- 32. “ La Ceguera separa las personas de las cosas, y la sordera separa a las personas de las personas ." Helen Keller Efectos en los Individuos Puede dañar el habla, lenguaje, las habilidades cognitivas Una niña sorda aprendiendo lenguaje de signos en una escuela de sordos en Asia Central Puede enlentecer el progreso escolar Una escolar que no responde a la pregunta de la profesora. Podria tener deterioro de la audicion Las personas pueden aislarse y ser estigmatizadas Una adolescente en Asia ha sido sorda desde su nacimiento. Sus padres la llevan a una clinica movil del oidopor primera vez en su vida Puede causar problemas laborales Evaluando la perdida auditiva de un trabador
- 33. Desafios Claves para la Prevencion del Deterioro Auditivo 4. Deberiamos prevenir?
- 36. Desafios Claves para la prevencion del Deterioro Auditivo 5. Perdida de la Conciencia
- 38. CBM supported
- 39. Desafios Claves para la prevencion del Deterioro Auditiva 6. Necesidad de un acercamiento de la salud publica
- 40. RUTA PARA PREVENIR LA SORDERA Y ALTERACION AUDITIVA Alta Prevalencia + Medios efectivos de Prevencion / Control Desarrollar una orientacion de Salud Publica Hallar medios para hacer la diferencia en una poblacion Atacar las condiciones
- 41. Causas Principales de Sordera y alteracion auditiva Baja frequencia: Nutritional Trauma Toxicos Enfermedad de Menière Tumores Enf. Cerebrovascular Frecuencia Moderada Ruido excesivo Drogas Ototoxicas Problemas Ante&peri-natales Meningitis, sarampion, paperas Cuerpos extraños, cerumen Alta frecuencia:- Causas Heredadas Otitis media cronica Presbiacucia totalmente prevenible
- 42. PREVENCION PRIMARIA (e.g. conservacion auditiva, inmunizaciones, tratar la OMA, uso racional de drogas ototoxicas) PREVENCION SECUNDARIA (e.g. detection temprana, tratar la OMC, cirugia para prevenir la discapacidad) PREVENCION TERCIARIA (e.g. audifonos, educacion especial, accesibilidad, integracion social) NIVELES DE PREVENCION Factores Etiologicos Patologia Alteracion Disabilidad Discapacidad (despues del ICIDH, 1980) Persona Sociedad Organo Enfermedad
- 43. Desafios Claves para la prevencion del Deterioro Auditiva 7. Importancia de las intervenciones costo-efectivas
- 44. GUIA OMS DE AUDIFONOS Y SERVICIOS PARA PAISES EN DESARROLLO, 2nda Edicion, 2004.
- 45. … la produccion anual de audifonos es... Un decimo de las necesidades globales ...paises en desarrollo tienen menos del 2.3% de los audifonos que necesitan … costo del audifino apropiado en paises en desarrollo…$200 to $500 … prohibitivo para la mayoria de la poblacion … precio…bajo a $20 por audifono
- 46. Mision Promover una mejor audicion a travez de la provision de audifonos y servicios apropiados y al alcance, con prioridad en los paises en desarrollo y comunidades pobres, usando las bases OMS de las GUIAS PARA AUDIFONOS Y SERVICIOS EN PAISES EN DESARROLLO EN PAISES EN DESARROLLO WW HEARING World-Wide hearing cuidado para paises en desarrollo
- 47. PPPs to provide Sociedad de WWHearing Global Nacional OMS Colaboradores OMS Expert monitoring group Research institutions & universities Societies for deaf/hard of hearing Govt. policy makers/providers in developing countries Professional organisations Not-for-profit manufacturers or assemblers Manufacturers’ Associations Implemen- tar ONGs Donors CBM, IMPACT, IA, Lions, WVI, CBM, LCIF EHIMA, HAAI, HIA, AHAP, Godisa HI, IFHOH HI, IALP, IAPA, IFOS, ISA Brazil, India, Oman, Philippines, South Africa HAWG Liverpool, Bangkok Copenhagen, Jakarta HQ, Regions CDPF/ CRRCDC, Hong Kong Uni., CMC, Vellore Regional Sound Hearing 2030
- 51. Desafios Claves para la prevencion del Deterioro Auditiva 8. Deficit de trabajadores de la Salud Entrenados.
- 53. Paginas del manual de entrenador intermedio (Version en Ingles)
- 54. Paginas del manual de entrenador intermedio (Version en Español)
- 55. Paginas del manual basico (Version China)
- 56. PEHC Training Resource on WHO Website http://www.who.int/pbd/deafness/activities/hearing_care/en/index.html
- 57. Entrenar a los entrenadores (Nigeria)
- 60. Luciano dos Santos Rocha 4 años, y sus padres en una favela en São Paulo. Su madre tuvo rubeola durante el embarazo y Luciano nacio con una alteracion auditiva bilateral severa. Afortunadamente una clinica local pudo proveerle con 2 audifonos de buena calidad. La historia de Luciano muestra lo que WWHearing puede hacer. © WHO/Chris de Bode
- 61. Previniendo las enfermedades cronicas: una inversion vital Reporte Global OMS 2006, 6 Idiomas
- 63. Luciano dos Santos Rocha Junior, Sao Paulo © WHO/Chris de Bode Gracias por su atencion
Hinweis der Redaktion
- The majority of deaths worldwide for all ages are due to chronic diseases. Cardiovascular diseases (mainly heart disease and stroke) are responsible for 30% of all deaths. Cancer, chronic respiratory diseases, and diabetes are also major causes of mortality. The contribution of diabetes is underestimated because although people may live for years with diabetes, their deaths are usually recorded as being caused by heart disease or kidney failure.
- See next slide notes for definitions.
- The chart shows numbers of people with all levels of hearing impairment, estimated for 2005. The bars are not cumulative. The bars within the continuous red line together form all those people with disabling hearing impairment . Disabling hearing impairment is defined as &quot;moderate or worse hearing loss in the better ear&quot; or &quot; moderate or worse bilateral hearing loss&quot;, which means the same. Some people find the first definition more difficult conceptually but it better expresses that the hearing level does not need to be the same in both ears as long as they both have at least moderate hearing loss. The threshold for moderate or worse hearing level is set at 41 decibels or greater in adults and 31 decibels or greater in children up to age 15. The hearing level is the average level measured at 4 frequencies (see below). THE OFFICIAL DEFINITIONS ARE: Disabling hearing impairment in adults should be defined as a permanent unaided hearing threshold level for the better ear of 41 dB or greater; for this purpose the “hearing threshold level” is to be taken as the better ear average hearing threshold level for the four frequencies 0.5, 1, 2, and 4 kHz.” Disabling hearing impairment in children under the age of 15 years should be defined as a permanent unaided hearing threshold level for the better ear of 31 dB or greater; for this purpose the “hearing threshold level” is to be taken as the better ear average hearing threshold level for the four frequencies 0.5, 1, 2, and 4 kHz.” FROM: Report of the Informal Working Group on Prevention of Deafness and Hearing Impairment Programme Planning WHO, Geneva, 1991. With adaptations from Report of the First Informal Consultation on Future Programme Developments for the Prevention of Deafness and Hearing Impairment, World Health Organization, Geneva, 23-24 January 1997, WHO/PDH/97.3. .
- Malignant neoplasms, cardiovascular diseases and other sense organ disorders are shown, for comparison to Hearing loss, adult onset. So far child-onset hearing loss has not been included as a separate line iin the GBD.
- The map shows location for all the 16 surveys from 10 countries that specifically used the WHO Survey protocol and received technical support or help from WHO. Some other projects have used the protocol in various ways without technical support. The figures in red show the prevalence rate of disabling hearing impairment for all ages, as found by each survey. The main aims of the surveys are to :- Raise awareness Determine priorities Select strategies for prevention Predict needs Help burden of disease measurement and economic analysis The 4 province China surveys have all completed collecting the data but they are still classed as&quot; in progress&quot; because analysis is not completed. Professor Xingkuan Bu from Nanjing will give a keynote speech on the Chinese results on the 26 th April.
- These data were quoted in ADG's speech. Professor Ruben, author of the US data, is attending and will give a keynote speech on this topic on 26 th April.
- The countries where A Smith took these photos are:- TOP RIGHT: Turkmenistan TOP LEFT: Kenya BOTTOM LEFT: India BOTTOM RIGHT: Nepal
- These are students at a school for deaf people in Brazil., using sign language to communicate. This relates to the next slide which highlights issues related to the &quot;Deaf&quot; community.
- The WFD quote represents an extreme view, and I believe that not all WFD members would subscribe to it. It could be used to highlight that the profoundly Deaf community sees itself as a linguistic minority, with similar rights to other minorities, rather than people with a disability. The International Federation for Hard of Hearing People (IFHOH), generally want to join with the hearing community and have no problem with the idea of prevention. The second quote is from the young people's branch of IFHOH.
- This independent journal is one way of raising awareness. It is funded by WHO through a grant from CBM. It can be sent free to primary level health workers and others in developing countries. It's also available on-line.
- 14
- The majority of causes and at least 50% of the burden can be fully prevented, the majority at the primary level of health care. The WHO strategy focuses on preventable causes in the High and Moderate frequency group.
- This slide is included to show that WHO covers secondary and tertiary prevention as well as primary prevention (this gives the rationale for including provision of hearing aids in PDH as an intervention for prevention). The slide uses the old ICIDH classification, not the newer one from ICF.
- Covers of the English and Chinese Editions. The first edition was launched in 2001 and eventually provided the foundation for the development of WWHearing. The covers show the second editions from 2004. The Chinese version was translated by Professor Xingkuan Bu, of the University of Medical Science of Nanjing. He is director of the Ear and Hearing Centre, Dept of Otolaryngology, People's Hospital of Jiangsu Province, Nanjing.
- This was the press release at the launch of the WHO Hearing Aids Guidelines in 2001, with some quotes that stimulated the setting up of WWHearing.
- Some of reasons for poor uptake of Hearing Aids Lack of awareness of the benefit of hearing aids Stigma attached to wearing hearing aids (h/aids) Limited availability of (h/aids) in rural areas Unaffordable Cost of h/aids ( $200 – $300) Unavailability of small hearing aid batteries Few trained technicians to fit & maintain h/aids Poor quality hearing aids Improper fitting of hearing aids
- The executive board from the regional body, Sound Hearing 2030, are attending the conference. Manufacturers (commercial and not-for-profit) are observers, and not members of WWHearing (hence their oval is surrounded by a dashed line).
- Rationale for the WHO&WWH Collaboration The 2 organizations are complementary:- WHO Global visibility & credibility Access to highest-level health decision makers Public health expertise Can assist prioritization of hearing impairment WWHearing Sharp focus on this issue Joins key stakeholders in partnership Links to other sectors Can develop innovative solutions Working together -> effects far greater than each alone OBJECTIVES OF THE WHO-WWH COLLABORATION PROJECT Data on provision and need for hearing aids and services [Leader WHO] Constraints to providing hearing aids & services in developing countries, and how to overcome them [Leader WWH] Projects to implement or improve provision of hearing aids and services [Leader WWH] Networks and partnerships from public & private sectors and civil society to provide affordable, appropriate hearing aids and services to satisfy the need [Leader WWH] Criteria to review, monitor and evaluate partnerships & projects . [Leader WWH] Studies on economic costs of hearing impairment, and cost/effectiveness of hearing aid interventions [Leader WHO] Encouraging Member States to introduce hearing health services to collect data in censuses on hearing impairment, hearing handicap and hearing aid use [Leader WHO]
- Pilot studies in India & China will complete in 2008. The studies are innovative community-based studies to fit & follow-up hearing aids by Community-Health Workers in adults in India, and by teachers of deaf children in China. Each study includes analysis of economic costs and cost-effectiveness of the intervention by Dr Rob Baltussen who is attending the conference. CRRCDC are conducting the pilot study in China. It is due to complete in late 2007. Both pilot studies are funded by Christoffel-Blindenmission, CBM.
- This shows the 4 manuals Implementation Phase 1: Launches Global virtual launch, March 2006 Launch & implementation planning workshops in regions West Africa: Nigeria (English) May 2006 Latin America: Colombia (Spanish) Jan 2007 East Africa: Kenya (?) 2007 Chinese, Urdu, Portuguese, French versions in 2007/08 Phase 2: Country training In-Country Implementation - countries adapt to their needs and use in training programmes Phase 3: Further development Dynamic process – like &quot;Open-Source Software&quot;
- WHO Home Page in March, 2006 when PEHC Training Resource was launched.
- Picture shows the Train the Trainers course that followed the launch of the PEHC Training Resource in Kaduna, Nigeria. These trainers then returned to the own institutions across Northern Nigeria, to train more trainers or directly train PEHC or PHC workers with the following attributes:- Become competent Primary Ear and Hearing Care Workers Demonstrate their understanding of Primary Ear & Hearing Care Confidently identify & manage common ear disease & hearing impairment Fulfil a vital role in decreasing the number of hearing impaired people
- The original question in the abstract was &quot;How does the hearing impairment programme adhere to the objectives of its parent team, and what is the programme doing in order to achieve measurable gains for the strategic objective?&quot; The slides do not answer that question, since there is still a long way to go. The question could be answered by the presenter during the presentation, as a kind of comment on the slides. Alternatively it could be left to the audience to make their own judgement.
- The last 3 slides are just a short story to finish with. The local clinic in Sao Paulo that provided Luciano's hearing aids is now working with WWHearing to set up a pilot study in Brazil to test the most effective ways to deliver hearing aids in such a context.
- Luciano also became famous and helped to launch the WHO Global report on Chronic Diseases..