The Malawi Hearing Project was established in 2023 to improve ear and hearing care. The project supports the provision of affordable hearing equipment, creates training and teaching resources, and enables more children with hearing problems to be treated so they can access education and continue learning.
In 2024 a Memorandum of Understanding (MOU) between Cambridge Global Health Partnerships, Cambridge University Hospital NHS Foundation Trust (CUH) and Kamuzu University of Health Sciences was signed, acknowledging the work that’s already taken place and the partnership development to come.
Why is this project needed?
In Malawi, there is a high incidence of childhood deafness from chronic ear infections that can cause a hole in the ear drum. With very few audiologists and ENT surgeons in the country, children sometimes wait years for treatment, severely disrupting their ability to learn.
Traditional hearing aids cost between US$100-300 in Malawi, which is too expensive for most of the population. Even if hearing aids are donated, replacing the batteries and travelling to clinics is often completely unaffordable. At a school for the deaf in Blantyre, Malawi’s second largest city, it was found that only 10% of children had access to hearing aids.
How the project started
Glue ear is a common childhood condition where the middle part of the ear canal fills up with fluid and causes temporary deafness. If it lasts a long time, it can affect a child’s speech development and progress at school.
During the COVID pandemic when families couldn’t access normal ENT services, a simple, over the ear headset was developed by Cambridge-based paediatrician Dr Tamsin Holland Brown that allowed children to keep learning without interruption. Tamsin and ENT surgeon Isobel Fitzgerald O’Connor recognised that the headset could also help deaf and hard of hearing children in Malawi to hear. It is simple, cheap, and rechargeable, making it suitable for children in rural, low-income settings. It can also be worn by those with discharging ears, which conventional hearing aids aren’t suitable for and is particularly important in a country with few ENT surgeons.
What’s happening in the project
A project team including Dr Tamsin Holland Brown and ENT surgeon Isobel Fitzgerald O’Connor visited Malawi in 2023 to conduct qualitative and practical research to understand the challenges and assess potential solutions. They conducted interviews with the lead audiologist at Queen Elizabeth Central Hospital in Blantyre and teachers at Maryview School for the Deaf, as well as testing the practicalities and limitations of solar chargers. They very quickly found the headsets to be transformative for the children who used them, as 2023 Global Health Fellow Catherine de Cates reports in this blog.
“Another girl with longstanding ear disease and infections was given the headset at age 13, and now aged 16, had been using this headset with the microphone to support her hearing at school….Having been unable to pass end-of-year exams previously, she had passed school exams every year since using the device. She now has ambitions to study medicine. She also used the device for socialising with friends and in the family home.”
Observations from 2023 Global Health Fellow Catherine de Cates during a visit to Blantyre, Malawi.
The team continued to work with Malawian colleagues in the audiology department at Queen Elizabeth Hospital in Blantyre to pilot bone conducting headsets co-creating training materials for the set up and use of the headsets in both English and Chichewa (the local language).
Expanding the partnership
WHO and UNICEF continue to emphasise the critical need for increased access to assistive products (AP). In line with this, the Malawi and UK based project team is exploring how best to expand hearing care provision to children in rural settings. They’re also considering solar powered hearing aids and charging options, because limited access to electricity and batteries is a barrier to using the bone-conducting and other hearing devices.
In 2024, a team of eight including ENT doctors and trainees who are East of England Global Health Fellows, CUH audiologists, a physiotherapist, paediatric nurse and a paediatrician visited Malawi to co-deliver ear camps with their Malawi colleagues. Working alongside staff from the Audiology Department at Queen Elizabeth Central Hospital, and with the support of Anzathu (a community engagement NGO), the aim was to evaluate the most practical, accessible and sustainable way to deliver remote ear and hearing care.
As well as providing assessment, treatment and/or referral to as many as possible, this was an opportunity to explore solutions to manage ear and hearing care issues in settings where it’s very difficult to access healthcare, including new hearing devices, antibiotic medication and removal of compacted wax.
During the visit the team collected data which is now being analysed and used to inform the development of a multi-year project plan to improve ear and hearing care services in Malawi. It will also provide learning and development opportunities for NHS staff from Cambridge and the East of England in a very different working environment and health system.
