HEALTH/EDUCATION-BRAZIL: Hearing Screening to Curb School Dropout

By Mario Osava Reprint | | Print |

Mario Osava

RIO DE JANEIRO, May 16 2001 (IPS) - Efforts to curb the school drop-out rate in Brazil, one of the country’s pressing problems, now include a campaign for identifying and treating hearing impairments among schoolchildren.

The campaign was launched this year by the Otolaryngological Foundation and the Brazilian Otology Association, in conjunction with the ministries of health and education.

Thanks to the national plan, three million second-grade students in 38,000 schools located in Brazil’s 486 municipalities with more than 50,000 inhabitants will be screened for hearing problems.

The necessary equipment will be distributed to the schools, where teachers will be trained to conduct the hearing tests. Around 1,000 doctors and audiometric specialists will be mobilised in a second phase of the plan, which will entail hearing and eyesight exams.

An estimate based on official statistics indicated that around four million Brazilians suffered some degree of hearing loss.

However, that figure was not based on recent statistics, and the number is undoubtedly higher now, due to the growth of the population to 170 million, and because many more premature babies and infants with health problems survive today, Clea Maria Netto Valverde, the coordinator of student monitoring at the National Institute of Education for the Deaf, in Rio de Janeiro, told IPS.

Her own daughter, Priscila Valverde Fernandes, suffered a hearing impairment as the consequence of an ear infection. But early diagnosis and treatment reduced the hearing loss, and although Priscila always had to sit in the front row of the classroom, she did not fall behind in school, and today, at age 19, she is attending university.

But in Brazil, Priscila’s case is an exception. The learning difficulties and delays in language acquisition, poor concentration and restlessness that tend to characterise young children with hearing loss tend to be blamed on other causes, such as mental retardation, which hurts the child’s socialisation process. The discrimination leaves psychological trauma and further aggravates the situation.

Hearing impairments are “more difficult to identify than other handicaps, because they are not readily apparent” in mild cases, Fernanda Giordano, a sociologist with the Sao Paulo Otolaryngological Foundation, told IPS.

And although hearing problems are more frequently seen among the poor, deafness “does not pick and choose among social classes,” and the higher rate of occurrence among lower-income sectors is a result of unequal access to screening and timely treatment, she added.

Since 1997, the Foundation has been conducting its own campaign in the public school system under the theme “the student who hears well, learns better”, aimed at preventing, identifying and treating cases of hearing loss among children in the first few years of school.

Of a total of 780,450 children screened from October 1999 to December 2000 using a recording presenting the sounds of dogs, cats and birds at different frequencies and intensities, the Foundation found that 36.4 percent merited further testing, although hearing impairments were confirmed in only a small fraction of the cases.

The hearing test found that only 1.1 percent of those who were referred for further testing suffered severe hearing loss, 1.6 percent had moderate loss and 5.2 percent had a slight problem, while 92.1 percent had hearing that fell within the “normal” range. Just over 3,000 students underwent surgery or were fitted with hearing aids.

Among the children who initially showed signs that there might be a problem, thousands were diagnosed with ear infections, perforations of the eardrum, and poor hygiene, especially earwax build-up.

Foreign objects like small beads, stones and dead insects were even extracted from the ears of a number of children, said Giordano, who helped coordinate the Sao Paulo Otolaryngological Foundation’s campaign.

The organisers stressed that the campaign did not produce a statistical study on the incidence of hearing impairments among Brazil’s schoolchildren, because most of those suffering profound hearing loss have been placed in one of the country’s few special schools for the deaf or do not attend school at all.

In the poorest parts of Brazil, lack of awareness and the lack of means for obtaining treatment lead families to isolate profoundly deaf children, who are often relegated to carrying out the household’s domestic chores.

“Many commit suicide when they reach the age of 30 or 40, due to the loneliness,” said phonoaudiologist Reinaldo Lopes.

The main cause of hearing loss in Brazil is maternal rubella during pregnancy. Vaccination against the disease became compulsory here in 1997.

Other key factors are meningitis, RH-positive children born to RH-negative mothers, premature birth, genetic disorders and birth defects.

Brazil has a shortage of ear, nose and throat specialists, who number just 5,000, 80 percent of whom are concentrated in the states of Rio de Janeiro and Sao Paulo, where the country’s two biggest cities are located. Of the municipalities with more than 50,000 people, less than half have an otolaryngologist.