Global Audiology/Africa/Ghana

Ghana is considered a middle-income country and the second most urbanized country in sub-Saharan Africa, with about 700,000 live births annually (Olusanya, 2008) and a population of about 27.41 million (World Bank, 2015). Ghana is a multi-cultural country in West Africa that covers an area of 239,460 square kilometers. It shares a northern border with Burkina Faso, an eastern border with Togo, and on the west, it is bordered by the Ivory Coast. The Atlantic Ocean lies at the south of the country, and the capital city is Accra.

According to Ghana Statistical Service estimates (Ghana Statistical Service, 2013), the prevalence of hearing loss in rural communities in Ghana is 16.8%, while in urban areas it is estimated to be 12.9%. Compared to global estimates of 5.3% (WHO, 2012), the Ghanaian estimate is high. Although Ghana does not have any systematic early identification and intervention programs for children with hearing loss, there are thousands of children with educationally significant hearing losses who have no prospect of having their hearing status checked. This has implications for education, particularly for children (Offei, 2013; Offei & Coninx, 2014). Ghana is a former British colony that gained independence on May 6, 1957. Although the official language is English, Ghana is home to more than 100 different ethnic groups, including Akan, a language that is spoken by about 40-44% of the population as a first language (Osam, 2004; Dolphyne, 2006). The mainstay of Ghana’s economy is agriculture however, gold, diamond, manganese, bauxite and recently oil and gas are also available in commercial quantities. The official currency is the Ghanaian Cedi.

Audiology service provision started in the early 1980s. This was precipitated by the need for school placement for children with hearing impairments in Ghana. Currently, there are 13 hearing assessment centers, of which 9 are public (government-owned) and 4 are private. Of the 9 public facilities, 3 are situated within special schools for the Deaf, 4 in public hospitals, 1 in a university (the University of Education, Winneba), and 1 at the National Assessment Center in Accra. The audiology center in Winneba was the first to be established in a school for the deaf in Ghana. Three out of four privately owned facilities are located in the Ghanaian capital, Accra, while one is situated in Tema, the industrial capital of Ghana. With regard to audiologists, there are currently about 20 audiologists in active practice in Ghana.

Currently, three universities in Ghana offer degrees in audiology education. These are the University of Ghana, the Kwame Nkrumah University of Science and Technology (MSc in Audiology and Speech Pathology programs), and the [uhas.edu.gh University of Health and Allied Health Sciences] (BSc in Audiology and Speech Therapy). The University of Education, Winneba, started a post-graduate diploma in educational audiology (e-learning) in 2009, but it is no longer available. The university is yet to roll out Masters’ courses in Communication Disorders and Sciences with a specific focus on training educational audiologists and speech therapists who will work in educational institutions.

Services and tests offered include the following:


 * Pure Tone Audiometry (PTA)
 * Tympanometry
 * Impedance Audiometry
 * Otoacoustic Emission (OAE)
 * Auditory Brainstem Response

Patrons of audiological services may or may not book an appointment in advance. Clients may walk in, or they may be referred by ENT, pediatricians or general medical practitioners. Medical insurance currently does not cover audiological services. Clients, therefore, have to pay for the costs of service at the point of delivery.

There are significant differences between the costs of services delivered in private and government-owned institutions. The private centers charge not less than 500% more than government-owned centers, although the quality of services provided may not be different. Indeed, the government-owned centers are generally well equipped and have well-qualified personnel compared to the private centers.

Most of the centers in Ghana do not charge separate costs for pure tone audiometry, tympanometry, OAE, and impedance audiometry. These services are normally put together as a package that is offered as part of a routine audiometric assessment. Costs may, however, differ from one center to the other, depending on whether the center is private or public, and may range from 30 USD to 120 USD equivalent in Ghanaian Cedis. The cost charged for ABR is equivalent to 120 USD, and currently it is available only in one hospital in Accra (Korle-Bu Teaching Hospital, Accra).

Otolaryngologists offer ear care services in hospitals in Ghana with the support of ENT nurses. Types of services include cerumen management, treatment of various forms of infection, and surgeries. According to Kitcher et al. (2007), the most common causes of ENT emergency admissions were foreign bodies in the esophagus, epistaxis, throat infections, and stridor (Kitcher, Jangu and Baidoo (2007).

Newborn Hearing Screening Programs
In Ghana, only two facilities have rolled out Universal Newborn Hearing Screening using otoacoustic emission. These are the Komfo Anokye Teaching Hospital (KATH), Kumasi (OAE) and the Korle-Bu Teaching Hospital Audiology Centre (KTHHAC) (OAE and ABR). There are also school hearing screening programs, mainly in the Central and Ashanti regions. No cochlear implants have been started in Ghana. Similarly, there are no tinnitus management, vestibular assessment and management, intraoperative monitoring, or auditory processing disorder programs in place. Cerumen management is done by otolaryngologists and ENT nurses in hospitals and small clinics.

Awareness Creation
It appears that there is very little information about audiological services in Ghana. This is not surprising because there are just a handful of audiologists and fewer audiological services and training programs available. This requires a lot of public education and raising awareness.

Mobile Audiology Services Available
Mobile audiological services are available in Ghana. At the moment, there are four mobile audiology vans (HARK) that serve mainly deprived communities. The University of Education, Winneba, and the Kwame Nkrumah University of Science and Technology have a mobile van (HARK) each, while the two other HARKs belong to the Ghana National Medical Outreach Service, popularly known as “Onuado”, an initiative of the government of Ghana. In the Central Region alone, the HARK has been used to screen thousands of individuals in rural communities.

Professionals
The table below shows the professionals who regularly interact with individuals with hearing loss. The ratios are estimates calculated based on the population of 28,567,723.

Professional and Regulatory Bodies

 * The Allied Health Profession Council was established by an act of Parliament (Act 857, 2013) to regulate the training and practice of Allied Health Professionals in Ghana. As part of its mandate, the Council is responsible for granting Professional Accreditation for all allied health programs
 * The Speech Therapists and Audiologists Association of Ghana (STAAG) is still in its formative stages and has yet to be inaugurated. The association will regulate the practice of audiology and advise relevant professions and bodies on matters related to audiology and speech therapy. This association will also be the official mouthpiece of audiologists and allied practitioners in Ghana, and these programs aim to provide high quality academic and clinical experiences.

Scope of Practice and Licensing
Audiologists are licensed by the Allied Health Profession Council. Currently, licensing is required for practice. A license is obtained by registering with the council, and it is renewable annually.

The following are organizations that aim to improve accessibility to audiology services in Ghana:


 * Starkey Hearing Foundation
 * Ghana Make a Difference (NGO)
 * Rotary International
 * Sound Seekers

Challenges

 * Lack of state of the art equipment
 * Services limited to pure tone audiometry, tympanometry and Otoacoustic emission testing
 * Few research researchers – only about three PhD holders in audiology, majority are MSc holders
 * Lack of collaboration between audiologists (private and public)


 * Adjase, E. T. (2015). Physician Assistants in Ghana. Journal of the Academy of Physician Assistants. Vol. 28(4) p.15. doi: 10.1097/01.JAA.0000462393.36053.13
 * Dolhyne, A.D. (2006). The Akan (Twi-Fante) Language: Its sound systems and tonal structure. Accra: Woeli Publishing Services.
 * Kitcher, E.D., Jangu, A & Baidoo, K (2007). Emergency Ear Nose and Throat admissions at the Korle-Bu teaching hospital. Ghana Medical Journal 41 (1). 9-11
 * Offei, Y.N., (2013). The need for early identification of auditory problems among children in Ghana.  African Journal of Interdisciplinary Studies 6 (2) 23– 29.
 * Offei, Y.N. & Coninx, F.,(2014). Mode of Administration of LittlEARS® (MED-EL) Auditory Questionnaire (LEAQ) as a Screening Tool in Ghana: Are there any differences in final test scores between “Self Administration” and “Interview”? Journal of Education and Practice 5 (35) 77-81.
 * Olusanya, B.O., (2008). Priorities for early hearing detection and intervention in sub-saharan Africa. International Journal of Audiology (Suppl. 1): S3-S 13.
 * Osam, E.K., (2004). The Trondheim Lectures-An Introduction to the structure of Akan: Its verbal and multiverbal systems. Legon: Department of Linguistics