The Challenges and Outcomes of Establishing a Cochlear Implant Service in Malawi, Sub-Saharan Africa

Introduction: We have worked on the development of ENT facilities in Malawi to try and deliver equity and quality of care. Part of this healthcare support has been the development of a CI program. The outcomes and challenges are reported.

Methods: From 2014 to date, we have implanted 19 post-lingual deafened children. In most cases, the etiology was for potentially preventable diseases. The assessment was from modified protocols used in the UK. Implants were supported by Med-El. Pre and post-tests involved a battery of open and closed-set speech and environmental sound perception tests derived from the Evaluation of Auditory Response to Speech.

Results: The mean PTA4 showed significant improvement from 110 dB to 37dB (p = 0.001). All children have gained benefits except 2 patients became non-users. All had recognizable speech with a Speech Intelligibility Rating, of 5 in 76%. Only 2 children had a Categories of Auditory Performance II score below 6. A Listening Progress Profile score of 40/42 was achieved in 77%. A single child had a score of 20; this was a decline because of Covid restrictions. A total of 5 or more of the Ling 6 sounds were achieved by 13. A score of 9 or more out of 10 for the Glendonald Auditory Screening Procedure performed in Chichewa in 14 and similar attainment Monosyllabic-Trochee-Polysyllabic assessment with scores of 18 or more out of 24. Results across all tests were scaled 0 min to 1 max. Of the children, 10 (58.8%) had a median score across tests of 1, and 13 (76.4%) had a median score of 0.9 or greater. The 4 remaining children had median scores across all seven tests of 0.87, 0.7, 0.5, and 0.4.

Conclusions: A safe and effective service is being delivered. Patient selection has improved but the quality of radiology remains a problem. The outcomes are very encouraging. With the standard of education being poor there is a need to teach a trade and hence a livelihood. Sustainability needs to be improved, currently reliant on charitable support. Introducing the rechargeable Rondo 2 processors has helped reduce reliance on batteries. Power in some cases using solar panels. Government involvement is required and this and other aspects of ENT services are ongoing.