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Experiences of accessing healthcare services by people with hearing loss/impairment (deaf) in sub‐Saharan Africa: An integrative review



The aim was to review published articles to identify experiences of people with hearing loss/impairment accessing healthcare services in sub-Saharan Africa.

Design and method

The study was guided by Cooper's integrative review methodology. Articles published between 2010 and 2020 were identified through electronic databases. The search included: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EBSCOHOST, MEDLINE, and Psyc INFO and using specific search terms. Ninety-one (91) articles were identified and screened for eligibility, and only seven articles were appraised using relevant tools for qualitative and quantitative designs.


The articles that met the inclusion criteria were from the following sub-Saharan countries: Ghana (n = 2) South Africa (n = 3) Uganda (n = 1) and Zimbabwe (n = 1). Review analysis revealed seven (7) major themes categorized as: communication, lack of knowledge, discrimination, financial problem, healthcare workers’ attitudes, and a lack of autonomy, security and privacy issues.


The review provides evidence that indicate the challenges faced by people with hearing loss/impairment in sub-Saharan Africa. Studies suggest that communication, lack of knowledge; financial problems, lack of autonomy and privacy, and a perception of being discriminated against were major impediments in accessing healthcare service. Undesirable attitudes were also a hindrance for healthcare access.

Clinical relevance

Communication is a major impediment in accessing healthcare for the hearing impaired people residing in sub-Saharan Africa.

Defining CD4 T helper and T regulatory cell endotypes of progressive and remitting pulmonary sarcoidosis (BRITE): protocol for a US-based, multicentre, longitudinal observational bronchoscopy study

Por: Koth · L. L. · Harmacek · L. D. · White · E. K. · Arger · N. K. · Powers · L. · Werner · B. R. · Magallon · R. E. · Grewal · P. · Barkes · B. Q. · Li · L. · Gillespie · M. · Collins · S. E. · Cardenas · J. · Chen · E. S. · Maier · L. A. · Leach · S. M. · OConnor · B. P. · Hamzeh · N. Y.

Sarcoidosis is a multiorgan granulomatous disorder thought to be triggered and influenced by gene–environment interactions. Sarcoidosis affects 45–300/100 000 individuals in the USA and has an increasing mortality rate. The greatest gap in knowledge about sarcoidosis pathobiology is a lack of understanding about the underlying immunological mechanisms driving progressive pulmonary disease. The objective of this study is to define the lung-specific and blood-specific longitudinal changes in the adaptive immune response and their relationship to progressive and non-progressive pulmonary outcomes in patients with recently diagnosed sarcoidosis.

Methods and analysis

The BRonchoscopy at Initial sarcoidosis diagnosis Targeting longitudinal Endpoints study is a US-based, NIH-sponsored longitudinal blood and bronchoscopy study. Enrolment will occur over four centres with a target sample size of 80 eligible participants within 18 months of tissue diagnosis. Participants will undergo six study visits over 18 months. In addition to serial measurement of lung function, symptom surveys and chest X-rays, participants will undergo collection of blood and two bronchoscopies with bronchoalveolar lavage separated by 6 months. Freshly processed samples will be stained and flow-sorted for isolation of CD4 +T helper (Th1, Th17.0 and Th17.1) and T regulatory cell immune populations, followed by next-generation RNA sequencing. We will construct bioinformatic tools using this gene expression to define sarcoidosis endotypes that associate with progressive and non-progressive pulmonary disease outcomes and validate the tools using an independent cohort.

Ethics and dissemination

The study protocol has been approved by the Institutional Review Boards at National Jewish Hospital (IRB# HS-3118), University of Iowa (IRB# 201801750), Johns Hopkins University (IRB# 00149513) and University of California, San Francisco (IRB# 17-23432). All participants will be required to provide written informed consent. Findings will be disseminated via journal publications, scientific conferences, patient advocacy group online content and social media platforms.