The Lives of Others. All About Hearing. Republic of Kazakhstan

— According to WHO, on average 7% of the total population suffers from hearing impairment. The population of the Republic of Kazakhstan at the beginning of 2023 was 19,899,377 people; therefore, 1,392,956 people should be registered for hearing loss.

According to the medical information system "Electronic Register of Dispensary Patients," there are 18,240 hearing-impaired people in the Republic of Kazakhstan, including 5,358 children, which is tens of times less than the actual number of people with hearing impairments. Many patients are monitored in private medical institutions and therefore are not entered into the information system of the Republic of Kazakhstan.

— There are no state hearing prosthetics centers in the Republic of Kazakhstan. There are about 60 private hearing prosthetics centers in the country. Some private hearing prosthetics centers (offices) have public-private partnerships and can provide services under CSHI (compulsory social health insurance).

Hearing aids at state expense can only be obtained by persons with disabilities. Children are recognized as having hearing disabilities if they have grade 3−4 hearing loss; adults — grade 4

— It should be noted that with the development and introduction of computer technologies, interest in practical audiology has tripled, and the ranks of audiologists are growing at the same arithmetic rate. In fact, the field of audiology is very multifaceted and complex. It incorporates elements of such fundamental sciences as physics, biophysics, chemistry, psychoacoustics, and linguistics, which makes it complex and at the same time very interesting. Nevertheless, an acute shortage of audiologists remains, especially in the regions. For example, while in Tashkent there are currently more than 20 practicing doctors, in the regions there are only 2−3 people for the entire region. Undoubtedly, this is very few.

— In the Republic of Kazakhstan, there are more than 60 practicing audiologists.

— In the Republic of Kazakhstan, university education lasts 5 years (bachelor's), followed by an internship (1 year). To obtain a narrow specialty, including otorhinolaryngology, it is necessary to complete residency training (3 years). After completing the residency, a certificate of "otorhinolaryngologist, audiologist" is issued. Also, otorhinolaryngologists can undergo advanced training in the cycle "audiology" at medical universities.

There is no separate specialty "audiology" in Kazakhstan; it is part of the specialty "otorhinolaryngology." Practicing audiologists mainly improve their qualifications abroad.

— Today in the Republic of Kazakhstan, all documentation in the field of healthcare is maintained electronically, using medical information systems. There is no paper-based documentation.
Unfortunately, no digital medical system (MIS) can display the real figures, the number of people (adults/children) diagnosed with hearing loss of varying severity. This is because the diagnosis is coded according to ICD-10, which does not reflect the degree of hearing loss.

There is no register of patients with chronic hearing impairment, and there is not even the possibility of entering conclusions indicating the severity of hearing loss (WHO classification) into existing digital systems. Consequently, it is impossible to correctly calculate the need for providing patients with assistive devices (hearing aids, cochlear implants, middle ear and bone conduction implants).

— Audiological screening was introduced in the Republic of Kazakhstan in 2010. The first stage of audiological screening was carried out using the TEOAE method in maternity hospitals on days 2−3; the second stage was carried out in primary healthcare organizations for children under 1 year quarterly, and for children aged 1 to 3 years — every 6 months. Since 2021, audiological screening has been carried out using two methods — TEOAE and screening ABR, in maternity organizations on days 2−3, in primary healthcare at 3 months, 1 year, 2 years, 3 years, and 6 years.

The target indicator for audiological screening coverage for 2022 was not achieved.

In total, using the TEOAE method in 2022, 78.1% (2,143,006) of newborns and children under 6 years old were examined in the Republic of Kazakhstan, including: 96.4% (366,707) of newborns; 81.4% (147,843) of children aged 3 months; 76.2% (285,603) of children aged 1 year; 73.0% (274,231) of children aged 2 years; 72.5% (270,567) of children aged 3 years; 68.9% (257,538) of children aged 6 years.

Using the ABR method (screening), a total of 297,798 (10.85%) children were examined, although according to the current order, audiological screening is considered completed only when examinations are carried out using both methods.

— Important reasons for the failure to carry out audiological screening today are that maternity organizations and primary healthcare institutions are insufficiently equipped with equipment for conducting audiological screening; there is no control over the provision and conduct of audiological screening on the ground; there is no systematic training of personnel involved in screening; there is no digital system for recording and tracking children who have undergone audiological screening in maternity organizations and primary healthcare institutions, which should ensure reliable statistical accounting and transmission of screening results to a centralized tracking center.

Organization leaders are not interested in conducting audiological screening due to low profitability, as the tariffs do not take into account the cost of equipment, its maintenance, annual calibration and verification, or expensive consumables (conductive disposable electrodes).

— One solution to the problem of non-compliance with audiological screening is the creation of a Center for Monitoring and Support of Audiological Screening Results (Tracking Center). The need to create a Tracking Center is due to the fact that a child whose hearing loss was detected as a result of audiological screening should be referred for further diagnosis to audiology offices and, if hearing impairment is confirmed, receive timely hearing prosthetics no later than 6 months of age.

Due to the lack of clear accounting and a tracking system, children are "lost" after discharge from maternity hospitals and do not undergo further in-depth hearing examination, which leads to hearing disability.