In July 2001 the World Health Organization (WHO) launched their "Guidelines for hearing aids and services for developing countries". The objective of this study was to evaluate the clinical outcome of an analogue, low-cost, behind-the-ear hearing aid (BTE-HA) that met the minimum technical requirements outlined by the WHO.A total of 25 subjects (17 males, 8 females; median age 74 years; range 50-86 years) were recruited among patients referred for audiological evaluation who consented to participate in the trial. All subjects had a hearing loss of < or = 60 dB HL at 2 kHz, were mobile and mentally unimpaired; 13 were experienced users of HAs, 3 suffered from mixed conductive/sensorineural hearing impairment (HI) and the remainder had pure sensorineural HI. Based on pure-tone, speech and impedance audiometry the BTE-HAs were fitted, using the National Acoustic Laboratories-R (NAL-R) prescription rule, 21 binaurally and 4 monaurally. All fittings were validated by insertion gain measurements, and the immediate benefit was measured by means of the speech recognition score in background noise (SRSN; signal:noise ratio = 10 dB) without and with the HA. After a 6-week trial period a structured interview based on the International Outcome Inventory for Hearing Aids (IOI-HAs) was performed.The results showed that the amplification of the HA deviated significantly from the NAL-R target at all frequencies, giving significantly more amplification at 500 and 1000 Hz despite maximum bass-cut, whenever relevant, and significantly less amplification as required at 2, 3 and 4 kHz. The median SRSN without HA was 48% (range 0-96%), which improved significantly to 80% (range 24-100%) with HA. The median individual difference in SRSN without and with HA was 20% (range 0-72%). The total IOI-HA score with the test HA was 4.1 (range 2.6-4.6), showing that it offered subjectively high satisfaction and reduction in limitations of activity.The low-cost HA: (i) provides benefit to the hearing-impaired person; (ii) offers poor amplification in the high frequencies; and (iii) gives subjective satisfaction similar to that for modern available HAs.