Maternal views on infant hearing loss in a developing country

Parental/Caregiver Satisfaction and Anxiety with Newborn Hearing Screening Program in Dakshina Karnataka, India - A Questionnaire Based Study

Aims

The present study aimed to assess parental/caregiver satisfaction with a Neonatal Hearing screening program and determine the levels of parental/caregiver stress and anxiety at the time of hearing screening/ rescreening.

Materials & Methods

A cross-sectional study design was adapted to collect data for the current study. The study was conducted in two phases, where phase one included the development of the questionnaire and its validation, and phase two included data collection and statistical analysis.

Results

The questionnaires on parental anxiety and satisfaction with the NHS were administered to 119 participants. These included 65 parents (53.8% mothers and 0.8% fathers) and 54 caregivers (45.3%). 85% of the participants were satisfied by the overall NHS program. More than 80% of participants were satisfied with the information and instructions provided and found it adequate and clear. 60% of participants disagreed that they were tensed. Participants expressed that they would have wanted a chance to ask for more details about the test procedures (85.7%) and results (81.5%).

Conclusion

The present study provides valuable information related to maternal/caregiver anxiety and satisfaction related to NHS. There is a need for developing better evidence-based materials and training resources in multiple languages for better dissemination of information and enable timely follow-up.

Evaluating parental knowledge and attitudes toward childhood hearing loss: a cross-sectional study in Rawalpindi, Pakistan

BACKGROUND

Childhood hearing loss poses a significant public health challenge in Pakistan, with prevalence rates over double the global average. Parental knowledge and attitudes play a crucial role in timely detection and intervention. However, limited research explores this issue within the Pakistani context. This study aimed to examine parental knowledge and attitudes regarding childhood hearing loss in Rawalpindi, Pakistan, and identify key demographic factors influencing parental perspectives.

METHODS

This cross-sectional survey was conducted in Rawalpindi, Pakistan from March 1 to August 31, 2023. A total of 150 parents (79 fathers and 71 mothers) of children aged 0-12 years were recruited through convenience sampling at public locations such as schools, malls, and hospitals. Data were collected through face-to-face interviews using the validated "Parental Knowledge and Attitudes towards Childhood Hearing Loss Questionnaire," administered by a graduate student to assess parental knowledge and attitudes about childhood hearing loss. Descriptive statistics determined the percentage of correct responses and knowledge/attitudes scores. Chi-square tests explored associations between demographic factors and parental perspectives.

RESULTS

Overall, 67.3% of parents demonstrated good knowledge of childhood hearing loss. Notably, parents scored high on recognizing congenital causes (79.3%) but displayed low awareness of measles as a risk factor (29.3%). Significant gender disparities emerged in parental knowledge, with mothers exhibiting superior knowledge compared to fathers regarding newborn screening (63.4% vs. 46.8%), treatment availability (81.7% vs. 64.6%), and educational inclusion for children with hearing impairment (57.7% vs. 38.0%). Despite these knowledge gaps, parents generally held positive attitudes towards childhood hearing loss, with an average score of 94.7%. Gender and educational level significantly influence knowledge and attitudes.

CONCLUSIONS

Although parents in Rawalpindi generally have a good understanding and positive attitudes towards childhood hearing loss, gaps in knowledge about preventable causes and gender disparities need attention. Providing tailored counselling for higher-risk, less educated groups and expanding policies for paediatric audiology services nationwide can help address these issues.

A Survey of the Knowledge and Attitudes of First-Time Pregnant Women Regarding Infant Hearing Loss

OBJECTIVES

The aim of the present study was to investigate the knowledge and attitudes of first-time pregnant women regarding hearing loss in infants, and to identify the key factors that influence their perceptions.

METHODS

After validating and ensuring the reliability of a well-structured questionnaire consisting of 15 items, it was distributed to a total of 400 pregnant women who were experiencing their first pregnancies. Utilizing a cluster sampling method, participants were selected from both public hospitals and private gynecologist offices across diverse geographic regions in Tehran, Iran. Participants were asked to respond on a three-point scale (No, Not Sure, Yes). The results were analyzed using both descriptive and analytic statistics.

RESULTS

The translated questionnaire exhibited suitable face validity, test-retest reliability, and internal consistency. Findings revealed the highest maternal knowledge for "newborns can be born with hearing loss "(77.5%) and the lowest knowledge score was observed for "delayed birth cry can lead to hearing loss" (23.8%). Regarding attitudes, 72.5% of mothers scored above the mean of 5.65 out of 6, indicating a preference for early diagnosis and intervention. Several factors, such as education level and the mother's city of residence, showed a significant correlation with certain knowledge and attitude-related questions. Notably, individuals receiving care at public hospitals showed greater knowledge compared to those visiting private clinics.

CONCLUSIONS FOR PRACTICE

Mothers play a crucial role in child health and need to have a thorough understanding of pediatric diseases in order to make informed decisions. One particular condition that mothers should be well-informed about is hearing loss, as it has a significant impact on language development. However, this study reveals that there are gaps in maternal knowledge when it comes to the specific causes of hearing loss.

Knowledge and Attitudes of Parents and Caregivers in New Delhi to Childhood Hearing Loss and Hearing Services

Parental and caregiver support is crucial for addressing childhood hearing loss in low and middle-income countries, where a significant burden of disabling hearing loss exists among children. This study aimed to assess the knowledge and attitudes of parents and caregivers regarding childhood hearing loss and available hearing services in both urban and rural settings in Delhi, India. A total of 314 participants were recruited and interviewed using a culturally adapted questionnaire consisting of 26 items, covering topics like biomedical and non-biomedical beliefs, knowledge of otitis media-related hearing loss, identification, and intervention. Statistical analysis of data was performed using  Mann Whitney U tests and categorical principal component analysis (PCA). The study found that parents generally had a higher percentage of correct responses compared to caregivers in both urban and rural areas. Categorical PCA revealed variations in responses between fathers, mothers, and caregivers. In the urban group, mothers exhibited higher knowledge and more positive attitudes, while fathers showed lower involvement. In the rural group, while mothers demonstrated relatively higher awareness on all categories compared to fathers, these differences were highly relevant on questions concerning noise exposure, maternal medicine during pregnancy, and communication milestones. The findings emphasize the importance of considering regional and cultural factors when designing programs. Additionally, involving fathers in awareness campaigns and support networks is crucial to achieve comprehensive coverage in addressing childhood hearing loss. In conclusion, this study contributes valuable insights into the preparedness of parents and caregivers for audiology services and the need for contextually appropriate strategies to enhance childhood hearing health services in India.

Predictors of Parental Recall of Newborn Hearing Screening Program in Saudi Arabia

Hearing impairment is a prevalent disabling condition among children; all newborns should undergo a universal newborn hearing screening (UNHS). Unfortunately, many newborns who fail the screening test are lost to follow-up. Our study aims to evaluate parents' perceptions of UNHS and to identify predictors for newborn hearing screening recall in Saudi Arabia. A cross-sectional study involving Saudi parents with 0-to-18-year-old children born in Saudi Arabia was conducted. Descriptive statistics and binary logistic regression were used to describe the participants' characteristics and to identify UNHS recall predictors. A total of 1533 parents were surveyed. Overall, 29.9% of them recalled a hearing screening at birth, while 22.2% reported no hearing screening, and 47.8% were unable to remember. Only (6.9%) participants reported a failed hearing screening, of which 75.9% recalled a follow-up recommendation. Females, parents aged 30-34 years, consanguineous parents, and parents of newborns who were treated with antibiotics were more likely to recall hearing screening compared to others. This study highlights inadequate awareness of UNHS among parents. Our findings support the need to improve the reporting system of UNHS results and implement educational programs to increase parents' recall of hearing test results and ensure early follow-ups for neonates with failed test results.

Knowledge and attitudes of female caregivers in Samoa to childhood hearing loss and hearing services

OBJECTIVES

To assess the knowledge and attitudes of 150 female caregivers in Samoa to childhood hearing loss and hearing services, and to compare findings between urban (n = 100) and rural-dwelling (n = 50) caregivers.

METHODS

A semi-structured interview using a 26-item questionnaire was administered to participants in the Samoan language. Participants were required to respond "yes", "no", or "unsure".

RESULTS

Highest awareness of aetiology of childhood hearing loss was found for otitis media (88.7%), followed by noise exposure (64.7%) and family history (38%). Highest awareness of public health measures that may prevent/reduce otitis media was found for routine childhood immunizations (74.7%) and breast-feeding for first 6 months of life (69.3%). Overall, 40% of Samoan caregivers agreed that curses may cause childhood hearing loss. There was overwhelming support for community-based hearing services for newborns/infants (98%) and school students (97.3%).

CONCLUSIONS

There is positive support for community-based hearing health services for children among female caregivers of Samoa. There was high awareness of otitis media as a major cause of childhood hearing loss, as well as good knowledge of public health measures that reduce/minimise the risk of otitis media.

Development of a questionnaire to assess mothers' knowledge, attitudes and practice with regard to childhood hearing loss and Universal Newborn Hearing Screening

BACKGROUND

The assessment of the validity and reliability of measurement tools in research provides quality data. However, evidence of the validity and reliability of parental knowledge and attitude regarding childhood hearing loss and newborn hearing screening is scarce.

OBJECTIVE

To design a Knowledge, Attitudes and Practice (KAP) survey tool regarding childhood hearing loss and a Universal Newborn Hearing Screening Programme of the rural Amajuba district, KwaZulu-Natal, South Africa, and then test for validity and test-retest repeatability.

METHODS

Face validity was conducted with 20 mothers and a content validity index was determined by two rounds of assessments, the first by 7 experts and the second by 3 experts. The kappa statistic was used to measure the stability of the tool using data from 160 mothers where repeated measurements were applied at two-week intervals. The feasibility of developing a tool was assessed by applying the criteria of science, population and resources.

RESULTS

The KAP tool was developed with twenty-nine items. For face validity, 97% of the participants reported that the items were clear, wording was appropriate and easy to read and the language was natural. Content validity produced excellent results with a scale and content validity index of 1. Test-retest repeatability for the KAP tool was good with a Cohen's kappa coefficient of 0.87 (95% CI: 0.87, 0.87). Individually, the knowledge scale had a kappa of 0.86 (95% CI: 0.77, 0.95); the attitude scale had a kappa of 0.87 (95% CI: 0.76, 0.99): the practice scale had a kappa of 0.86 (95% CI: 0.75, 0.97) and the awareness scale had a kappa of 0.92 (0.83, 1.00). The development of a KAP tool was shown to be feasible, given sufficient time, funds, motivation and a study population.

CONCLUSION

The study produced a valid and reliable tool that can be useful in generating quality evidence of a community's KAP with respect to childhood hearing loss and newborn hearing screening. Evidence gathered could be used to tailor health education and health promotion material for a Universal New-born Hearing Screening (UNHS) programme in a culturally sensitive manner to promote service uptake.

Knowledge and Attitude of Parents Residing in Urban and Rural Areas Towards Infant Hearing Loss

To investigate the knowledge and attitude of parents residing in urban and rural areas towards infant hearing loss. This was a cross sectional study with 384 participants. Initially, a pre-test interview was carried out to collect demographic data such as age, gender, educational qualifications, and residential status. The participants' consent was taken prior to the study followed by, administration of knowledge and attitude questionnaire. Mann-Whitney U Test was used to analyze the data and offer inferences. Results revealed poor awareness on knowledge of risk factors towards infant hearing loss among parents. Parents showed positive attitude towards early identification and intervention of hearing loss. There were no significant differences in knowledge of risk factors and attitudes between Urban and Rural population. Statistically significant differences were found only in the second domain which dealt with knowledge of identification and intervention. Overall, the study provides baseline information regarding the parental knowledge and attitude towards infant hearing loss in urban and rural areas. The outcome of this study indicates a dire need for educating and creating awareness among parents regarding the general risk factors and need for early identification and intervention.

Views of Syrian Mothers in Ankara on Infant Hearing Loss: Cross-sectional Survey

Background

Mothers’ awareness of hearing loss, its risk factors, and available detection and intervention choices have been well known to play an essential role in the early detection and intervention of hearing loss.

Objective

To investigate the knowledge and attitude of Syrian mothers toward infant hearing loss, early identification, and intervention.

Methods

The “Maternal Views on Infant Hearing Loss” questionnaire was adapted and translated into Arabic and then administered to 100 Syrian mothers living in different neighborhoods in Ankara within the age range of 18–68 years old. The internal consistency for the main domains of the questionnaire was tested by Cronbach’s alpha coefficient. Descriptive statistics and Spearman’s rank correlation coefficient were used to evaluate the responses.

Results

The highest level of knowledge about the risk factors was about noise exposure (76%), while the lowest level of knowledge was about jaundice (25%). While 98% of the mothers had a positive attitude toward early detection, 97% of them did not mind the early intervention.

Conclusions

The present findings showed the need to improve mothers’ awareness about infant hearing loss risk factors, available detection, and intervention. Such results may help in performing programs that aim to increase awareness about hearing loss.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10995-022-03488-1.

Universal Newborn Hearing Screening: An Indian Experience of Conceptualizing and Testing a Comprehensive Model

There have been isolated attempts to implement newborn hearing screening at various setups across India. However, none of these attempts has followed a holistic model comprising of multiple components. Therefore, a need was felt to design and implement a comprehensive universal newborn hearing-screening model to, improve follow-up, and provide practically implementable solutions for developing economies. The model was conceptualized after a detailed preliminary planning level. Separate protocols for newborns from well-baby nursery and neonatal intensive care unit were implemented. Measures were implemented to improve follow-up. Knowledge, attitude, and practices survey followed by a sensitization program was carried out to highlight the importance of newborn hearing screening among the healthcare providers. A knowledge and attitude survey was also carried out among mothers. The estimated prevalence rate was 8.78 per 1000. Measures enabled an improved follow-up rate that lead to a reduced age of identification to 6 months. The surveys among mothers and healthcare providers helped to identify the lacunae in knowledge levels, which need to be filled in order to improve their attitudes. Thus, this was a successful model for universal newborn hearing screening comprising of two-stage screening, separate protocols, steps to improve follow-up, improving awareness among parents, sensitization programs, and surveys among mothers as well as healthcare providers.

Feasibility of establishing an infant hearing screening program and measuring hearing loss among infants at a regional referral hospital in south western Uganda

Introduction

Despite the high burden of hearing loss (HL) globaly, most countries in resource limited settings lack infant hearing screening programs(IHS) for early HL detection. We examined the feasibility of establishing an IHS program in this setting, and in this pilot program measured the prevalence of infant hearing loss (IHL) and described the characteristics of the infants with HL.

Methods

We assessed feasibility of establishing an IHS program at a regional referral hospital in south-western Uganda. We recruited infants aged 1 day to 3 months and performed a three-staged screening. At stage 1, we used Transient Evoked Oto-acoustic Emissions (TEOAEs), at stage 2 we repeated TEOAEs for infants who failed TEOAEs at stage 1 and at stage 3, we conducted Automated brainstem responses(ABRs) for those who failed stage 2. IHL was present if they failed an ABR at 35dBHL.

Results

We screened 401 infants, mean age was 7.2 days (SD = 7.1). 74.6% (299 of 401) passed stage 1, the rest (25.4% or 102 of 401) were referred for stage 2. Of those referred (n = 102), only 34.3% (35 of 102) returned for stage 2 screening. About 14.3% (5/35) failed the repeat TEOAEs in at least one ear. At stage 3, 80% (4 of 5) failed the ABR screening in at least one ear, while 25% (n = 1) failed the test bilaterally. Among the 334 infants that completed the staged screening, the prevalence of IHL was 4/334 or 12 per 1000. Risk factors to IHL were Newborn Special Care Unit (NSCU) admission, gentamycin or oxygen therapy and prematurity.

Conclusions

IHS program establishment in a resource limited setting is feasible. Preliminary data indicate a high prevalence of IHL. Targeted screening of infants at high risk may be a more realistic and sustainable initial step towards establishing IHS program s in a developing country like Uganda.

Maternal knowledge on infant hearing loss and acceptability of hearing aids as an intervention at a Referral Hospital in southwestern Uganda

OBJECTIVE

Infant hearing screening enables early detection and management of hearing loss (HL) so that speech and language development delays are minimized. Parents play a critical role in successful screening and management of Infant Hearing loss (IHL) but there is limited data from resource limited settings on parental knowledge about HL and acceptability of IHL interventions. This study was aimed at exploring the maternal knowledge on the various causes of IHL and their acceptability of hearing aids as an intervention for IHL.

METHODS

A cross-sectional study was conducted at a referral hospital in southwestern Uganda. A semi-structured questionnaire was used to interview postpartum mothers to assess their knowledge on causes of IHL and acceptability of a hearing aid if prescribed. Logistic regression was used to calculate odds ratio (OR) for the factors associated with hearing aid refusal.

RESULTS

401 mothers with a mean age of 25 years (Standard Deviation = 5.6 years) were recruited. Half of the mothers correctly identified at least five causes of IHL. The most well-known causes were measles (63.3%) and a positive family history of HL (61.6%). 60% of mothers held at least one superstitious belief as a cause of IHL. Majority of mothers (86%) would accept a hearing aid as an IHL intervention. Mothers with a positive family history of HL (OR = 0.42, p = 0.04), in middle or higher socioeconomic class (OR = 0.45, p = 0.01) and those with more than 3 antenatal visits in their recent pregnancy (OR = 0.44, p = 0.01) were less likely to refuse a hearing aid while mothers that were either widowed or separated from their spouses (OR = 15.64, p = 0.01) were more likely to refuse a hearing aid.

CONCLUSION

Although mothers had limited knowledge on some causes of IHL, there was a high acceptability of hearing aids as an intervention for IHL. Marital status, family history of hearing loss, socioeconomic status and antenatal care attendance are factors that could be used to identify mothers that might accept or refuse a hearing aid for their infant. There is need to increase awareness about causes of hearing loss to improve knowledge as well as dispel any non-biological beliefs held by communities.

Challenges faced by parents when seeking diagnosis for children with sensorineural hearing loss

INTRODUCTION

The Joint Committee of Infant Hearing (JCIH) recommended hearing screening by one month of age, diagnosis of hearing loss by three months of age, and intervention initiated by six months of age. In Malaysia however, the age of diagnosis of hearing loss in children is relatively late. This study aimed to identify the challenges faced by parents in seeking a diagnosis of hearing loss for their children.

METHOD

The study utilized a semi-structured interview with open-ended questions to obtain information about parents' experiences during the diagnosis period and their challenges when going through that process. In this study, a total of 16 parents of children who were diagnosed with moderate to profound sensorineural hearing loss and received intervention within three years at the time of the study participated. Ten of the children were cochlear implant users, and six were hearing aid users.

RESULTS

Thematic analysis was used to analyse themes generated from the data according to the study objective. Four main themes and 17 subthemes were identified from this study. The four main themes were 1) Parents' emotion; 2) Parental knowledge; 3) Others; 4) Profesional services. Challenges that parents faced often include emotional behaviours such as feeling guilty and devastated during the diagnosis, lack of information-sharing from healthcare givers, lack of knowledge on childhood hearing loss among parents, support from families, seek for a second opinion, worry about others' acceptance, longer time for diagnosis to confirm, late referral to other related profesionals and no priority for the appointment.

CONCLUSION

Emotion is identified as the biggest challenge faced by parents in the process of diagnosis for their children with hearing loss. Hence, management of parental emotion needs to be emphasized by health profesionals as it influences the acceptance of parents towards their child's diagnosis.

Knowledge and Practice of Hearing Screening and Hearing Loss Management among Ear, Nose, and Throat Physicians in Jordan

Introduction  One of the main factors that affect the early diagnosis and intervention of hearing loss is inadequate knowledge by the health care workers. Ear, nose, and throat (ENT) specialists are the main source of information about hearing loss and its management in most developing countries, such as Jordan. Objective  The purpose of the present study is to explore the level of knowledge and the practice of hearing screening and hearing loss management for children among ENT physicians in Jordan as an example of health care providers in developing countries of the Middle East. Methods  This was a cross-sectional study, adapting a questionnaire of knowledge and the practice of hearing screening and hearing loss management for children. The questionnaire consisted of 2 sections with 20 questions. A total of 40 ENT physicians completed the questionnaire. Results  The majority of the respondents acknowledged the importance of hearing screening for children; however, there was limited knowledge regarding hearing loss management and testing. Only 10 of the ENT physicians believed that a referral to an audiologist is warranted, and the majority of the respondents were not aware that a child with a confirmed permanent hearing loss should be referred to a speech pathologist or to a rehabilitation center. Managing unilateral and mild sensorineural hearing loss (SNHL) was another area about which ENT physicians have limited knowledge. Conclusion  There is a strong need for professional intervention programs, providing the latest updates and standardizations in the field of audiology and pediatric rehabilitation for ENT physicians.

Maternal knowledge and views regarding early hearing detection and intervention in children aged 0-5 years at a semi-urban primary care clinic in South Africa

BACKGROUND

South Africans have an increasing burden of hearing loss, especially in low-income rural areas. Limited information is available regarding caregivers' knowledge and views regarding infant hearing loss, which is essential for the successful implementation of early hearing detection and intervention (EHDI) programmes.

OBJECTIVES

The main aim of the study was to describe the knowledge and views of mothers with children aged between 0 and 5 years old regarding hearing screening, risk factors, symptoms of hearing loss, and intervention options for hearing loss.

METHOD

A survey was employed at a primary care clinic to gain insight into the maternal views on hearing loss and early intervention services for children aged 0-5 years old.

RESULTS

The majority (83.2%) of the mothers believed that hearing can be tested at birth, 90.7% believed in the biomedical model of intervention which is based on cure, prevention, and pathology as opposed to traditional or alternative medicinal beliefs, and 95.3% indicated that they would seek medical attention if they noticed symptoms of hearing loss. Consequences of hearing loss, such as academic, communication and social problems, were indicated by 65.4% of mothers.

CONCLUSION

The findings demonstrated that although cultural beliefs regarding superstitious causes of hearing loss and use of traditional medicine exist, satisfactory maternal knowledge regarding detection and intervention for hearing loss is present. Maternal views are favourable and a general willingness to participate in EHDI programmes was present. This study advocates for the implementation of EHDI programmes at all primary healthcare clinics across South Africa.

Parental knowledge and attitudes to childhood hearing loss and hearing services in Qassim, Saudi Arabia

Background

Successful audiology service delivery depends on support from the community, and agreement to utilize hearing healthcare programs. Assessment of parents’ awareness regarding hearing loss (HL) and audiology services is necessary for the development of suitable hearing programs for children. Previous studies reported that early detection and intervention for hearing problems are typically strongly supported by parents. The current study sought to evaluate parents’ knowledge and attitudes regarding childhood HL and hearing services.

Methods

A cross-sectional study conducted at five centers in Qassim region of Saudi Arabia. A self-report questionnaire was administered to collect demographic data in addition to 31 questions regarding the knowledge and attitudes of parents toward HL. IBM SPSS Statistics for Windows, Version 21 was used for data analysis. A p-value cut-off point of 0.05 at 95% CI was used to determine statistical significance. The analyses examined the association between socio-demographic characteristics and knowledge and attitudes toward HL using chi-square tests.

Results

Overall, participants included in this study were 243 participants. Of these, 105 (43.2%) were fathers, and 138 (56.8%) were mothers. Ages ranged from 21 to 60+ years. Assessment of the prevalence of various aspects of knowledge and attitudes among parents toward childhood HL revealed that 103 participants (42.4%) possessed good knowledge, while 140 participants (57.6%) possessed poor knowledge. In contrast, the attitude analysis revealed that 224 participants (92.2%) expressed positive attitudes, while only 19 participants (07.8%) showed a negative attitude regarding audiology services. We found a significant association between age group and knowledge (p = 0.002).

Conclusion

Most parents in our sample possessed poor knowledge regarding childhood HL. However, most parents expressed positive attitudes regarding audiology services. The current findings suggest a need to increase awareness among parents regarding childhood HL.

Parents' satisfaction with a trial of a newborn hearing screening programme in Jordan

OBJECTIVE

This study examines parents' satisfaction level toward a trial of a newborn hearing screening programme (NHSP) that was applied in King Abdullah II University Hospital (KAUH) in Jordan over one year. This is the first study that investigated parents' satisfaction toward a hearing screening programme in the Arab countries, and the results will improve any future screening programmes in the Arabian region.

METHOD

The main tool for this study was a questionnaire that was translated and modified from the original version of the Parental Satisfaction with the Newborn Hearing Screening Programme (PSQ-NHSPs1). The questionnaire consisted of 19 items covering five main aspects of the NHSP. The parents' responses were not anonymously given where the parents whose children had undergone the hearing screening were contacted by phone using the data record of the hospital.

RESULTS

The majority of the parents were very satisfied with the programme overall and showed great support and appreciation for the effort in testing their babies and increasing their awareness. The satisfaction levels varied among the specific aspects of the programme. Good portion of the parents did not receive the brochure containing information about the screening, and almost half of them did not know the results of the hearing screening.

CONCLUSION

Parents were overall satisfied with neonatal hearing screening programme that was conducted at KAUH. However, parents were less satisfied with information related to the test procedure and results. Parents' responses in this study could be used to improve any future hearing screening program in Jordan or in the Arab countries.

Knowledge and attitude on childhood hearing loss among mothers and mothers-to-be in urban and rural areas in Malaysia

OBJECTIVES

Maternal knowledge and attitude towards childhood hearing loss play an important role in determining the success of early diagnosis and intervention of hearing loss programs in children. This study aimed to 1) assess the knowledge and attitude of childhood hearing loss among mothers, 2) compare knowledge and attitude of childhood hearing loss in urban and rural mothers, 3) investigate the relationship between knowledge and attitude on childhood hearing loss, and 4) identify socio-demographic factors that influence mothers' knowledge and attitude on childhood hearing loss.

METHOD

A cross-sectional survey was conducted on 362 mothers and mothers-to-be (mean age: 31.9 ± 4.9 years, range: 20-48 years old) recruited from Hospital Universiti Kebangsaan Malaysia in Cheras, Kuala Lumpur and two health clinics in Lenggeng, Negeri Sembilan and Beranang, Selangor representing the urban and rural areas respectively. All participants were interviewed in person using a newly developed and reliable questionnaire that tested their knowledge and attitude on childhood hearing loss.

RESULTS

Generally, the majority of mothers had a moderate level of knowledge and positive attitude towards childhood hearing loss. Urban mothers had a significantly higher knowledge than those of the rural area (p < 0.05). However, no significant differences were observed in attitude toward childhood hearing loss between urban and rural mothers. In addition, there was no significant relationship found between knowledge and attitude on childhood hearing loss among mothers. Age, race, occupation and education level contributed to the knowledge score significantly (p < 0.05), whereas, only race was significantly associated with attitude.

CONCLUSION

In spite of positive attitude towards childhood hearing loss, the majority of mothers and mothers-to-be demonstrated poor knowledge on this aspect. Therefore, this study highlights the urgent need to develop and implement appropriate health education campaigns to improve mothers' knowledge of childhood hearing loss.

Hearing impairment detection and intervention in children from centre-based early intervention programmes

The study aimed to describe ages at identification and initiation of early intervention (EI) services for children enrolled in centre-based EI programmes in Gauteng, as well as to describe the nature of EI services that the children received. The researchers conducted retrospective record reviews of the EI programme files. In addition, caregivers of eight children identified with hearing impairments and enrolled in centre-based EI programmes in Gauteng completed a newly constructed questionnaire. The caregiver questionnaire produced data pertaining to the child's family demographics, background information and schooling history. Descriptive statistics were used to analyse the data, using frequency distribution and measures of central tendency. None of the children received newborn hearing screening services, thus they were identified late following maternal suspicion of hearing impairment. Late identification of the hearing impairment resulted in suboptimal initiation of EI services. All the children received aural habilitation and/or speech-language therapy services. These findings indicate that there is a great need for the establishment of widespread early hearing detection and intervention programmes that will lead to earlier identification of infant and childhood hearing impairment and timely initiation of EI services.

Mapping the content of mothers' knowledge, attitude and practice towards universal newborn hearing screening for development of a KAP survey tool

Understanding mother’s knowledge, attitude and practice (KAP) of permanent childhood hearing impairment (PCHI) is essential for the success of universal newborn hearing screening (UNHS) as poor compliance and follow-up remains a global challenge. To determine content area for a questionnaire that measures PCHI-related KAP in rural mothers, we trained moderators who interviewed 145 pregnant women (17 groups) from 5 ante-natal clinics. Interviews were recorded, transcribed, summarised and analysed using thematic framework analysis. Four knowledge themes were identified: 1) PCHI was perceived as the malfunction of hearing leading to disability; 2) a poorly-responsive/communicative child may have PCHI; 3) lifestyle, hereditary and environmental factors are significant causes of PCHI; 4) medical management of PCHI was doubted, with some advocating birth and ancestral rituals. Two themes were identified for attitude: 1) beliefs that PCHI was emotionalised due to the negative lifelong impact on the child and family; 2) UNHS processes were favourable though some preferred other belief systems. Three themes were identified for practice: 1) doctors were the first choice followed by traditional healers; 2) willingness to continue follow-up although challenges exist; 3) minimal family support during consultation. The contextualised KAP of women regarding UNHS processes and PCHI provided content area for the design of a KAP tool.

Models of service delivery for ear and hearing care in remote or resource-constrained environments

Background

There is poor availability of ear and hearing services globally, because of a lack of infrastructure, funding, equipment and appropriately trained personnel. When deciding upon delivery of ear and hearing services, an approach based upon community assessment is advocated, with subsequent asset mapping and acquisition.

Objectives

Some of the challenges to delivery of care in resource-constrained or remote environments are acknowledged, with discussion of several existing models of service delivery, and their advantages and disadvantages. Public health and telehealth are also mentioned. This article may assist those trying to set up new programmes in ear and hearing health.

Parent Cognitive Satisfaction and Demand Research of Neonatal Hearing Screening

The primary aim of the present study was to investigate parent cognitive satisfaction and demand by using a valid and reliable questionnaire developed for this purpose (Parent Cognitive Satisfaction and Demand Questionnaire with Neonatal Hearing Screening Program, PCSDQ-NHSP). About 1000 parents whose children received hearing screening participated in this study. The satisfaction questionnaire was found to be a useful instrument for identifying service shortfalls, and the routine use of the PCSDQ-NHSP in other neonatal hearing screening programs is recommended. Overall, parents focused their attention to the neonatal hearing screening results and had high levels of expectations. They also longed for more information about relevant knowledge. Screening ability differed in different areas of Guangdong province where grass-roots hospitals had poor ability to perform this well. More preappointment information leaflets or brochures should be sent to parents. Regular training for neonatal hearing screening test is needed in primary hospitals. We can establish a neonatal hearing screening network to link as many hospitals as possible, and develop a standardized neonatal hearing screening system.

Parental knowledge and attitudes to childhood hearing loss and hearing services in the Solomon Islands

OBJECTIVE

An understanding of parental knowledge and attitudes towards childhood hearing loss is essential to the successful implementation of audiology services. The present study aimed to investigate parental knowledge and attitudes among parents in the Solomon Islands.

METHODS AND MATERIALS

A total of 100 mothers and 50 fathers were administered a questionnaire via semi-structured interviews.

RESULTS

Highest parental awareness of aetiology of childhood hearing loss was noted for otitis media (94%), noise exposure (87.3%), and family history (72.7%). The highest parental awareness concerning public health initiatives to reduce/prevent otitis media was noted for routine childhood immunizations (84%) and breast-feeding (76%). Higher rates of knowledge in fathers than in mothers included otitis media (p = 0.038), noise exposure (p = 0.007), and breast-feeding (p = 0.031). Approximately half of parents (56%) agreed that curses may cause hearing loss. Overall parental responses showed positive support for infant hearing screening programs (96%) and school-based ear and hearing health examinations (99.3%).

CONCLUSIONS

High levels of parental readiness and support for childhood hearing services in the Solomon Islands was evident. Knowledge of aetiology of childhood hearing loss was highest for otitis media, noise exposure, and family history. Knowledge and attitudes of fathers to childhood hearing loss and hearing services was either the same or better than that of mothers.

Knowledge and attitude of mothers regarding infant hearing loss in Changsha, Hunan province, China

OBJECTIVE

The objective of this study was to explore the knowledge and attitude among mothers of newborns regarding infant hearing loss (HL) in Changsha, Hunan province, China.

DESIGN

A questionnaire including 18 items was given to mothers.

STUDY SAMPLE

A total of 115 mothers participated in the study.

RESULTS

Seven risk factors for hearing loss were identified correctly by above 60% of respondents and the top three were prolonged noise (88.7%), high fever (82.6%) and ear discharge (82.6%). Poor knowledge was demonstrated on risk factors jaundice (20.0%), measles (22.6%), convulsion (33.0%) and traditional Chinese medicine (39.1%). Maternal knowledge scores in identification and intervention (2.68 ± 0.31) was slightly higher than the score in risk factors (2.47 ± 0.34). Ninety-nine per cent of the mothers expressed the willingness to test baby's hearing soon after birth and concern about hearing.

CONCLUSIONS

Mothers were concerned about baby's hearing and the attitude was positive. However, the correct recognition rate towards some risk factors for HL was low. Action needs to be taken to raise awareness about ear and hearing care, prevent HL caused by preventable causes and prompt early identification, early diagnosis and intervention of HL.

A Qualitative Study on Knowledge and Attitude towards Risk Factors, Early Identification and Intervention of Infant Hearing Loss among Puerperal Mothers- A Short Survey

INTRODUCTION

Maternal active participation and their support are critical for the success of early hearing loss detection program. Erroneous maternal decisions may have large life long consequences on the infant's life. The mothers' knowledge and their attitudes towards infant hearing loss is the basis for their decisions.

AIM

The present study was done to determine the mothers' knowledge and their attitude towards risk factors of infant hearing loss, its early identification and intervention and also awareness of effect of consanguinity on hearing loss.

MATERIALS AND METHODS

In this cross-sectional questionnaire survey study, a total of 100 mothers were interviewed using the questionnaire which consisted of three sections namely risk factors, early identification and early intervention of hearing loss. Chi-square test was used to establish relationship between consanguineous and non-consanguineous mother's responses to its effect on hearing loss. A p-value < 0.05 was considered as significant.

RESULTS

Mothers' awareness was significantly high for visible causes (ear pain/discharge, head injury and slap to ear) of hearing loss. Positive attitude was seen for importance of screening programs and follow up testing. Moderate level of awareness was found on hazards of consanguinity and benefits of early identification. However, mothers were least aware of neonatal jaundice, NICU admission (>5 days), signs of late-onset and neural hearing loss, management of hearing loss, hearing aid fitting and therapy necessity, which might interfere in early detection and intervention of hearing loss.

CONCLUSION

It is crucial to educate mothers on few risk factors and management of hearing loss to reduce its consequences.

Knowledge and attitude of parents/caregivers towards hearing loss and screening in newborns - a systematic review

OBJECTIVE

The parents/caregivers of a newborn play a pivotal role in the process of hearing screening and intervention. The decisions taken by them depend on their knowledge and attitude. The purpose of this study was to review the literature systematically on knowledge and attitude of parents/caregivers towards infant hearing loss and newborn hearing screening.

DESIGN

A systematic search was conducted using electronic databases for the periods from 1990 to March 2016. Two authors scrutinized the studies and extracted the data based on predetermined criteria.

STUDY SAMPLE

Ten studies.

RESULTS

Ear discharge was correctly identified as a risk factor for hearing loss along with measles, drugs/medication, family history, congenital causes and noise exposure. The studies revealed mixed results for knowledge about newborn hearing screening. Overall, the parents/caregivers showed positive attitudes towards hearing screening and intervention options. However, due to heterogeneity in the studies, it's hard to derive a conclusion.

CONCLUSIONS

The present review sheds light on the common areas of misconception among parents/caregivers about risk factors of infant hearing loss and newborn hearing screening. The review also draws attention to the need to have more studies exploring this knowledge and attitude of parents/caregivers among diverse populations.

Overview of a public health approach to pediatric hearing impairment in the Pacific Islands

BACKGROUND

Childhood hearing impairment is a significant cause of disability in developing countries. Otitis media and meningitis are leading infectious causes of preventable hearing loss in children. It is estimated that the Pacific Islands have among the greatest global burden of childhood hearing impairment due to infectious causes, and yet there is currently very little in the research literature on pediatric hearing disorders in this region.

OBJECTIVES

(1) To review existing research literature on pediatric hearing impairment in the Pacific Islands, and (2) to present a public health approach to the development and improvement of childhood hearing services in the Pacific Islands.

DATA

The primary tool was a comprehensive literature review. MEDLINE and ScienceDirect databases were searched for relevant journal articles. There was no limit on the date of publication. Any article reporting on hearing impairment in the Pacific Region was included.

RESULTS

A total of 23 journal articles were found that satisfied the above inclusion criteria. The limited information available in the literature suggests that otitis media and vaccine-preventable infections are a significant cause of avoidable childhood hearing impairment in the Pacific Islands. Pediatric audiology services are limited in this region. Further research is required to develop effective public health programs that should reduce the burden of preventable childhood hearing loss in the Pacific Islands.

CONCLUSIONS

There is limited information in the research literature on pediatric hearing impairment and audiology services in the Pacific Islands. Epidemiological data based on the WHO Ear and Hearing Disorders Survey Protocol are urgently needed, and the development of audiology services within the existing public and primary health care framework should reduce the burden of preventable hearing loss in the Pacific Islands.

Knowledge and attitude (KA) survey regarding infant hearing loss in Karnataka, India

INTRODUCTION

The support provided and the decisions taken by mothers determine the success of Universal Newborn Hearing Screening (UNHS). Attempts at exploring the existing knowledge-attitude among mothers is crucial to create/modify the existing screening programs. The present study attempts to explore the knowledge and attitude toward infant hearing loss (HL) among mothers of newborns in the Indian state of Karnataka.

METHOD

A cross-sectional survey was conducted among 219 mothers of newborns in Karnataka, India. The questionnaire was framed from existing literature and consisted of 19 questions assessing knowledge and attitude toward infant HL to be rated on a three-point scale (no, not sure, yes). Descriptive statistics and Cronbach's α were used to analyze the data.

RESULTS

Mothers exhibited good knowledge of risk factors; noise (70.3%) and ear discharge (54.3%). More than 75% agreed that treatment for HL is available and that these children can attend school. The questions of superstitions and cultural beliefs yielded mixed responses. A large number of mothers expressed desire to have their children tested at birth (84.9%) and were concerned about their children's hearing (87.7%). Yet only 54.3% stated that they would allow their children to wear hearing aids.

SUMMARY AND CONCLUSION

The present study is an attempt to understand the knowledge and attitude of mothers toward infant HL in Karnataka and facilitate identification of potential areas of less knowledge as a reference for endeavors of enhancement. It further highlights the need for implementing public awareness programs to improve knowledge and attitude of mothers toward infant HL for better implementation of UNHS.

Paediatric diagnostic audiology testing in South Africa

INTRODUCTION

With the increased emphasis on the importance of early identification of paediatric hearing loss within developing countries such as South Africa and Nigeria there has been a recognition of the ethical obligation to ensure access to timely diagnostic and intervention services for children identified with hearing loss; regardless of their geographic or socioeconomic status. There are limited studies on diagnosis of paediatric hearing loss in a developing world context.

OBJECTIVES

The objective of this study was to determine processes used for diagnosis of paediatric hearing loss in South Africa, across the private and public healthcare sectors, and to profile the age of testing for each component of the diagnostic test battery.

METHODS

Diagnostic audiology testing data of 230 children enrolled in an early intervention programme was analysed to profile the reporting of diagnostic audiology testing as well as diagnostic audiology procedures employed. Results were analysed according to province as well as healthcare sector to compare diagnostic services across regions as well as healthcare sectors.

RESULTS

The differences in audiology practice and tests employed with paediatric clients across the regions of Gauteng, Kwazulu Natal and Western Cape indicates that services across regions and across the public and private sector are not equitable. Each region is equally unlikely to complete a full, comprehensive diagnostic evaluation on paediatric clients. The age of testing highlights the increased age of diagnosis of hearing loss.

CONCLUSION

Paediatric diagnostic audiology is a section of Early Hearing Detection and Intervention services that requires attention in terms of the appropriateness of procedures as well as equity of services. Further studies on diagnostic practice and resources in South Africa will provide information on factors that are preventing adherence to international best practice guidelines for paediatric diagnostic audiology.

Prevalence and Risk Factors of Hearing Impairment Among Primary-School Children in Shebin El-Kom District, Egypt

Purpose

This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students.

Method

A total of 555 children (6–12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools.

Results

The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice.

Conclusions

The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.

Community-based infant hearing screening in a developing country: parental uptake of follow-up services

Background

Universal newborn hearing screening is now considered an essential public health care for the early detection of disabling life-long childhood hearing impairment globally. However, like any health interventions in early childhood, parental support and participation is essential for achieving satisfactory uptake of services. This study set out to determine maternal/infant socio-demographic factors associated with follow-up compliance in community-based infant hearing screening programmes in a developing country.

Methods

After health educational/counselling sessions, infants attending routine childhood immunisation clinics at four primary care centres were enrolled into a two-stage infant hearing screening programme consisting of a first-stage screening with transient-evoked otoacoustic emissions and second-stage screening with automated auditory brainstem response. Infants referred after the second-stage screening were scheduled for diagnostic evaluation within three months. Maternal and infant factors associated with completion of the hearing screening protocol were determined with multivariable logistic regression analysis.

Results

No mother declined participation during the study period. A total of 285 out of 2,003 eligible infants were referred after the first-stage screening out of which 148 (51.9%) did not return for the second-stage, while 32 (39.0%) of the 82 infants scheduled for diagnostic evaluation defaulted. Mothers who delivered outside hospitals were significantly more likely to return for follow-up screening than those who delivered in hospitals (Odds ratio: 1.62; 95% confidence intervals: 0.98 – 2.70; p = 0.062). No other factors correlated with follow-up compliance for screening and diagnostic services.

Conclusion

Place of delivery was the only factor that correlated albeit marginally with infant hearing screening compliance in this population. The likely influence of issues such as the number of return visits for follow-up services, ineffective tracking system and the prevailing unfavourable cultural perception towards childhood deafness on non-compliance independently or through these factors warrant further investigation.

Newborn hearing screening: an outpatient model

OBJECTIVE

The purpose of this study was to assess the feasibility of implementing an outpatient model of a newborn hearing screening program with a particular focus on determining how compliance with the follow-up appointment related to specific socio-economic and demographic factors associated with the mother.

METHOD

Mothers who delivered their babies in public hospitals in Recife, northeast Brazil, were invited to participate in a two-step program. In Step 1 they were interviewed with regard to specific socio-economic and demographic factors, and then scheduled for a hearing screening test for their baby 1 month after discharge. In Step 2, the baby's hearing was screened using transient otoacoustic emissions.

RESULTS

A total of 1035 mothers consented to participate in Step 1, but only 149 returned to participate in Step 2 (14.3%). Analysis of the socio-economic and demographic factors indicated that mothers who did not comply with the scheduled newborn hearing screening (NHS) test generally had less than a high school education and came from primarily lower income families who lived in rural areas outside of Recife.

CONCLUSION

The results of this study highlight some socio-economic and demographic factors of the population of northeast Brazil that contribute to a low compliance rate for an outpatient model of a newborn hearing screening program. Possible solutions to the low compliance rate are considered.

The prevalence of congenital and early-onset hearing loss in Jordanian and Israeli infants

The objective of the study was to investigate the prevalence of congenital and early-onset hearing loss, and the influence of the known risk factors for hearing loss on infants in Jordan and Israel. Subjects were a total of nearly 17,000 infants from both countries, including infants with and without risk factors for hearing loss. The hearing screening protocol included distortion product otoacoustic emission, followed in case of repeated OAE referral or high risk (HR) infant by diagnostic auditory brainstem responses. The results indicate that the prevalence and severity of hearing loss amongst Jordanian infants (1.37%) is remarkably higher as compared to the Israeli infants (0.48%). The overall prevalence of bilateral SNHL was seven times more in the Jordanian infants, 18 times in non-risk, and three times in the HR infants relative to the Israeli infants. Risk factors including family history, hyperbilirubinemia, bacterial meningitis, and associated syndromes were more prevalent amongst Jordanian infants. This unique study underscores the importance of sharing and exchanging information to create empirical data to guide health-care providers in adapting protocols to the local constraints in developing countries.

Parental awareness of hearing impairment in their school-going children and healthcare seeking behaviour in Kisumu district, Kenya

BACKGROUND

Hearing-impaired children who are identified early and appropriately managed have improved outcomes in speech, language, cognitive and social development. Enhanced parental awareness of their child's hearing disability, behavioral, developmental and psychosocial limitations is essential to sustaining timely detection and appropriate intervention. Additionally, availability of services for diagnosis, treatment and habilitation would improve the demand for pedaudiological care in this community.

OBJECTIVE

To describe level of parental awareness of childhood HI and the pattern of access to and utilization of ambulatory care services.

SUBJECTS

Thirty-three parents of lower primary school-going children who failed audiometric screening from sampled schools in Kisumu district, western Kenya.

MAIN OUTCOME MEASURES

First person to detect HI, age of child at first suspicion of HI, source of ambulatory health care and use of the health care facilities.

RESULTS

The prevalence of HI was 2.48%. Most parents/guardians (69.7%) were aware of their child's hearing impairment. Of these, 63.6% were first to detect HI in the pupils, while 30.3% were detected by screen. Most children (57.2%) were first recognized with (HI) after age 2 years. The mean age at identification was 5.5 years. The median travel distance to the preferred health care facility was 2 km (IQR 1-2.5). Parents seldom sought or lacked help for their hearing-impaired children. Of 27.3% who asked for hearing assessment, 9.1% received some counsel on HI and 12.1% received medication, one (3%) was referred for audiological assessment and none used a hearing aid. Use of health facilities for maternal care was (65.7%) and immunization (62.9%).

CONCLUSIONS

Despite adequate parental awareness of chronic childhood disability, health facilities were underutilized. This indicates the need to further stimulate and maintain a desirable level of uptake of services for diagnosis, treatment and habilitation of childhood HI, while sustaining delivery of effective and acceptable high quality paediatric care.