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Mazlan R, Raman K, Abdullah A. A 10-year retrospective analysis of newborn hearing screening in a tertiary hospital in Malaysia. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00331-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abstract
Background
Universal newborn hearing screening (UNHS) has been widely adopted worldwide as a standard of care because it enables the detection of congenital hearing loss early in life. Therefore, the concepts of regular measurement of performance using pre-determined quality measures are recommended for continuous improvement of the program. This study aimed to evaluate and update the performance of a UNHS program by measuring the recommended quality measures between 2010 and 2019. A retrospective study analyzing data of 50569 babies screened between January 2010 and December 2019 was performed. The pre-determined quality measures of coverage rate, initial referral rate, return to follow-up rate, diagnosis rate, and age at diagnosis were measured.
Results
The average coverage rate was 95.5%, with all years achieving the recommended benchmark of ≥ 95% except 2014 (91.8%) and 2019 (89.5%). Generally, the initial referral rate (10%) exceeded the benchmark of ≤ 4%. The program only managed to reach the benchmark for initial referral rate in 2013, 2014, and 2015. Both quality indicators for return to follow-up and diagnosis rates also did not meet the ≥ 95% and ≥ 90% standards, respectively. The return to follow-up ranged from 62 to 72.7%, while the average diagnosis rate was 73.4% (60–100%). One hundred thirty-seven infants were diagnosed with hearing loss at a median age of 3.8 months (± 0.4 months), resulting in a prevalence of 0.27%.
Conclusion
The findings demonstrated an excellent coverage rate but unsatisfactory performance for other quality indicators. Hence, the current program needs to be revisited to remain relevant and effective.
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Joshi DB, Ramkumar V, Anand S. Outcomes of Training Nurses Engaged in a Public Sector Newborn Hearing Screening Program in South India. Indian J Otolaryngol Head Neck Surg 2022; 74:5588-5596. [PMID: 36742597 PMCID: PMC9895562 DOI: 10.1007/s12070-021-02920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
This study evaluated the outcomes of training nurses engaged in a public sector newborn hearing screening (NHS) program in one urban district in South India. Twenty nurses performing NHS in Corporation Maternity Hospitals (CMH) participated in the training and evaluation. Baseline knowledge and skill of nurses regarding NHS and overall program outcomes were obtained eight months post the initial training. Knowledge was evaluated using questionnaire, skill was evaluated using Objective Structured Clinical Examination (OSCE) and agreement between screening results obtained by audiologist and nurse. Records used for documentation of screening were analysed to evaluate program outcomes. A two-day retraining was designed to address the gaps identified. Evaluations were conducted immediately post and three months post retraining following the same procedure as baseline evaluations. Gaps were identified in knowledge and skill as well as in the program outcomes. Immediate post retraining evaluation results showed overall improvement in nurses' knowledge and skill. Three months post retraining, all the nurses achieved benchmark criteria of 75% in knowledge and skill. Program outcomes, such as coverage (95.3%), refer rate (3.2%) and follow up rate (86.1%) improved post retraining. The findings of this study suggests that knowledge and skill of nurses improved with periodic training. Periodic evaluation and monitoring enhanced the overall outcomes of the program. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02920-2.
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Affiliation(s)
- Deepashree B. Joshi
- Department of Speech Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamilnadu 600116 India
| | - Vidya Ramkumar
- Department of Speech Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamilnadu 600116 India
| | - Sheeba Anand
- District Differently Abled Welfare Office, State Resource Cum Training Centre, Chennai, Tamilnadu India
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Hrncic N, Goga A, Hrncic S, Hatibovic H, Hodzic D. Factors Affecting Neonatal Hearing Screening Follow-up in Developing Countries: One Insitution Prospective Pilot Study. Medeni Med J 2021; 36:14-22. [PMID: 33828885 PMCID: PMC8020185 DOI: 10.5222/mmj.2021.19577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To detect factors related with loss to follow-up (LTF) in neonatal hearing screening (NHS) program of one institution in a developing country. Methods A prospective study was planned based on the data collected in a pilot study conducted a year before in the same institution. In this pilot study, hearing screening was performed before hospital discharge for every infant (1217 newborns) in six months period. Total referral rate was 19.1% (223/1217). Loss to follow-up (LTF) was 38.1% (85/223). Telephonic interviews were done with 50 parents who had not come with their child to the second hearing test. For these telephonic interviews the questionnaire with four sections (socio-demographic information; information about pregnancy, birth, and present health condition of the child; caregiver knowledge of neonatal hearing screening, and reasons for default on follow-up) was created. Results The mothers participated in this study were 29.1 years (±5.2 SD) of age in average. Place of residence was mostly rural (64%; n=32) with 39.4 Km (±24.8 SD) away from from the rescreen referral center. Their knowledge on neonatal hearing screening, hearing impairment incidence or treatment opportunities was at a very low level. Caregivers’ perceptions that follow-up was unnecessary (50%; n=25), was most frequently given reason for follow-up default, followed by newborns bad health condition (12%; n=6) and forgetting about the follow-up visits (8%; n=6). Conclusion The main reason for default in follow-up in our study was caregiver’s poor knowledge about this topic.
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Affiliation(s)
| | - Amna Goga
- Cantonal Hospital Zenica, Bosnia and Herzegovina
| | - Selma Hrncic
- Public Health Center Zenica, Bosnia and Herzegovina
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Wong YA, Mazlan R, Abdul Wahab NA, Ja'afar R, Huda Bani N, Abdullah NA. Quality measures of a multicentre universal newborn hearing screening program in Malaysia. J Med Screen 2020; 28:238-243. [PMID: 33202173 DOI: 10.1177/0969141320973060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate and discuss the outcomes of the universal newborn hearing screening program conducted at four public hospitals in Malaysia. METHOD A retrospective analysis of the universal newborn hearing screening database from each hospital was performed. The database consisted of 28,432 and 30,340 screening results of babies born in 2015 and 2016, respectively. Quality indicators (coverage rate, referral rate, return for follow-up rate, and ages at screening and diagnosis) were calculated. RESULTS Overall coverage rate across the four hospitals was 75% in 2015 and 87.4% in 2016. Over the two years, the referral rates for the first screening ranged from 2.7% to 33.93% with only one hospital achieving the recommended benchmark of <4% in both years. The return for follow-up rates for each participating hospital was generally below the recommended benchmark of ≥95%. The mean age at screening was 3.9 ± 1.2 days and 3.3 ± 0.4 days, respectively. The mean age at diagnosis for 70 infants diagnosed with permanent hearing loss was 4.7 ± 0.7 months in 2015 and 3.6 ± 0.9 months in 2016. CONCLUSIONS Quality measures for the universal newborn hearing screening program in four public hospitals in Malaysia were lower than the required standards. Nevertheless, some quality indicators showed statistically significant improvements over the two years. Next steps involve identifying and implementing the best practice strategies to improve the outcome measures and thus the quality of the program.
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Affiliation(s)
- Yun Ai Wong
- Audiology Programme, Centre for Rehabilitation & Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rafidah Mazlan
- Audiology Programme, Centre for Rehabilitation & Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Centre for Ear, Hearing and Speech, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noor Alaudin Abdul Wahab
- Centre for Ear, Hearing and Speech, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Roslan Ja'afar
- Graduate School of Business, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Nurul Huda Bani
- Unit Audiologi, Hospital Rehabilitasi Cheras, Ministry of Health Malaysia, Jalan Ya'acob Latiff, Cheras, Malaysia
| | - Nurul Ain Abdullah
- Unit Audiologi, Hospital Sungai Buloh, Ministry of Health Malaysia, Jalan Hospital, Sungai Buloh, Malaysia
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Mahmood Z, Dogar MR, Waheed A, Ahmad AN, Anwar Z, Abbasi SZ, Anwar A, Hashmi AA. Screening Programs for Hearing Assessment in Newborns and Children. Cureus 2020; 12:e11284. [PMID: 33274158 PMCID: PMC7707914 DOI: 10.7759/cureus.11284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective In this study, we aimed to assess the incidence of hearing loss in the pediatric population through otoacoustic emission (OAE) and brainstem evoked response audiometry (BERA) and to analyze the possible etiological factors responsible for it. Material and methods A retrospective observational study was conducted in the Otolaryngology (ENT) and Gynecology and Obstetrics Departments at the Jinnah Postgraduate Medical Centre and National Institute of Child Health in Karachi, Pakistan between July 2019 and October 2019. The convenient sampling technique was used to select the patients. The final sample size consisting of newborns and children was 108. Initially, screening procedures were undertaken for newborns to detect permanent or fluctuating, bilateral or unilateral, and sensory or conductive hearing loss, averaging 30-40 dB or more in the frequency region, which indicated potential issues related to speech recognition (approximately 500-4,000 Hz). The screening of newborns involved the use of non-invasive, objective physiologic measures that included OAEs and/or auditory brainstem response (ABR). The children with hearing impairment then underwent BERA; thereafter, further investigations were performed to confirm the defects found on BERA testing. Results Of the 108 cases, 96 had normal hearing on OAE screening, and 12 were found to have hearing loss on the OAE test. Further testing was carried out on BERA for 12 cases that had been detected to have hearing loss on OAE, and BERA showed normal hearing for five cases whereas seven were found to have hearing loss. Of the seven patients with hearing loss on the BERA test, five were diagnosed with cochlear deafness, and two had retrocochlear deafness. Conclusion Our present study concludes that in order to avoid any hearing problems in infants, OAE hearing screening and diagnostic BERA screening programs should be carried out in all the hospitals of Pakistan to assess newborn hearing at an early age.
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Affiliation(s)
- Zafar Mahmood
- Otolaryngology, Liaquat College of Medicine and Dentistry, Darul Sehat Hospital, Karachi, PAK
| | | | - Abdul Waheed
- Otolaryngology, Sindh Employees Social Security Institution (SESSI) Landhi Hospital, Karachi, PAK
| | - Ahmad Nawaz Ahmad
- Otolaryngology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Zubair Anwar
- Otolaryngology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Adnan Anwar
- Physiology, Al-Tibri Medical College, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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Yakıştıran B, Karslı M, Canpolat E, Oğuz Y, Altınboğa O, Celen S. The Effect of Anesthesia Type During Delivery on Neonatal Otoacoustic Emission Hearing Test Results: A Tertiary Center Experience. Z Geburtshilfe Neonatol 2020; 225:262-266. [PMID: 32992403 DOI: 10.1055/a-1253-8727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hearing is essential for the healthy development of an infant as language is one of the main stimulants of intellectual capacity. We investigate the effect of anesthesia type during delivery on neonatal otoacoustic emission (OAE) hearing test results. METHODS This retrospective cross-sectional study includes 1,493 healthy, full-term (39/0-40/6 gestational weeks) newborns of healthy women and who were delivered by cesarean section. Newborns were divided into 2 groups based on their anesthesia type during delivery: 1) general anesthesia group (n=160), and 2) spinal anesthesia group (n=1333). Maternal age, anesthesia type, birth weight, gestational age at birth, neonatal gender, 1st-5th minute APGAR scores, and OAE results were compared between the groups. RESULTS 1287 (86.2%) newborns were reported to have passed the first step of OAE; 206 (13.8%) newborns were reported to have failed the first step and passed the second test. In the general anesthesia group, 133 (83.1%) of the newborns passed the first OAE test and 27 (16.9%) newborns had false-positive results. In the spinal anesthesia group, 1,154 (86.6%) of the newborns passed the first OAE test and 179 (13.4%) newborns had false-positive results. The difference between the 2 groups by false-positive values was found to be statistically significant (p<0.001). CONCLUSIONS Type of delivery anesthesia may have an effect on the false-positive rates of OAE test results.
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Affiliation(s)
- Betül Yakıştıran
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital
| | - Mehmet Karslı
- Obstetrics and gynecology, Istanbul Universitesi-Cerrahpasa, Istanbul, Turkey
| | - Emre Canpolat
- Neonatology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Yüksel Oğuz
- Obstetrics and gynecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Orhan Altınboğa
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital
| | - Sevki Celen
- Obstetrics and gynecology, Etlik İhtisas Eğitim ve Araştırma Hastanesi, Ankara, Turkey
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Abdullah A, Dahari KASA, Tamil AM, Rohana J, Razif MYM, Shareena I. The Prevalence of Hearing Loss Among Babies in the Neonatal Intensive Care Unit in a Tertiary Hospital in Malaysia. Medeni Med J 2020; 35:116-120. [PMID: 32733760 PMCID: PMC7384509 DOI: 10.5222/mmj.2020.68466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/27/2020] [Indexed: 11/05/2022] Open
Abstract
Objective To study the prevalence of hearing loss (HL) and to identify the possible risk factors causing HL. Methods This retrospective study was conducted from January 2014-December 2016 at a tertiary hospital in Malaysia. All neonates admitted to the neonatal intensive care unit (NICU), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were screened with a two-step protocol using an automated auditory brain response (AABR) and/or Otoacoustic Emission and auditory brain response (ABR). Descriptive analysis was used for the prevalence of HL, degree of HL and number of risk factors per infant. Results A total of 2713 babies underwent hearing screening in NICU was enrolled in this study. Two thousand six hundred eight (96%) babies passed the screening test and 214 (4%) babies required further diagnostic test. Only 105 (49%) babies completed diagnostic tests. Out of 105 babies, 40 (38.1%) babies had HL. Mild HL was the commonest HL with 22 (55%), moderate HL was in seven babies (17.5%), severe HL in two babies (5%), and profound HL in nine babies (22.5%). The presence of craniofacial anomalies was the only significant independent risk factor for HL with p<0.05 with an odds ratio of 0.105 CI 95% [0.028-0.389]. Of Babies with the presence of three or more risk factors, 100% of them had HL.There was an increased risk of hearing loss in those with craniofacial anomalies up to 11 times higher compared to those without such anomalies. Conclusion The prevalence of HL among the NICU babies was 1.5% and mild HL was the commonest degree of HL (55%).
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Affiliation(s)
- Asma Abdullah
- Universiti Kebangsaan Malaysia Medical Centre, Department of Otorhinolaryngology- Head and Neck Surgery, Kuala Lumpur, Malaysia
| | | | - Azmi Mohd Tamil
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Public Health, Kuala Lumpur, Malaysia
| | - Jaafar Rohana
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Pediatric, Kuala Lumpur, Malaysia
| | - Mohamad Yunus Mohd Razif
- Universiti Kebangsaan Malaysia Medical Centre, Department of Otorhinolaryngology, Kuala Lumpur, Malaysia
| | - Ishak Shareena
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Pediatric, Kuala Lumpur, Malaysia
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Kolethekkat AA, Al Abri R, Hlaiwah O, Al Harasi Z, Al Omrani A, Sulaiman AA, Al Bahlani H, Al Jaradi M, Mathew J. Limitations and drawbacks of the hospital-based universal neonatal hearing screening program: First report from the Arabian Peninsula and insights. Int J Pediatr Otorhinolaryngol 2020; 132:109926. [PMID: 32036167 DOI: 10.1016/j.ijporl.2020.109926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/02/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the efficacy of the current universal neonatal hearing screening program in a tertiary medical institution in Oman, identify its limitations and drawbacks, and explore their causative factors. METHODS A retrospective review was carried out to analyse the hearing screening of 12,743 live babies born between January 2016 and December 2018. Screen coverage, drop outs, follow up rate, and age at completion of screening, diagnosis, and intervention were analysed. The results were compared with the Joint Committee on Infant Hearing (JCIH) performance quality indices. Prospective questionnaire-based telephonic interviews were then conducted with the parents or caregivers of neonates with hearing loss. Finally, the causes of loss to follow up or delays in hearing screenings, diagnosis, and/or early intervention were studied. RESULTS The true prevalence of hearing loss was 4.0 in 1000. The coverage of first-stage screening was 90% whereas the compliance with the second stage was 88.04%. 22.8% of the patients eventually obtained final diagnostic confirmation. The overall compliance with amplification was 30.2%. The completion ages of primary screening and final confirmation were 7.98 and 17.3 weeks respectively. The importance of hearing screening is well received by parents, but problems related to communication, delays in the appointment system, and inefficient follow up tracking were identified as the main limitations and drawbacks of the program. CONCLUSION The coverage of the neonatal hearing screening program had not yet reached the required goal of 95%. The performance indicators also fell below the international benchmark. There is a need to address the identified causative factors. Effective communication and well-maintained tracking systems need to be implemented.
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Affiliation(s)
| | | | - Omar Hlaiwah
- ENT Division, Department of Surgery, SQU Hospital, Oman
| | | | | | | | | | | | - John Mathew
- ENT Division, Department of Surgery, SQU Hospital, Oman
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Escobar-Ipuz FA, Soria-Bretones C, García-Jiménez MA, Cueto EM, Torres Aranda AM, Sotos JM. Early detection of neonatal hearing loss by otoacoustic emissions and auditory brainstem response over 10 years of experience. Int J Pediatr Otorhinolaryngol 2019; 127:109647. [PMID: 31470205 DOI: 10.1016/j.ijporl.2019.109647] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES A number of different screening protocols for detecting neonatal hearing loss currently exist. We present our 10 years of experience with using auditory brainstem response (ABR) complementary to otoacoustic emissions (OAEs) in the three phases hearing screening process in our hospital. Furthermore, we want to demonstrate the usefulness of these screening techniques used in combination, that remain valid to identify cases of neonatal hearing loss and meet the well-established program quality criteria for these screening protocols. METHODS Data were collected retrospectively from patient record forms completed on 9698 newborns from 2007 to 2017. The screening protocol for neonatal hearing loss in our centre is carried out in three phases. First phase, prior to discharge from the hospital, consists of carrying out the OAE evaluation on the newborn. Second phase is carried out in the paediatric consultation department. There, the newborns who did not pass the first phase are again studied with OAE. If this phase is not passed either, the child is referred to a third phase for the realization of ABR, in the clinical neurophysiology service. Newborns with risk factors for hearing loss, identified in the first phase, also go on to this third phase. When this hearing threshold exceeds 30 dB, it is considered abnormal. Cases with abnormal ABR, has a re-test conducted within the next six months from the initial ABR assessment. RESULTS A total of 9390 (97.1%) OAEs were performed during first phase, with 8245 newborns (87.8%) passing the screening test, while 1145 children (12.1%) presented an abnormal OAE and were included in the second screening phase. Second phase involving a repeat OAE examination performed on 1077 newborns (94%). In this second phase, 941 newborns (87.3%) passed the test. Nevertheless, 136 newborns (12.6%) failing the retest and were referred to continue on to phase three. Furthermore, 181 newborns (1.8%) presented high-risk factors at birth and were also included in this third phase. However, in the registries of children referred to this phase, only 255 (80%) ABR evaluations were confirmed. In total, 227 newborns (2.3%) were missed from the first to third phases of the screening process. According to the database of the clinical neurophysiology service, ABRs evaluations were performed in 352 newborns referred between December 2007 and December 2017. Of this sample, 38.9% were boys and 61.1% were girls. From among cases underwent ABR, 34% of newborns did not pass the OAEs. The most common risk factor was prematurity (with admission to the neonatal intensive care unit for more than five days), affecting 28%. Abnormal ABRs waveforms were found in 43.9%, with 12.3% having a sensorineural hearing loss, 26.5% showing mixed hearing loss and, conductive hearing loss being present in 61.9%. Considering sensorineural hearing loss and other types of severe hearing loss, affected patients constituted only 1.7% of the total number of individuals studied. Finally, regarding quality control of the program participation in the first phase of care included 97.2% of all newborns, yielding a third phase referral rate of 2.9%, confirmation of a diagnosis before the fourth month of life in more than 90% of cases with an average of 3.4 months of age, and a hearing impairment detection rate as an outcome indicator of 4.5%. CONCLUSIONS Our data are similar to those of previous studies on screening for hearing loss in newborns. We have demonstrated the advantages of carrying out this protocol in three phases using the otoacoustic emissions together with auditory brainstem response, diagnostic tools that remain as a Gold Standard. Also, we want to highlight and demonstrate the importance of interdisciplinary coordination between the paediatric and clinical neurophysiology services in the implementation of this screening protocol. The foregoing has allowed us to comply with the proposed quality indicators, reaching coverage percentages of more than 95%, confirming the diagnosis of hearing loss within the first six months of life and making timely referrals to benefit the newborns with hearing impairment by way of treatment and follow-up in the early stages of development, avoiding future disabilities.
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Affiliation(s)
- Fredy A Escobar-Ipuz
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; Service of Clinical Neurophysiology, Castilla-La Mancha Health Service. Virgen de La Luz Hospital, Cuenca, Spain
| | - Carmen Soria-Bretones
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; Service of Clinical Neurophysiology, Castilla-La Mancha Health Service. Virgen de La Luz Hospital, Cuenca, Spain
| | - María A García-Jiménez
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain; Service of Clinical Neurophysiology, Castilla-La Mancha Health Service. Virgen de La Luz Hospital, Cuenca, Spain
| | - Elisa M Cueto
- Service of Paediatrics, Castilla-La Mancha Health Service. Virgen de La Luz Hospital, Cuenca, Spain
| | - Ana M Torres Aranda
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Jorge Mateo Sotos
- Neurobiological Research Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain.
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Ramkumar V, Nagarajan R, Shankarnarayan VC, Kumaravelu S, Hall JW. Implementation and evaluation of a rural community-based pediatric hearing screening program integrating in-person and tele-diagnostic auditory brainstem response (ABR). BMC Health Serv Res 2019; 19:1. [PMID: 30606168 PMCID: PMC6318860 DOI: 10.1186/s12913-018-3827-x] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In an attempt to reach remote rural areas, this study explores a community-based, pediatric hearing screening program in villages, integrating two models of diagnostic ABR testing; one using a tele-medicine approach and the other a traditional in-person testing at a tertiary care hospital. METHODS Village health workers (VHWs) underwent a five day training program on conducting Distortion Product Oto Acoustic Emissions (DPOAE) screening and assisting in tele-ABR. VHWs conducted DPOAE screening in 91 villages and hamlets in two administrative units (blocks) of a district in South India. A two-step DPOAE screening was carried out by VHWs in the homes of infants and children under five years of age in the selected villages. Those with 'refer' results in 2nd screening were recommended for a follow-up diagnostic ABR testing in person (Group A) at the tertiary care hospital or via tele-medicine (Group B). The overall outcome of the community-based hearing screening program was analyzed with respect to coverage, refer rate, follow-up rate for 2nd screenings and diagnostic testing. A comparison of the outcomes of tele-versus in-person diagnostic ABR follow-up was carried out. RESULTS Six VHWs who fulfilled the post training evaluation criteria were recruited for the screening program. VHWs screened 1335 children in Group A and 1480 children in Group B. The refer rate for 2nd screening was very low (0.8%); the follow-up rate for 2nd screening was between 80 and 97% across the different age groups. Integration of tele-ABR resulted in 11% improvement in follow-up compared to in-person ABR at a tertiary care hospital. CONCLUSIONS Non-availability of audiologists and limited infrastructure in rural areas has prevented the establishment of large scale hearing screening programs. In existing programs, considerable challenges with respect to follow-up for diagnostic testing was reported, due to patients being submitted to traveling long distance to access services and potential wage losses during that time. In this program model, integration of a tele-ABR diagnostic follow-up improved follow-up in comparison to in-person follow-up. VHWs were successfully trained to conduct accurate screenings in rural communities. The very low refer rate, and improved follow-up rate reflect the success of this community-based hearing screening program.
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Affiliation(s)
- Vidya Ramkumar
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Na, du-400116, India
| | - Roopa Nagarajan
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Na, du-400116, India.
| | - Vanaja C Shankarnarayan
- Department of Audiology & Speech Language Pathology, Bharati Vidyapeeth Deemed University, Pune, India
| | - Selvakumar Kumaravelu
- Department of Neurosurgery, Chairman Telemedicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - James W Hall
- Department of Audiology, Nova Southeastern University, Fort Lauderdale, USA.,Department of Communication Pathology, University of Pretoria, Pretoria, South Africa
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Kanji A, Krabbenhoft K. Audiological follow-up in a risk-based newborn hearing screening programme: An exploratory study of the influencing factors. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2018; 65:e1-e7. [PMID: 30456962 PMCID: PMC6244148 DOI: 10.4102/sajcd.v65i1.587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 06/30/2018] [Accepted: 08/26/2018] [Indexed: 12/03/2022] Open
Abstract
Background Follow-up return rate in Early Hearing Detection and Intervention (EHDI) programmes is of specific importance as it ensures that benchmarks are met and that no child with suspected hearing loss is left unidentified. Objectives The aim of this study was to determine the factors influencing audiological follow-up of high-risk infants in a risk-based newborn hearing screening programme. Method A non-experimental, exploratory, qualitative research design was employed. Purposive sampling was used. The study was conducted at a secondary level hospital in the public health care sector in South Africa. Participants comprised 10 caregivers (age range 26–40 years) of infants who had been enrolled in a risk-based newborn hearing screening programme, and returned for follow-up appointments. Data were collected using semi-structured interviews. Responses were recorded by the researcher and a colleague to ensure rigour and trustworthiness of findings. Data were analysed using thematic analysis for open-ended questions and descriptive statistics for the closed-ended questions. Results The most common positive contributors that facilitated participants’ attendance at follow-up appointments were: having friendly audiologists; a clear line of communication between caregiver and audiologist and a reminder of the appointment. The most significant perceived challenge that participants described in returning for the follow-up appointment was living in far proximity from the hospital. Conclusion Findings of the study revealed that influencing factors on follow-up return rate are demographic, socio-economic, and interpersonal in nature and further suggested the need for an all-inclusive appointment day. It may be of importance to not only look at what is being done to improve the follow-up return rate but also how it should be done in terms of professional-to-patient communication and interactions.
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Affiliation(s)
- Amisha Kanji
- Department of Speech Pathology and Audiology, University of the Witwatersrand.
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Follow-up in newborn hearing screening - A systematic review. Int J Pediatr Otorhinolaryngol 2016; 90:29-36. [PMID: 27729148 DOI: 10.1016/j.ijporl.2016.08.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The quality and efficiency of newborn hearing screening programs (NHS) rely heavily on appropriate follow-up. The Joint Committee on Infant Hearing recommends a follow-up rate of more than 95% of infants who fail the initial hearing screening. However, a 70% benchmark is considered to be more feasible. This high loss to follow-up (LTF) rate acts as a threat to the overall success of NHS programs. The objective of the study was to identify and examine the reported rates of LTF, attributed reasons for LTF and strategies undertaken to reduce LTF. METHODS Using a systematic search, articles published between 2005 to December 2015 were identified from PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Ovid, ProQuest, and Cochrane Library. To be included in the review, the study should be exploring the loss to follow-up or drop-out rate in newborn hearing screening programs and be published in an indexed peer-reviewed journal in the English language. The main outcome measures were overall rate of LTF, factors leading to LTF and measures adopted to overcome LTF. RESULTS 53 articles were short-listed for data extraction. Out of these, 27 were single-centre studies, 19 were multi-centre, 3 compared multiple databases, and 4 used survey-based methods. Overall LTF rates of 20% in single-centre and 21% in multiple-centre studies were observed. Educational disparity and lack of adequate knowledge among parents were associated with LTF. The most commonly used strategy to overcome LTF suggested by studies was the use of an adequate data management system. CONCLUSION This review is a novel attempt to explore the LTF among NHS studies, reasons for LTF and strategies to reduce LTF. This review can act as a basis for planning and execution of effective NHS programs.
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Haghshenas M, Zadeh P, Javadian Y, Fard H, Delavari K, Panjaki H, Gorji H. Auditory screening in infants for early detection of permanent hearing loss in northern iran. Ann Med Health Sci Res 2014; 4:340-4. [PMID: 24971205 PMCID: PMC4071730 DOI: 10.4103/2141-9248.133456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Undiagnosed hearing loss can cause disorders in speech and language and delay in social and emotional development. Aim: This study aimed to screen for hearing loss in all newborns born in Babol city during 2009-2011. Subjects and Methods: Fifteen thousand one hundred and sixty-five newborns (49% [7430/15165] male and 51% [7735/15165] female) born during a 30-month period in Babol, underwent hearing screening by the otoacoustic emission (OAE) test at the age of 15 days. In infants referred at this stage, an auditory brainstem response (ABR) test was the next investigation. Data analyzed using Statistical Package for the Social Sciences software Version 16 (Chicago, IL, USA, 16) through descriptive statistic method. Results: In the first screening stage, 10.8% (1648/15165) cases were referred to the second stage for further investigation. 9.4% (154/1648) were lost to follow-up from among the referred cases despite continuous contact and education about the importance of the problem. Among the participants in the second stage, 6.2% (92/1494) were referred to the third stage and underwent ABR and OAE testing. 14.1% (13/92) were lost at this stage. Of the remaining participants, 34.2% (27/79) were diagnosed with a hearing loss. Therefore, the incidence of hearing loss in this study was 1.8/1,000 newborns. Conclusion: Given the prevalence of hearing loss in this study, implementation of a universal newborn hearing screening program is recommended.
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Affiliation(s)
- M Haghshenas
- Department of Pediatrics, Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Py Zadeh
- Department of Pediatrics, Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Y Javadian
- Department of Rehabilitation, Babol University of Medical Sciences, Babol, Iran
| | - Ha Fard
- Audiologist, B. Saddress, Babol University of Medical Sciences, Babol, Iran
| | - K Delavari
- Pediatrist, Babol University of Medical Sciences, Babol, Iran
| | - Hsa Panjaki
- GP, Department of Employment, Ministry of Health Affair, Tehran, Iran
| | - Hamh Gorji
- Department of Education Development Centre, Mazandaran University of Medical Science, Sari, Iran
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Alvarenga KDF, Araújo ES, Melo TMD, Martinez MAN, Bevilacqua MC. Questionnaire for monitoring auditory and language development in the first year. Codas 2014; 25:16-21. [PMID: 24408165 DOI: 10.1590/s2317-17822013000100004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 04/09/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To validate a monitoring questionnaire about hearing and language development applied by community health agents in the first year of life. METHODS Seventy six community health agents, previously trained on infant hearing health, administered a questionnaire to the families of 304 children with ages from 0 to 1 year. The questionnaire contains questions regarding hearing and language development and, for all age groups, the question "Does your child hear well?" was presented. The validity of the questionnaire was assessed by analyzing false positive and false negative rates of the identified children. A double-blind study was conducted so that all children assessed by the questionnaire were submitted to hearing evaluation performed by audiologists. RESULTS Four children (1.32%) were diagnosed with sensorineural hearing loss (two unilateral), and 69 (22.7%) with conductive hearing loss. The monitoring questionnaire showed specificity of 96% and sensitivity of 67%, with a false-negative rate of 33% for not identifying the unilateral hearing loss, and a false-positive rate of 4%. CONCLUSION The questionnaire used has shown to be feasible and relevant to actions of the community health agents of the Family Health Strategy program, with high specificity and moderate sensitivity. The use of the validated instrument should be considered to complement Newborn Hearing Screening Programs, in order to identify late onset or acquired hearing loss.
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Barbosa CP, Griz SMS. Educação em saúde com vistas à triagem neonatal e audição: uma revisão integrativa. REVISTA CEFAC 2014. [DOI: 10.1590/1982-0216201413012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste trabalho foi investigar estudos sobre educação em saúde e capacitação que abordassem o tema triagem neonatal e/ou audição. Trata-se de uma revisão integrativa, realizada em agosto de 2011, com busca na Biblioteca Virtual em Saúde, a partir dos Descritores em Ciências da Saúde: “Audição”;, “Capacitação”;, “Educação em Saúde”; e “Triagem Neonatal”;. A amostra final constituiu-se por 10 estudos. A base de dados com maior número de artigos foi a Medline e a maioria dos artigos (n=07) foi classificado com nível de evidência três. Nesta revisão integrativa, pode-se observar o quão é interessante adotar as estratégias de educação em saúde e/ou capacitação nos serviços de saúde como uma forma de educação permanente ou continuada. A população mais frequentemente estudada foi mães/pais e médicos. Ações educativas podem empoderar a população em relação à audição, englobando aspectos sobre a Triagem Auditiva Neonatal e seus procedimentos.
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Scheepers LJ, Swanepoel DW, Roux TL. Why parents refuse newborn hearing screening and default on follow-up rescreening--a South African perspective. Int J Pediatr Otorhinolaryngol 2014; 78:652-8. [PMID: 24560238 DOI: 10.1016/j.ijporl.2014.01.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/20/2014] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study describes screen refusal and follow-up default characteristics together with caregiver reasons for screen refusal and follow-up default in two South African universal newborn hearing screening programs. METHODS A retrospective record review of universal newborn hearing screening conducted at two hospitals (Hospital A n = 954 infants; Hospital B n = 2135) over a 31-33 month period. Otoacoustic emission screening was conducted with rescreen recommended within six weeks for a uni- or bilateral refer. Program efficacy was described according to coverage, referral and follow-up rates. A prospective telephonic interview with caregivers who declined the initial screen (n = 25) and who defaulted on follow-up (n = 25) constituted the next study component. Caregivers were randomly selected from the screening programs for a survey related to reasons for newborn hearing screening refusal and follow-up default. RESULTS Screening coverage (89.3% Hospital A; 57.4% Hospital B), initial referral rates (11.6% Hospital A; 21.2% Hospital B) and follow-up return rates (56.1% Hospital A; 35.8% Hospital B) differed significantly between hospitals and were below benchmarks. The most frequent reasons for screen refusal were related to costs (72%), caregiver knowledge of newborn hearing screening (64%) and health care professional knowledge and team collaboration (16%). Almost all caregivers (96%) indicated that if costs had been included in the birthing package or covered by medical insurance they would have agreed to newborn hearing screening. Reasons for follow-up default were most commonly related to caregiver knowledge of newborn hearing screening (32%) and costs (28%). One in four caregivers (24%) defaulted on follow-up because they forgot to bring their infant for a rescreen. Only half of caregivers (48%) who defaulted on follow-up reported being aware of initial screen results while 60% reported being aware of the recommended follow-up rescreen. CONCLUSION Caregivers most commonly refused screening due to associated costs and mostly defaulted on follow-up due to an apparent lack of knowledge regarding initial screen outcome and recommendations made for follow-up. Including NHS as a mandated birthing service is essential if coverage is to be increased, while reducing follow-up defaults requires proactive reminders and improved communication with caregivers.
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Affiliation(s)
- Lucia Jane Scheepers
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa; Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia; Ear Science Institute Australia, Subiaco, Australia.
| | - Talita le Roux
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Krishnan LA, Donaldson LK. Newborn Hearing Screening in Developing Countries: Understanding the Challenges and Complexities of Implementation. ACTA ACUST UNITED AC 2013. [DOI: 10.1044/gics3.2.54] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lata A. Krishnan
- Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN
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Liu Z, Liu L. Hearing screening and diagnosis in a large sample of infants in Central China. J Med Screen 2013; 20:21-6. [PMID: 23486645 DOI: 10.1177/0969141313478002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the referral rate, prevalence and aetiology of neonatal hearing loss. METHODS A total of 11,894 infants were screened by two-stage transient evoked otoacoustic emission testing. Those who failed were diagnosed by distortion product otoacoustic emission, 1000 Hz probe tone tympanometry and auditory brainstem response. The results of these tests were analysed by statistical software SPSS16.0. RESULTS The initial referral rate was 17.36%. The rescreening referral rate was 21.29%. The referral rate of initial screening in maternity wards (15.37%) was lower than in neonatal intensive care unit wards (22%) (chi-square [χ(2)], P < 0.05). There were 68 cases (106 ears) diagnosed with hearing loss (incidence 0.571%). Of these, 31 cases were conductive, 16 cases were sensorineural, and 21 cases were mixed hearing loss. The prevalence of hearing loss was 12.92% (38/294) in the bilateral referred group and 5.00% (30/600) in the unilateral referred group. The moderate/severe hearing loss was 33.33% (10/30) and 86.84% (66/76), respectively (χ(2), P < 0.05). The causes of hearing loss included jaundice (24.56%, 14/57), infection (24.56%, 14/57), asphyxia (19.30%, 11/57), low birth weight (17.54%, 10/57) and other factors (14.04%, 8/57). CONCLUSION Bilateral referrals were more likely to suffer greater degrees of hearing loss than unilateral referrals. Jaundice, infection, asphyxia and low birth weight were the major aetiologies of neonatal hearing loss.
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Affiliation(s)
- Zhiqi Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095, Jiefang Road, Wuhan, Hubei Province, China
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Cavalcanti HG, Guerra RO. The role of maternal socioeconomic factors in the commitment to universal newborn hearing screening in the Northeastern region of Brazil. Int J Pediatr Otorhinolaryngol 2012; 76:1661-7. [PMID: 22921603 DOI: 10.1016/j.ijporl.2012.07.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/21/2012] [Accepted: 07/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The implementation of early hearing detection in developing countries remains elusive. The fragile health care system along with insufficient funding for health care services leads to inadequate universal newborn hearing screening programs. There is a high incidence of loss to follow-up, at different stages of the program, in these countries, compromising the effect of early hearing screening programs. Strategies must be developed to improve family commitment to such programs. The objective of the present study was to examine factors that predict loss to second-stage follow-up at a municipal based, universal newborn hearing screening program in the Northeastern region of Brazil. METHOD The current cross sectional study includes 577 newborns who underwent hearing screening and failed. The population was divided into two groups: those who returned and those who were lost to second-stage screening. Differences between groups were explored and adjusted odds ratios were derived. RESULTS There was a significantly increased risk of non-adherence to the universal newborn hearing screening program in mothers with low income, few prenatal care visits, minimal education and with a multiparous child. CONCLUSION Socioeconomic factors may have a significant influence on the effectiveness of hearing screening programs in poorer regions of Brazil and other low-income countries. Improvements in health care politics, tracking system and public awareness is crucial for successful program implementation.
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Affiliation(s)
- Hannalice Gottschalck Cavalcanti
- Departamento de Fonoaudiologia, Campus 1, Centro de Ciências da Saúde, Universidade Federal da Paraíba, João Pessoa-PB, 58051-900, Brazil.
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Araújo ES, Lima FDS, Alvarenga KDF. Monitoramento de crianças com indicadores de risco para a deficiência auditiva. REVISTA CEFAC 2012. [DOI: 10.1590/s1516-18462012005000077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: descrever uma proposta de monitoramento de crianças, no primeiro ano de vida, que não foram identificadas na triagem auditiva neonatal, mas apresentavam indicadores de risco para deficiência auditiva. MÉTODO: participaram do estudo 258 crianças de risco que haviam obtido o resultado "passa" no Programa de Triagem Auditiva Neonatal Universal da Maternidade Santa Isabel - Bauru/SP no período de junho a novembro de 2008. Foi aplicado, via telefone, um questionário de acompanhamento do desenvolvimento da audição e da linguagem, validado em estudo anterior, contendo questões sobre a audição e a linguagem. Para cada questão havia duas possibilidades de resposta "sim" ou "não" e considerou-se como "falha", a obtenção de pelo menos uma resposta "não". Tal resultado refletia no agendamento da criança para realização de uma avaliação audiológica imediata. RESULTADOS: o questionário foi aplicado com 169 famílias, com as demais não foi obtido contato. Deste total, 164 (97,04%) apresentaram resultado "passa" e cinco (2,96%) resultado "falha". Dentre as cinco crianças, apenas três compareceram para avaliação audiológica e destas, uma não apresentava alterações e duas apresentavam perda auditiva condutiva. Observou-se prevalências distintas entre os fatores de risco e não houve relação (p>0,05) dos mesmos com a evasão no processo de monitoramento. CONCLUSÃO: o monitoramento por meio de aplicação de questionário via telefone mostrou-se viável, entretanto, é necessário o desenvolvimento de estratégias que favoreçam sua execução.
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Meyer ME, Swanepoel DW, le Roux T, van der Linde M. Early detection of infant hearing loss in the private health care sector of South Africa. Int J Pediatr Otorhinolaryngol 2012; 76:698-703. [PMID: 22386272 DOI: 10.1016/j.ijporl.2012.02.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/03/2012] [Accepted: 02/05/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A national survey of early hearing detection services was undertaken to describe the demographics, protocols and performance of early hearing detection, referral, follow-up and data management practices in the private health care sector of South Africa. METHODS All private hospitals with obstetric units (n=166) in South Africa were surveyed telephonically. This data was incorporated with data collected from self-administered questionnaires subsequently distributed nationally to audiology private practices providing hearing screening at the respective hospitals reporting hearing screening services (n=87). Data was analyzed descriptively to yield national percentages and frequency distributions and possible statistical associations between variables were explored. RESULTS Newborn hearing screening was available in 53% of private health care obstetric units in South Africa of which only 14% provided universal screening. Most (81%) of the healthy baby screening programs used only otoacoustic emission screening. Auditory brainstem response screening was employed by 24% of neonatal intensive care unit screening programs with only 16% repeating auditory brainstem response screening during the follow-up screen. Consequently 84% of neonatal intensive care unit hearing screening programs will not identify auditory neuropathy. A referral rate of less than 5% for diagnostic assessments was reported by 80% of universal programs. Follow-up return rates were reported to exceed 70% by only 28% of programs. Using multiple methods of reminding parents did not significantly increase reported follow-up return rates. Data management was mainly paper based with only 10% of programs using an electronic database primarily to manage screening data. CONCLUSIONS A shortage of programs and suboptimal and variable protocols for early hearing detection, follow-up and data management in existing programs mean the majority of babies with hearing loss in the South African private health care sector will not be identified early. Newborn hearing screening must be integrated with hospital-based birthing services, ideally with centralized data management and quality control.
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Affiliation(s)
- Miriam Elsa Meyer
- Department of Communication Pathology, University of Pretoria, South Africa
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Martines F, Bentivegna D, Ciprì S, Costantino C, Marchese D, Martines E. On the threshold of effective well infant nursery hearing screening in Western Sicily. Int J Pediatr Otorhinolaryngol 2012; 76:423-7. [PMID: 22277265 DOI: 10.1016/j.ijporl.2011.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 12/22/2011] [Accepted: 12/26/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the feasibility and effectiveness of well-infant nursery hearing screening programme for the early identification of hearing impairment, based on transient evoked otoacoustic emission (TEOAE) with a high "screen sensitivity" reducing the number of more expensive secondary level exams. METHODS The newborns were screened by non-specialist health workers in well babies nursery at the twentieth day of life for 6 years consecutive. Based on PASS/FAIL criteria and presence/absence of audiological risk factors the newborns were divided into four groups each one with its personal step programme: G1 - PASS without risk factor, free to go home; G2 - PASS with risk factor, retest at the age of 7 months; G3 - FAIL without risk factor, re-screening after 2 weeks for a maximum of four times before audiology assessment; G4 - FAIL with risk factor, retest after 2 weeks. RESULTS The coverage rate increased progressively from 89.8% to 92%. The referral rate was 1.51% after second stage with a specificity value of 98.78%. The four-stage screening performed for G3 reduced the numbers of global audiology assessment to 0.91% with a final global specificity of 99.4 ± 0.4%. CONCLUSION Less than 1% of infants underwent audiological assessment; the false positives resulted 0.62% with hearing loss global incidence of 2.95/1000 and a mean age of confirmation of 3.5 months of age. It is reasonable to think that this screening programme could be implement to overall 42 Western Sicily birth centres within few years.
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Affiliation(s)
- Francesco Martines
- Università degli Studi di Palermo, Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Sezione di Otorinolaringoiatria, Via del Vespro, 129 - 90127 Palermo, Italy.
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Scaziotta MDACM, Andrade IFCD, Lewis DR. Programa de triagem auditiva seletiva em crianças de risco em um serviço de saúde auditiva de São Paulo. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: descrever a população de neonatos encaminhada para um programa de triagem auditiva seletiva, caracterizando e comparando o grupo de lactentes que compareceram à triagem (grupo I) com o grupo de lactentes que não compareceu (grupo II). MÉTODO: a amostra foi constituída por 55 lactentes, provenientes de uma maternidade de São Paulo. A metodologia incluiu a análise de prontuários e entrevistas com as mães. Foram variáveis do estudo: idade da alta hospitalar, resultado da triagem auditiva, resultado do diagnóstico, o tempo entre a alta hospitalar e a triagem, o tempo entre a alta hospitalar e o diagnóstico e, por fim, o tempo entre triagem e diagnóstico. Além destes aspectos, as características socioeconômicas e culturais dos grupos e os indicadores de risco foram analisados. RESULTADOS: foram encaminhados 55 lactentes e o comparecimento à triagem auditiva foi de 76% (42). A média de idade da alta hospitalar foi de 38 dias, da triagem auditiva foi de 42 dias e do diagnóstico foi de 95,1 dias. A média do tempo entre a alta e a triagem foi de 13 dias e da alta e diagnóstico de 40,8 dias. O grupo que compareceu à triagem apresentou peso menor, maior período de internação na UTI, maior número de indicadores de risco, maior renda familiar por pessoa e maior número de consultas pré-natal em comparação aos que não compareceram. CONCLUSÕES: as crianças que mostraram maior adesão à realização da triagem auditiva neonatal seletiva foram aquelas cujas mães compareceram a um maior número de consultas no pré-natal, as que apresentaram maior ocorrência de indicadores de risco, maior tempo de internação e quando as informações na maternidade mostraram-se mais efetivas.
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Ahmad A, Mohamad I, Mansor S, Daud MK, Sidek D. Outcome of a newborn hearing screening program in a tertiary hospital in Malaysia: the first five years. Ann Saudi Med 2011; 31:24-8. [PMID: 21245595 PMCID: PMC3101720 DOI: 10.4103/0256-4947.75774] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Universal newborn hearing screening (UNHS) was started in the Hospital Universiti Sains Malaysia (HUSM) in January 2003. To comply with international standards, we determined the outcome of the newborn hearing screening program for the first 5 years of its implementation, from January 2003 to December 2007. METHODS The program screened all infants who were delivered in HUSM. In a retrospective review, the outcomes in terms of coverage, prevalence of hearing impairment, referral rate for each screening, age at detection of hearing impairment and at hearing aid-fitting were analyzed. RESULTS Ninety-eight percent of newborns were screened. The study included 16,100 randomly selected newborns. The initial screening referral rate was 25.5%. The prevalence of default for second and third screening was 33.9% and 40.7%, respectively. The mean (SD) age at detection of hearing impairment was 3.3 months (0.86). The mean (SD) age at fitting of a hearing aid was 13.6 (4.8) months.The prevalence of hearing impairment was 0.09%. CONCLUSION A newborn hearing screening program is an important tool for early diagnosis and treatment. Even though the prevalence of hearing impairment may be low, the problem needs to be addressed early as the development of infants requires normal hearing.
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Affiliation(s)
- Amirozi Ahmad
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Kota Bharu, Kelantan, Malaysia
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Schade G. Early detection of hearing loss. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2010; 7:Doc05. [PMID: 22073092 PMCID: PMC3199831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The universal newborn hearing screening (UNHS) is currently spreading in Germany, as well, even though there can be no talk of a comprehensive establishment. The introduction of UNHS in several federal states such as Hamburg, Hessen, and Schleswig-Holstein can be ascribed to the personal commitment of individual pediatric audiologists. Apart from the procurement of the screening equipment and the training of the staff responsible for the examination of the newborns, the tracking, i.e. the follow-up on children with conspicuous test results, is of utmost importance. This involves significant administration effort and work and is subject to data protection laws that can differ substantially between the various federal states. Among audiologists, there is consensus that within the first three months of a child's life, a hearing loss must be diagnosed and that between the age of 3 and 6 months, the supply of a hearing aid must have been initiated. For this purpose, screening steps 1 (usually a TEOAE measurement) and 2 (AABR testing) need to be conducted in the maternity hospital. The follow-up of step 1 then comprises the repetition of the TEOAE- and AABR measurement for conspicuous children by a specialized physician. The follow-up of step 2 comprises the confirmatory diagnostics in a pediatric audiological center. This always implies BERA diagnostics during spontaneous sleep or under sedation. The subsequent early supply of a hearing aid should generally be conducted by a (pediatric) acoustician specialized on children.
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Affiliation(s)
- Götz Schade
- Univ. HNO-Klinik Bonn, Deutschland,*To whom correspondence should be addressed: Götz Schade, Univ. HNO-Klinik Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Deutschland, Tel.: +49(0)228 28715563, E-mail:
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Tann J, Wilson WJ, Bradley AP, Wanless G. Progress Towards Universal Neonatal Hearing Screening: A World Review. ACTA ACUST UNITED AC 2009. [DOI: 10.1375/audi.31.1.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Olusanya BO, Wirz SL, Luxon LM. Community-based infant hearing screening for early detection of permanent hearing loss in Lagos, Nigeria: a cross-sectional study. Bull World Health Organ 2009; 86:956-63. [PMID: 19142296 DOI: 10.2471/blt.07.050005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 04/15/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To determine the feasibility and effectiveness of a community-based universal infant hearing screening programme for detecting permanent congenital and early-onset hearing loss (PCEHL) in Lagos, Nigeria. METHODS This is a cross-sectional study in which all infants aged 3 months or under attending four bacille Calmette-Guérin (BCG) immunization clinics accounting for over 75% of the BCG coverage in the study location were screened by community health workers between July 2005 and April 2006. Screening followed a two-stage protocol involving transient evoked otoacoustic emissions and automated auditory brainstem responses. The main outcome measures were screening coverage, referral rates, return rates for second-stage screening and evaluation, yield and age at PCEHL diagnosis. FINDINGS In total, 2003 (88%) of 2277 eligible infants attending the four BCG clinics were successfully screened between July 2005 and April 2006 at a mean age of 17.7 days, with no parent declining screening. The majority (55.2%) were born outside a hospital and, of such infants, 77% were born in traditional herbal maternity homes. The overall referral rate for diagnostic evaluation was 4.1%. Only 61% (50/82) of those referred returned for evaluation, and 45 of them were confirmed with PCEHL. Additionally, 11 infants who had previously passed the first screening stage were also found to have PCEHL, resulting in a yield of 28 per 1000 (56/2003). The mean age at diagnosis was 51 days. The sensitivity, specificity and positive predictive value of the first screening stage were 80.4%, 99.7% and 90.0%, respectively. The positive likelihood ratio was 268, while the negative likelihood ratio was 0.2. CONCLUSION Routine hearing screening of infants attending BCG immunization clinics by community health workers was feasible and effective for the early detection of PCEHL in Lagos, Nigeria. However, an efficient tracking and follow-up system is needed to improve return rates for second-stage screening and diagnostic evaluation.
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Affiliation(s)
- B O Olusanya
- College of Medicine, University of Lagos, Surulere, Nigeria.
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Olusanya BO. Follow-up default in a hospital-based universal newborn hearing screening programme in a low-income country. Child Care Health Dev 2009; 35:190-8. [PMID: 19228154 DOI: 10.1111/j.1365-2214.2008.00923.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective early detection of infants with permanent hearing impairment requires parental compliance with various stages of a screening protocol. However, many infants who failed initial screening tests are often not presented for follow-up evaluation, thus compromising prospects for early detection and intervention. This study set out to determine maternal and infant factors associated with loss to follow-up in a hospital-based universal hearing screening programme in a low-income country. METHODS A cross-sectional study in which babies in a tertiary maternity hospital were enrolled into a two-stage hearing screening programme with transient-evoked otoacoustic emissions followed by automated auditory brainstem response (AABR) for all transient-evoked otoacoustic emissions referrals before hospital discharge. Diagnostic evaluation was scheduled for AABR referrals on outpatient basis. Correlates of non-compliance were determined through multivariable logistic regression analyses of relevant maternal and infant factors. RESULTS Some 1330 babies participated in the first-stage screening and of 551 scheduled for AABR; 56 (10.2%) did not complete. Some 37 (84.1%) of the 44 AABR referrals did not complete the diagnostic evaluation. There were no significant differences between the profile of those who did not complete either the second-stage screening or diagnostic evaluation and those who completed across virtually all socio-demographic factors except that Christian mothers were significantly more likely not to complete the second-stage screening than diagnostic evaluation compared with their Muslim counterparts (odds ratio: 3.01; 95% confidence intervals: 1.17-7.87). The only independent predictors of non-compliance with pre-discharge screening were delivery by spontaneous vertex (odds ratio: 2.76; 95% confidence intervals: 1.47-5.19) and admission into special care baby unit (odds ratio: 5.62; 95% confidence intervals: 2.92-10.84) while no factor was predictive of non-compliance with diagnostic evaluation. CONCLUSIONS Mode of delivery or having high-risk baby influences compliance before hospital discharge while factors other than maternal or infant socio-demographic/medical profile such as unfavourable cultural beliefs and stigma may be key determinants of follow-up compliance after discharge.
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Affiliation(s)
- B O Olusanya
- Unit of Audiological Medicine/Centre for International Child Health, Institute of Child Health, London, UK.
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Mattos WMD, Cardoso LF, Bissani C, Pinheiro MMC, Viveiros CM, Carreirão Filho W. Newborn hearing screening program implantation analysis at a University Hospital. Braz J Otorhinolaryngol 2009; 75:237-44. [PMID: 19575110 PMCID: PMC9450655 DOI: 10.1016/s1808-8694(15)30784-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 04/08/2008] [Indexed: 11/02/2022] Open
Abstract
UNLABELLED Hearing loss is more prevalent than other disorders found at birth. Efforts have been put up towards the early identification and treatment of hearing loss by means of neonatal hearing screening programs. AIM prospective study with the goal of characterizing the process of implementing a Neonatal Auditory Screening Program (NASP) at a University Hospital. To analyze hearing loss diagnostic investigations in newborns, and to present proposals for NASP improvement. MATERIALS AND METHODS We studied newborns (NB) submitted to Newborn Auditory Screening (NAS) by transient evoked otoacoustic emissions (TEOE), cochlear-eyelid reflex (CER) and Brainstem Evoked Auditory Potential (BEAP). RESULTS We tested 625 children. In the first stage, 458 NBs passed and 155 failed. 122 NBs returned to the second stage, and 8 underwent it because they were positive for HL risk factors. 12 NBs (1.9%) were referred for diagnostic investigation. Of the 5 who returned for the BAEP, we observed HL in two NBs. CONCLUSIONS The program tested 81.7% of the candidates. The program compliance rate was of 68.2%. In the first stage, 26.7% of the NBs failed. The program is being implemented and requires constant analyzes of its difficulties, aiming at solving them in order to turn the Universal Newborn Auditory Screening into reality.
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The Need for Standardization of Methods for Worldwide Infant Hearing Screening: A Systematic Review. Laryngoscope 2008; 118:1830-6. [DOI: 10.1097/mlg.0b013e31817d755e] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Olusanya BO, Wirz SL, Luxon LM. Hospital-based universal newborn hearing screening for early detection of permanent congenital hearing loss in Lagos, Nigeria. Int J Pediatr Otorhinolaryngol 2008; 72:991-1001. [PMID: 18433883 DOI: 10.1016/j.ijporl.2008.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Revised: 03/05/2008] [Accepted: 03/06/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the feasibility and effectiveness of hospital-based universal newborn hearing screening programme for the early detection of permanent congenital or early-onset hearing loss (PCEHL) in Lagos, Nigeria. METHODS A cross-sectional pilot study based on a two-stage universal newborn hearing screening by non-specialist health workers using transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem-response (AABR) in an inner-city maternity hospital over a consecutive period of 40 weeks. The main outcome measures were the practicality of screening by non-specialist staff with minimal training, functionality of screening instruments in an inner-city environment, screening coverage, referral rate, return rate for diagnosis, yield of PCEHL and average age of PCEHL confirmation. RESULTS Universal hearing screening of newborns by non-specialist staff without prior audiological experience is feasible in an inner-city environment in Lagos after a training period of two-weeks. Notwithstanding excessive ambient noise within and outside the wards, it was possible to identify a test site for TEOAE screening within the hospital. The screening coverage was 98.7% (1330/1347) of all eligible newborns and the mean age of screening was 2.6 days. Forty-four babies out of the 1274 who completed the two-stage screening were referred yielding a referral rate of 3.5%. Only 16% (7/44) of babies scheduled for diagnostic evaluation returned and all were confirmed with hearing loss resulting in an incidence of 5.5 (7/1274) per 1000 live births or a programme yield of 5.3 (7/1330) per 1000. Six infants had bilateral hearing loss and the degree was severe (> or =70 dB nHL) in three infants, moderate (40 dB nHL) in one infant and mild (<40 dB nHL) in two infants. The age at diagnosis ranged from 46 days to 360 days and only two infants were diagnosed within 90 days. CONCLUSIONS Hospital-based universal hearing screening of newborns before discharge is feasible in Nigeria. Non-specialist staff are valuable in achieving a satisfactory referral rate with a two-stage screening protocol. However, a more efficient tracking and follow-up system is needed to improve the return rate for diagnosis and age of confirmation of hearing loss.
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Affiliation(s)
- B O Olusanya
- Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, UK.
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Olusanya BO, Swanepoel DW, Chapchap MJ, Castillo S, Habib H, Mukari SZ, Martinez NV, Lin HC, McPherson B. Progress towards early detection services for infants with hearing loss in developing countries. BMC Health Serv Res 2007; 7:14. [PMID: 17266763 PMCID: PMC1802737 DOI: 10.1186/1472-6963-7-14] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 01/31/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region. METHODS A cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline. RESULTS Pilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes. CONCLUSION Lack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery.
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Affiliation(s)
- Bolajoko O Olusanya
- Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - De Wet Swanepoel
- Department of Communication Pathology, University of Pretoria, Pretoria, South Africa
| | | | - Salvador Castillo
- Audiology and Phoniatrics Department, México Children's Hospital, 'Federico Gómez" Dr. Márquez 162, Colonia Doctores, 06726 México City, Mexico
| | - Hamed Habib
- Pediatric Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Siti Z Mukari
- Department of Audiology & Speech Sciences, Faculty of Allied Health Sciences Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | | | - Hung-Ching Lin
- Department of Otolaryngology, Hearing and Speech Centre, Mackay Memorial Hospital, Taipei, Taiwan
| | - Bradley McPherson
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China
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