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Khan NB, Joseph L. Risk factors and hearing outcomes in infants and young children in KwaZulu-Natal, South Africa. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e11. [PMID: 39221742 PMCID: PMC11369661 DOI: 10.4102/sajcd.v71i1.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/23/2024] [Accepted: 05/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Targeted new-born hearing screening, based on high risk factors is recommended in the absence of universal new-born hearing screening in resource-constrained settings. The relevance of risk factors listed in the guidelines of high-income countries and used by low-middle income countries remains relatively unknown. Risk factors consistent with the epidemiological profile, evolution of risks and disease burden in these countries need to be considered. OBJECTIVES This study aimed to profile the frequency of risk factors and their manifestation in hearing outcomes of young children in the KwaZulu-Natal province of South Africa. METHOD A chart review of N = 1433 patients' archival audiology records was conducted, conveniently sampled from a single tertiary hospital (n = 351), a provincial assessment and therapy centre (n = 649), a university clinic (n = 291), and two schools for the deaf (n = 142). RESULTS Overall, 56% of the participants presented with either a conductive, sensorineural or a mixed hearing loss; 62% of the children had between 1 and 2 risk factors present (Mean [M] = 1.1; standard deviation [s.d.] = 0.98). Admission to neonatal intensive care unit, maternal infections, bacterial and viral infections and chemotherapy, from the Joint Committee on Infant Hearing list of high risk factors were significantly associated with hearing loss (p 0.05). Known non-JCIH risks, emerging risks and other statistically significant contextually relevant risk factors were also noted. CONCLUSION Understanding the profile of high risk factors in a given context has implications for prevention, early hearing identification and intervention services.Contribution: Targeted new-born hearing screening needs to be based on risk factors that are contextually relevant. This study is one of the first profiling high risk factors for hearing loss in children in KZN, the province with the second highest population in South Africa.
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Affiliation(s)
- Nasim B Khan
- Discipline of Audiology, School of Health Sciences, University of KwaZulu-Natal, Durban.
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Jansen SNG, Kamphorst BA, Mulder BC, van Kamp I, Boekhold S, van den Hazel P, Verweij MF. Ethics of early detection of disease risk factors: A scoping review. BMC Med Ethics 2024; 25:25. [PMID: 38443930 PMCID: PMC10913641 DOI: 10.1186/s12910-024-01012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. METHODS To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher's Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. RESULTS After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. CONCLUSIONS The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.
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Affiliation(s)
- Sammie N G Jansen
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands.
| | - Bart A Kamphorst
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands
| | - Bob C Mulder
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands
| | - Irene van Kamp
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Sandra Boekhold
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Peter van den Hazel
- International Network on Children's Health, Environment & Safety (INCHES), Ellecom, the Netherlands
| | - Marcel F Verweij
- Ethics Institute, Utrecht University, Janskerkhof 13a, Utrecht, 3512 BL, The Netherlands
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Kaspar A, Driscoll C, Pifeleti S, Faumuina PA. Ethical considerations for universal newborn hearing screening in the Pacific Islands: a Samoan case study. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106718. [PMID: 33234548 DOI: 10.1136/medethics-2020-106718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 06/11/2023]
Abstract
Permanent congenital and early-onset hearing impairment (PCEOHI) is the most common sensory disorder among newborns. The WHO recommends newborn and infant hearing screening for all member states to facilitate early identification and intervention for children with PCEOHI. Ethical implications of newborn/infant hearing screening in low-income and middle-income countries should be considered. Although the Pacific Island region is estimated to have among the highest global burden of hearing loss, hearing health services are limited and virtually non-existent in Pacific Island countries. The aim of this brief report is to consider the ethical implications of implementing hospital-based universal newborn hearing screening (UNHS) in Samoa. Based on well-acknowledged screening principles, this report found that the Samoan context does not satisfy the screening principles for such a programme, and that the implementation of UNHS would, therefore, be unethical. This conclusion was reached even after considering the hypothetical provision of necessary screening and diagnostic audiology equipment from external donors. We recommend that current efforts should be directed towards the wider professional community involved in the daily care of children with a permanent hearing loss. Given the high prevalence of paediatric ear disease in the Pacific Islander population, an interim ear and hearing programme could be considered at the community level. These strategies should provide the infrastructure and referral pathways required in the advent of UNHS in Samoa.
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Affiliation(s)
- Annette Kaspar
- ENT Department, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa
- Audiology Division, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Carlie Driscoll
- Audiology Division, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Sione Pifeleti
- ENT Department, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa
| | - Penaia A Faumuina
- ENT Department, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa
- ORL Consultant, Wanganui Hospital, Wanganui, New Zealand
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Kaspar A, Kei J, Driscoll C, Swanepoel DW, Goulios H. A public health approach to pediatric hearing impairment in the Pacific Islands. J Glob Health 2019; 8:010302. [PMID: 29391945 PMCID: PMC5782834 DOI: 10.7189/jogh.08.010302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Annette Kaspar
- ENT Clinic, National Referral Hospital, Honiara, Solomon Islands.,Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Joseph Kei
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Carlie Driscoll
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Helen Goulios
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, Australia
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Khan NB, Joseph L, Adhikari M. The hearing screening experiences and practices of primary health care nurses: Indications for referral based on high-risk factors and community views about hearing loss. Afr J Prim Health Care Fam Med 2018; 10:e1-e11. [PMID: 30326720 PMCID: PMC6191740 DOI: 10.4102/phcfm.v10i1.1848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In South Africa, primary health care is the first point of contact with the health system for at least 85% of the population, yet early hearing detection and intervention continues to be elusive in these settings. Nurses at community level may, therefore, be missing an opportunity to identify prelingual infants with hearing losses and alter their developmental trajectory. AIM To determine primary health care nurses' experiences, practices and beliefs regarding hearing loss in infants. SETTING The study was conducted in the eThekwini District of KwaZulu-Natal, South Africa. METHODS A descriptive survey was used with quantitative methods of analysis. Fourteen primary health care clinics from the eThekwini district were selected, from which 75 nurses participated by completing a self-administered questionnaire. RESULTS At least one-third of primary health care nurses had never screened a child for hearing loss, and most clinics did not have access to basic hearing screening equipment or materials. Only 49% of nurses had access to an otoscope, while 31% used the Road to Health Development screener to check for hearing loss. None of the clinics had access to an otoacoustic emission screener nor the Swart questionnaire. Although nurses reported that they would refer to audiology services for some of the risk factors, as indicated on the Joint Committee on Infant Hearing (JCIH) 2007 list, they were less likely to refer if the child was in a neonatal intensive care unit (ICU) longer than five days, had neurodegenerative disorders, meningitis, hyperbilirubinaemia requiring blood transfusion or were undergoing chemotherapy. Less than a third of nurses always referred if the child displayed additional non-JCIH risk factors or those pertinent to the South African context. Approximately 38% reported that communities believed that hearing loss could be because of some form of spiritual or supernatural causes. CONCLUSION This study demonstrates that hearing screening and referral practices at primary health care clinics need to be strengthened. Nurses need to be capacitated to conduct basic screening, make necessary referrals, provide information to caregivers and understand community beliefs about hearing loss in order to counsel caregivers appropriately and facilitate the process of early hearing detection and intervention.
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Affiliation(s)
- Nasim B Khan
- Discipline of Audiology, University of KwaZulu-Natal.
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Kaspar A, Newton O, Kei J, Driscoll C, Swanepoel DW, Goulios H. Prevalence of otitis media and risk-factors for sensorineural hearing loss among infants attending Child Welfare Clinics in the Solomon Islands. Int J Pediatr Otorhinolaryngol 2018; 111:21-25. [PMID: 29958609 DOI: 10.1016/j.ijporl.2018.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The present study aimed to assess the prevalence of otitis media and risk-factors for sensorineural hearing loss among infants in the Solomon Islands, in order to recommend an Infant Ear and Hearing Program that would be suitable to the Pacific Island context. METHODS Ear examinations and the JCIH Risk-Factor Questionnaire were administered to 288 infants attending Child Welfare Clinics in the Solomon Islands. RESULTS Overall, 150 infants (52.084%) presented with bilateral normal ear examinations and no risk-factors for SNHL. There were 73 infants (25.34%) with ear pathology in at least one ear, 13 (4.5%) of whom required referral to the ENT Clinic for medical management. The most common pathology was otitis media with effusion (OME) (21.87%). Infants aged 7-12 months were significantly more likely to present with OME (p<0.001) and a history of otitis media (p=0.017) than infants aged 0-6 months. There were 71 infants (24.65%) with at least one risk-factor for sensorineural hearing loss. The most common risk-factors were ototoxicity (8.3%), non-elective caesarean delivery (6.59%), and possible in-utero syphilis infection (5.55%). CONCLUSIONS The prevalence of otitis media and risk-factors for sensorineural hearing loss indicate the importance of initiating Infant Ear and Hearing Programs in the Solomon Islands. Program should facilitate early education on prevention of ear disease, as well as early diagnosis and management of children with hearing loss.
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Affiliation(s)
- Annette Kaspar
- ENT Clinic, National Referral Hospital, PO BOX 349, Honiara, Solomon Islands; Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Queensland, Brisbane, QLD 4072, Australia.
| | - Obiga Newton
- ENT Clinic, National Referral Hospital, PO BOX 349, Honiara, Solomon Islands.
| | - Joseph Kei
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Queensland, Brisbane, QLD 4072, Australia.
| | - Carlie Driscoll
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Queensland, Brisbane, QLD 4072, Australia.
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Cnr Lynnwood and University Roads, Pretoria, South Africa.
| | - Helen Goulios
- School of Anatomy, Physiology and Human Biology, University of Western Australia (M309), 35 Stirling Highway, Crawley, Perth WA 6009, Australia.
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Kaspar A, Kei J, Driscoll C, Swanepoel DW, Goulios H. Overview of a public health approach to pediatric hearing impairment in the Pacific Islands. Int J Pediatr Otorhinolaryngol 2016; 86:43-52. [PMID: 27260578 DOI: 10.1016/j.ijporl.2016.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Annette Kaspar
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Australia; ENT Clinic, National Referral Hospital, Honiara, Solomon Islands.
| | - Joseph Kei
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Carlie Driscoll
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Helen Goulios
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Australia
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Char D. Parental Refusal of Newborn Screening for Congenital Hearing Loss. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:33-35. [PMID: 26734745 DOI: 10.1080/15265161.2015.1115145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Khoza-Shangase K, Harbinson S. Evaluation of universal newborn hearing screening in South African primary care. Afr J Prim Health Care Fam Med 2015; 7:769. [PMID: 26245605 PMCID: PMC4564907 DOI: 10.4102/phcfm.v7i1.769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/23/2015] [Accepted: 02/05/2015] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Universal Newborn Hearing Screening (UNHC) is the gold standard toward early hearing detection and intervention, hence the importance of its deliberation within the South African context. AIM To determine the feasibility of screening in low-risk neonates, using Otoacoustic Emissions (OAEs), within the Midwife Obstetric Unit (MOU) three-day assessment clinic at a Community Health Centre (CHC), at various test times following birth. METHOD Within a quantitative, prospective design, 272 neonates were included. Case history interviews, otoscopic examinations and Distortion Product OAEs (DPOAEs) screening were conducted at two sessions (within six hours and approximately three days after birth). Data were analysed via descriptive statistics. RESULTS Based on current staffing profile and practice, efficient and comprehensive screening is not successful within hours of birth, but is more so at the MOU three-day assessment clinic. Significantly higher numbers of infants were screened at session 2, with significantly less false-positive results. At session 1, only 38.1% of the neonates were screened, as opposed to more than 100% at session 2. Session 1 yielded an 82.1% rate of false positive findings, a rate that not only has important implications for the emotional well-being of the parents; but also for resource-stricken environments where expenditure has to be accounted for carefully. CONCLUSION Current findings highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. These findings argue for UNHS initiatives to include the MOU three-day assessment to ensure that a higher number of neonates are reached and confounding variables such as vernix have been eliminated.
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Naudé AM, Bornman J. A systematic review of ethics knowledge in audiology (1980-2010). Am J Audiol 2014; 23:151-7. [PMID: 24695796 DOI: 10.1044/2014_aja-13-0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this research was to apply multiple perspectives as part of a systematic review to analyze literature regarding ethics in audiology. Audiologists are particularly vulnerable to the changing requirements of the discipline that compel them to straddle both professional obligations and business principles, creating a hybrid professional. METHOD The authors used a 2-phase mixed-method approach to analyze publications. Publications were sorted into categories, namely, ethics approach, author, decade, role of the audiologist, component of morality, and common themes. The sample consisted of peer-reviewed articles cited in MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide Information, and Academic Search Premier electronic databases and non-peer-reviewed articles in Seminars in Hearing. RESULTS The publications were predominantly philosophical, focused on the rehabilitative role of the audiologist, and addressed the moral judgment component of moral behavior. CONCLUSIONS Despite the fact that knowledge of ethics grew between 1980 and 2010, this retrospective analysis identified gaps in current knowledge. Research is needed to address the unique ethical problems commonly encountered in all 8 roles of the audiologist; patient perspectives on ethics; ethical approaches; factors affecting moral judgment, sensitivity, motivation, and courage; and cultural dimensions of ethical practice in audiology.
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Affiliation(s)
- Alida Maryna Naudé
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, 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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Khoza-Shangase K, Joubert K. The influence of epidural anesthesia on new-born hearing screening: A pilot study. J Pharm Bioallied Sci 2011; 3:135-41. [PMID: 21430964 PMCID: PMC3053511 DOI: 10.4103/0975-7406.76493] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/07/2010] [Accepted: 12/09/2010] [Indexed: 11/16/2022] Open
Abstract
Objective: The main aim was to establish if epidural anesthesia had an influence on new-born hearing screening results in newborns born via elective Cesarean section in healthy pregnancies. Specific objectives included determining screening results in a group of newborns born to mothers who had undergone epidural anesthesia during Cesarean section childbirth (experimental group); and comparing the findings with those of a group of newborns born to mothers who had undergone natural delivery without epidural anesthesia (comparison group); while establishing if the time of screening following delivery had any effect on the overall screening results. Materials and Methods: The above objectives were achieved through the use of a prospective quasi-experimental repeated measures design with a comparison group, where 40 newborns (20 in the experimental and 20 in the comparison group) were screened at three different times through transient otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) measures. All participants were screened while resting quietly in open bassinets in an empty new-born nursery. For both test measures, the results were recorded as either pass or refer. Data were analyzed through both descriptive and inferential statistics. Results: Findings indicated that hearing screening earlier than four hours after birth, for both the experimental and comparison groups yielded more false positive findings than testing conducted after 24 hours. An index of suspicion in relation to the influence of epidural anesthesia on Automated Auditory Brainstem Response (AABR), when conducted less than four hours after birth, was raised, as statistically significant findings (P<0.05) were obtained. Conclusions: The findings have implications for timing of screening where universal newborn hearing screening is being implemented.
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Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Olusanya BO. Priorities for early hearing detection and intervention in sub-Saharan Africa. Int J Audiol 2009; 47 Suppl 1:S3-13. [DOI: 10.1080/14992020802287143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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 B, Emokpae A, Renner J, Wirz S. Costs and performance of early hearing detection programmes in Lagos, Nigeria. Trans R Soc Trop Med Hyg 2009; 103:179-86. [DOI: 10.1016/j.trstmh.2008.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 06/24/2008] [Accepted: 07/10/2008] [Indexed: 11/29/2022] Open
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