Background: To evaluate three-year outcomes of a pilot community-based universal infant hearing screening programme (UNHS) and the associated factors in a low-income country where a high proportion of births occur outside hospitals.
Methods: Two-stage screening programme consisting of a first-stage transient evoked otoacoustic emissions and a second-stage automated auditory brainstem-response test was implemented in an inner-city community in Lagos, Nigeria from 2005 to 2008. Programme performance was measured by screening coverage, first-stage referral rate, and second-stage screening results. The impact of infant’s age-at-screening on otoacoustic emissions referral was assessed with survival analysis while maternal/infant factors associated with screening results were explored by multinomial logistic regression analysis.
Results: About 96.7% (7,175) of eligible infants were screened, 51.7% of whom were born outside hospitals. Overall referral rate after second-stage screening was 1.8%. Cumulative proportion of otoacoustic emissions failures was significantly higher (p=0.045) among infants born outside hospital compared to those born in hospitals. Low social class (OR:7.85; 95%CI:1.88 to 32.81), screening after one month of age (OR:5.07; 95%CI:3.49 to 7.35), multiple gestation (OR:2.64; 95%CI:1.36 to 5.12) and severe neonatal jaundice (OR:7.70; 95%CI:3.82 to 15.53) were predictive of screen failure while multiparity (OR:1.33; 95%CI: 1.06 to 1.67), screening after one month of age (OR:2.44: 95%CI: 1.92 to 3.10) and severe jaundice (OR:2.53; 95%CI: 1.40 to 4.56) were independently associated with programme drop-out.
Conclusions: Community-based UNHS facilitates early detection of infants at risk of sensorineural hearing loss born outside hospitals and the overall performance is comparable to conventional hospital-based UNHS. Maternal education at antenatal clinics may be valuable in addressing the associated risk factors.