Background: To evaluate three-year outcomes of a pilot community-based universal newborn/infant hearing screening programme (UNHS) and the associated factors in a low-income country where a high proportion of births occur outside hospitals.
Methods: A 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% (7175) 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, screening after one month of age, multiple gestation and severe neonatal jaundice were predictive of screen failure, while multiparity, screening after one month of age and severe jaundice 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.
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Competing interests: None.
Funding: Instruments for this study were provided by Natus Medical Inc., USA, Otodynamics (UK) Ltd and Oticon Foundation, Denmark. Training support was received from NHS Newborn Hearing Screening Programme/MRC Hearing and Communication Group, UK. The data management software was donated by the National Centre for Hearing Assessment and Management (NCHAM), USA. Educational materials for parents and health professionals were sponsored by the Education Trust Fund (ETF) an agency of the Federal Government of Nigeria. Hearing International Nigeria (HING), a local charitable organisation provided financial support for all the operational costs of the project. None of the sponsors was involved in the study design, collection, analysis and interpretation of data; the writing of the manuscript; or the decision to submit these results for publication.
Ethics approval: Obtained from the Lagos State Health Management Board, Nigeria (Reference: SHMB/729T) and University College London, UK (Reference: 03AM04) as part of a wider pilot study on universal infant hearing screening in Lagos, Nigeria.
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