Challenges of Universal Newborn Hearing Screening in a Developing Country-a Double-Edged Sword

Jacob, Jaise; Kurien, Mary; Sindhusha,; Kumar, Pradeep; Krishnan, Lalitha

doi:10.1007/s12070-020-02170-8

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…Sixteen studies that reported a two-stage hearing screening protocol, employed OAE (TE/DP-OAE) or AABR as screening tests (individually or combined in either stage) 17–31. The other 25 studies used only OAEs (DP/TE)32–49 or AABR screening50 51 for testing in both stages. Those studies that reported the use of AABR in the initial stage of screening either employed AABR solely for both stages50 or a combination of AABR and OAE to screen only high-risk newborns 20 52.…”

Section: Resultsmentioning

confidence: 99%

“…Diagnostic ABR was the only testing carried out to confirm the hearing loss in studies in newborns and infants 25 28 32 35–37 42 54 63 86–89. Comprehensive test battery including the diagnostic BERA, OAE, and tympanometry was mentioned only in 11 studies 20 29 58.…”

Section: Resultsmentioning

confidence: 99%

“…Loss to follow-up for second screening and diagnostics20 29 35–37 40 43 48 54 56 59 81 87 was reported as a major challenge. Loss to follow-up was linked to parental rejection for diagnosis,33 43 50 poor tracking system,20 29 financial burden of parents, low socioeconomic status51 and travel distance to testing distance.…”

Section: Resultsmentioning

confidence: 99%

“…Loss to follow-up was linked to parental rejection for diagnosis,33 43 50 poor tracking system,20 29 financial burden of parents, low socioeconomic status51 and travel distance to testing distance. Other major challenges highlighted in relation to outcomes included limited coverage35 82 and a high referral rate,18 37 54 poor long-term outcomes with respect to coverage and referral rate 24…”

Section: Resultsmentioning

confidence: 99%

“…Use of appropriate tracking or data management systems, were reported to be helpful in minimising loss to follow-up 20 28 33 35 81. Combining hearing screening with other screenings improved follow-up rates 25 62.…”

Section: Resultsmentioning

confidence: 99%

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Early hearing detection and intervention (EHDI) programmes for infants and young children in low-income and middle-income countries in Asia: a systematic review

Ramkumar

Nair³

et al. 2023

bmjpo

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BackgroundEarly hearing detection and intervention (EHDI) measures initiated in high-income countries (HICs) were attempted in low-income and middle-income countries (L&MICs). However, information regarding the models of EHDI, context-specific adaptations made to strategies and outcomes are not known.AimsThe aims of this systematic review were to identify the various models of EHDI used in Asian L&MICs in the published scientific literature and to describe their efficacy and validity.MethodsThe studies were eligible if the programme was from Asian L&MICs, implemented for children below 6 years of age and published between 2010 and 2021. Google Scholar, PubMed, Web of Science, Scopus, EBSCOHost and EBSCO–CINAHL were used to find articles. Data were extracted from each selected article, and the risk of bias was assessed. The search results were summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. For primary outcomes, narrative synthesis was used, and forest plots were generated for secondary outcomes.ResultsIn all, 82 studies were included, and these studies were divided into two categories: newborn and infant screening programmes and screening programmes for older children. Predominantly, a two-stage objective otoacoustic emission (Distortion Product/Transient Evoked) or automated auditory brainstem response screening, followed by a detailed auditory brainstem response to confirm the hearing loss, was used in newborn and infant screening programmes. Audiologists were the most frequent screening personnel. Screening of older children was mostly done by otolaryngologists, school instructors and nurses. They performed a single-stage pure tone audiometry screening followed by a detailed examination.ConclusionThe screening tools and protocols used were similar to those used in HICs. However, no uniform protocols were followed within each country. Long-term viability of EHDI programmes was not known as there was limited information on impact outcomes such as cost–benefit.PROSPERO registration numberCRD42021240341.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Early hearing detection and intervention (EHDI) programmes for infants and young children in low-income and middle-income countries in Asia: a systematic review

Ramkumar

Nair³

et al. 2023

bmjpo

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Protocol and programme factors associated with referral and loss to follow-up from newborn hearing screening: a systematic review

et al. 2022

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Background An effective newborn hearing screening programme has low referral rate and low loss to follow-up (LTFU) rate after referral from initial screening. This systematic review identified studies evaluating the effect of protocol and programme factors on these two outcomes, including the screening method used and the infant group. Methods Five databases were searched (latest: April 2021). Included studies reported original data from newborn hearing screening and described the target outcomes against a protocol or programme level factor. Studies were excluded if results were only available for one risk condition, for each ear, or for < 100 infants, or if methodological bias was observed. Included studies were evaluated for quality across three domains: sample, screening and outcome, using modified criteria from the Ottawa-Newcastle and QUADAS-2 scales. Findings from the included studies were synthesised in tables, figures and text. Results Fifty-eight studies reported on referral rate, 8 on LTFU rate, and 35 on both. Only 15 studies defined LTFU. Substantial diversity in referral and LTFU rate was observed across studies. Twelve of fourteen studies that evaluated screening method showed lower referral rates with aABR compared to TEOAE for well babies (WB). Rescreening before hospital discharge and screening after 3 days of age reduced referral rates. Studies investigating LTFU reported lower rates for programmes that had audiologist involvement, did not require fees for step 2, were embedded in a larger regional or national programme, and scheduled follow-up in a location accessible to the families. In programmes with low overall LTFU, higher LTFU was observed for infants from the NICU compared to WB. Conclusion Although poor reporting and exclusion of non-English articles may limit the generalisability from this review, key influential factors for referral and LTFU rates were identified. Including aABR in WB screening can effectively reduce referral rates, but it is not the only solution. The reported referral and LTFU rates vary largely across studies, implying the contribution of several parameters identified in this review and the context in which the programme is performed. Extra attention should be paid to infants with higher risk for hearing impairment to ensure their return to follow-up.

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Pilot Implementation Outcomes of a Community-Based Tele- Practice Model for Identification and Rehabilitation of Children with Hearing loss within a Public-health system of a Rural District in Southern India

Satheesh,

Ramkumar,

Joshi

et al. 2024

Preprint

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Background The current study is an effort to evaluate pilot outcomes of a comprehensive tele-practice model for identification and rehabilitation of hearing loss among children below 6 years of age which can then inform suitable adaptations prior to the implementation. The outcomes of tele-facilitator training, limited-efficacy measures, and caregiver acceptability and satisfaction with tele-practice were analysed. Method Two special educators were trained as tele-facilitators for tele-diagnostic testing. Screening was done using the validated SRESHT screener in the Perambalur district by trained nurses in UPHC’s at all 4 blocks until at least 5 children with ‘refer’ results were obtained. 5 children with hearing loss using amplification devices enrolled in the District Early Intervention Centre (DEIC) were enrolled for tele-rehabilitation. To measure the limited- efficacy, the outcomes of pre-pilot and post-pilot were compared. The caregiver acceptability and satisfaction with tele-practice was also assessed Results In all 12 children with ‘refer’ results loss underwent tele- diagnostic testing. Tele-rehabilitation outcomes were studied on 5 children with hearing loss already using amplification devices. When comparing the outcomes of limited -efficacy with the existing data it was found that the model identified older children with hearing loss. The time lapse between screening/hearing loss suspicion to diagnosis reduced from a median of 216 days to 8 days. For tele- rehabilitation the number of sessions attended in a span of 3 months increased from a median of zero to 3 sessions. Based on the satisfaction questionnaire, most people had a positive experience, and found the travel time to the testing site convenient and affordable. Few parents reported encountering difficulties as a result of inadequate ventilation and internet connectivity within the mobile van where tele-diagnostic testing was conducted. Conclusion The pilot outcomes suggests that a block level service enabled using tele- practice to overcome professional shortages, beneficial in reducing time gap between screening/suspicion to diagnosis and also enhanced attendance for rehabilitation. The pilot outcomes provided insights on adaptations related to screening site, test infrastructure and internet optimization that may be required before implementation.

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Challenges of Universal Newborn Hearing Screening in a Developing Country-a Double-Edged Sword

Cited by 5 publications

References 23 publications

Early hearing detection and intervention (EHDI) programmes for infants and young children in low-income and middle-income countries in Asia: a systematic review

Early hearing detection and intervention (EHDI) programmes for infants and young children in low-income and middle-income countries in Asia: a systematic review

Protocol and programme factors associated with referral and loss to follow-up from newborn hearing screening: a systematic review

Pilot Implementation Outcomes of a Community-Based Tele- Practice Model for Identification and Rehabilitation of Children with Hearing loss within a Public-health system of a Rural District in Southern India

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