Early detection of infant hearing loss in the private health care sector of South Africa

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.

Profound childhood hearing loss in a South Africa cohort: Risk profile, diagnosis and age of intervention

“…This could be a reason for earlier suspicion, diagnosis and intervention within this study sample, in contrast to former South African reports that included children with degrees of hearing loss ranging from mild to profound. In spite of earlier diagnosis, NHS was not done for 72.9% of children (n=62/85), reflecting the current EHDI status in South Africa where NHS services are offered in only a few hospitals in both the public and private health care sectors [19,20].…”

“…Unfortunately it is estimated that less than 10% of the more than 1 million babies born annually in South Africa will have their hearing screened, implying that children with hearing loss will most likely miss out on necessary early auditory stimulation [19][20][21]. Within the public health care system, which serves approximately 85% of the South African population [22], less than 7.5% of hospitals offered any infant hearing screening services when surveyed in 2008 [19].…”

“…Slightly better coverage is provided in the private health care system, with 53% of obstetric units offering some form of screening, but only 14% offering universal newborn screening [20]. As a result, the average age of hearing loss diagnosis in South Africa has been reported to be between 23 to 44.5 months [23][24][25], in contrast to the recommended age of 3 months [26].…”

“…Despite recent reports on early hearing detection services in the public and private health care sectors of South Africa [19,20], information on the status of intervention in terms of amplification and enrollment into early intervention programs is limited [2]. Contextual data on profound childhood hearing loss, in particular, is non-existing.…”

“…As a result of limited early hearing detection and intervention (EHDI) programs and poor data capturing and management amongst existing programs [20,24] the prevalence and nature of PCEHL in South Africa is largely unknown along with the associated risk profiles. Except for a series of etiological surveys of children in schools for the deaf dating back to the 1970s and early 80s [28], no data has been available to describe the risk profile of PCEHL in South Africa.…”