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

Abstract

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.

Evaluation of the Design and Development of the HeLe Newborn Hearing Screening Tele-Audiology Systems for the Philippines

“…17 More relevant to the Philippines, a systematic review of EHDI programs in low-and middle-income countries in Asia revealed three of 82 studies describing "the use of ICT for storing and forwarding results, database management, and sending reminders for follow-up screening". 18 This HeLe evaluation centered on the NHS program and technical / technology inputs, based on the CDC guidelines for evaluating public health surveillance systems. We evaluated information quality (relevance, accuracy, completeness, timeliness) and system quality (availability, usability/ accessibility, functionality, comprehensive data capture, error reduction, and security).…”

The prevalence of risk for hearing impairment in newborns with congenital syphilis in a newborn hearing screening program (NHS)

“…A lack of standardized protocols is evident in neonatal hearing screening practices ( 33 , 34 ). Despite this, there is a prevailing tendency toward recommending protocols involving the application of AABR due to its demonstrated higher specificity and reduced false positives in detecting hearing loss.…”

Audiologists’ perspective on newborn hearing screening in a developing nation: a questionnaire-based survey

“…They stressed the need for an urgent implementation of universal neonatal hearing screening in all the healthcare facilities in the country at large. A review of early detection and intervention programs in low-and middle-income countries of Asia by Joshi et al (2022) [5] showed that a majority of the NBHS programs in India, primarily employed a two-step approach. Initially, either otoacoustic emission screening (utilizing Distortion Product or Transient Evoked emissions) or automated auditory brainstem response screening was conducted.…”

“…Audiologists were the professionals most commonly involved in conducting these screenings. Joshi et al (2022) [5] further reported that the screening tools and procedures employed in low-and middle-income countries were comparable to those in high-income countries but, there was a lack of standardized protocols within individual countries.…”

“…It is still a struggle for developing countries such as India to make NBHS a reality because of the many challenges faced at the grassroots level [2]. Out of the multiple challenges faced, the ones that are marked as major red flags in the poor implementation rates of the program are failure to follow a uniform protocol across hospitals, lack of cost-effectiveness, lack of follow-ups, lack of skilled manpower, increased load on audiologists, audiological services, absence of collaboration from/gap in communication between audiologists and other professionals [5]. In fact, a few programs in India opt for screening only a targeted population, high-risk infants in order to reduce the load on audiological services [6].…”