Efficacy of a community-based infant hearing screening program utilizing existing clinic personnel in Western Cape, South Africa

Abstract

Objective: Screening programs at primary health care immunization clinics have been proposed as an alternative to hospital-based programs in South Africa. The objective of this study was to evaluate the first systematic community-based infant hearing screening program in a developing South African community in the Western Cape.Methods: A community-based universal infant hearing screening program initiated at eight primary health care clinics in the Cape Metropolitan area was evaluated over a 19-month research period. During this time 6227 infants that were candidates for screening attended their 6, 10 or 14-week immunization visit at the relevant clinic. Clinic nurses were trained as screening personnel. A two-stage distortion product otoacoustic emissions screening protocol was utilized.The target disorder was uni-or bilateral hearing loss and infants referring the first screen were scheduled for a 4-week follow-up visit at the clinic. Diagnostic audiological and medical evaluations were scheduled at referral hospitals when indicated. The study evaluated the 3 efficacy of the program based on coverage, referral and follow-up rates and diagnostic outcomes according to guidelines specified by the Health Professions Council of South Africa 2007 Position Statement.Results: Overall coverage rate across the eight clinics was 32.4% with 2018 infants (aged 0-14 weeks) screened. The mean age of the sample at first stage screen was 3.9 weeks of age and 13.5 weeks of age for first hospital visit. Overall first stage screen referral rate was 9.5% with 62 subjects (3%) referred for diagnostic services at hospital level after a follow-up screen. The average follow-up rate for rescreens at clinic level was 85.1% and for initial diagnostic assessments at hospital level it was 91.8%. Prevalence rates were 4.5/1000 with significant hearing loss, including sensorineural (1.5/1000) and conductive (3/1000) losses, and 12.9/1000 for subjects with middle ear effusion. Conclusions:The community-based infant hearing screening program was valuable in attaining high follow-up return rates but reaching sufficient coverage may require dedicated screening personnel as opposed to existing nursing personnel.

Outcomes with OAE and AABR screening in the first 48h—Implications for newborn hearing screening in developing countries

“…UNHS protocols for contexts like the South African public health care sector may require AABR technology (without the burden of disposable-related costs) in hospital-based settings with OAE reserved for screening older infants at health care visits, such as community-based immunization clinics or midwife obstetric units [14,46,47]. Utilizing different cost-effective technologies in various health contexts relating to infant age may be essential to ensure that such screening programs in developing countries like South Africa are successful.…”

“…Ideally, however, newborns should be screened as late post birth as possible with best results evident after 48 hours post birth. If a hospital is unable to screen a newborn from 24 hours after birth before discharge alternative screening contexts in developing countries like South Africa may need to be considered such as immunization clinics and Midwife Obstetric Units (MOUs) in order to reduce high referral rates and the risk of excessive follow-up defaults [47,48]. 16 …”

Newborn hearing screening at a community-based obstetric unit: Screening and diagnostic outcomes

“…Despite initial reports verifying immunisation clinics as a useful platform for infant hearing screening [5,15], Friderichs, Swanepoel & Hall [16] reported low coverage rates mainly attributed to the use of already burdened nursing staff as screeners. To date, only one systematic government 5 supported community-based infant hearing screening programme has been reported at immunisation clinics in the Western Cape [16]. Friderichs et al [16] emphasised the need for dedicated screening personnel and proposed an alternative community-based platform such as midwife obstetric units (MOUs).…”

“…To date, only one systematic government 5 supported community-based infant hearing screening programme has been reported at immunisation clinics in the Western Cape [16]. Friderichs et al [16] emphasised the need for dedicated screening personnel and proposed an alternative community-based platform such as midwife obstetric units (MOUs). MOUs are birthing units run by midwives in the community for primary healthcare patients.…”

“…However, despite these recommendations, infant hearing screening conducted by audiologists is still common practice in South Africa [7]. A few studies have investigated the use of nursing staff as screening personnel [15,16], but there are no published reports on the use of non-professional screeners. A dearth of research also exists describing the capacity of screeners, that is, the number of tests that can be performed per day or per month, for different screening technology.…”