Ethical considerations for universal newborn hearing screening in the Pacific Islands: a Samoan case study

Abstract

Permanent congenital and early-onset hearing impairment (PCEOHI) is the most common sensory disorder among newborns. The WHO recommends newborn and infant hearing screening for all member states to facilitate early identification and intervention for children with PCEOHI. Ethical implications of newborn/infant hearing screening in low-income and middle-income countries should be considered. Although the Pacific Island region is estimated to have among the highest global burden of hearing loss, hearing health services are limited and virtually non-existent in Pacific Island countries. The aim of this brief report is to consider the ethical implications of implementing hospital-based universal newborn hearing screening (UNHS) in Samoa. Based on well-acknowledged screening principles, this report found that the Samoan context does not satisfy the screening principles for such a programme, and that the implementation of UNHS would, therefore, be unethical. This conclusion was reached even after considering the hypothetical provision of necessary screening and diagnostic audiology equipment from external donors. We recommend that current efforts should be directed towards the wider professional community involved in the daily care of children with a permanent hearing loss. Given the high prevalence of paediatric ear disease in the Pacific Islander population, an interim ear and hearing programme could be considered at the community level. These strategies should provide the infrastructure and referral pathways required in the advent of UNHS in Samoa.

Awareness and Perceptions of University Nursing Students in Samoa Towards Childhood Hearing Impairment and Hearing Healthcare: A Cross-Sectional Study

“…The fact that almost half of the participants were aware of early identification and intervention services may be explained by the close relationship between Samoa and New Zealand, and the fact that people in Samoa may know of such health services through the experiences of their family living overseas. While Samoa does not have the resources at this time to implement an early hearing identification and intervention program (Kaspar et al, 2020), the updated Samoan Baby Health Book will include a hearing development milestone checklist to enable early identification of infants and toddlers with hearing impairment (Kaspar, Driscoll et al, 2021).…”

Effectiveness of universal newborn hearing screening: A systematic review and meta-analysis

“…Children also require equipment such as hearing aids, and speech and language therapy, which can be expensive and difficult to access [39,40].…”