Evaluation of universal newborn hearing screening in South African primary care

Abstract

Background: Universal Newborn Hearing Screening (UNHC) is the gold standard toward early hearing detection and intervention, hence the importance of its deliberation within the South African context.Aim: To determine the feasibility of screening in low-risk neonates, using Otoacoustic Emissions (OAEs), within the Midwife Obstetric Unit (MOU) three-day assessment clinic at a Community Health Centre (CHC), at various test times following birth.Method: Within a quantitative, prospective design, 272 neonates were included. Case history interviews, otoscopic examinations and Distortion Product OAEs (DPOAEs) screening were conducted at two sessions (within six hours and approximately three days after birth). Data were analysed via descriptive statistics.Results: Based on current staffing profile and practice, efficient and comprehensive screening is not successful within hours of birth, but is more so at the MOU three-day assessment clinic. Significantly higher numbers of infants were screened at session 2, with significantly less false-positive results. At session 1, only 38.1% of the neonates were screened, as opposed to more than 100% at session 2. Session 1 yielded an 82.1% rate of false positive findings, a rate that not only has important implications for the emotional well-being of the parents; but also for resource-stricken environments where expenditure has to be accounted for carefully.Conclusion: Current findings highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. These findings argue for UNHS initiatives to include the MOU three-day assessment to ensure that a higher number of neonates are reached and confounding variables such as vernix have been eliminated.

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

“…Consistent with previous reports [7,22], the least optimal time to screen was within the first 48 hours after birth for both technologies. Lowest initial referral rates were at the age of 4 days for AABR (1.4%) and 6 days for DPOAE (2.7%).…”

“…The necessity of early hearing detection and intervention (EHDI) to contest the detrimental consequences, both individual and societal, of permanent congenital or early-onset hearing loss (PCEHL) is widely documented [2][3][4]. With at least 90% of infants with PCEHL residing in the developing world [5], focus has shifted from validation of EHDI to the development of contextually feasible models of service delivery [6][7].…”

“…Although discharge at these units usually happens six hours after birth if both mother and baby are in good health, they return to the MOU for postnatal follow-ups focussing on umbilical cord stump care and feeding advice [17]. A small scale study in Gauteng South Africa verified that MOU postnatal visits (also called three-day assessments) offered a practical and efficient option for hearing screening [7].…”

“…The use of these persons as screeners is cost-effective and releases the audiologist to resume the role of programme coordinator or diagnostic specialist. 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.…”

“…Referral rates of both technologies increased post two weeks of age, as infants are typically more difficult to test and transient middle ear effusion might be more prevalent [16,34]. MOU postnatal follow-up visits present a very useful platform for screening that results in lower referral rates compared to earlier (<48h) or later (immunisation-linked) screening [7,16]. Additionally, this study highlights that AABR technology could significantly reduce initial referral rates and allow more efficient screening at an earlier age on this platform.…”