Implementation of Newborn Hearing Screening in Albania

Abstract

Newborn hearing screening (NHS) was implemented in Albania in four maternity hospitals in 2018 and 2019. Implementation outcome, screening outcome, and screening quality measures were evaluated. Infants were first screened by midwives and nurses before discharge from the maternity hospital and returned for follow-up screening. Acceptability, appropriateness, feasibility, adoption, fidelity, coverage, attendance, and stepwise and final-referral rates were assessed by onsite observations, interviews, questionnaires, and a screening database. A post hoc analysis was performed to identify reasons for loss to follow up (LTFU) in a multivariate logistic regression. In total, 22,818 infants were born, of which 96.6% were screened. For the second screening step, 33.6% of infants were LTFU, 40.4% for the third, and 35.8% for diagnostic assessment. Twenty-two (0.1%) were diagnosed with hearing loss of ≥40 dB, six unilateral. NHS was appropriate and feasible: most infants are born in maternity hospitals, hence nurses and midwives could perform screening, and screening rooms and logistic support were supplied. Adoption among screeners was good. Referral rates decreased steadily, reflecting increasing skill. Occasionally, screening was repeated during a screening step, contrary to the protocol. NHS in Albania was implemented successfully, though LTFU was high. It is important to have effective data tracking and supervision throughout the screening.

Quality measures of two-stage newborn hearing screening: Systematic review with a Bayesian meta-analysis

“…In many cases this was due to a failure to provide the required data at each screening step (n=77), an unsuitable study design (n=50), or not performing the first or second test within the specified time frame of one month (n=44). Additional reasons for exclusion are listed in Fig 1 . N=7 reports comprised more than one screening protocol (n=6 two protocols [24][25][26][27][28][29] and n=1 three protocols [30]). Of the reports with more than one protocol, three [27,29,30] provided data on simultaneous TEOAE and AABR testing and were included in both the TEOAE-AABR and AABR-TEOAE groups.…”