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

Abstract

Objective: Postnatal visits at community-based midwife obstetric units (MOUs) have been proposed as an alternative primary healthcare screening platform in South Africa. This study evaluated the outcomes of distortion product otoacoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) screening conducted by a dedicated nonprofessional screener at a community-based MOU in the Western Cape, South Africa.Methods: Universal newborn hearing screening (UNHS) at a community-based MOU was evaluated over a 16-month period. A dedicated non-professional screener was trained to follow a two-stage screening protocol targeting bilateral hearing loss. A two group comparative design was used alternating AABR (Maico MB11 BERAphone TM) and DPOAE (Bio-logic AuDX I) technology on a daily basis. Infants referring the initial screen received a follow-up appointment in two days' time and were rescreened with the same technology used at their first screen.Those referring the second stage were booked for diagnostic assessments.Results: 7452 infants were screened including 47.9% (n=3573) with DPOAE and 52.1% (n=3879) with AABR technology. Mean age at first stage screen was 6.1 days. The initial bilateral referral rate was significantly lower for AABR (4.6%) compared to DPOAE (7.0%) and dropped to 0.3% and 0.7% respectively following the second stage screenings. First rescreen and initial diagnostic follow-up rates of 90% and 92.3% were obtained for the DPOAE group and 86.6% and 90% for the AABR group. Follow-up rates showed no significant difference between technology groups. Diagnostic assessment revealed a higher prevalence rate for bilateral sensorineural hearing loss among the AABR group (1/1000) compared to the DPOAE group (0.3/1000). Screening technology had no significant influence on daily screening capacity (23 AABR/day; 24 DPOAE/day). 3Conclusions: Postnatal visits at community-based MOUs create a useful platform for hearing screening and follow-up. AABR technology with negligible disposable costs provides opportunity for AABR screening to be utilised in community-based programmes. AABR screening offers lower initial referral rates and a higher true positive rate compared to DPOAE.

Hearing and vision screening for preschool children using mobile technology, South Africa

“…Employing CHWs from the community was invaluable for raising awareness with preschool centre staff and parents 12 , 14 , 22 , 30 . Selecting communities where an existing public health pathway to intervention was already in place was another important factor contributing to the success of the model 31 , 32 . A high informed consent return was supported by strong community involvement and the provision of simplified forms in local languages.…”

Hearing impairment detection and intervention in children from centre-based early intervention programmes

“…Only 7.5% of public sector hospitals and 53% of private sector hospitals offer NHS programmes in South Africa (Butler et al, 2015). UNHS is offered by less than 1% of public sector hospitals and 15% of private sector hospitals (De Kock et al, 2015). Owing to the lack of universal and systematic implementation of newborn hearing screening (NHS) in South Africa, children with hearing impairment are still identified late, after the age of 12 months (Storbeck and Young, 2016).…”

Data management for early hearing detection and intervention in South Africa

“…Pilot respondents included an international as well as South African expert in the field of audiology, as well as two audiologists in the public and private health sectors, respectively. The piloting of the questionnaire allowed for checking of the appropriateness of the questionnaire for answering the research questions, as well as detecting any flaws in the questionnaire (Brink, van der Walt & van Rensburg 2006).…”