Newborn hearing screening in a South African private health care hospital

Abstract

Summary ObjectiveEarly Hearing Detection and Intervention (EHDI) programs are being established as part of the public health systems in increasing numbers of countries. In developing countries, however, little progress has been made towards implementing NHS programs and South Africa's public and private health care sectors is no exception.The current study presents the first report on a hospital-based UNHS program conducted in the South African private health care sector to provide preliminary results towards advocating for and guiding future programs. MethodsA retrospective study of a UNHS program at a private hospital in urban Gauteng, South Africa over a 4 year period of time was performed. Screening was conducted with Transient Evoked Otoacoustic Emissions (TEOAE) with a rescreen recommended within 6 weeks if referred. Diagnostic audiological assessments were performed on those infants referring the rescreen. The discharge screening costs were subsidized through the hospital birthing package for the first 22 months of the program. openUP (September 2007) ResultsSix thousand two hundred and forty-one newborns were screened from 13,799 hospital births during the first 4 years. Ninety-four percent of these infants were from the well-baby nurseries. During the initial 22 months, whilst the service was subsidized as part of the hospital birthing package, coverage of 75% was attained compared to 20% during the subsequent 26 months. The overall referral rate for the screening program across the 4 years was 11.1% but referral rates decreased by between 2 and 4% for each year of program existence with a 5% rate in year 4. Only 32% of the rescreens were completed at the hospital and no data was available for the remaining infants because parents were provided a choice of follow up centers.Referral for a diagnostic assessment after the rescreens at the hospital was predictive of sensorineural hearing loss in one-third of cases and the estimated prevalence was 3 in every 1000. ConclusionsScreening coverage in the current study was not adequately high and can be attributed to insufficient parental knowledge to make an informed decision. Improvements in program efficiency over time also suggest that pilot programs must be monitored over sufficiently long periods of time to allow observations of optimal efficiency. Initial referral rates and prevalence data indicate a large hearing loss burden and the capacity to implement increasingly efficient programs in South Africa.

Early detection of infant hearing loss in the private health care sector of South Africa

“…Similarly a pilot infant hearing screening program at a public health care immunization clinic reported an even higher initial referral rate of 14% but only evaluated the initial 5 months of implementation [27]. Suboptimal referral rates reported by the remaining 20% of universal programs in this survey may have been due to factors such as poor data management or quality control, recently commenced programs, suboptimal screening technologies (such as AOAE implemented in NICUs) and test environment or procedural issues [16,[32][33].…”

“…Eighty per cent of these universal programs reported a referral rate for audiological and medical evaluation of less than 5%, on par with international benchmarks. Previously reported referral rates from South African studies have however been higher [27,32]. A review of a private health care universal newborn screening program indicated a referral rate of 11% across a 4 year analyses [32].…”

“…Previously reported referral rates from South African studies have however been higher [27,32]. A review of a private health care universal newborn screening program indicated a referral rate of 11% across a 4 year analyses [32]. Similarly a pilot infant hearing screening program at a public health care immunization clinic reported an even higher initial referral rate of 14% but only evaluated the initial 5 months of implementation [27].…”

“…Also, a suboptimal follow-up return rate of 60% was reported for a pilot screening program at an immunization clinic in South Africa [27]. Since hearing screening is not yet mandated or regulated in South Africa there is a lack of program quality control and no systematic protocol for tracking parents and their babies to attend follow-up appointments which may contribute to poor follow-up compliance [32][33][34]. In addition, insufficient support from other key health professionals such as family physicians and pediatricians may discourage parents from prioritizing hearing screening follow-up [16,34,37].…”

“…Parental compliance throughout the various stages of the screening protocol is essential for effective early detection of infants with permanent hearing impairment [37]. Furthermore, various maternal and infant factors, such as the lack of knowledge about the prevalence of infant hearing loss or unfavorable attitudes towards childhood deafness, anxiety about the possibility of hearing loss or low priority for audiological follow-up when other medical conditions are present, maybe associated with loss to follow-up in hospitalbased hearing screening programs [21,32,37].…”