The link between hearing impairment and child maltreatment among Aboriginal children in the Northern Territory of Australia: is there an opportunity for a public health approach in child protection?

Abstract

Background International studies provide evidence of an association between child disabilities, including hearing impairment (HI), and child maltreatment. There are high prevalences of ear disease with associated HI, and child maltreatment among Australian Aboriginal children, but the link between HI and child maltreatment is unknown. This study investigates the association between HI and child maltreatment for Aboriginal children living in the Northern Territory (NT) of Australia. Methods This was a retrospective cohort study of 3895 Aboriginal school-aged children (born between 1999 and 2008) living in remote NT communities. The study used linked individual-level information from health, education and child protection services. The outcome variables were child maltreatment notifications and substantiations. The key explanatory variable, HI, was based on audiometric assessment. The Kaplan–Meier estimator method was used in univariate analysis; Cox proportional hazards regression was used in multivariable analysis. Results A majority of the study cohort lived in very remote (94.5%) and most disadvantaged (93.1%) regions. Among all children in the study cohort, 56.1% had a record of either HI or unilateral hearing loss (UHL), and for those with a history of contact with child protection services (n = 2757), 56.7% had a record of HI/UHL (n = 1564). In the 1999–2003 birth cohort, by age 12 years, 53.5% of children with a record of moderate or worse HI had at least one maltreatment notification, compared to 47.3% of children with normal hearing. In the 2004–2008 cohort, the corresponding results were 83.4 and 71.7% respectively. In multivariable analysis, using the full cohort, children with moderate or worse HI had higher risk of any child maltreatment notification (adjusted Hazard Ratios (adjHR): 1.16, 95% CI:1.04–1.30), notification for neglect (adjHR:1.17, 95% CI:1.04–1.31) and substantiation (adjHR:1.20, 95% CI:1.04–1.40), than children with normal hearing. In the 2004–2008 birth cohort, children with moderate or worse HI had higher risk of a substantiated episode of physical abuse (adjHR:1.47, 95% CI:1.07–2.03) than children with normal hearing. Conclusion Our findings demonstrate the urgent need for HI and child maltreatment prevention strategies through raised community awareness and inter-agency collaboration. Effective information-sharing between service providers is a critical first step to a public health approach in child protection.

INFLATE: a protocol for a randomised controlled trial comparing nasal balloon autoinflation to no nasal balloon autoinflation for otitis media with effusion in Aboriginal and Torres Strait Islander children

“…In the absence of medical intervention, 30% of OME cases in children resolve within the first month of diagnosis, and 90% within 3 months of diagnosis, as determined by international longitudinal research [15]. Although most cases resolve spontaneously by 3 months, recurrent episodes and persistent OME can result in impaired hearing and delay in language development with a negative impact on education and wellbeing [16][17][18]. All forms of OM, including OME, are associated with hearing loss, increasing in severity with more severe forms of OM [19].…”

Guest Editorial: Hearing Care for All—An Opportunity to Globally Unite to Address Inequities in Hearing Health

“…Associations between social, cultural, and environmental determinants and health and hearing health outcomes are wellestablished (Marmot 2005;Nieman et al 2016;Bergmark & Sedaghat 2017;Donkin et al 2018;DeLacy et al 2020). For example, associations between over-crowding in houses, tobacco smoke, and air pollutants significantly increase the risk of otitis media in young children (Jervis- Bardy et al 2014;Kennedy et al 2018). Poor housing hardware has also been associated with poor health and hearing health outcomes in Australian Aboriginal communities (Bailie & Wayte 2006;Standen et al 2020).…”

“…Strategies implemented to limit the spread of the pandemic—lockdowns, mask-wearing, reductions in social gatherings—have demonstrated the importance of hearing and communication in deepening and maintaining social bonds (Venkatesh & Edirappuli 2020), a key part of what it truly means to be human. Hearing and communication scaffold the development of listening and learning, promotes school readiness and vocational outcomes, and enables social and cultural belonging (He et al 2020; Su et al 2020). Hearing loss in the early years can profoundly disrupt childhood development and carries an increased risk of maltreatment, which has long-term health consequences (He et al 2020; Olusanya & Newton 2007).…”

“…Hearing and communication scaffold the development of listening and learning, promotes school readiness and vocational outcomes, and enables social and cultural belonging (He et al 2020; Su et al 2020). Hearing loss in the early years can profoundly disrupt childhood development and carries an increased risk of maltreatment, which has long-term health consequences (He et al 2020; Olusanya & Newton 2007). In older adults, hearing loss remains highly stigmatized largely because of its relationship with aging (Wallhagen 2010).…”

What does microbiology have to do with the Hearing for Learning Initiative (HfLI)?

“…[5][6][7][8] Children with hearing loss are at increased risk of substantiated maltreatment. 9 OM must be prevented and appropriately managed to enable all children to develop their full potential.…”