Universal newborn hearing screening in public healthcare in South Africa: Challenges to implementation

Abstract

Background. The implementation of early hearing detection and intervention (EHDI) remains a challenge in developing countries, despite the known benefits. Objectives. To investigate challenges encountered during implementation of universal newborn hearing screening (UNHS) at a secondarylevel public hospital in Johannesburg, South Africa. Methods. A prospective cohort study design that assessed the feasibility of conducting UNHS was adopted. This feasibility assessment was conducted during a 3-month period, and all challenges encountered were identified and documented. Screening time was also recorded for each neonate. Data were entered into Excel, and later analysed using Stata version 11. Results. Of 2 740 neonates born during the study period, 490 (17.9%) were identified for screening, and distortion product otoacoustic emissions screening was conducted on 121 (4.4%). The majority (74.4%) were screened in the first 24 hours of life. Repeat screening was required in 57 (47.1%) neonates, but only 20 returned for follow-up. The most important challenges to the feasibility of UNHS implementation were the insufficient number of audiologists available to provide screening, the high rate of false positive test results and the unacceptably high rates of loss to follow-up. Two modifiable factors, namely the presence of vernix caseosa in the external ear canal and high ambient noise levels, were found to have significantly influenced the screening process. Conclusion.The identified challenges are important considerations for any successful implementation of universal screening protocols. Careful planning to mitigate the challenges will have a positive impact on EHDI initiatives in these contexts.

Outcomes of newborn hearing screening at an academic secondary level hospital in Johannesburg, South Africa

“…For this part of the study, the parameters being investigated were specific to the outcomes of the screening. Some of the findings, presented and discussed in depth in this study, were published in the Bezuidenhout et al’s ( 2018 ) study.…”

“…This study was part of another study programme titled ‘Universal Newborn Hearing Screening in Public Healthcare in South Africa: Challenges to Implementation’ (Bezuidenhout et al, 2018 ), where the design was a prospective non-experimental cohort study that looked at the feasibility assessment of a UNHS programme. In that study, the focus was on identifying challenges to implementation of the screening programme.…”

“…Other factors influencing successful implementation of hearing screening within the South African context, particularly UNHS, include the insufficient number of audiologists available to provide screening, the high rate of false positive test results and the high rates of loss to follow-up (Bezuidenhout, Khoza-Shangase, De Maayer, & Strehlau, 2018 ; Khoza-Shangase, 2021b ). Furthermore, the quadruple burden of disease that guides priorities within the South African healthcare sector places hearing impairment low as a risk priority.…”

Screening for <b><i>GJB2</i></b>-R143W-Associated Hearing Impairment: Implications for Health Policy and Practice in Ghana

“…The UNHS has been implemented in several countries [27-29] with the aim of diagnosing HI in newborn babies to give appropriate interventions, follow-up tests, or treatments to children with permanent HI [29]. The UNHS program is also referred to as early hearing detection and intervention (EHDI) program [28].…”

“…Special devices with inbuilt algorithms are used to evaluate the auditory brainstem response of the child. In most cases, the children who did not pass the first UNHS test are scheduled for a second test and subsequently referred to a specialist when no response is obtained from the initial tests [28, 29].…”