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Community-based infant hearing screening for early detection of permanent hearing loss in Lagos, Nigeria: a
B O Olusanya1, S L Wirz, L M Luxon
1College of Medicine, University of Lagos, Surulere, Nigeria. boolusanya@aol.com
Insights
Community health workers effectively screened infants for permanent congenital and early-onset hearing loss in Lagos, Nigeria. Early detection was feasible, but improved follow-up systems are needed for better diagnostic evaluation rates.
Area of Science:
- Public Health
- Audiology
- Pediatrics
Background:
- Permanent congenital and early-onset hearing loss (PCEHL) is a significant global health concern.
- Early detection and intervention are crucial for optimal developmental outcomes in infants.
- Universal infant hearing screening programs are essential for identifying hearing loss in newborns.
Purpose of the Study:
- To assess the feasibility and effectiveness of a community-based universal infant hearing screening program.
- To detect permanent congenital and early-onset hearing loss (PCEHL) in infants in Lagos, Nigeria.
- To evaluate screening coverage, referral rates, and diagnostic yield.
Main Methods:
- A cross-sectional study screened infants aged 3 months and under at BCG immunization clinics.
- A two-stage screening protocol utilized transient evoked otoacoustic emissions and automated auditory brainstem responses.
- Community health workers conducted screenings between July 2005 and April 2006.
Main Results:
- 88% of eligible infants (2003) were screened, with no parental refusal.
- The overall referral rate was 4.1%, with a 61% return rate for diagnostic evaluation.
- The screening yield for PCEHL was 28 per 1000 infants, with a mean age at diagnosis of 51 days.
Conclusions:
- Community-based infant hearing screening at BCG clinics is feasible and effective for early PCEHL detection in Lagos.
- The program demonstrated high sensitivity (80.4%) and specificity (99.7%).
- An improved tracking and follow-up system is necessary to enhance return rates for second-stage screening and evaluation.
Objective:
To determine the feasibility and effectiveness of a community-based universal infant hearing screening programme for detecting permanent congenital and early-onset hearing loss (PCEHL) in Lagos, Nigeria.
Methods:
This is a cross-sectional study in which all infants aged 3 months or under attending four bacille Calmette-Guérin (BCG) immunization clinics accounting for over 75% of the BCG coverage in the study location were screened by community health workers between July 2005 and April 2006. Screening followed a two-stage protocol involving transient evoked otoacoustic emissions and automated auditory brainstem responses. The main outcome measures were screening coverage, referral rates, return rates for second-stage screening and evaluation, yield and age at PCEHL diagnosis.
Findings:
In total, 2003 (88%) of 2277 eligible infants attending the four BCG clinics were successfully screened between July 2005 and April 2006 at a mean age of 17.7 days, with no parent declining screening. The majority (55.2%) were born outside a hospital and, of such infants, 77% were born in traditional herbal maternity homes. The overall referral rate for diagnostic evaluation was 4.1%. Only 61% (50/82) of those referred returned for evaluation, and 45 of them were confirmed with PCEHL. Additionally, 11 infants who had previously passed the first screening stage were also found to have PCEHL, resulting in a yield of 28 per 1000 (56/2003). The mean age at diagnosis was 51 days. The sensitivity, specificity and positive predictive value of the first screening stage were 80.4%, 99.7% and 90.0%, respectively. The positive likelihood ratio was 268, while the negative likelihood ratio was 0.2.
Conclusion:
Routine hearing screening of infants attending BCG immunization clinics by community health workers was feasible and effective for the early detection of PCEHL in Lagos, Nigeria. However, an efficient tracking and follow-up system is needed to improve return rates for second-stage screening and diagnostic evaluation.
