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Follow-up default in a hospital-based universal newborn hearing screening programme in a low-income country
1Unit of Audiological Medicine/Centre for International Child Health, Institute of Child Health, London, UK. boolusanya@aol.com
Insights
Parental compliance is crucial for infant hearing screening. Factors like delivery method and special care unit admission affect pre-discharge follow-up, while cultural beliefs may impact post-discharge compliance.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Effective early detection of permanent infant hearing impairment relies on parental adherence to screening protocols.
- Many infants failing initial screenings are lost to follow-up, hindering early intervention.
- This study investigated factors associated with loss to follow-up in a low-income country's universal hearing screening program.
Purpose of the Study:
- To identify maternal and infant factors influencing loss to follow-up in a hospital-based universal infant hearing screening program.
- To understand compliance challenges in a low-income country setting.
- To inform strategies for improving screening and diagnostic evaluation completion rates.
Main Methods:
- A cross-sectional study involving a two-stage hearing screening (transient-evoked otoacoustic emissions and automated auditory brainstem response).
- Diagnostic evaluation scheduled for automated auditory brainstem response referrals.
- Multivariable logistic regression analyses were used to determine correlates of non-compliance.
Main Results:
- 10.2% of infants scheduled for automated auditory brainstem response and 84.1% of those referred for diagnostic evaluation did not complete the process.
- Spontaneous vertex delivery and special care baby unit admission were predictors of non-compliance before discharge.
- No factors predicted non-compliance with diagnostic evaluation; religious affiliation showed a difference in pre-discharge screening completion.
Conclusions:
- Mode of delivery and high-risk infant status significantly influence pre-discharge screening compliance.
- Factors beyond socio-demographic or medical profiles, such as cultural beliefs and stigma, likely affect post-discharge follow-up compliance.
- Improving follow-up requires addressing potential barriers beyond the immediate clinical setting.
Background:
Effective early detection of infants with permanent hearing impairment requires parental compliance with various stages of a screening protocol. However, many infants who failed initial screening tests are often not presented for follow-up evaluation, thus compromising prospects for early detection and intervention. This study set out to determine maternal and infant factors associated with loss to follow-up in a hospital-based universal hearing screening programme in a low-income country.
Methods:
A cross-sectional study in which babies in a tertiary maternity hospital were enrolled into a two-stage hearing screening programme with transient-evoked otoacoustic emissions followed by automated auditory brainstem response (AABR) for all transient-evoked otoacoustic emissions referrals before hospital discharge. Diagnostic evaluation was scheduled for AABR referrals on outpatient basis. Correlates of non-compliance were determined through multivariable logistic regression analyses of relevant maternal and infant factors.
Results:
Some 1330 babies participated in the first-stage screening and of 551 scheduled for AABR; 56 (10.2%) did not complete. Some 37 (84.1%) of the 44 AABR referrals did not complete the diagnostic evaluation. There were no significant differences between the profile of those who did not complete either the second-stage screening or diagnostic evaluation and those who completed across virtually all socio-demographic factors except that Christian mothers were significantly more likely not to complete the second-stage screening than diagnostic evaluation compared with their Muslim counterparts (odds ratio: 3.01; 95% confidence intervals: 1.17-7.87). The only independent predictors of non-compliance with pre-discharge screening were delivery by spontaneous vertex (odds ratio: 2.76; 95% confidence intervals: 1.47-5.19) and admission into special care baby unit (odds ratio: 5.62; 95% confidence intervals: 2.92-10.84) while no factor was predictive of non-compliance with diagnostic evaluation.
Conclusions:
Mode of delivery or having high-risk baby influences compliance before hospital discharge while factors other than maternal or infant socio-demographic/medical profile such as unfavourable cultural beliefs and stigma may be key determinants of follow-up compliance after discharge.
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