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Efficacy of a community-based infant hearing screening program utilizing existing clinic personnel in Western Cape,
Niki Friderichs1, DeWet Swanepoel, James W Hall
1Department of Communication Pathology, University of Pretoria, South Africa.
Insights
This study found that community-based infant hearing screening in South Africa achieved high follow-up rates but low coverage. Dedicated staff may be needed to improve screening program reach.
Area of Science:
- Public Health
- Audiology
- Pediatrics
Background:
- Screening programs for infant hearing loss are crucial for early intervention.
- Primary health care clinics offer a potential alternative to hospital-based screening in South Africa.
- Evaluating community-based programs is essential for improving access in developing regions.
Purpose of the Study:
- To evaluate the first systematic community-based infant hearing screening program in a developing South African community.
- To assess the efficacy of the program based on coverage, referral, and follow-up rates.
- To determine diagnostic outcomes for hearing loss in infants.
Main Methods:
- A 19-month evaluation of a universal infant hearing screening program at eight primary health care clinics.
- Trained clinic nurses utilized a two-stage distortion product otoacoustic emissions protocol.
- Infants were screened during routine immunization visits, with follow-up and diagnostic evaluations as needed.
Main Results:
- Screening coverage was 32.4% (2018 infants screened).
- The first-stage referral rate was 9.5%, with 3% referred for hospital-level diagnostics.
- High follow-up rates were observed: 85.1% for rescreens and 91.8% for initial diagnostic assessments.
Conclusions:
- The community-based program demonstrated value through high follow-up rates.
- Achieving sufficient screening coverage may necessitate dedicated screening personnel.
- The findings inform strategies for optimizing infant hearing screening in similar settings.
Objective:
Screening programs at primary health care immunization clinics have been proposed as an alternative to hospital-based programs in South Africa. The objective of this study was to evaluate the first systematic community-based infant hearing screening program in a developing South African community in the Western Cape.
Methods:
A community-based universal infant hearing screening program initiated at eight primary health care clinics in the Cape Metropolitan area was evaluated over a 19-month research period. During this time 6227 infants that were candidates for screening attended their 6, 10 or 14-week immunization visit at the relevant clinic. Clinic nurses were trained as screening personnel. A two-stage distortion product otoacoustic emissions screening protocol was utilized. The target disorder was uni- or bilateral hearing loss and infants referring the first screen were scheduled for a 4-week follow-up visit at the clinic. Diagnostic audiological and medical evaluations were scheduled at referral hospitals when indicated. The study evaluated the efficacy of the program based on coverage, referral and follow-up rates and diagnostic outcomes according to guidelines specified by the Health Professions Council of South Africa 2007 Position Statement.
Results:
Overall coverage rate across the eight clinics was 32.4% with 2018 infants (aged 0-14 weeks) screened. The mean age of the sample at first stage screen was 3.9 weeks of age and 13.5 weeks of age for first hospital visit. Overall first stage screen referral rate was 9.5% with 62 subjects (3%) referred for diagnostic services at hospital level after a follow-up screen. The average follow-up rate for rescreens at clinic level was 85.1% and for initial diagnostic assessments at hospital level it was 91.8%. Prevalence rates were 4.5/1000 with significant hearing loss, including sensorineural (1.5/1000) and conductive (3/1000) losses, and 12.9/1000 for subjects with middle ear effusion.
Conclusions:
The community-based infant hearing screening program was valuable in attaining high follow-up return rates but reaching sufficient coverage may require dedicated screening personnel as opposed to existing nursing personnel.
