Assessment of hearing screening programmes across 47 countries or regions II: coverage, referral, follow-up and
Allison R Mackey1, Andrea M L Bussé2, Hans L J Hoeve2
1CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Insights
Newborn hearing screening (NHS) programs show high coverage but variable referral rates influenced by screening protocols. Many programs lack comprehensive quality data, impacting performance assessment.
Area of Science:
- Public Health
- Audiology
- Pediatrics
Background:
- Newborn hearing screening (NHS) is crucial for early detection of hearing impairment.
- Assessing the performance of global NHS programs is essential for improving outcomes.
- Variations in screening protocols may affect program effectiveness.
Purpose of the Study:
- To evaluate the performance of newborn hearing screening programs using quality indicators.
- To examine the relationship between screening protocol design and program outcomes.
- To identify factors influencing referral rates in newborn hearing screening.
Main Methods:
- A global survey of experts in newborn hearing screening was conducted.
- Data on NHS coverage, referral, follow-up, and detection rates were collected and aggregated.
- Referral rates were analyzed in relation to age at screening, number of steps, and test methods (OAE, aABR).
Main Results:
- Median NHS coverage reached 96%, but data on follow-up and detection rates were limited.
- Referral rates varied significantly based on age at screening, with lower rates for later screening.
- Protocol design, including the number of screening steps and test methods, impacted referral rates.
Conclusions:
- Referral rates in newborn hearing screening are demonstrably linked to screening age, test modality, and protocol complexity.
- A significant gap exists in the availability of comprehensive quality measures for many NHS programs worldwide.
- Further standardization and data collection are needed to effectively assess and enhance NHS program performance.
Objectives:
To assess the performance of newborn hearing screening (NHS) programmes, through selected quality measures and their relationship to protocol design.
Design:
NHS coverage, referral, follow-up and detection rates were aggregated. Referral rates were compared to age at screening step 1, number of steps, and test method: OAE or aABR.
Study Sample:
A questionnaire on existing hearing screening was completed by experts from countries in Europe, plus Russia, Malawi, Rwanda, India and China.
Results:
Out of 47 countries or regions, NHS coverage rates were reported from 26, referral rates from 23, follow up from 12 and detection rates from 13. Median coverage rate for step 1 was 96%. Referral rate from step 1 was 6-22% where screening may be performed <24 h from birth, 2-15% for >24 h, and 4% for >72 h. Referral rates to diagnostic assessment averaged 2.1% after one to two steps using OAE only, 1.7% after two steps including aABR, and 0.8% after three to four steps including aABR. Median detection rate for bilateral permanent hearing impairment ≥40dB was 1 per 1000 infants.
Conclusion:
Referral rates were related to age, test method and number of screening steps. Quality measures were not available for many NHS programmes.
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