Implementing hearing screening among children aged 0-59 months at established immunization clinics in Uganda: A
Christopher Ndoleriire1, Kagga Douglas Ssenyonjo1, Kabagenyi Fiona1
1Department of Ear, Nose and Throat Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Insights
Childhood hearing loss is prevalent in Uganda. Implementing hearing screening by non-specialist health workers at immunization clinics is feasible and identifies key risk factors.
Area of Science:
- Public Health
- Audiology
- Pediatrics
Background:
- Childhood hearing loss (HL) significantly impacts communication and education, particularly in low and middle-income countries (LMICs).
- Uganda lacks established childhood hearing screening programs despite global advocacy.
- Early identification and intervention are crucial for mitigating the effects of HL.
Purpose of the Study:
- To introduce hearing screening services using non-specialist health workers at immunization clinics for children aged 0-59 months in Uganda.
- To determine the prevalence and associated factors of failed hearing screening (HS) in this population.
Main Methods:
- A cross-sectional, multi-center study was conducted at three regional referral hospitals (RRHs) in Uganda.
- Transient Evoked Oto-acoustic Emissions (TEOAEs) were used for two-stage hearing screening in children aged 0-59 months.
- Logistic regression analysis identified factors associated with failed HS.
Main Results:
- 1217 children aged 0-59 months were screened, with a 3.7% prevalence of failed HS (3.7%).
- Factors associated with increased odds of failed HS included rural residence, hospital admission after birth, and a history of childhood suppurative otitis media.
- Having relatives with hearing loss significantly increased the odds of failed HS (aOR=4.64).
Conclusions:
- The prevalence of failed childhood hearing screening in Uganda is substantial.
- Non-specialist health workers can effectively implement TEOAE-based hearing screening at immunization clinics.
- This approach represents a viable first step towards a national childhood hearing screening program.
Objective:
The prevalence of childhood hearing loss (HL) is high in low and middle income countries (LMICs), with many of the affected children facing communication delays and poor opportunities for education. Despite the increased advocacy for childhood hearing screening globally, Uganda has no established childhood hearing screening programs. This study set out to introduce hearing screening services by non-specialist health workers at routine immunization clinics among children aged 0-59 months and describe the prevalence and factors associated with failed hearing screening (HS) in these children.
Methods:
A cross-sectional multi-center study was conducted at immunization clinics at three regional referral hospitals (RRHs). A semi structured questionnaire was used to capture data on socio-demographic, clinical factors and the two stage Transient Evoked Oto-acoustic emissions (TEOAEs) screening performed on children aged 0-59 months. A child that failed two stage screening was considered to have failed HS. Logistic regression was used to calculate odds ratios (OR) for factors associated with failed HS.
Results:
1217 children were recruited at three RRHs, with a median age of 2 months (range: 0 to 59), half were male 52% (n = 633). Overall 45 children failed two staged TEOAE screening giving a prevalence of failed HS of 3.7%, of these 27 (2.2%) and 18 (1.5%) failed unilaterally and bilaterally respectively. Children of rural residence (aOR = 2.18, p = 0.027), of low birth weight (aOR = 0.42, p = 0.045), with relatives having hearing loss (aOR = 4.64, p= <0.001), who were admitted in hospital after birth (aOR = 3.72, p = 0.012) and a history of a childhood suppurative otitis media (aOR = 9.53, p = 0.015) all had increased odds of failed HS.
Conclusions:
The prevalence of failed screening is high. Implementation of childhood hearing screening by non-specialist health workers at immunization clinics using TEOAEs is possible and may be a necessary initial step in starting countrywide hearing screening in Uganda.
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