Olusanya, Bolajoko Olubukunola; (2008) Infant hearing screening models for the early detection of permanent childhood hearing loss in Nigeria. Doctoral thesis , UCL (University College London).

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Abstract

Permanent congenital and early-onset hearing loss (PCEHL) is associated with significant developmental deficits in speech, language and cognitive skills when detected beyond the first year of life. Hospital-based universal newborn hearing screening is recognised as an essential component of neonatal care worldwide. Although about 32,000 babies are estimated to have PCEHL annually in Nigeria infants are rarely offered any form of hearing screening tests. This research therefore set out to establish suitable infant hearing screening model(s) for Nigeria within the context of the significant proportion of births outside hospital facilities. In a cross-sectional prospective study, all consecutive newborn babies at the Lagos Island Maternity Hospital, Lagos and babies less than 3 months of age attending four community health centres for BCG immunisation were enrolled over a period of 40 weeks in a two-staged screening protocol consisting of transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR). Those who failed the second-stage screening with AABR were referred for appropriate diagnostic evaluation. Fees were not required of parents for any of the services. The results demonstrated that both hospital-based and community-based universal infant hearing screening programmes were feasible in Nigeria and that screening tests can be conducted effectively by non-specialists without prior audiological expertise in primary care settings. The screening coverage was over 90%. However, the community-based programme showed a superior yield for children with PCEHL and lower cost-per-baby screened. The only independent predictor of PCEHL under the hospital-based programme was admission into Special Care Baby Unit while hyperbilirubinaemia necessitating exchange blood transfusion and birth outside hospital facilities were predictive of PCEHL in the community-based programme. Loss to follow-up was the most significant challenge to both programmes while failure to explore likely effects of payments for screening tests on the uptake of services was a major limitation.

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