Non-hospital delivery and permanent congenital and early-onset hearing loss in a developing country.
OBJECTIVE
The objective of this study was to determine the role of non-hospital delivery and other risk factors for permanent congenital and early-onset hearing loss (PCEHL) in a developing country.


METHODS
Matched case-control study.


METHODS
Four primary healthcare centres in inner-city Lagos, Nigeria.


METHODS
Fifty-six infants with PCEHL and 280 normal hearing controls matched for age and sex from a population of infants not older than 3 months attending Bacille de Calmette-Guérin immunisation clinics.


METHODS
Conditional logistic regression analyses of infant and maternal characteristics associated with PCEHL, and the evaluation of population exposure to each risk factor.


METHODS
Adjusted matched odds ratios and population attributable risk percent (PAR%).


RESULTS
Children with PCEHL were significantly more likely to be first born (OR 1.9, 95% CI 1.1-3.6) without skilled attendants at birth (OR 2.4, 95% CI 1.3-4.5) and have a history of neonatal jaundice requiring exchange blood transfusion (NNJ/EBT) (OR 9.6, 95% CI 2.4-38.2) but less likely to be small for gestational age (SGA) (OR 0.1, 95% CI 0.0-0.5). After controlling for other covariates, the absence of skilled attendants at birth (OR 4.2, 95% CI 2.0-8.6) and NNJ/EBT (OR 19.1, 95% CI 4.3-85.5) emerged as predictors of PCEHL, while SGA (OR 0.1, 95% CI 0.0-0.2) retained its inverse relationship with PCEHL. The PAR% was 35.9% for the lack of skilled attendants at birth and 10.6% for having NNJ/EBT. About 23% of children with PCEHL did not exhibit any risk factors.


CONCLUSIONS
NNJ/EBT and the absence of skilled attendant at birth rather than the place of delivery are significant predictors of PCEHL in this study population. Targeted hearing screening using these risk factors would facilitate the detection of about 77% of children with PCEHL.
Olusanya
B O
BO
Maternal and Child Health Unit, Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria. boolusanya@aol.com
Wirz
S L
SL
Luxon
L M
LM
D000328:Adult; D016022:Case-Control Studies; D003906:Developing Countries; D005260:Female; D034381:Hearing Loss / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology*; D006320:Hearing Tests; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000209:etiology; D008297:Male; D008423:Maternal Age; D008880:Midwifery / Q000592:standards*; D009549:Nigeria; D018743:Perinatal Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult