title: Community-based infant hearing screening for early detection of permanent hearing loss in Lagos, Nigeria: a cross-sectional study.
abstract: OBJECTIVE
  To determine the feasibility and effectiveness of a community-based universal infant hearing screening programme for detecting permanent congenital and early-onset hearing loss (PCEHL) in Lagos, Nigeria.
  
  
  METHODS
  This is a cross-sectional study in which all infants aged 3 months or under attending four bacille Calmette-Guérin (BCG) immunization clinics accounting for over 75% of the BCG coverage in the study location were screened by community health workers between July 2005 and April 2006. Screening followed a two-stage protocol involving transient evoked otoacoustic emissions and automated auditory brainstem responses. The main outcome measures were screening coverage, referral rates, return rates for second-stage screening and evaluation, yield and age at PCEHL diagnosis.
  
  
  RESULTS
  In total, 2003 (88%) of 2277 eligible infants attending the four BCG clinics were successfully screened between July 2005 and April 2006 at a mean age of 17.7 days, with no parent declining screening. The majority (55.2%) were born outside a hospital and, of such infants, 77% were born in traditional herbal maternity homes. The overall referral rate for diagnostic evaluation was 4.1%. Only 61% (50/82) of those referred returned for evaluation, and 45 of them were confirmed with PCEHL. Additionally, 11 infants who had previously passed the first screening stage were also found to have PCEHL, resulting in a yield of 28 per 1000 (56/2003). The mean age at diagnosis was 51 days. The sensitivity, specificity and positive predictive value of the first screening stage were 80.4%, 99.7% and 90.0%, respectively. The positive likelihood ratio was 268, while the negative likelihood ratio was 0.2.
  
  
  CONCLUSIONS
  Routine hearing screening of infants attending BCG immunization clinics by community health workers was feasible and effective for the early detection of PCEHL in Lagos, Nigeria. However, an efficient tracking and follow-up system is needed to improve return rates for second-stage screening and diagnostic evaluation.
authors.affiliation: College of Medicine, University of Lagos, Surulere, Nigeria. boolusanya@aol.com
authors.forename: B O
authors.initials: BO
authors.lastname: Olusanya
authors.forename: S L
authors.initials: SL
authors.lastname: Wirz
authors.forename: L M
authors.initials: LM
authors.lastname: Luxon
mesh_terms: D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D034381:Hearing Loss / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D009549:Nigeria / Q000453:epidemiology; D013997:Time Factors