title: Follow-up default in a hospital-based universal newborn hearing screening programme in a low-income country.
abstract: BACKGROUND
  Effective early detection of infants with permanent hearing impairment requires parental compliance with various stages of a screening protocol. However, many infants who failed initial screening tests are often not presented for follow-up evaluation, thus compromising prospects for early detection and intervention. This study set out to determine maternal and infant factors associated with loss to follow-up in a hospital-based universal hearing screening programme in a low-income country.
  
  
  METHODS
  A cross-sectional study in which babies in a tertiary maternity hospital were enrolled into a two-stage hearing screening programme with transient-evoked otoacoustic emissions followed by automated auditory brainstem response (AABR) for all transient-evoked otoacoustic emissions referrals before hospital discharge. Diagnostic evaluation was scheduled for AABR referrals on outpatient basis. Correlates of non-compliance were determined through multivariable logistic regression analyses of relevant maternal and infant factors.
  
  
  RESULTS
  Some 1330 babies participated in the first-stage screening and of 551 scheduled for AABR; 56 (10.2%) did not complete. Some 37 (84.1%) of the 44 AABR referrals did not complete the diagnostic evaluation. There were no significant differences between the profile of those who did not complete either the second-stage screening or diagnostic evaluation and those who completed across virtually all socio-demographic factors except that Christian mothers were significantly more likely not to complete the second-stage screening than diagnostic evaluation compared with their Muslim counterparts (odds ratio: 3.01; 95% confidence intervals: 1.17-7.87). The only independent predictors of non-compliance with pre-discharge screening were delivery by spontaneous vertex (odds ratio: 2.76; 95% confidence intervals: 1.47-5.19) and admission into special care baby unit (odds ratio: 5.62; 95% confidence intervals: 2.92-10.84) while no factor was predictive of non-compliance with diagnostic evaluation.
  
  
  CONCLUSIONS
  Mode of delivery or having high-risk baby influences compliance before hospital discharge while factors other than maternal or infant socio-demographic/medical profile such as unfavourable cultural beliefs and stigma may be key determinants of follow-up compliance after discharge.
authors.affiliation: Unit of Audiological Medicine/Centre for International Child Health, Institute of Child Health, London, UK. boolusanya@aol.com
authors.forename: B O
authors.initials: BO
authors.lastname: Olusanya
mesh_terms: D003430:Cross-Sectional Studies; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D034381:Hearing Loss / Q000175:diagnosis* / Q000453:epidemiology; D006320:Hearing Tests / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D009035:Mothers / Q000706:statistics & numerical data*; D015997:Neonatal Screening / Q000379:methods; D009549:Nigeria / Q000453:epidemiology; D017084:Otoacoustic Emissions, Spontaneous; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D012067:Religion; D012959:Socioeconomic Factors; D055815:Young Adult