title: Universal infant hearing screening programme in a community with predominant non-hospital births: a three-year experience.
abstract: BACKGROUND
  To evaluate three-year outcomes of a pilot community-based universal newborn/infant hearing screening programme (UNHS) and the associated factors in a low-income country where a high proportion of births occur outside hospitals.
  
  
  METHODS
  A two-stage screening programme consisting of a first-stage transient evoked otoacoustic emissions and a second-stage automated auditory brainstem-response test was implemented in an inner-city community in Lagos, Nigeria from 2005 to 2008. Programme performance was measured by screening coverage, first-stage referral rate and second-stage screening results. The impact of infant's age-at-screening on otoacoustic emissions referral was assessed with survival analysis, while maternal/infant factors associated with screening results were explored by multinomial logistic regression analysis.
  
  
  RESULTS
  About 96.7% (7175) of eligible infants were screened, 51.7% of whom were born outside hospitals. Overall referral rate after second-stage screening was 1.8%. Cumulative proportion of otoacoustic emissions failures was significantly higher (p = 0.045) among infants born outside hospital compared to those born in hospitals. Low social class, screening after one month of age, multiple gestation and severe neonatal jaundice were predictive of screen failure, while multiparity, screening after one month of age and severe jaundice were independently associated with programme drop-out.
  
  
  CONCLUSIONS
  Community-based UNHS facilitates early detection of infants at risk of sensorineural hearing loss born outside hospitals and the overall performance is comparable to conventional hospital-based UNHS. Maternal education at antenatal clinics may be valuable in addressing the associated risk factors.
authors.affiliation: Department of Community Health and Primary Care, University of Lagos, Nigeria. boolusanya@aol.com
authors.forename: B O
authors.initials: BO
authors.lastname: Olusanya
authors.forename: O M
authors.initials: OM
authors.lastname: Ebuehi
authors.forename: A O
authors.initials: AO
authors.lastname: Somefun
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003153:Community Health Services / Q000458:organization & administration*; D004812:Epidemiologic Methods; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000453:epidemiology; D006320:Hearing Tests / Q000379:methods; D006700:Home Childbirth; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008423:Maternal Age; D009549:Nigeria / Q000453:epidemiology; D015397:Program Evaluation; D012923:Social Class; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult