title: The role of maternal socioeconomic factors in the commitment to universal newborn hearing screening in the Northeastern region of Brazil.
abstract: OBJECTIVE
  The implementation of early hearing detection in developing countries remains elusive. The fragile health care system along with insufficient funding for health care services leads to inadequate universal newborn hearing screening programs. There is a high incidence of loss to follow-up, at different stages of the program, in these countries, compromising the effect of early hearing screening programs. Strategies must be developed to improve family commitment to such programs. The objective of the present study was to examine factors that predict loss to second-stage follow-up at a municipal based, universal newborn hearing screening program in the Northeastern region of Brazil.
  
  
  METHODS
  The current cross sectional study includes 577 newborns who underwent hearing screening and failed. The population was divided into two groups: those who returned and those who were lost to second-stage screening. Differences between groups were explored and adjusted odds ratios were derived.
  
  
  RESULTS
  There was a significantly increased risk of non-adherence to the universal newborn hearing screening program in mothers with low income, few prenatal care visits, minimal education and with a multiparous child.
  
  
  CONCLUSIONS
  Socioeconomic factors may have a significant influence on the effectiveness of hearing screening programs in poorer regions of Brazil and other low-income countries. Improvements in health care politics, tracking system and public awareness is crucial for successful program implementation.
authors.affiliation: Departamento de Fonoaudiologia, Campus 1, Centro de Ciências da Saúde, Universidade Federal da Paraíba, João Pessoa-PB, 58051-900, Brazil. hannafono@gmail.com
authors.forename: Hannalice Gottschalck
authors.initials: HG
authors.lastname: Cavalcanti
authors.forename: Ricardo Oliveira
authors.initials: RO
authors.lastname: Guerra
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003241:Consanguinity; D019465:Craniofacial Abnormalities / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D034381:Hearing Loss / Q000175:diagnosis* / Q000453:epidemiology; D006320:Hearing Tests; D006801:Humans; D007231:Infant, Newborn; D059012:Lost to Follow-Up; D008875:Middle Aged; D015999:Multivariate Analysis; D015997:Neonatal Screening; D010298:Parity; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D013590:Syphilis, Congenital / Q000453:epidemiology; D055815:Young Adult