Olusanya B.O., Emokpae A., Renner J.K., Wirz S.L.
Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria; Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London, WC1N 1EH, United K
Olusanya, B.O., Institute of Child Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria, Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London, WC1N 1EH, United Kingdom; Emokpae, A., Massey Street Children's Hospital, Lagos, Nigeria; Renner, J.K., Department of Pediatrics, Lagos University Teaching Hospital, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria; Wirz, S.L., Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London, WC1N 1EH, United Kingdom
In line with global progress towards early detection of permanent congenital and early-onset hearing loss (PCEHL), the costs and performance of hospital-based and community-based infant hearing screening models were evaluated in Lagos, Nigeria. The protocol consisted of two-stage screening with transient-evoked otoacoustic emissions and automated auditory brainstem response followed by diagnostic evaluation for all infants referred after the second-stage screening. The main outcome measures were referral rates at screening, cost per baby screened, cost per case detected and yield for PCEHL. First-stage referrals were 32.2% for universal and 31.7% for targeted screening in the hospital, compared with 14.3% and 15.2%, respectively for the community-based programme. Second-stage referrals ranged from 3.3% under hospital-based universal screening to 4.9% under community-based targeted screening. The highest yields of 27.4 and 22.5 per 1000 were recorded under community-based targeted and universal screening, respectively. Screening cost per child was lowest (US$7.62) under community-based universal screening and highest (US$73.24) under hospital-based targeted screening. Similarly, cost per child detected with PCEHL was lowest (US$602.49) for community-based universal screening and highest (US$4631.33) for hospital-based targeted screening. Community-based universal screening of infants during routine immunisation clinics appears to be the most cost-effective model for early detection of PCEHL in low-income countries. © 2008 Royal Society of Tropical Medicine and Hygiene.
article; community care; congenital deafness; cost effectiveness analysis; diagnostic procedure; early diagnosis; evoked brain stem auditory response; evoked otoacoustic emission; health care cost; health program; human; infant; lowest income group; major clinical study; Nigeria; patient referral; screening; Early Diagnosis; Evoked Potentials, Auditory, Brain Stem; Female; Hearing Loss; Hearing Tests; Humans; Infant; Infant, Newborn; Male; Neonatal Screening; Nigeria