الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Congenital hearing loss has been commonly reported as a significant health problem for which NS is a cost-effective way to reduce its burden. The aim of the current study was to implement the screening and follow up program for detecting PCEHL in neonates attending PHC units in Al-Agami district, Alexandria, Egypt. Using OAE tests are believed to reflect the active biomechanical movement of the basilar membrane of the cochlea. Initial hearing screening takes place during the first month of life using the OAE. ”Refer” or ”did not pass” means that the child will be rescreened, and then referred for a diagnostic audiological evaluation using ABR if confirmed as ”refer” for a second time. Testing with ABR detects electrical activity from the inner ear to the inferior colliculus. It is used as a diagnostic tool to estimate the degree and type of HI, determine the cause of delayed speech and localize the site of lesion in patients with HI.
A prospective longitudinal study design was carried out on 6344 neonate/ caregiver dyads attended the eight PHC units in Al-Agami district for NS of congenital hypothyroidism. An awareness intervention was conducted to inform and encourage all families about the EHDI program during their attendance to the PHC units for NS of congenital hypothyroidism and they were referred to Al-Bitash family health unit for EHDI program. The total number of neonates whose families responded and timely attached to initial screening of HI were 4164 neonates. Data were collected through:
•A predesigned structured interview questionnaire.
•General examination of the neonates.
•Audiological evaluation in the form of hearing screening and rescreening protocols.
•Referrals for diagnostic audiological evaluation with ABR.
•Follow up of infants with a defined risk factor of HI at age of 18 months to assess their linguistic development corresponding to their age
The SPSS 20.0 statistical package was used for data entry and analysis.
The study’s finding was as follows:
-Age of the studied neonates ranged between 1 and 28 days (mean: 7.29 ± 5.30 days). The percentage of boys and girls were 51.1% and 48.9% respectively. About one third (29.2%) represented the first child born to their families.
-Mothers were significantly (P=0.000) more involved in the screening process as an accompanied person in later neonatal age group.
-Less than one third (30.5%) of mothers were completed their university education and most of them were housewives (87.2%), while more than one half of fathers were completed their university education and almost all of them were working (99%). The mean family size was 1.41 members ± 0.496. The mean crowding index was 2.84 ± 0.454. Most families (69.1%) were always in debt. More than three quarters (77.8%) were of medium SES.
-Consanguineous marriage was reported among families of 581 neonate (60 % of them had 1st cousin marriage).
-Most of the mothers (98.4%) stated that they had ANC. All of them denied receiving any health education message about EHDI during ANC visits.
-Neonates with high risk of HI represent 4.3% of the studied neonates. Low birth weight and family history of HI are the most frequent high-risk indicators of HI in the current study (2.1 % and 2% respectively).
-About two thirds (66%) of the neonates attended for NS of congenital hypothyroidism had early screening of HI during the study period compared to 16% during six months prior to the study and 13% during four months following the study with increasing trend in monthly coverage rate of initial screening throughout the study period.
-Parents’ response to ”face-to-face orientation” was significantly high (P=0.000) among those referred from the screening setting itself (internal routing).
-The initial screening coverage rate was indirectly proportionate to the distance between the hearing screening setting and referral unit.
- The vast majority of parents/ caregivers (97.9%) had a poor knowledge level regarding HI and EHDI service and only 2.1% had a fair knowledge level with mean knowledge score of 4.39±1.76.
- Most neonates (93.6%) passed the initial hearing screening. About two thirds of the referred neonates (62.4%) showed bilateral referral results. The highest percent (92.2%) of neonates who failed the initial screening came back for rescreening and they all passed the rescreening test. All neonates with high-risk indicators of HI (179) were referred to ABR before completion of 3 months of age, one quarter of parents (27.4%) commit to the referral. Among neonates who performed ABR, HI was reported among 3 neonates (6%). The coverage rate of linguistic follow up at age of 18 months was (191/ 231= 82.7%).
-The prevalence of HI among the studied neonates was 0.07%.
-The mean age of initial screening was significantly lower among neonates of high SES and those with family history of HI among 1st degree relatives.
-Right ear advantage (pass result) was seen among 80% of neonates who tested the right ear first and 45.7% of neonates who tested the left ear first with significant difference between both groups (P= 0.001).
-The most frequent cause of dropout from rescreening was caregiver misbeliefs (61.1%) while that of dropout from ABR confirmation was the far distance to place of ABR (71.5 %) and all children who dropped from follow up can’t be reached by phone calling.
-Initial OAE screening referral rate was significantly higher (P= 0.013) among those with high-risk indicators of HI than those without risk factors.
-Rescreening return rate was significantly higher among those with higher socioeconomic standard and those who travel shorter distance for rescreening.
-Parents of higher SES were significantly more likely to attend for ABR confirmation than those of lower SES. Significant higher response rate was noticed also among neonates with FH of HI, and those who had NICU-related high-risk indicators.
-Low SES was significantly associated with presence of NICU-related high-risk indicators (P=0.001), while high SES was significantly associated with presence of any risk factor (P=0.028).
-Twins tended to show significantly higher percentage of low birth weight (P=0.001), prematurity (P=0.000), existence of NICU related high-risk indicators (P=0.000), and presence of any high-risk indicators (P=0.000) than non-twins.
-Significant association was found between consanguinity and NICU- related high-risk indicators (P=0.031). Maternal illness during pregnancy significantly associated with neonatal low birth weight (P=0.000), prematurity (P=0.000), existence of NICU- related high-risk indicators (P=0.000), and presence of any risk factor (P=0.000).
Based on the current study findings, the following can be recommended:
•Implementing large-scale health education campaigns to raise the general knowledge level and increase community awareness of the prevalence of HI, the risk factors that contributed to it, and the importance of EHDI.
•National policy to support the application of EHDI program universally and inclusion of hearing screening services to the integrated childcare system.
•Control the challenges and obstacles facing caregivers to be timely attached to different stages of EHDI.
•Choosing a well-manufactured OAE device with available spare parts, that meeting quality standard, with regular maintenance, and clear and easy calibration methods.
•Further researches on national scales are recommended to estimate frequency of HI, to investigate on depth variable risks of HI, and to elaborate main barriers facing UNHS.