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Hearing Impairment Among Children Referred to a Public Audiology Clinic in Gaborone, Botswana

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Hearing Impairment Among Children Referred to a Public Audiology Clinic in Gaborone, Botswana Hearing Impairment Among Children Referred to a Public Audiology Clinic in Gaborone, Botswana The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Banda, Francis M., Kathleen M. Powis, Agnes B. Mokoka, Moalosi Mmapetla, Katherine D. Westmoreland, Thuso David, and Andrew P. Steenhoff. 2018. “Hearing Impairment Among Children Referred to a Public Audiology Clinic in Gaborone, Botswana.” Global Pediatric Health 5 (1): 2333794X18770079. doi:10.1177/2333794X18770079. http://dx.doi.org/10.1177/2333794X18770079. Published Version doi:10.1177/2333794X18770079 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:37160298 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA GPHXXX10.1177/2333794X18770079Global Pediatric HealthBanda et al 770079research-article2018 Original Article Global Pediatric Health Volume 5: 1 –8 Hearing Impairment Among Children © The Author(s) 2018 Reprints and permissions: sagepub.com/journalsPermissions.nav Referred to a Public Audiology Clinic DOI:https://doi.org/10.1177/2333794X18770079 10.1177/2333794X18770079 in Gaborone, Botswana journals.sagepub.com/home/gph Francis M. Banda, MBBS, FCPaed1, Kathleen M. Powis, MD, MPH, MBA2,4, Agnes B. Mokoka, MClin Aud5, Moalosi Mmapetla, MClin Aud5, Katherine D. Westmoreland, MD1,6,7, Thuso David, MBCHB, BAO, FCPaed1, and Andrew P. Steenhoff, MBBCh, DCH, FCPaed, FAAP1,6,7,8 Abstract Objective. To describe and quantify hearing impairment among children referred to the audiology clinic in Princess Marina Hospital, a public referral hospital in Botswana. Methods. In a retrospective case series, we reviewed medical records of children aged 10 years and younger whose hearing was assessed between January 2006 and December 2015 at the audiology clinic of Princess Marina Hospital in Gaborone, Botswana. Results. Of 622 children, 50% were male, and median age was 6.7 years (interquartile range = 5.0-8.3). Hearing impairment was diagnosed in 32% of clinic attendees, comprising sensorineural (23%), conductive (25%), and mixed (11%) hearing loss, while 41% of children with diagnosed hearing impairment did not have a classification type. Hearing impairment was mild in 22.9%, moderate in 22.4%, severe in 19.4%, profound in 16.9%, and of undocumented severity in 18.4%. Children younger than 5 years were 2.7 times (95% confidence interval = 1.29-5.49; P = .008) more likely to be diagnosed with sensorineural hearing impairment compared with those older than 5 years. By contrast, children older than 5 years were 9.6 times (95% confidence interval = 2.22-41.0; P = .002) more likely to be diagnosed with conductive hearing loss compared with those under 5 years. Conclusion. Hearing impairment was common among children referred to this audiology clinic in Botswana. Of those with hearing impairment, more than a third had moderate or severe deficits, suggesting that referrals for hearing assessments are not occurring early enough. Hearing awareness programs individually tailored to parents, educators, and health care workers are needed. Neonatal and school hearing screening programs would also be beneficial. Keywords children, Botswana, hearing impairment, hearing loss, audiology Received January 8, 2018. Accepted for publication January 22, 2018. Introduction Childhood-onset hearing impairment is very common, 1University of Botswana, Gaborone, Botswana with global estimates that 5 of every 1000 infants are 2Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana born with or develop disabling hearing impairment in 3Massachusetts General Hospital, Boston, MA, USA early childhood.1 Hearing impairment is estimated to be 4Harvard University, Boston, MA, USA 5 the most common disabling condition worldwide.2 Princess Marina Hospital, Gaborone, Botswana 6University of Pennsylvania, Philadelphia, PA, USA Global estimates by the World Health Organization 7Children’s Hospital of Philadelphia, Philadelphia, PA, USA (WHO) indicate that close to 360 million people have 8Botswana-UPenn Partnership, Philadelphia, PA, USA disabling hearing impairment, of which 32 million are Corresponding Author: children.1 Two thirds of people with hearing impair- 3 Francis M. Banda, Department of Paediatric & Adolescent Health, ment worldwide live in developing countries, where University of Botswana, Post Bag 00713, Gaborone, Botswana. 4 2000 infants with hearing impairment are born daily. Email: [email protected] Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non- commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 Global Pediatric Health Disabling hearing impairment in children is defined loss. Universal infant hearing screening is not currently a by a hearing loss greater than 30 decibels (dB) in the component of newborn health care in Botswana. better hearing ear.5 The severity of hearing impairment Hearing outcomes of children in Botswana have not is classified as mild (26-40 dB hearing level [dB HL]), been well studied. Using data from children referred to moderate (41-60 dB HL), severe (61-80 dB HL), and an audiology clinic at Botswana’s largest hospital, we profound (81 dB HL or greater).5,6 address this gap, summarizing referral reasons, age at Hearing impairment in children has both developmen- first referral, and the nature and magnitude of hearing tal and economic impacts. It causes significant delays in impairment, if identified. language development and academic achievement.3,7 These delays are apparent even with mild to moderate 2,8-11 Methods hearing impairment. Without early intervention, the poor academic performance of children with hearing Study Site, Participants, and Design impairment persists. In these children, their hearing impairment may only be identified much later in their edu- Princess Marina Hospital (PMH), located in Gaborone, cation.12 Hearing impairment in children also has an eco- Botswana’s capital city, is the nation’s largest hospital nomic impact.13 It is associated with lower employment and serves as 1 of 2 public service audiology clinics in levels during adulthood.14 In 2000 in the United States, Botswana. Using a retrospective descriptive design, we severe to profound hearing impairment was estimated to reviewed records of children aged 10 years and younger, cost society $297 000 over the lifetime of an affected indi- with audiology assessments between January 2006 and vidual, mostly due to reduced work productivity.15 December 2015 at PMH’s audiology clinic. Furthermore, in 2015 in South Africa, the total average medical costs for a child for the first 5 and 10 years post– Procedure cochlear implantation were $27 000 and $40 000, respec- tively.16 Conversely, outcomes are excellent in infants in Data were extracted from archived paper patient medi- whom hearing impairment is identified early and an inter- cal records. Variables of interest included age of the vention is initiated by 9 months of age. These infants child at the time of referral, sex, reason for referral, type develop language at a rate that has the potential to match of hearing test done, whether hearing impairment was that of their peers who have no hearing impairment.3,4,17 present, and type and severity of hearing impairment 3,5 There is, therefore, an urgent need to identify infants using the WHO classification system. and children with hearing impairment as early as possi- ble so that appropriate interventions can be instituted. Data Analysis The Joint Committee of Infant Hearing, the American Academy of Pediatrics, and the American Academy of We generated descriptive statistics and compared pro- Audiology have published guidelines that recommend portions of children with or without hearing impairment, early detection of and intervention for infants with hear- including severity, using the χ2 test. P < .05 was consid- ing impairment.18,19 The goal of “Early Hearing ered statistically significant. We used SAS 9.4 software Detection and Intervention” is to maximize linguistic (SAS Institute, Cary, NC; 2012) for analyses. competence and literacy development for children who have hearing impairment so that they do not fall behind their hearing unimpaired peers in communication, cog- Ethical Approval 18 nition, reading, and social-emotional development. Approval was obtained from the institutional review The magnitude of hearing impairment among chil- boards of the University of Botswana, Princess Marina dren in Botswana is not known. Given that at least 2 new- Hospital, and the Botswana Ministry of Health. borns are born deaf for every 1000 live births in developing countries,3 and using Botswana’s 2012 birth cohort of 47 700 live births,20 at least 96 newborns would Results be expected to be born deaf each year in Botswana. There are only 2 government-run audiology clinics in Botswana. Demographics and Study Population Recently, audiology services are also offered at one pri- We screened 666 patient records, excluding 44 (7%) that vate hospital. The Botswana government funds special had an inconclusive hearing test, resulting in 622 (93%) education programs for children with severe hearing children with a conclusive hearing test for analysis loss.21 Botswana’s public health service also provides (Figure 1). Fifty percent of the children were males, and hearing aids to selected children with significant hearing the median age was 6.7 years (interquartile range [IQR] Banda et al 3 Figure 1. Study flow diagram. = 5.0-8.3; Table 1). A quarter of the children were less Of the 622 children with known hearing outcome, 201 than 5 years old when first seen at the audiology clinic. (32%) had hearing impairment, while 421 (68%) had normal hearing (Table 2).
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