International Journal of Pediatric Otorhinolaryngology
Identification and follow-up of children with hearing loss in Mauritius
Introduction
Early intervention is an umbrella term inclusive of identification of hearing loss, placement of hearing aids followed by communication intervention and education with parent-professional partnership throughout the early intervention programme [1]. Early intervention holds the promise of optimising a hearing-impaired child's language, speech, intellectual and psychosocial development and occupational/economic opportunity [2], [3]. The major goal of early intervention is to prevent the development of secondary problems in language, communication, cognition and social interaction. Early infancy is the most appropriate time for the child to acquire the foundations of language and communication, so that he/she can then follow the same naturally developing patterns of hearing children. [4], [5], [6], [27].
Clinical observations indicate that, in Mauritius, children with hearing loss are not identified early enough and that the follow-up seem to be fragmented and inconsistent. To effect necessary changes in health care, countries must decide on the best approaches to adopt within the context of their specific characteristics and needs. This requires detailed and accurate information on needs, possibilities and consequences of recommended actions. Such information is often lacking, inadequate or unreliable, resulting in inappropriate policy choices [7].
This is especially true in the case of developing countries. The constraints to early intervention that often characterize these countries can be summarised as follows:
- •
Lack of data regarding prevalence and epidemiology of hearing loss;
- •
Lack of human resources in the hearing care field (Audiologists, Teachers for the Deaf);
- •
Lack of technology;
- •
Inconsistent and fragmented follow-up hearing programmes;
- •
Lack of hearing aids and effective back-up service thereof [8];
- •
Lack of specific policies regarding education service [28];
- •
Multiplicity of languages spoken among the hearing population [9].
These constraints are common to Mauritius, which is a small developing country in the Indian Ocean. The island spans an area of 1865 km2. In 1997, the total population was estimated at 1 112 636. The crude birth rate was 17.4 with a total fertility rate of 2.12 [10]. The size of the island has positive implications for early intervention as children with hearing loss can access the available services readily and the limited population makes intervention goals achievable.
As Mauritius is a welfare state, the education and health services are free. Primary education is compulsory from the ages of 5–12 years and the literacy rate in the island is 83.2%. The infrastructure for Primary Health Care is well organised. Public awareness in paediatric care is very high, as health centres are centred in every district to promote health care and education. The immunisation system includes B.C.G, measles, M.M.R. D.P.T poliomyelitis and Hepatitis B. Immunisation coverage for 1997 was 87.1% [10]. This is important from the point of view of preventable causes of hearing loss.
Socio-economic factors and health structure indicate that Mauritius, a small developing country, is ready to take on the challenge of Healthy People 2000 [11], that is ‘identification of hearing loss by 12 months of age’. However, identification programmes should be instituted only when all components are available to provide appropriate follow-up services to the infant and his/her family [12], [13]. This emphasizes the importance of planning and co-ordination of early intervention programmes based on the needs and services available.
Sound research and the documentation of results should be implemented in order to support decisions regarding the implementation of early intervention for children with hearing loss. Local constraints and limitations must be considered when implementing recommendations for early intervention. However this should not deter efforts to resolve any constraints and limitations on best practice [14].
Thus, it is the aim of this study is to answer the following question: What is the current situation pertaining to early identification and the subsequent follow-up for children with hearing loss in Mauritius? The outcome of this study is not only the audit of a situation in a specific context (Mauritius) but it can form the basis of a proposal for an early intervention programme for a developing country.
Section snippets
Methodology
The following research aims were formulated:
- •
To determine the high-risk indicators for hearing loss that are present among the children with hearing loss
- •
To determine the age of identification and describe the identification process
- •
To describe the diagnostic process and relevant milestones
- •
To describe the management process followed after diagnosis of hearing loss
An exploratory, descriptive, qualitative research design was selected. The method selected for the data collection was a survey research
Etiology and high risk indicators
From responses to sections 3 and 4 of the questionnaire it was concluded that most of the respondents could indicate the possible cause of their children's hearing loss. This information is presented in Table 2.
Age of identification and related aspects
Quantitative analyses using medians were performed on the following variables: age of suspicion of hearing loss; age of referral for hearing assessment; age of diagnosis of hearing loss; age of hearing aids placement on the child (Table 3).
Maximum delays were noted from age of suspicion
Etiology and high risk indicators
From Table 2 it is clear that 21.6% had family history of hearing loss. However, no history of consanguineous marriages was reported among the parents of the children studied. It is important to note that in the case of six children the maternal high risk factor of rubella was indicated. In the open questions all the mothers stated that this aspect was discussed at the prenatal clinic which is indicative of a system that can successfully be used for identification.
What is also important is that
Conclusion
The strengths present within the Mauritian community offer opportunities for creative problem solving. Families of infants and young children with hearing loss face a range of difficulties and frustrations in obtaining services and utilising the existing service delivery system. The difficulties appear to be surmountable with effective planning. From the descriptive study, it can be concluded that for children with hearing loss in Mauritius change is possible, as the building blocks are
References (29)
Early intervention and management of the infant with hearing loss
Semin. Hear.
(1996)- et al.
Universal screening for infant hearing impairment: necessary, beneficial and justifiable
Audiol. Today
(1994) Efficacy of early identification and early intervention
Semin. Hear.
(1995)- American Speech–Language–Hearing Association, The prevention of communication disorders tutorial, ASHA, 33 (Suppl. 6)...
- et al.
Infants and Toddlers with Hearing Loss
(1994) Models and current practices in early intervention with hearing-impaired infants
Semin. Hear.
(1994)- C.M. Varkevisser, I. Panthmanathan, A. Brownlee, Health Systems Research Training Series, vol. 2, part 1, International...
- World Health Organization, Prevention of hearing impairment in Africa: Report of a WHO Workshop, Nairobi,...
Programs For hearing impaired children overseas
Semin. Hear.
(1997)- Health Statistics Annual, Ministry of Health and Quality of Life, Island of Mauritius,...
Universal hearing screening for infant hearing impairment: not simple, not risk-free, not necessarily beneficial, and not presently justifiable
Pediatrics
Universal hearing screening: the question is, not if, but when?
Hear. J.
Cited by (28)
Knowledge and attitude of nurses about newborn hearing screening in Nepal
2022, Journal of Neonatal NursingCitation Excerpt :However, hearing loss in newborns can be an invisible or a concealed disability that usually manifests after the first year of life due to delayed speech and language development. Parents, however, typically do not become suspicious until the second year of a child's life (Elton, 2005; Gopal et al., 2001). The period from birth to five years is frequently referred to as the “critical phase” for language development (Carney and Moeller, 1998).
State of deaf children in West Bengal, India: What can be done to improve outcome
2018, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Furthermore, it is instructive to consider the situation of deaf children in the broader context of other developing countries. For example, studies from South Africa (median age of maternal suspicion and identification of deafness of 18 and 28 months respectively) [31], Brazil (age of suspicion, diagnosis and provision of hearing aid of 1 year and 9 months, 4 years and 3 months and 7 years and 5 months respectively) [32], Nigeria (mean age of parental detection of hearing loss of 2.3 years) [33], Cameroon (mean age of diagnosis of 3.3 years) [34], Kenya (mean age of identification of 5.5 years [35], Mauritius (mean age of identification of 24 months) [36] and Malaysia (in majority of cases, parental suspicion was between 1 and 3 years and diagnosis between 1 and over 3 years of age [37]. Thus, without newborn hearing screening, most developing countries are also substantially missing the benchmark EHDI standards.
Societal impact of bilirubin-induced hearing impairment in resource-limited nations
2015, Seminars in Fetal and Neonatal MedicineCitation Excerpt :In fact, all degrees and configurations of permanent hearing impairments in early childhood can present with great subtlety; most parents are unable to identify their child's hearing impairment before the associated speech and language delays become apparent. In the absence of a systematic effort to screen infants with hearing loss, the average age of detection is well over 2 years and detection may be as late as 6 years and beyond [43,44]. Whereas speech and language difficulties are the most direct consequences of hearing loss, auditory deficits in early childhood compromise optimal growth and functioning in all developmental domains (fine and gross motor, cognitive, speech and language, and psychosocial/emotional behavior) as shown in Fig. 1 [4,45–49].
The effectiveness of the promotion of newborn hearing screening in Taiwan
2014, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Before the era of UNHS, diagnostic audiological assessments were only conducted for the children suspected with hearing loss when they were found with a speech and language delay or poor response to sound by their parents. Without UNHS, the average age of detection of congenital hearing loss remains later than 24 months and hearing aid fitting on 30 months [15]. It seems that early diagnosis and intervention of congenital hearing impaired children cannot be achieved without UNHS.
Age of identification of hearing impairment in Mumbai-A trend analysis
2011, International Journal of Pediatric OtorhinolaryngologyNeonatal hearing screening in Benin City
2010, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :Parental concern may be non-existent for children with mild, unilateral or fluctuating hearing loss. Because of the lack of a well established screening program for neonatal hearing loss at present, the age of identification could be 12 months and over in developing countries [13]. In this study, the absence of otoacoustic emissions in both ears was taken as the neonate failing the test while its presence in one or both ears was considered as a pass.
- 1
Ministry of Health, Mauritius.