China

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China

  • Percent of children screened for hearing loss: 22%
  • Incidence of permanent hearing loss among newborns: 4.4 per 1,000

Current Status of Early Hearing Detection and Intervention for Children (500 word limit)

Approximately 20 million babies are born each year in China – of whom about 60 000 are expected to have congenital hearing loss. Recognizing the severe public health and social problems associated with hearing loss in infants and young children, the Chinese government has conducted pilot studies since 1999 and recommends newborn hearing screening as a routine procedure. Various regulations, national plans and technical criteria have been developed, and national and local training courses have been held every year since 2000. Newborn hearing screening practitioners must pass a government examination and be certified. Public-awareness activities and a National Ear Care Day, held every year are helping people recognize the importance of such screening.

Because China has so many births, three different models are used to identify hearing loss in infants and young children. First, hospital-based universal newborn hearing screening is strongly recommended by the government. About 20 of ? provinces (covering ?% of the population) have newborn hearing screening program that are conducted using OAE in the well-baby nurseries, and AABR in NICUs. The re-screening of infants who do not pass is done within 42 days. A diagnosis for those that do not pass the hearing screening is made in ENT/Audiology departments in the tertiary hospitals of each province when babies are 3–6 months of age. After diagnosis, educational and audiological programs are provided in dedicated centres beginning at age ?. Parents currently pay for screening (US$ 7 for OAE and US$ 14 for AABR) but there is an expectation that public health insurance will soon cover these costs. Education for children who are deaf or hard of hearing is (??free or paid for by parents or shared??)

Second, targeted screening is recommended for infants living in rural and remote areas. Neonates who have high-risk factors are referred to the screening centre within one month of birth. Third, questionnaires and simple tests are recommended to monitor every child’s hearing as part of a community screening approach.

Screening is designed to detect permanent bilateral or unilateral hearing loss of 30 dB or worse. Because there is no national database, accurate incidence data are not yet available but reports indicate that 2.87–5.90 per 1000 neonates are identified with hearing loss. It is estimated that 20–25% of all babies in China are screened for hearing loss but this is highly variable. In the capital and coastal cities, 95–98% of all neonates are screened. Hearing screening is also conducted in some cities on 6-year-old children (estimate % of population). In addition, a number of hospitals are conducting pilot studies evaluating newborn hearing screening plus screening for genetic mutations in mt12SrRNA 1555G; GJB2; and SLC26A4 genes.

The biggest challenges at the current time are the lack of human resources (especially audiological professionals), difficulty with follow-up of those who do not pass hearing screening, the lack of national and provincial databases, and the difficulties of programme implementation in remote and/or rural areas.


Demographics

  • Population (2012 est): 1,343,239,923
  • Number of Annual Births (2012 est): 16,534,800
  • Birth rate: 12.31 per 1,000
  • Percent of GDP spent on health care (2009): 4.6%
  • Percent of Health Care expenditures spent by government: 47.3%
  • Physician density: 1.41 per 1,000
  • Percent of newborns attended by skilled providers: 96%
  • Infant Mortality: 15.62 per 1,000
  • Literacy (age 15 and over can read and write): 92.2%

Publications about EHDI Programs in China (maximum of 5)

  1. Nie, W.Y., Wu, H.R., Qi, Y.S., Lin, Q., Zhang, M., Hou, Q., Gong, L.X., Li, H., Li, Y.H., Dong, Y.R., Guo, Y.L. Shi, J.N., Yin, S.Y., Li, P.Y., and Zhang, W.H. 2007. Simultaneous screening program for newborns hearing and ocular diseases. Chinese Journal of Otorhinolaryngology Head and Neck Surgery 42 (2):115-120.
  2. Sun, X., Shen X., Lv, J., Xu, Z., and Wu, H. 2009. Development of an effective public health screening program to assess hearing disabilities among newborns in Shanghai: A prospective cohort study. World Health & Population 11 (1):14-23.
  3. Wang, Q.J., Zhao, Y.L., Rao, SQ, Guo, Y.F., He, Y., Lan, L., Yang, W.Y., Zheng, Q.Y., Ruben, R.J., Han, D.Y., and Shen, Y. 2011. Newborn hearing concurrent gene screening can improve care for hearing loss: a study on 14913 Chinese newborns. International Journal of Pediatric Otorhinolaryngology 75 (4):535-542.
  4. World Health Organization. 2010. Newborn and infant hearing screening- current issues and guiding principles for action. WHO Report 2010:1-39.
  5. Zhang, V.W., McPherson, B., Shi, B.X., Tang, J.L.F., and Wong, B.Y.K. 2008. Neonatal hearing screening: a combined click evoked and tone burst otoacoustic emission approach. International Journal of Pediatric Otorhinolaryngology 72(3):351-360.

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