Nigeria

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Nigeria

  • Percent of children screened for hearing loss:
  • Incidence of permanent hearing loss among newborns:

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

The secondary prevention strategy of screening infants for the early detection of conditions that cannot be addressed by primary prevention is rare in Nigeria – as it is in many developing countries. The high prevalence of hearing loss (about 14%) documented by one 1995 study conducted among school-age children in regular schools, as well as a 2002 national population survey, culminated in the first early childhood hearing detection and intervention policy for Nigeria in 2004.

In 2005, a local nongovernmental organization (Hearing International Nigeria) in partnership with the Federal and Lagos State Ministries of Health initiated the first pilot infant hearing screening programmes. Between May 2005 and April 2006, a total of 3333 infants were screened either in the hospital at birth (n = 1330) or in 4 community clinics when they received Bacille de Calmette-Guérin (BCG) immunization (n = 2003). About 99% of eligible neonates were successfully screened at a mean age of 1.3 days in the hospital compared to 88% of infants at a mean age of 17.7 days in the community – where the majority were born outside hospital facilities. First-stage referrals were 32.2% in the hospital compared with 14.3% in the community-based programme, while second-stage referrals were 3.3% and 4.2% respectively. However, only 50 out of 82 infants (61%) referred in the community returned for diagnostic evaluation. Of these, 45 (90%) were confirmed with hearing loss. Additionally, 11 infants who had previously passed the first-stage screening were also confirmed with hearing loss resulting in a yield of 28 per 1000 (56 out of 2003).

The mean age at diagnosis in the hospital-based and community-based programmes was 233 and 51 days respectively. Sensitivity, specificity and positive predictive values for the community-based programme were 80.4%, 99.7% and 90.0% respectively. Corresponding values for the hospital-based programme were not available due to a very poor follow-up return rate. In the community-based programme, positive and negative likelihood ratios were 268 and 0.2 respectively, whilst the screening cost per infant and the cost per infant detected with sensorineural hearing loss were US$ 7.62 and US$ 602.49 respectively. Risk factors for sensorineural hearing loss were hyperbilirubinaemia requiring exchange blood transfusion, birth asphyxia (indexed by low Apgar scores), admission into a special care baby unit (SCBU), absence of a skilled attendant at birth, maternal hypertension and undernourished physical state.

The routine screening of infants attending BCG immunization clinics by community health workers without prior audiological experience is feasible and effective in the early detection of permanent congenital or early-onset hearing loss in Nigeria. It also appears to be more cost effective in this setting where non-hospital deliveries are predominant, a situation typical of many resource-poor countries. However, an efficient tracking and follow-up system is needed to improve the return rates for screening completion and diagnostic evaluation.


Demographics

  • Population (2012 est): 170,073,740
  • Number of Annual Births (2012 est): 6,671,900
  • Birth rate: 39.23 per 1,000
  • Percent of GDP spent on health care (2009): 5.2%
  • Percent of Health Care expenditures spent by government: 36.7%
  • Physician density: 0.395 per 1,000
  • Percent of newborns attended by skilled providers: 39%
  • Infant Mortality: 74.36 per 1,000
  • Literacy (age 15 and over can read and write): 68%


Publications about EHDI Programs in Nigeria (maximum of 5)

  1. Olusanya, B.O., Swanepoel, D.W., Chapchap, M.J., Castillo, S., Habib, H. Mukari, S.Z., Martinez, N.V., Lin, H.C., and McPherson, B. 2007. Progress towards early detection services for infants with hearing loss in developing countries BMC Health Service Research 7: 14.
  2. Olusanya, B.O., Wirz, S.L., Luxon, L.M. 2008. Hospital-based universal newborn hearing screening for early detection of permanent congential hearing loss in Lagos, Nigeria. International Journal of Pediatric Otorhinolaryngology 72 (7): 991-1001.
  3. World Health Organization. 2010. Newborn and infant hearing screening- current issues and guiding principles for action. WHO Report 2010: 1-39.

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