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South Africa

  • Percent of children screened for hearing loss:
  • Incidence of permanent hearing loss among newborns: 9 infants in every 1000 births

Current Status of Early Hearing Detection and Intervention for Children

The South African health care system is divided into the public sector which serves 85% of the population and the private sector which serves the remaining 15% of the population. Recent South African reports evidence some progress in the initiation of early hearing detection and intervention (EHDI) programs in both health care settings, but no mandated systematic hearing screening programs are available as yet. At present the prevalence of infant hearing loss has been estimated at 6/1000 live births in the public sector and 3/1000 live births in the private sector which amounts to a total of 17 babies to be born with or acquire early permanent hearing loss every day. These infants can only be detected early enough for optimal intervention outcomes through comprehensive hearing screening programs.

The negative effects associated with hearing loss are intensified by the burdened health care system and poor socio-economic conditions in South Africa. The longer the hearing loss goes undetected, the poorer the language and speech outcomes are likely to be with higher associated costs to the family and society. Vocational accomplishment is also severely hampered in South Africa where a considerable number of the disabled population resort to begging as an occupation and are nearly always economically dependent.

Infant hearing loss in South Africa is primarily detected passively when parents become concerned about speech and language delays, and usually occurs after 2 years of age. A recent study performed on an urban sample reported a mean age of diagnosis of hearing loss of 23 months (ranging from 2-27 months) and a mean age of initial hearing aid fitting of 28 months (ranging from 2-76 months). In this urban sample it was furthermore reported that the mean age of initial enrollment into an early intervention program was 31 months (ranging from 2-76 months). The pervasive lack of audiologic services is more significant in rural areas.

This can be attributed to the poor status of current EHDI services in South Africa. In the public sector, only 7.5% of hospitals provide some form of neonatal and infant hearing screening and less than 1% offer universal screening. In the private sector newborn hearing screening is available in 53% of obstetric units of which only 14% provided universal screening.

Although the principles of EHDI programs are supported by the Integrated National Disability Strategy White Paper and therefore the government, as well as the Position Statement produced by the Health Professions Council of South Africa it is not mandated by hospital management or universally included as part of maternal birthing services. Consequently, efforts to implement EHDI programs remain unsystematic and only available in certain hospitals with the exact status unknown.

A shortage of programs and suboptimal and inconsistent protocols for early hearing detection, follow-up, diagnosis, intervention and data management in existing programs mean the majority (>90%) of babies with hearing loss in South Africa will not be identified early. Newborn hearing screening must be integrated with hospital-based birthing services, ideally with a centralized data management and quality control system.

Publications about EHDI Programs in South Africa (maximum of 5)

  1. Swanepoel D., Störbeck C., & Friedland, P. (2009). Early hearing detection and intervention services in South Africa. International Journal of Pediatric Otorhinolaryngology, 2009(73), 783-786.
  2. Theunissen M., & Swanepoel, D. (2008). Early hearing detection and intervention services in the public health sector in South Africa. International Journal of Audiology, 47(Suppl. 1), S23-S29. DOI: 10.10801/14992020802294032
  3. Van der Spuy, T., & Pottas, L. (2008). Infant hearing loss in South Africa: Age of intervention and parental needs for support. International Journal of Audiology, 47(Suppl. 1), S30-S35.
  4. Meyer, M.E., Swanepoel, D., Le Roux, T. & Van der Linde, M. (2012). Early detection of infant hearing loss in the private health care sector of South Africa. International Journal of Pediatric Otorhinolaryngology, 76, 698-703.
  5. Meyer, M.E. & Swanepoel, D. (2011). Newborn hearing screening in the private health care sector –a national survey. South African Medical Journal, 101, 665-667.

Person responsible for most recent update:

Name: Miriam Elsa (Mirisa) Meyer & Prof De Wet Swanepoel

Affiliation: Department of Communication Pathology, University of Pretoria, South Africa