Lecture 2: Screening Across the Lifespan PDF

Lecture 2 z Screening across the lifespan z OVERVIEW § INTRODUCTION § HEARING SCREENING IN NEW BORNS AND INFANTS Ø Need and rationale Ø Current status and practices Ø Guiding principles Ø Target groups and aims z Introduction...

Lecture 2 z Screening across the lifespan z OVERVIEW § INTRODUCTION § HEARING SCREENING IN NEW BORNS AND INFANTS Ø Need and rationale Ø Current status and practices Ø Guiding principles Ø Target groups and aims z Introduction z Introduction § By 2050 nearly 2.5 billion people will be living with some degree of hearing loss, at least 700 million of whom will require rehabilitation services (WHO report on hearing,2022) § Currently, this number is 430 million, which includes people with moderate or higher grades of hearing loss who are most likely to benefit from hearing rehabilitation services. § The sizeable gap in the need for, and access to, EHC services is indicated by the fact that only 17% of those who could benefit from a hearing aid, actually access or use one. z INTRODUCTION § In the World report on hearing,it was recommended that integrated people- centred ear and hearing care (IPC-EHC) within national health systems, and § Outlines a set of H.E.A.R.I.N.G. interventions (next slides), that ensure that people with hearing loss or ear diseases receive the care and rehabilitation services they need. § Early intervention is critical to successful rehabilitation outcomes in people with hearing loss, as delays have a negative impact on language development, communication, social well-being and cognition z Hearing intervention z § Since hearing loss is invisible, it commonly remains undetected, both in children and adults. For this reason, it is important that special measures are put in place to screen for hearing loss at different stages across the life course § Those most likely at risk include: § O newborns and infants; § O children, especially in pre-school and school settings; § O older people; and § O those who are exposed to noise, ototoxic chemicals and ototoxic medicines and are thus at greater risk of hearing loss. z HEARING SCREENING ON NEW BORNS AND INFANTS z NEED AND RATIONALE § Unaddressed hearing loss, including congenital hearing loss, constitutes a serious obstacle to a child’s development, education, and social integration § The impact of unaddressed hearing loss extends beyond adverse speech and language outcomes, especially in low- and middle countries § A key mitigating factor is the age at which intervention (amplification or enrolment in educational programmes) is initiated z NEED AND RATIONALE 2 § There is a significant body of research demonstrating that children whose hearing loss is identified at an early stage and who receive early intervention have better outcomes than those with later detection and treatment § Literature shows that children who are born deaf or who acquire hearing loss very early in their life and who are identified and receive appropriate interventions within 6 months of age are on a par with their hearing peers in terms of language development by the time they are 5 years of age z NEED AND RATIONALE § Early identification and intervention in newborns is made possible through newborn hearing screening (NHS) § When followed by prompt and suitable rehabilitation, hearing screening of newborns brings significant advantages both in terms of reducing the age of diagnosis and intervention and of improved language and cognitive development § These advantages translate into improved social and educational outcomes for infants who receive timely and suitable care z NEED AND RATIONALE § Cost–effectiveness studies have further demonstrated the financial benefits of universal newborn hearing screening (UNHS) in high-income, lower-middle- income and middle-income countries z CURRENT STATUS AND PRACTICES § Successful newborn hearing screening programmes have been implemented in several countries using a variety of screening methods, protocols, and linkages to existing health care, social and educational systems § It is estimated that nearly one third of the world’s population, living mainly in high-income regions, is fully or nearly fully covered by newborn hearing screening programmes z CURRENT STATUS AND PRACTICES § The degree of implementation and coverage of such programmes varies substantially across the world. A recent publication shows that screening coverage is closely associated with average living standards and economic well-being § The lack of relevant policies, human resources, equipment and financial resources for NHS are challenges very commonly faced in low- and middle- income countries. z CURRENT STATUS AND PRACTICES § These challenges are further aggravated by a low awareness about hearing loss and its associated stigma § There is also variation in how NHS is currently implemented worldwide. However, most guidelines adopted are based on the underlying principles of the position statement of the Joint Committee on Infant Hearing (JCIH) z CURRENT STATUS AND PRACTICES § While each country must develop its screening protocol based on several factors, such as the nature and severity of the hearing loss to be identified, Ø the screening tools available, Ø legislative support, Ø the availability of qualified personnel and competent audiology services, Ø cultural diversity, resources available and cost value , Ø the principles underpinning the JCIH recommendations form a strong basis for UNHS z GHANA CURRENT SITUATION § ?????????????????????????????? z JOINT COMMITTEE ON INFANT HEARING(JCIH) § Newborn hearing screening, where practicable, should be based on the “1– 3–6” principle  z JOINT COMMITTEE ON INFANT HEARING GOALS GOALS § All infants should undergo hearing screening within the § In places where infants are predominantly born first month of life. outside of hospital settings or where access to health care is limited and where it is not feasible to § All infants whose initial screening and subsequent re- achieve the 1–3–6 timeline, the NHS programmes screening warrant diagnostic testing, should have should strive to remedy this over time. appropriate audiologic evaluation by no later than 3 months of age to confirm the infant’s hearing status. § Wherever feasible, the NHS programme should be integrated with, or linked to, existing health-care, § Once hearing loss has been diagnosed, the infant and educational or social systems, and the procedures family should have immediate access to early intervention and outcomes documented and reported service. This should begin as soon as possible after diagnosis, and no later than 6 months of age.  z JCIH goals cont. § The programme should adopt a family-centred § Regardless of the outcome of their approach, with infant and family rights and newborn hearing screening, all privacy guaranteed through informed and shared infants and children should be decision-making, and family consent in routinely monitored with respect accordance with state and national guidelines to: hearing, cognitive development, communication, attainment of § Interventions, including provision of hearing educational milestones, general technology and rehabilitation services, must health and well-being. reflect the family’s preferences and goals for their child. z TARGET GROUP AND AIMS § Newborn hearing screening should be universal, and all infants (in the area or facility where screening is implemented) should be covered and assessed to identify hearing loss. § However, in countries where the number of annual births is large and where resource limitations do not allow for universal screening, countries may choose to start a screening programme using selective (or targeted) screening only § for example by including only infants considered “at-risk”; geographical subsets; or infants in a special care nursery (SCN) or neonatal intensive care unit (NICU) z TARGET GROUP AND AIMS § Countries should, however, plan to expand selective screening to universal screening over time. § Testing only infants considered “at risk” is likely to miss approximately 50% who have no apparent cause for hearing loss. § The aim of any hearing screening programme is to diagnose hearing loss in infants at the earliest possible stage and to enrol them in timely intervention. z z TARGET GROUP AND AIMS § Countries should decide the level and nature of hearing loss on which to focus, based on the capacity of their health system. § The ear and hearing programmes of many countries focus on early intervention of infants with moderate or higher grade of hearing loss (i.e. above 35 dBHL) in the better hearing ear § However, where resources permit, mild hearing loss and unilateral hearing loss should also be addressed due to the impact these have on language development and education