Author(s)
L. Wong
F. Espinoza Ortiz
K. Mojica Alvarez
D. Molter
J. E. Saunders
Affiliation(s)
Dartmouth Medical School; Washington University; Hospital Metropolitano Vivían Pellas; National Association Of Casa Materna
Abstract:
This study aimed to determine the incidence and risk factors for congenital hearing loss in a remote region of Nicaragua and to perform cost analysis of screening programs in this setting. Otoacoustic emissions (OAE) screening of infants (< 6 months) were performed in Jinotega, Nicaragua in 8 municipalities with varying socioeconomic status and birth settings including NICU, institutional, and home births. Data on 15 risk factors were analyzed. Cost analysis for universal screening in each health center was conducted. Of 640 infants screened, 38 failed (5.94%). There were 69 (10.8%) NICU births and 29 (4.5%) home births in the cohort with a failure rate of 8.7% and 6.9%, respectively. These results were not statistically different from the other births. Only family history and birth defects were predictors of OAE failure (p <.05). Projected 10 year cost analysis for 4 scenarios of universal newborn screening in this region demonstrated an estimated cost per baby screened of $0.60 - $1.09 and cost per screening failure of $4.10 - $17.42. Universal newborn screening is not available in most developing countries; thus the incidence of congenital hearing loss is unknown. Surprisingly, our rate of OAE failures was comparable to developed countries and there was not a correlation with the birth setting (NICU and home births). Family history did correlate with hearing loss, consistent with previous studies of this population. OAE screening of infants is feasible and cost effective in rural Nicaragua. However, geographically diverse births and a lack of centralized healthcare access remain challenges.