Infant Hearing Screening in Addis Ababa, Ethiopia – Lessons Learned in Strengthening National Hearing Care

The World Health Organization reports that more than 430 million people currently live with disabling hearing loss [1], and that number is projected to rise to over 700 million by 2050, affecting about one in every ten people [1]. Over 80% of those affected live in low- and middle-income countries, where early detection and rehabilitation are rarely available [2]. Ethiopia has a population of more than 135 million and two thirds of our people are under 30 years of age [3]. Despite this young population, there is still no national hearing screening program [4].

Four recent pilot studies have gathered limited population data on adults and school aged children in Ethiopia [5-8]. One of these studies trialed newborn screening in 368 infants at a single institution in 2021 [8]. However, there is currently no national screening initiative, no prevalence data, and hence no formalized audiology training program. As a corollary, rehabilitation services are also not yet supported. In addition, the burden of hearing loss on communication, education, and social development remains underrecognized in Ethiopia. In summary, there is little national or governmental awareness of how common hearing loss is, or its lifelong effects on individuals, families, and society.

The authors recognized that without solid data, hearing care could never become a national priority. However, the authors felt that with prevalence data, policymakers would be able to see the importance of including hearing care within child health services. Therefore, the authors participated in the first multi-site infant screening program in Addis Ababa, which might serve as a model for a national program. This report describes the initiative, how it was organized, what actually happened during implementation, and especially focuses on the lessons learned.

1) Sponsors of the screening program were Hearing Ethiopia (an NGO dedicated to identifying and rehabilitating children with hearing loss as early as possible), Med-el (a cochlear implant company), PATH Medical, and the Austrian Development Agency. PATH Medical donated the QScreen testing system, expert trainers, and 4-day OAE and ABR training sessions for ENT and vaccination clinic nurses./p>

Selecting screeners at the nursing level proved to provide more efficient access to hearing screening than referral to doctors’ offices. And the 4-day training sessions proved to be sufficient training.

2) The pilot ran for about 12 months across four hospitals in Addis Ababa. Most newborns delivered in hospitals in Addis Ababa are discharged within eight hours leaving little opportunity for hearing screening. Therefore, newborns were tested upon their return to vaccination clinics.

Integrating hearing screens into existing child-health services offered a practical and efficient way to reach the babies without requiring extra visits.

3) The workflow for the pilot project started with infants coming in for their vaccinations. Parents received leaflets explaining that their child’s hearing would be tested. Before the child would receive its shots, it would be screened by the trained nurses, then any failures would be referred to ENT offices for further testing and for possible rehabilitation.

Initially we found parents to be reluctant when they learned their child would be undergoing a “hearing test,” fearing that something was wrong. When the testing was reframed as a routine part of infant care, similar to developed countries, acceptance improved. Also, vaccination staff were initially hesitant to refer infants for screening, fearing it would disrupt their workflow. This led our screeners having to go to the vaccination rooms to screen the babies there. This caused the secondary problem of having to work in noisy rooms, which caused many false failures that had to be retested later. But gradually, as everyone saw how quick and useful the process was, cooperation and support increased. Routine equipment malfunctions also caused delays. And – as related to the low-resource setting technical issues and lack of maintenance capacity were major barriers.

4) During the pilot period the four participating hospitals were equipped and successfully screened 962 infants. A total of 932 screenings occurred.

The success of implementation was manifold:

The nurses were efficiently trained. The screenings increased awareness among parents as to hearing loss issues. The staff of the hospital became very supportive. The screening succeeded even in this resource-limited setting.

In conclusion, this pilot project proved that infant hearing screening is feasible in low-resource settings. Collaboration, awareness, and consistent data collection are the foundation for sustainability. Although the program was time limited, its feasibility laid the groundwork for future national efforts.

On the implementation side, we identified several key challenges and lessons. Awareness about the importance of hearing screening is still limited among both professionals and the public. We learned that local training programs are essential, and that integrating screening into existing maternal and child health services makes it easier to sustain. Also, we learned that regular engagement with healthcare staff and communities helps maintain participation and success.

On the public policy side: programs like this can continue to raise awareness, strengthen collaborations, and establish support from both local and international partners. With such data, we can begin influencing policymakers to create sustainable systems of evaluation and rehabilitation for hearing care.

None.

This study had no funding, and the authors have no conflicts of interest to declare.

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2. World Health Organization Fact sheet on deafness and hearing loss. April 1, 2021.
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