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Knowledge and attitude of Malaysian healthcare professionals towards newborn hearing screening program

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Abstract

Newborn hearing screening program (NHSP) is a standard of care in many countries around the world. Its success to a great extent depends on professionals understanding of the program's goals and the screening procedures. Hence, this study aimed to investigate the knowledge and attitudes of Malaysian healthcare professionals involved in NHSP. A cross-sectional survey study using a 25 items questionnaire was conducted on a purposive sample of healthcare professionals who worked in 30 Malaysian government hospitals that run NHSP. Four hundred and three questionnaires were distributed, only 138 completed questionnaires were analysed, yielding a response rate of 34.2%. Of the 138 healthcare professionals, 35 (25.4%) were paediatricians, 43 (31.2%) were ear, nose and throat (ENT) specialists, and 60 (43.5%) were nurses. In general, the study revealed that the ENT specialists scored significantly higher that the paediatricians and nurses on both knowledge and attitude. Although the majority of all three healthcare professionals ( > 75%) viewed NHSP as very important, yet many nurses and paediatricians ( > 70%) reported received limited information during their training in this area and felt uncomfortable in explaining about the whole hearing screening process to the parents. Despite the positive attitude towards NHSP, 22.5% of the healthcare professionals were not aware of the existence of the program. In conclusion, this study has demonstrated knowledge gap in NHSP among the healthcare professionals, but their positive attitudes could be an indication of a strong interest to learn more about NHSP. Therefore, there is a need to take urgent efforts to improve the knowledge of healthcare professionals on NHSP.

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... Children with hearing loss commonly present to various health care practitioners, as hearing loss is one of the most common disorders present at birth [1]. Hearing loss in the early years of life has significant consequences on the child's quality of life, affecting speech and language development [2,3]. ...
... Our data show a consistent result to previously performed research, which indicates that there are areas of improvement regarding knowledge of neonatal hearing loss risk factors and interventions. These results were consistently shown in previous studies among pediatricians, general practitioners, family physicians, and pediatric otolaryngologists [1,2,8,11,19]. As demonstrated by Danhauer et al., among pediatric otolaryngologists, there were incorrect responses in regard to timing for referral to hearing services for intervention. ...
Article
Introduction Early detection of hearing loss is important to the management of infants and young children with hearing loss. Pediatricians are often the first to encounter a child suspected to have hearing loss. The objective of this study is to evaluate the knowledge and attitude of newborn hearing screening and management of hearing in among pediatricians. Methods A cross-sectional survey-based study utilizing a validated questionnaire that was distributed to pediatricians in single tertiary academic health care institution that aims to evaluate the knowledge and attitudes related to children with hearing loss and newborn hearing screening. Results A total of 67 pediatricians agreed to participate and were involved in our study. Mean age was 35 years and 44.1% were males. The majority (79.4%) thought it was very important to have a newborn hearing screening program. However, two-thirds (64.7%) were unsure that there is a universal hearing screening program in the country. Never the less, the majority of the respondents (75%) were at least somewhat confident in explaining the hearing screening program process in our institution. There was a gap in the knowledge of our pediatricians with regard to the process of dealing with a newborn who failed screening program and the candidacy for cochlear implants. Also, some participants were unsure whether to refer a child with hearing impairment to an otolaryngologist or not. Most of the participants thought that physicians need more information related to permanent hearing loss. Conclusion There are gaps in Pediatricians knowledge and awareness towards hearing loss assessment and management in newborns. This likely requires further academic collaboration between specialties to improve the care of newborns. Future research should focus on the auditory and speech outcome and rehabilitation awareness.
... Only 70.7% of our participants indicated that infants with profound bilateral hearing loss are candidates for a cochlear implant. Similar findings were reported by Mazlan and Min (2015) [33]. However, Goedert et al. (2011) reported that the participants had a great deficiency in knowledge concerning cochlear implants [22], and 40.6% and 30.8% of participants were able to determine the best screening test for preschool children (PTA) and neonates (ABR), respectively. ...
... The overall review of the results indicates that family doctors are aware of textbook knowledge about neonatal screening, but they showed a lack of comprehensive understanding of the practical details of paediatric hearing impairment, such as the reasons for conducting hearing screening, specialist referral, gold standard hearing tests, hearing loss interventions and the risk factors of postnatal hearing loss. These findings were consistent with other studies that discussed knowledge regarding the early identification and management of hearing loss in children among health care providers in general [30], and specifically in primary care physicians [21,34], paediatricians [27,31,35], ENT specialists [33] and neurologists [28]. A lack of clinical application of hearing screening procedures and communication between different health organizations and hospitals regarding early hearing detection and intervention programs show gaps in critical knowledge, warranting outreach and educational programs. ...
Article
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Background Early detection and management of hearing loss are important to develop ordinary speaking language and academic skills during childhood. Lack of knowledge by either parents or health care providers could hinder the process of hearing loss diagnosis, such that the intervention will be less effective. There is little evidence about the knowledge and practice of family physicians regarding hearing screening in Saudi Arabia and worldwide. Objectives This study aimed to assess family physicians’ knowledge, attitudes, and practices related to hearing loss in children. This in turn will help policy makers and educational institutions to establish and promote a program concerned with screening, diagnosis and intervention of paediatric hearing loss. Methods A cross-sectional descriptive study enrolled 133 family physicians working at primary health centres in Saudi Arabia from March 2020 to September 2020. A self-reported questionnaire was used to assess the knowledge, attitudes, and practices of family physicians concerning hearing loss in children. Results The majority of the participants were working under the umbrella of the Ministry of Health and around half of them did not screen any child for hearing loss. Despite that, 91.7% indicated the importance of neonatal hearing screening, 70.7% indicate infant candidacy for cochlear implant and only 33.1% know about the existence of the early hearing detection and intervention (EHDI) governmental program in kingdom of Saudi Arabia (KSA). Participants were able to identify factors associated with hearing loss such as a family history of hearing loss (85.6%), meningitis (75%) and craniofacial anomalies (51.5%). The most frequent specialists for patient referrals were ear nose and throat ENT (75.2%) and audiologists (67.7%). Conclusion This study shows that family physicians have good general background about the benefits of EHDI programs and the management of hearing loss in the paediatric population. However, it also indicated insufficient knowledge in other domains of hearing loss, including assessments and the presence of the EHDI governmental program in KSA. Further actions on the involvement of family physicians in the process of neonatal hearing screening, diagnosis and intervention for hearing impairment are needed.
... This finding highlights the need for interventions to encompass not only medical aspects but also broader considerations like educational inclusion and the capabilities of children with hearing loss. Additionally, only a minority of participants (22%) correctly understood the capabilities and limitations of hearing aids, which is consistent with the findings of Mazlan and Min's study [20] involving healthcare professionals who directly manage children with hearing loss. This finding underscores the challenge non-audiology professionals may encounter in comprehending hearing aid concepts, emphasizing the importance of clearly communicating key points, including the inability of hearing aids to restore normal hearing or repair damaged hair cells. ...
Article
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Background Childhood hearing loss is a significant health concern. Early identification and intervention are essential to maximize hearing potential and developmental outcomes, with primary care physicians (PCPs) playing a pivotal role in this process. Objectives This study aimed to assess PCPs’ knowledge and attitudes toward childhood hearing loss, investigate the association between knowledge and attitudes, and examine the influence of demographic factors on PCPs’ knowledge and attitudes towards childhood hearing loss. Methods This cross-sectional study was conducted from 30 November 2017 to 30 July 2018 at three public health clinics in Malaysia, specifically in the Federal Territory of Kuala Lumpur, Selangor, and Terengganu. A self-administered questionnaire assessed PCPs’ knowledge of general facts, diagnosis and intervention, and risk factors for childhood hearing loss. Additionally, the questionnaire evaluated PCPS’ attitudes across cognitive, affective, and behavioural domains regarding childhood hearing loss. Results Most participants lacked sufficient knowledge about childhood hearing loss, with 61.4% not seeing it as a major health issue. Almost half (45.9%) didn’t know that children with hearing loss can succeed in regular schools, and 78% were unaware that hearing aids don’t fully restore normal hearing. Participants’ awareness of risk factors varied widely, ranging from 24.6% to 90.3%. Despite these knowledge gaps, participants generally had positive attitudes towards childhood hearing loss, especially in cognitive and behavioural aspects. The study found a strong positive link between knowledge and attitudes, but demographic factors didn’t significantly affect them. Conclusions This study highlights the urgent need to address knowledge gaps among Malaysian PCPs regarding childhood hearing loss. While these knowledge gaps exist, PCPs’ positive attitudes form a foundation for developing targeted educational interventions to improve PCPs’ knowledge and skills in managing childhood hearing loss. Collaborative efforts are essential to translate these findings into meaningful improvements in paediatric audiological care.
... The studies available usually investigate awareness and perceptions of medical practitioners only (López-Vázquez et al., 2009;Olusanya & Roberts, 2006;Yerraguntla et al., 2016). Furthermore, research from low-and middle-income countries tends to focus on awareness and perceptions towards the implementation of newborn/infant hearing screening programs, with the aim of improving existing early hearing identification and intervention strategies for babies with congenital or early-onset hearing impairment (Khan & Joseph, 2020;Mazlan & Min, 2018;Ravi et al., 2017;Ravi et al., 2018). Only one study was found that investigated awareness and perceptions of nurses (Sanju et al., 2018): a total of 115 nurses from India who worked in primary care, corporate, and government hospitals completed an online survey, and the results found that both awareness and perceptions to childhood hearing impairment were low. ...
Article
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Introduction Pacific Islands have among the highest prevalence of pediatric hearing impairment in the world. Given the limited availability of ear and hearing specialists in the Pacific region, the broader health professional community plays a vital role in the prevention of avoidable pediatric hearing impairment. Nurses emerge as one of the ideal candidates for task-sharing in the administration of ear and hearing care at the public and primary healthcare levels. Objectives The aim of this study is to evaluate the awareness and perceptions of university nursing students in Samoa to pediatric hearing impairment and hearing healthcare. Methods This study employed a cross-sectional study design. A 10-item questionnaire was administered to university nursing students in Samoa ( N = 100). The statements aimed to evaluate perceptions towards childhood hearing impairment, as well as awareness of causal factors of permanent childhood hearing loss and available hearing healthcare. Participants were required to provide a response based on the five-point Likert scale “Strongly Agree,” “Agree,” “Neutral/Don’t know,” “Disagree,” and “Strongly Disagree.” Results Overall, 79% of participants responded “Disagree/Strongly Disagree” to the item “Hearing loss is not that important because it does not kill.” Overall, 52% of respondents were aware of hearing impairment as a public health concern in Samoa. Early identification and intervention services for newborns with hearing impairment are nonexistent in Samoa, and awareness was low for the importance of early detection (62%) and amplification suitability for babies (49%). Overall, awareness was also low for causal factors of permanent sensorineural hearing loss. Conclusions A borderline neutral/positive perception was found among our future nursing professionals to engage with pediatric hearing impairment in Samoa. Awareness regarding the causes of permanent childhood hearing impairment, as well as early identification and intervention services, could be integrated in the university curriculum.
... Hamzah and colleagues [15] identified late referrals and long waiting time for appointments as factors leading to delayed diagnosis. This is exacerbated by a lack of awareness among healthcare professionals, where a local study revealed only 20% had good knowledge on newborn hearing screening and 22% were not aware of the program [16]. This is compounded by poor knowledge among mothers regarding childhood hearing loss and its impact [17]. ...
Article
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Background Congenital aural atresia (CAA) and stenosis is a rare defect affecting the external auditory canal which causes varying degrees of hearing impairment. This malformation may be unilateral or bilateral. Timely hearing rehabilitation in these patients is paramount to ensure appropriate speech and language development. Thus, early detection and hearing assessment with timely intervention in the form of hearing device is crucial. There is a wide range of hearing amplification devices available for these patients, catering to individual needs and preferences. This study investigated the options and choices of hearing rehabilitation among patients with CAA in our center. This study also compared the hearing gain of different types of hearing devices and patient satisfaction levels. Methods This was a retrospective analysis of 55 patients with congenital aural atresia or stenosis under follow-up at the Otorhinolaryngology and Audiology Clinic of a tertiary academic institution. Data on the timing of hearing loss diagnosis and intervention, type of hearing rehabilitation, hearing gain, Jahrsdoerfer score from temporal bone computed tomography, and patient satisfaction level was collected and analyzed. Results Fifty-five patients were recruited with ages between 3.6 months to 58 years old. The majority of patients (63.6%) had moderate hearing loss, followed by severe hearing loss (18.2%), mild hearing loss (9.1%) and profound hearing loss (7.3%). 32.7% of patients had early hearing loss diagnosed by 3 months old, while 67.3% were diagnosed after 3 months of age. Bone anchored hearing implant (BAHA Attract/Connect) gave the highest mean hearing gain of 35.23 dB (SD ± 9.75) compared to air conduction hearing aid, bone conduction hearing aid, and canalplasty. Patients implanted with BAHA Attract/Connect reported the highest average satisfaction scores of 7.74. Conclusion A significant proportion of patients have delayed diagnosis and intervention. Bone-anchored hearing implants provide excellent hearing improvements in patients with CAA with good patient satisfaction.
... majority of children with hearing loss live, 6 the outlook is bleaker due to higher levels of poverty that reduce access to early identification of hearing loss and early intervention. 6,7 Implementing a newborn hearing screening program (NHSP) to detect hearing loss early in life can dramatically reduce the impact of hearing loss. 8 Unfortunately, such programs are not well-established or do not even exist in some developing countries. ...
Article
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Purpose The aim of this study is to assess the knowledge, attitude, and practice of physicians regarding hearing loss and its management among children in Jordan as an example of developing countries. Method The cross-sectional survey composed of 18 questions was used to fulfill the aim of the study. The study population consisted of 335 physicians working in Jordan, with different specialties. The data were collected through site visits to a variety of health care facilities, as well as an online version of the survey to facilitate data collection and ensure participants' comfort. Results The majority of physicians (30.7%) were general practitioners or family doctors, followed by pediatricians (12.8%). Most of the physicians (88.7%) had experience ranging from 1 to 10 years; the majority of physicians (60.3%) were younger than 30 years of age. Most of the physicians identified the importance of newborn hearing screening. Physicians showed limited knowledge about the management and intervention of infants with permanent hearing loss. Only 11.5% of respondents would refer a child with confirmed hearing loss to an audiologist, and 1.9% of them would refer to a speech therapist. Even though the majority of the physicians (69.0%) reported not receiving any training to deal with deaf and hard of hearing children, they felt confident in talking with parents about hearing loss and its management. Conclusions This study revealed that physicians have limited knowledge regarding hearing loss in children as well as its management and intervention. Furthermore, this study illustrates the need for more ongoing medical education programs regarding hearing loss in children.
... [3][4][5] In Jordan, as in all other developing countries, where the majority of children with hearing loss live, 6 the outlook is bleaker due to higher levels of poverty that reduce access to early identification of hearing loss and early intervention. 6,7 Implementing a newborn hearing screening program (NHSP) to detect hearing loss early in life can dramatically reduce the impact of hearing loss. 8 Unfortunately, such programs are not well-established or do not even exist in some developing countries. ...
Article
Full-text available
Introduction One of the main factors that affect the early diagnosis and intervention of hearing loss is inadequate knowledge by the health care workers. Ear, nose, and throat (ENT) specialists are the main source of information about hearing loss and its management in most developing countries, such as Jordan. Objective The purpose of the present study is to explore the level of knowledge and the practice of hearing screening and hearing loss management for children among ENT physicians in Jordan as an example of health care providers in developing countries of the Middle East. Methods This was a cross-sectional study, adapting a questionnaire of knowledge and the practice of hearing screening and hearing loss management for children. The questionnaire consisted of 2 sections with 20 questions. A total of 40 ENT physicians completed the questionnaire. Results The majority of the respondents acknowledged the importance of hearing screening for children; however, there was limited knowledge regarding hearing loss management and testing. Only 10 of the ENT physicians believed that a referral to an audiologist is warranted, and the majority of the respondents were not aware that a child with a confirmed permanent hearing loss should be referred to a speech pathologist or to a rehabilitation center. Managing unilateral and mild sensorineural hearing loss (SNHL) was another area about which ENT physicians have limited knowledge. Conclusion There is a strong need for professional intervention programs, providing the latest updates and standardizations in the field of audiology and pediatric rehabilitation for ENT physicians.
... A recent study shows that about 22.5% of Malaysian health care professionals were not aware of the UNHS program in Malaysia. 9 These factors could explain the reason why some children with hearing loss were not screened at birth or missed during the new born screening and the impairment in hearing were only detected later in their life. ...
Article
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Introduction: To correlate the score obtained using a bilingual (Malay and English) 14 points questionnaire in the detection of hearing loss at the University of Malaya, Medical Centre (UMMC), Kuala Lumpur, Malaysia over a 9 month period. Methods: This is a prospective instrument correlation study done on 93 children aged 1-4 years of age with speech and language delay for at least 3 months. Hearing status was confirmed using otoacoustic emissions, pure tone audiometry and brainstem evoked response (BSER). Hearing status was then compared to the 14-point questionnaire final scores and is statistically correlated. Results: There were 26 patients, 15 males (58%) and 11(42%) females who were diagnosed to have hearing loss. The average age of presentation was 2.49 and conductive hearing loss accounted for about 74% of cases of hearing loss. The mean questionnaire score obtained through our patients was 3.83±1.987. Discriminant analysis suggests that a questionnaire score of above 4 was indicative that the child was suffering from hearing loss. Conclusion: Our study suggests that the low-cost bilingual (Malay and English) questionnaire can be used to detect hearing loss in the Malaysian population and could potentially be useful in rural health centres to help detect hearing loss and to determine the urgency of referral to a tertiary health centre.
... A recent study shows that about 22.5% of Malaysian health care professionals were not aware of the UNHS program in Malaysia. 9 These factors could explain the reason why some children with hearing loss were not screened at birth or missed during the new born screening and the impairment in hearing were only detected later in their life. ...
Article
Full-text available
Objectives To correlate the score obtained using a bilingual (Malay and English) 14 points questionnaire in the detection of hearing loss at the University of Malaya, medical centre (UMMC),Kuala Lumpur, Malaysia over a 9 month period. Methods This is a prospective instrument correlation study done on Children aged 1-4 years of age with speech and language delay for at least 3 months. Hearing status was confirmed using otoacoustic emissions, pure tone audiometry and brainstem evoked response (BSER). Hearing status was then compared to the 14 point questionnaire final scores and is statistically correlated. Results A total of 93 patients, were assessed in this study whereby 26 patients consisting 15 males (58%) and 11(42%) females were diagnosed to have hearing loss. The average age of presentation was 2.49 and conductive hearing loss accounted for about 74% of cases of hearing loss. The mean questionnaire score obtains through our studied population was 3.83 +/- 1.987. Discriminant analysis suggests that a questionnaire score of above 4 was indicative that the child was suffering from hearing loss. Conclusion Our study suggests that the low-cost bilingual (Malay and English) questionnaire can be used to detect hearing loss in the Malaysian population and could potentially be useful in rural health centres to help detect hearing loss and to determine the urgency of referral to a tertiary health centre.
Article
Unlabelled: This study evaluated the outcomes of training nurses engaged in a public sector newborn hearing screening (NHS) program in one urban district in South India. Twenty nurses performing NHS in Corporation Maternity Hospitals (CMH) participated in the training and evaluation. Baseline knowledge and skill of nurses regarding NHS and overall program outcomes were obtained eight months post the initial training. Knowledge was evaluated using questionnaire, skill was evaluated using Objective Structured Clinical Examination (OSCE) and agreement between screening results obtained by audiologist and nurse. Records used for documentation of screening were analysed to evaluate program outcomes. A two-day retraining was designed to address the gaps identified. Evaluations were conducted immediately post and three months post retraining following the same procedure as baseline evaluations. Gaps were identified in knowledge and skill as well as in the program outcomes. Immediate post retraining evaluation results showed overall improvement in nurses' knowledge and skill. Three months post retraining, all the nurses achieved benchmark criteria of 75% in knowledge and skill. Program outcomes, such as coverage (95.3%), refer rate (3.2%) and follow up rate (86.1%) improved post retraining. The findings of this study suggests that knowledge and skill of nurses improved with periodic training. Periodic evaluation and monitoring enhanced the overall outcomes of the program. Supplementary information: The online version contains supplementary material available at 10.1007/s12070-021-02920-2.
Article
Objective To evaluate and discuss the outcomes of the universal newborn hearing screening program conducted at four public hospitals in Malaysia. Method A retrospective analysis of the universal newborn hearing screening database from each hospital was performed. The database consisted of 28,432 and 30,340 screening results of babies born in 2015 and 2016, respectively. Quality indicators (coverage rate, referral rate, return for follow-up rate, and ages at screening and diagnosis) were calculated. Results Overall coverage rate across the four hospitals was 75% in 2015 and 87.4% in 2016. Over the two years, the referral rates for the first screening ranged from 2.7% to 33.93% with only one hospital achieving the recommended benchmark of <4% in both years. The return for follow-up rates for each participating hospital was generally below the recommended benchmark of ≥95%. The mean age at screening was 3.9 ± 1.2 days and 3.3 ± 0.4 days, respectively. The mean age at diagnosis for 70 infants diagnosed with permanent hearing loss was 4.7 ± 0.7 months in 2015 and 3.6 ± 0.9 months in 2016. Conclusions Quality measures for the universal newborn hearing screening program in four public hospitals in Malaysia were lower than the required standards. Nevertheless, some quality indicators showed statistically significant improvements over the two years. Next steps involve identifying and implementing the best practice strategies to improve the outcome measures and thus the quality of the program.
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