OBJECTIVE : A national survey of early hearing detection services was undertaken to describe the
demographics, protocols and performance of early hearing detection, referral, follow-up and data
management practices in the private health care sector of South Africa.
METHODS : All private hospitals with obstetric units (n = 166) in South Africa were surveyed
telephonically. This data was incorporated with data collected from self-administered questionnaires
subsequently distributed nationally to audiology private practices providing hearing screening at the
respective hospitals reporting hearing screening services (n = 87). Data was analyzed descriptively to
yield national percentages and frequency distributions and possible statistical associations between
variables were explored.
RESULTS : Newborn hearing screening was available in 53% of private health care obstetric units in South
Africa of which only 14% provided universal screening. Most (81%) of the healthy baby screening
programs used only otoacoustic emission screening. Auditory brainstem response screening was
employed by 24% of neonatal intensive care unit screening programs with only 16% repeating auditory
brainstem response screening during the follow-up screen. Consequently 84% of neonatal intensive care
unit hearing screening programs will not identify auditory neuropathy. A referral rate of less than 5% for
diagnostic assessments was reported by 80% of universal programs. Follow-up return rates were reported
to exceed 70% by only 28% of programs. Using multiple methods of reminding parents did not
significantly increase reported follow-up return rates. Data management was mainly paper based with
only 10% of programs using an electronic database primarily to manage screening data.
CONCLUSIONS : A shortage of programs and suboptimal and variable protocols for early hearing detection,
follow-up and data management in existing programs mean the majority of babies with hearing loss in
the South African private health care sector will not be identified early. Newborn hearing screening must
be integrated with hospital-based birthing services, ideally with centralized data management and