Childhood deafness poses problems in developing countries
http://www.100md.com
《英国医生杂志》
EDITOR—Childhood deafness is an important disorder globally affecting more than 62 million children younger than 15 years. Two thirds reside in developing countries.1 Although many studies have been reported on the aetiology of deafness, the age/mode of detection and intervention in many developing countries is unknown.
Our questionnaire based study of 363 parents of children attending the only public schools for the deaf in Lagos, Nigeria, with a total enrolment of 429, showed that parents were predominantly (81%) the first to suspect or detect hearing difficulty in their children (table). Parental suspicion occurred mostly at 12-24 months, compared with 8-14 months in developed countries.2 3 Only 12% suspected hearing difficulty by age 6 months. The commonest mode of detection was a child's failure to respond to sound (49%). Speech/language defects or unintelligible speech were least associated with hearing difficulty (1%).
Responses to parental questionnaire (n=363)
As in developed countries, doctors were most commonly consulted for help (77%). However, most children (80%) were not provided with hearing aids even where appropriate, granted that cochlear implantation was improbable. Parents were often told that their children were "slow starters" and would outgrow the speech delays, only to be enrolled in schools for the deaf when this optimism failed. Ironically, only 6% were so enrolled by age 6 years (mean age of enrolment 10.3 years). This protracted delay especially for the 363 hearing parents may be indicative of their preference for spoken rather than sign language after initial denial and grief.
Screening the hearing of newborn babies allows prompt detection of congenital and early onset deafness, for optimal development of speech and language development.4 Until such a programme becomes available, doctors should follow the lead from parental suspicion especially as part of ongoing surveillance to detect children with late onset deafness. The World Health Organization's current initiatives for affordable hearing aids and support services in developing countries should encourage the development of auditory-verbal intervention services.5
Bolajoko O Olusanya, research fellow, Academic Unit of Audiological Medicine
b.olusanya@ich.ucl.ac.uk, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London WC1N 1EH
Linda M Luxon, professor, Academic Unit of Audiological Medicine, Sheila L Wirz, professor, Centre for International Child Health
Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London WC1N 1EH
The full paper from which this letter is derived is available at http://bmj.bmjjournals.com/cgi/eletters/315/7119/1327/j#95290
Competing interests: None declared.
References
Smith A. Preventing deafness—an achievable challenge. The WHO perspective. Int Congr Series 1240; 2003: 183-91.
Watkin PM, Baldwin M, Laoide S. Parental suspicion and identification of hearing impairment. Arch Dis Child 1990;65: 846-50.
Harrison M, Roush J. Age of suspicion, identification, and intervention for infants and young children with hearing loss: a national study. Ear Hear 1996;17: 55-62.
Abbasi K. Neonatal screening recommended for hearing impairment. BMJ 1997;315: 1327.
Kumar S. WHO tackles hearing disabilities in developing world. Lancet 2001;358: 219.
Our questionnaire based study of 363 parents of children attending the only public schools for the deaf in Lagos, Nigeria, with a total enrolment of 429, showed that parents were predominantly (81%) the first to suspect or detect hearing difficulty in their children (table). Parental suspicion occurred mostly at 12-24 months, compared with 8-14 months in developed countries.2 3 Only 12% suspected hearing difficulty by age 6 months. The commonest mode of detection was a child's failure to respond to sound (49%). Speech/language defects or unintelligible speech were least associated with hearing difficulty (1%).
Responses to parental questionnaire (n=363)
As in developed countries, doctors were most commonly consulted for help (77%). However, most children (80%) were not provided with hearing aids even where appropriate, granted that cochlear implantation was improbable. Parents were often told that their children were "slow starters" and would outgrow the speech delays, only to be enrolled in schools for the deaf when this optimism failed. Ironically, only 6% were so enrolled by age 6 years (mean age of enrolment 10.3 years). This protracted delay especially for the 363 hearing parents may be indicative of their preference for spoken rather than sign language after initial denial and grief.
Screening the hearing of newborn babies allows prompt detection of congenital and early onset deafness, for optimal development of speech and language development.4 Until such a programme becomes available, doctors should follow the lead from parental suspicion especially as part of ongoing surveillance to detect children with late onset deafness. The World Health Organization's current initiatives for affordable hearing aids and support services in developing countries should encourage the development of auditory-verbal intervention services.5
Bolajoko O Olusanya, research fellow, Academic Unit of Audiological Medicine
b.olusanya@ich.ucl.ac.uk, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London WC1N 1EH
Linda M Luxon, professor, Academic Unit of Audiological Medicine, Sheila L Wirz, professor, Centre for International Child Health
Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London WC1N 1EH
The full paper from which this letter is derived is available at http://bmj.bmjjournals.com/cgi/eletters/315/7119/1327/j#95290
Competing interests: None declared.
References
Smith A. Preventing deafness—an achievable challenge. The WHO perspective. Int Congr Series 1240; 2003: 183-91.
Watkin PM, Baldwin M, Laoide S. Parental suspicion and identification of hearing impairment. Arch Dis Child 1990;65: 846-50.
Harrison M, Roush J. Age of suspicion, identification, and intervention for infants and young children with hearing loss: a national study. Ear Hear 1996;17: 55-62.
Abbasi K. Neonatal screening recommended for hearing impairment. BMJ 1997;315: 1327.
Kumar S. WHO tackles hearing disabilities in developing world. Lancet 2001;358: 219.