Neonatal hearing screening in remote areas of China: a comparison between rural and urban populations

Objectives Universal neonatal hearing screening (UNHS) started late in some underdeveloped areas in China, with relatively scarce screening resources and a wide regional distribution. This study aimed to compare the screening performance between rural and urban populations, and to examine the characteristics and problems of UNHS in underdeveloped regions in China. Methods A two-step hearing screening program was used in neonates born in Liuzhou Maternal and Child Health Hospital and in patients who were born in other hospitals, but admitted to the neonatal intensive care unit. This program involved distortion product otoacoustic emission and automated auditory brainstem response. Characteristics of each newborn, as well as the screening outcomes and performance were compared between rural and urban populations. Results A total of 19,098 newborns were screened with a referral rate of 17.9% at the first step. Sixty-three (0.33%) newborns had hearing loss. The prevalence of permanent hearing loss was 2.25. The average screening age was significantly older in the rural population than in the urban population in the first (P<0.01) and second steps of screening (P<0.05). The rural population had a higher referral rate in both steps than the urban population (P<0.01). The follow-up rate was much lower in the rural population than in the urban population (P<0.05), but dramatically increased in 2014 compared with the previous 2 years. Conclusions A low follow-up rate is a critical issue when carrying out UNHS in developing countries, such as China, especially for rural populations. The government should establish more hearing referral centres to increase service coverage and supply financial assistance for low-income populations.