Lakhasly

Recent estimates by the World Health Organization (WHO)
indicated growing absolute numbers and prevalences of
people with disabling hearing loss (Olusanya et al., 2019;
WHO, 2018a). For children, too, the absolute numbers
are rising as the world population grows. An estimated
34 million children currently have disabling hearing loss,
most of them living in South Asia, Asia Pacific, and Sub-
Saharan Africa (Vos et al., 2016; WHO, 2018a, 2018b,
2018c; Wilson et al., 2017). These children are in danger
of impaired language, social, emotional, and academic
development (Ching et al., 2010; Ching et al., 2018;
Neumann et al., 2006; Vohr et al., 2011; WHO, 2016;
Yoshinaga-Itano et al., 1998; Yoshinaga-Itano et al., 2018).
Universal newborn hearing screening (UNHS) and
prevention of permanent childhood hearing loss (PCHL)
are the most effective measures to reduce both the
prevalence and negative consequences of PCHL, with
UNHS being very effective for high-income countries (Joint
Committee on Infant Hearing [JCIH], 2013; Pimperton et
al., 2016; WHO, 2010; Wilson et al., 2017), and prevention
expected to show higher relative effects for low-income
countries (Ching et al., 2010; Ching et al., 2018; Neumann
et al, 2006; Vohr et al., 2011; Vos et al., 2016; WHO, 2016,
2020a; Wilson et al., 2017).
According to the recommendations of the Joint Committee
on Infant Hearing (JCIH, 2007, 2019), babies should
undergo UNHS before one month of age, those who fail
the screening should get an audiological diagnosis before
3 months, and those with PCHL should be enrolled in
early intervention before 6 months of age (EHDI 1-3-6
guidelines). If a country is already accomplishing this goal,
it is advised that this country should strive to achieve the
new goal of undergoing UNHS by 1 month of age, getting
an audiological diagnosis before 2 months of age, and
enrolling in early intervention by 3 months of age (JCIH,
2019).
Many studies convincingly demonstrate that children with
PCHL who were identified and treated early have better
language and academic outcomes than those with late-
treated hearing loss. This has been shown for general
language development (Ching et al., 2018, Neumann
et al., 2006; Yoshinaga-Itano et al., 1998), vocabulary
(Yoshinaga-Itano et al., 2017), developmental scores,
and quality-of-life (Korver et al., 2010) for children whose
hearing loss was identified by NIHS, who were fitted
early with hearing aids (Tomblin et al., 2015) or cochlear
implants (Yoshinaga-Itano et al., 2018), or who were
enrolled in early intervention services (Vohr et al., 2011)
compared to children without UNHS. Recent large-scale
epidemiological studies in Australia and Great Britain
have provided strong evidence of the positive long-term
outcomes of earlier treatment of infant hearing loss that
can be achieved through UNHS programs, compared to
later treatment in terms of language, cognitive, reading,
and general academic development of hearing impaired
children and adoslescents (Ching et al., 2018; Kennedy
et al., 2006; Pimperton et al., 2016; Wake et al., 2016).
Although the direct and indirect costs and some potential
negative consequences of UNHS programs have to be
taken into consideration (Kemper et al., 2000; Zhao et
al., 2003), studies on parents’ perspectives (Fitzpatrick et
al., 2007; van der Ploeg et al., 2008; Young & Tattersall,
2007) and cost-benefit analyses of unaddressed hearing
loss (WHO, 2017a) showed that advantages of early
hearing detection and intervention (EHDI) outweigh the
disadvantages.
In 1995 a WHO resolution called on member states to
prepare national plans for the prevention and control of
major causes of avoidable hearing loss, and for early
detection of hearing loss in babies, toddlers, and children
(WHO, 1995). Yet, in 2012 only 32 countries reported the
implementation of such policies, and the WHO bemoaned
an overall scarcity of epidemiological evidence regarding
prevalence of hearing loss and ear diseases (WHO, 2013).
A second resolution by WHO, adopted in 2017, reaffirmed
the goals of the first and urged member states to collect
high-quality population-based data on ear diseases and
hearing loss (WHO, 2017b). So far, no information has
been gathered about the global situation of NIHS.
The international study presented here aimed to assess
the global status of coverage, strategies, and results of
NIHS programs and child audiology services in as many
countries or territories (referred to hereafter as countries)
as possible to serve as a baseline for further evaluation
and improvement of NIHS effectiveness. In addition, the
study explores the relation between national economical
indices and key screening parameter