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Barriers, facilitators, and policy recommendations for neonatal hearing screening: a systematic review

Published onJun 13, 2023
Barriers, facilitators, and policy recommendations for neonatal hearing screening: a systematic review


Between 0.5-5.0 in 1000 newborns, depending on country income levels, are born annually with some degree of hearing loss. Although neonatal hearing screening (NHS) is vital for reducing the global burden of hearing loss, the WHO reported that only 38% of newborns globally receive screening. As part of the Lancet Commission on Global Hearing Loss, we sought to: 1) identify current barriers and facilitators of NHS uptake in lower-middle (LMICs), upper-middle (UMICs), and high-income countries (HICs), and 2) recommend potential policy solutions.  


Our systematic review analyzes barriers and facilitators to hearing healthcare access. After searching articles in Embase, Global Health & Global Health Archive, Global Index Medicus, PubMed, and Web of Science, we extracted barriers and facilitators that corresponded with the Access domains in the Levesque “Access to Healthcare” Framework. Two reviewers independently assessed the quality of each article using the Mixed Methods Appraisal Tool.  


From the 3,860 included articles, 75 related to NHS. Studies were conducted across 7 LMICs (number of studies=12), 8 UMICs (n=28), and 12 HICs (n=33) or span income categories (n=2). Most studies were conducted in urban (n=32) or both urban and rural settings (n=19). Only 1 study was in an exclusively rural setting, 23 did not report setting. More studies identified barriers (n=34) than facilitators (n=12) or both (n=29). Within identified barriers, a higher proportion related to the supply-side (health system/provider-perspective) than demand-side (patient-perspective). The most common barriers reported were related to “Appropriateness” (n=47), or quality and coordination of care, across LMICs (n=9), UMICs (n=19), and HICs (n=17). These included systemic organizational failures (n=22), and limited provider knowledge, training, and support (n=16). Barriers associated with “Availability” (n=38) of providers and hearing facilities were the second-most commonly reported (LMICs, n=7; UMICs, n=17; HICs, n=12), especially availability staff and equipment (n=18).  

Policy Implications: 

Our findings reveal the importance of policy solutions that target availability and appropriateness of care to facilitate NHS. Potential policy solutions include: standardizing screening protocols; expanding screening capacity; troubleshooting documentation and data sharing; incentivizing a greater workforce in NHS; supporting equipment maintenance; and enhancing education and training for providers.  

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