Management pathways and outcomes of children with hearing loss identified through newborn and infant hearing screening at a tertiary paediatric hospital in the Western Cape, South Africa

Abstract

Background: Early Hearing Detection and Intervention programmes support early identification and management of hearing loss. However, limited data exist on post-diagnostic pathways, amplification uptake, and continuity of care within public-sector paediatric services.
Objectives: To describe management pathways and outcomes of children diagnosed with hearing loss following newborn and infant hearing screening (NIHS) at a tertiary paediatric hospital in the Western Cape.
Method: A retrospective descriptive cohort study was conducted at the Red Cross War Memorial Children’s Hospital. Records of children under 6 years (August 2019 – August 2024) with documented NIHS results and confirmed hearing loss were reviewed using departmental databases and a self-developed data extraction tool. Data included demographics, risk factors, diagnostic outcomes, amplification, referrals, and follow-up attendance.
Results: Of 7871 children seen, 511 (6.5%) had NIHS results. Eighty-three underwent diagnostic testing, of whom 72 (86.7%) were diagnosed with hearing loss. The mean age at diagnosis was 17.3 months. Infectious (32.5%) and neurological (28.9%) risk factors predominated. Mild (31.3%) and moderate (33.7%) conductive loss was most frequent. Only 15.3% received amplification, predominantly bilateral behind-the-ear devices. Most children (78.3%) were referred to additional services, primarily otolaryngology (81.5%). Follow-up attendance remained high (85.5%).
Conclusion: High follow-up rates contrast with low uptake of amplification, likely reflecting conductive pathology and systemic constraints. Greater integration across audiology, otolaryngology, and early intervention services is needed.
Contribution: This study provides contextually relevant evidence on post-diagnostic paediatric hearing care, including amplification uptake, referral patterns, and continuity to follow-up in the South African public sector.