Introduction

1. A Survey of the Knowledge, Attitudes and Practices of Pediatricians in relation to Newborn Hearing Screening Alonzo, Aldaba, Almenario, Bato, Batoon, Bautista, Benito, Bondoc, Borela, Buenaventura L., and Buenaventura N. Research Adviser: Grace H. Encelan-Brizuela M.D., M.S.P.H.

2. Introduction Hearing Loss • Conductive or sensorineural; dB lost from slight to profound • Affects approximately 2-4 per 1000 live birth infants • One of the most common congenital anomalies leading to impediment of speech, language, and development • Children identified >6 months can have speech and language delays. Children identified <6 months do not • Greater prevalence rate than that of most other diseases and syndromes screened at birth such as PKU and sickle cell disease

3. Introduction • In the US, Universal newborn hearing screening is the standard of care in providing early detection and intervention for infants with permanent hearing loss • 1993: less than 5% of newborns screened • At present: ~93% newborns screened • Over-all success depends on timely and effective diagnostic and intervention services • In the Philippines, NBS program of select metabolic conditions in 1996 • Only country in East Asia Pacific Region with no government support program for hearing screening (Olusanya et.al.)

4. Introduction • Legislative support, technology and expertise to implement such program on a national level has only been recently realized • Pediatrician’s roles: - to provide early identification and interventions - to educate families - to ensure follow-up care and surveillance - to make appropriate referrals • Requires pediatricians to have awareness on neonatal hearing loss and the hearing screening process

5. Significance of the Study The study will reflect the degree of knowledge of our pediatricians regarding NBHS, provide leverage on what they still need to know and how they prefer to learn this new information to further improve their practice. Such findings are essential for creating effective partnership with the family of infants diagnosed with hearing loss in meeting their needs.

6. Objectives • To determine the knowledge, attitude and practices of pediatricians in hospitals in Quezon City on NBHS using a descriptive study design • To establish a baseline data on knowledge, attitude and practices of pediatricians on NBHS locally

7. Methodology Descriptive Study Design

8. Methodology

9. Randomly Selected Hospitals in Quezon City • AFP Medical Center • Capitol Medical Center • Dr. Fe del Mundo Medical Center • De Los Santos Medical Center • FEU – NRMF • East Avenue Medical Center • Jesus Delgado General Hospital • National Children’s Hospital • Philippine Children’s Medical Center • Philippine Heart Center • Quezon City General Hospital • Quirino Memorial Medical Center • St. Luke’s Medical Center • UERMMMCI • United Doctor’s Hospital • Veteran’s Memorial Medical Center • World Citi Medical Center

10. Data and Results

11. Table 1. Demographics of sample population

12. Table 2. Respondents’ number of years in practice and their encounter with patients with hearing loss • 68.48% of respondents has majority of patients <5 yo, Q1 • An average of 6.62 patients with hearing loss encountered for the past 3yrs • (applicable only to respondents with encountered cases of hearing loss), Q2 Table 3. Estimate of pediatric cases for 2008 for which pediatricians received screening results

13. Figure 1. Importance of NBHS, Q5 Figure 2. NBHS causes excessive anxiety to parents, Q6

14. Table 4. Physicians’ confidence in talking to parents of children with permanent hearing loss, Q10 Figure 3. Physician’s confidence in explaining NBHS process, Q9

15. Table 5. Percentage of pediatricians who selected specific conditions from a given set as risk factorsfor Late-Onset NHL, Q14 Table 6. Percentage of pediatricianswith correctresponse per condition as indication for cochlear implants, Q15

16. Figure 6. Awareness of pediatricians regarding the availability of early hearing detection and intervention programs at their respective hospitals, Q18 Figure 7. Routine referrals of pediatricians for cases of confirmed hearing loss, Q4

17. Figure 8. Awareness of the cost of NBHS, Q7 Figure 9. Perception on the practicality of the cost of NBHS, Q8

18. Table 7. Percentage of physician’s estimates of ages at which follow-up procedures should be conducted, Q13 Figure 10. Primary sources of information on NBHS, Q14

19. Table 5. Perception of the adequacy of pediatric training towards infant permanent hearing loss, Q11 Table 8. Pediatrician’s Perceptions About the Need for Training and/or Resources on Various Topics, Q12

20. Discussion

21. Profile of Respondents • The study showed that majority of respondents (60%), has encountered patients with hearing loss in their practice (Table 2) • Among the 60%, an average of 6.62 patients with hearing loss were seen for the past 3 years • 63.33% of all respondents have estimated that they received <50% screening results from their patients in 2008. Only 25% received >50%. It emphasized on the fact that NBHS is not yet a standard practice among pediatricians (Table 3)

22. Attitude • As for the respondents’ attitude towards NBHS, 90% deemed it “very important” and 10% as “somewhat important” (Fig. 1) • 57% of respondents did not considerthe screening process as source of anxiety/concern for parents, while 40% believed otherwise (Fig.2).But a study by Young&Tattersall in 2005, showed that parents’ response may vary significantly. This demonstrates the importance of a reassuring screening manner • The DOH has set a maximum rate of P550 for NBHS and the approximate price in Philippine hospitals is P400. 88% of the respondents agreed that the cost is reasonable, only 5% said that is unreasonable. This reflects the value that the respondents put into the procedure and its benefits

23. Knowledge • The study also reflected a relative lack of confidence of the respondents in talking to parents on certain issues pertaining to hearing loss as shown by the 54.6% who answered “somewhat confident” compared to a 26.8% with “very confident” response (Table 4) • On the other hand, a majority expressed confidence in explaining the NHBS process to the families of patients (very confident: 58% and somewhat confident: 35% in Fig 3) • When asked about risk factors in developing HL, respondents where able to select from a given set of choices, most of the correct ones. However, there was still a significant number who selected risk factors unrelated to hearing loss (Table 5)

24. Profound bilateral hearing loss is the only indication for cochlear implants. Only 67% of the respondents selected the correct response among a given set of conditions. (Table 6) • Newborn hearing screening, yet to be mandated by our government or any local professional medical organization, has not been implemented in all hospitals. The study revealed that only 52% of the respondents were aware of the presence or absence of an early hearing detection and intervention program in their respective hospitals (Fig. 6) • 52% responded correctly with <P550, 37% estimated it at >P550, the remaining 11% was unsure (Fig. 8) This may cause parents to assume that the

25. screening is more expensive than what it really is. This may affect their decision to avail of the procedure and this may sacrifice the possible benefits it may provide the infant • A sound knowledge on hearing loss, its causes, risk factors, consequences, possible outcomes given appropriate interventions such as the use of cochlear implants and NBH screening: its cost, availability, indications as well as its advantages will improve the physicians’ confidence and competence in addressing this problem

26. Practices • The study showed that 92% respondents routinely refer cases of HL to ENT and the remaining 8% to both ENT and Neurology (Fig. 7) • Alarmingly, a significant percentage of their responses on estimates of ages at which necessary follow-ups should be taken per specific case concerning detection and intervention for HL, did not match the recommended age for follow-ups. This will a negative impact on the overall outcome of patients with HL (Table 8)

27. Miscellaneous • The primary sources of information of the respondents regarding NBHS were lectures, training hospitals and medical textbooks (Fig. 10) • 55% of respondents deemed the pediatric training they had was inadequate in addressing hearing loss while only 17.33% reckon it adequate (Table 5) • Respondents expressed the need for further training and access to more resources on various topics regarding HL, screening and interventions as enumerated in (Fig. 8)

28. Conclusion There is evidence that pediatricians know of Newborn Hearing Screening. However, a more in-depth awareness about NBHS is highly recommended to bridge the knowledge gaps through primary sources of information and provision of action-oriented resources that will aid in the familiarity not only about NBHS but also hearing loss itself. This will catapult the pediatricians in a better position to support families and identification of infants with hearing loss and prevention of its ramifications.

29. Limitations and Recommendations • Study population was limited to pediatric consultants within Quezon City only. A larger sampling population is recommended to better reflect the current status • Only 60 of the 126 distributed survey forms were returned and some were incompletely filled-out. We attribute this to the varying interests of the respondents in participating in such endeavor. Ensuring a properly filled-out forms, a more efficient distribution and collection methods can further increase the accuracy and significance of the study. • Survey questions could still be polished to better fit the local setting

30. THANK YOU!!!