Wong Lye-Yeng, Espinoza Francisca, Alvarez Karen Mojica, Molter Dave, Saunders James E
1 Dartmouth Hitchcock Medical Center, West Lebanon, New Hampshire, USA.
2 National Association of Casa Materna, Jinotega, Nicaragua.
Otolaryngol Head Neck Surg. 2017 May;156(5):877-885. doi: 10.1177/0194599817696306. Epub 2017 Feb 1.
Objective (1) Determine the incidence and risk factors for congenital hearing loss. (2) Perform cost analysis of screening programs. Study Design Proportionally distributed cross-sectional survey. Setting Jinotega, Nicaragua. Subjects and Methods Otoacoustic emissions (OAEs) were used to screen 640 infants <6 months of age from neonatal intensive care unit, institutional, and home birth settings. Data on 15 risk factors were analyzed. Cost of 4 implementation strategies was studied: universal screening, screening at the regional health center (RHC), targeted screening, and screening at the RHC plus targeted screening. Cost-effectiveness analysis over 10 years was based on disability-adjusted life year estimates, with the World Health Organization standard of cost-effectiveness ratio (CER) / gross domestic product (GDP) <3, with GDP set at $4884.15. Results Thirty-eight infants failed the initial OAE (5.94%). In terms of births, 325 (50.8%) were in the RHC, 69 (10.8%) in the neonatal intensive care unit, and 29 (4.5%) at home. Family history and birth defect were significant in univariate analysis; birth defect was significant in multivariate analysis. Cost-effectiveness analysis demonstrated that OAE screening is cost-effective without treatment (CER/GDP = 0.06-2.00) and with treatment (CER/GDP = 0.58-2.52). Conclusions Our rate of OAE failures was comparable to those of developed countries and lower than hearing loss rates noted among Nicaraguan schoolchildren, suggesting acquired or progressive etiology in the latter. Birth defects and familial hearing loss correlated with OAE failure. OAE screening of infants is feasible and cost-effective in rural Nicaragua, although highly influenced by estimated hearing loss severity in identified infants and the high travel costs incurred in a targeted screening strategy.
（1）确定先天性听力损失的发病率及风险因素。（2）开展筛查项目的成本分析。研究设计：按比例分布的横断面调查。研究地点：尼加拉瓜的希诺特加。研究对象与方法：采用耳声发射（OAE）技术对640名6个月以下婴儿进行筛查，这些婴儿分别来自新生儿重症监护病房、福利院及在家出生。分析了15种风险因素的数据。研究了4种实施策略的成本：普遍筛查、在区域卫生中心（RHC）筛查、针对性筛查以及在RHC筛查加针对性筛查。基于伤残调整生命年估计值进行了为期10年的成本效益分析，采用世界卫生组织成本效益比（CER）/国内生产总值（GDP）<3的标准，设定GDP为4884.15美元。结果：38名婴儿首次OAE筛查未通过（5.94%）。就出生地点而言，325例（50.8%）在RHC，69例（10.8%）在新生儿重症监护病房，29例（4.5%）在家中出生。单因素分析显示家族史和出生缺陷具有显著性；多因素分析显示出生缺陷具有显著性。成本效益分析表明，无论是否进行治疗，OAE筛查均具有成本效益（CER/GDP = 0.06 - 2.00）以及进行治疗时（CER/GDP = 0.58 - 2.52）。结论：我们的OAE筛查未通过率与发达国家相当，且低于尼加拉瓜学童的听力损失率，这表明后者存在后天性或进行性病因。出生缺陷和家族性听力损失与OAE筛查未通过相关。在尼加拉瓜农村地区，对婴儿进行OAE筛查是可行且具有成本效益的，尽管该筛查受到所确定婴儿估计听力损失严重程度以及针对性筛查策略中产生的高额交通成本的高度影响。
