Page 36 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 2
Tests
The most widely used audiometric test is OAE. Flanders has used aABR in all neonates, but in 2013 introduced additional auditory steady state responses (ASSR). Some regions in Denmark, Estonia, France, Germany, Spain, and Sweden use aABR, OAE, or both in the same infant as first test in healthy babies. In nearly all programmes both ears are tested, except in Finland and Switzerland, where one or two ears are tested, depending on the institution or the presence of risk factors. Testing is not staged in five countries, two-staged in 13 countries, three-staged in 19 countries, and 4-staged in one country. aABR is used as final stage in the majority of countries. In high risk groups, eg. premature newborns, most programmes use aABR or a combination of OAE and aABR, but in eight countries OAE only is used. In Wallonia (Belgium) all premature infants undergo full ABR.
In less than half of the countries, a hearing test in pre-school or early school age children is a regular part of health screening programmes.
Referral
Neonates who do not pass the test are referred to a combined audiology / ear, nose, throat (ENT) institution in most countries, in some countries to an audiologist, and in a few countries to an ENT specialist.
Funding
In most countries the government or health insurance finances the neonatal hearing screening programme. Other reported funding includes hospital, parents, and private funds.
Coverage
UNHS programmes cover an estimated 10-50% in Romania, 50-95% in nine countries, and more than 95% in 23 other countries. Malta has a nationwide selective screening programme with good coverage, whereas Bulgaria, Moldova, and Serbia have local selective screening programmes, with low coverage. Albania’s discontinued pilot nationwide UNHS programme had a low coverage. Further detail is available in table 3 and Appendix Map 2.
Public-health
Extra information on public health screening programmes was obtained from 23 countries including one Belgian region (Flanders). All have a public health screening programme, but in Albania, Belgium, and Spain this is a regional programme.
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