Audit of the Southern DHB B4 School hearing screening referral process: is there unmet need?

Abstract

The B4 School Check aims for early detection and appropriate management of hearing loss prior to school entry. In light of increasing awareness of inequitable health outcomes across a variety of measures in Aotearoa New Zealand, particularly for Māori and Pasifika, we performed an audit of B4 School screening hearing related referrals. For the census year 2018, we examined the hearing screening data for age, gender, ethnicity, region and locality. For those children whose screening triggered a referral, the district health board (DHB) record was examined to assess whether a referral was received by the public audiology or otolaryngology head and neck surgery (ORLHNS) departments and if any appointment was subsequently attended. For Otago, but not Southland, there was a mismatch between census and screening programme estimates of the number of children eligible for screening. Māori and Pasifika children were significantly less likely to pass the screening tests (p<0.00001) compared to other ethnicities. Referral rates were not significantly different among ethnic groups, but Pasifika children were significantly less likely be assessed by an audiologist or otolaryngologist (p<0.004). Despite an equal distribution of screening and referral, significantly more Māori and Pasifika children will start primary school with potential hearing impairment compared to other ethnicities. While the Southern DHB B4 School hearing screening programme is equal in capturing children of different backgrounds, it demonstrates a greater prevalence of potential hearing impairment among Māori and Pasifika children when entering primary school. This raises the need to consider how to better provide ongoing care for these children.