Risk factors for hearing impairment in infants and toddlers in the Gaza governorates: a case-control study

Abstract

BackgroundThe risk factors for congenital or early-onset hearing loss vary across countries. This study aimed to explore the risk factors for hearing impairment in children younger than 3 years in Gaza governorates to inform preventive strategies. MethodsThis case-control study started in February, 2017, and ended in July, 2018. Ethical approval was obtained from the Helsinki Committee in Palestine, a national committee established in 1986 that reviews all proposals for heath research, and whose approval is a requirement before any health research in Palestine. Data were collected through face-to-face household interviews. Cases were defined as children diagnosed with moderate, severe, or profound sensorineural hearing impairment within the first 3 years of life (n=169), whereas controls were children who had been screened and found to have unimpaired hearing (n=169). Cases and controls were randomly selected through a systematic sampling approach from the screening lists of the Atfaluna Society for Deaf Children, a registered Palestinian non-governmental organisation that has been working in the field of deaf education and allied services since 1992 and that regularly leads hearing screening campaign for neonates and children younger than 5 years in primary health centres over all Gaza governorates. SPSS version 21 was used for data entry and logistic regression analysis with the chi-square test, odds ratio, and t test. FindingsMaternal unemployment was more prevalent in cases than in controls (p=0·025). Having a family history and consanguinity were more prevalent in cases than in controls (p=0·001 for both). Taking folic acid during the preconception period (p=0·007) and iron supplements during pregnancy (p=0·002) were associated with a lower prevalence of hearing loss. The proportion of mothers of cases who were registered as having received antenatal care during the first trimester was lower for cases than for controls (odds ratio 0·341 [95% CI 0·181–0·640]; p=0·002). Prematurity (p=0·006), low birthweight (p<0·0001), and admission to a neonatal intensive care unit (p=0·002) were strongly associated with hearing impairments. The study also showed that children with recurrent otitis media were at a greater risk of hearing impairment (p<0·0001), as were children who had been exposed to sporadic loud noises, such as nearby bombing, or continuous loud noise at home, such as from nearby factories. (p=0·01). InterpretationThe study concluded that hearing impairment among children younger than 3 years is associated with a wide array of socioeconomic, health, and environmental vulnerabilities. A health promotion programme should be established to address consanguinity, prematurity prevention, and timely and appropriate preconception and antenatal care, alongside universal screening for all children, particularly those at risk as identified in this study. FundingNone.