Absence of new-born hearing screening delays care, drives late detection in children

The absence of a sustained new-born hearing screening programme in Nigeria’s public hospitals is contributing significantly to the late detection of hearing loss in children, limiting their access to timely and effective treatment, a clinical audiologist, Dr. Simeon Afolabi, has said.

Dr. Afolabi, promoter of the BSA Hearing and Speech Centre in Lagos, spoke with The Nation at the weekend during a Cochlear Implant information and support meeting for patients and parents. He warned that the lack of routine screening means many Nigerian children with hearing impairment are only identified years after birth, long after critical windows for speech and language development have begun to close.

According to him, hearing loss in new-borns can be detected within hours of birth through a simple, non-invasive test known as otoacoustic emission (OAE) screening. The test measures sound waves produced in the inner ear in response to auditory stimuli and takes only a few minutes to perform. Despite its simplicity and effectiveness, Dr. Afolabi noted that the screening is not routinely offered in government hospitals across the country. “In many countries, new-born hearing screening is standard practice and part of routine postnatal care,” he said. “In Nigeria, however, it is largely absent in public hospitals, even though early detection can change the entire trajectory of a child’s development.”

He explained that in private healthcare facilities, the cost of an OAE screening test ranges between N10,000 and N15,000, putting it beyond the reach of many families. Without a publicly funded programme, parents often remain unaware that such screening exists, and signs of hearing loss may go unnoticed until a child fails to develop speech or struggles academically.

Dr. Afolabi recalled that Lagos State had previously piloted new-born hearing screening programmes in selected facilities, including the Lagos State University Teaching Hospital (LASUTH) and General Hospital, Gbagada. However, he said the initiative was not sustained due to staffing constraints and administrative challenges. “As a result, many children are diagnosed very late, sometimes at seven or eight years of age, when speech and language development have already been significantly affected,” he said.

He noted that delayed diagnosis has far-reaching consequences, extending beyond communication difficulties to include social isolation, poor academic performance, and reduced economic opportunities later in life. Early detection, he stressed, allows for timely intervention, which may include hearing aids, speech therapy, or cochlear implantation, depending on the severity of the hearing loss. Dr. Afolabi explained that cochlear implants, which are electronic medical devices that bypass damaged parts of the inner ear and directly stimulate the auditory nerve, are most effective when implanted early—ideally before the age of six. When hearing loss is identified late, the benefits of cochlear implantation are significantly reduced, and children often require longer and more intensive rehabilitation to develop functional speech and language skills. “Time is critical in auditory development,” he said. “The brain’s ability to process sound and develop language is strongest in the early years. When we miss that window, we are trying to correct years of lost stimulation.”

According to him, children account for about 70 per cent of cochlear implant users in Nigeria. However, overall access to the technology remains limited due to a combination of low awareness, late diagnosis, and high cost. He disclosed that a single cochlear implant costs between N19 million and N20 million per ear, a figure that places it far beyond the reach of most Nigerian families without external support.

He argued that the high cost of treatment underscores the importance of early screening, which can reduce long-term expenses by enabling less complex and more cost-effective interventions at an earlier stage. Dr. Afolabi called on health authorities to integrate new-born hearing screening into routine postnatal services in public hospitals, alongside existing checks such as immunisation and metabolic screening. He also urged greater investment in training audiology personnel and equipping public health facilities with basic screening tools.

According to him, institutionalising new-born hearing screening would not only improve clinical outcomes for children with hearing loss but also reduce the broader social and economic burden associated with untreated hearing impairment. “Early detection is not a luxury; it is a necessity,” he said. “If Nigeria is serious about improving child health and developmental outcomes, new-born hearing screening must become part of standard care in our public hospitals.”