Implementation of a neonatal hearing screening program in Kinshasa, Democratic Republic of Congo: a pilot study in maternity hospitals

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To assess the operational feasibility of neonatal screening in Kinshasa, Democratic Republic of Congo, through a pilot study. This was a cross-sectional study conducted in the city of Kinshasa between October and December 2024. A total of 1,017 newborns whose parents gave consent were enrolled in four referral maternity hospitals in the city. Screening was performed using distortion product otoacoustic emissions (DPOAE) and automated auditory brainstem response (AABR). Statistical analyses were carried out using IBM SPSS version 27.0 for Windows. All 1,017 newborns were screened using DPOAE; 25/1,017 were referred, yielding a referral rate of 2.5%. The follow-up return rate was 80% (20/25). Five newborns were lost to follow-up. Among the 20 referred newborns who participated in the second screening stage using DPOAE, 19 passed and one remained referred even after AABR testing. Hearing loss was confirmed at 3 months of age by ABR, with a prevalence of 1 per 1000, i.e., 1/1,017. Early detection of hearing loss is feasible in the Democratic Republic of the Congo despite major organizational and financial challenges. Health sciences/Health care Health sciences/Medical research Screening Neonatal Hearing loss Kinshasa/Democratic Republic of the Congo Figures Figure 1 Figure 2 Introduction Neonatal screening is a public health intervention aimed at detecting certain rare diseases at birth when they are severe or disabling ( 1 ). For the early identification of hearing loss, the World Health Organization (WHO) and the Joint Committee on Infant Hearing (JCIH) recommend universal newborn hearing screening (UNHS), a practice that is now routine in high-income countries ( 2 ). Early diagnosis determines the timely implementation of appropriate interventions before the age of 3 to 6 months. This leads to better outcomes, particularly in speech development and language acquisition, with appropriate vocabulary and articulation, as well as cognitive, social, and emotional development comparable to that of normal-hearing children, unlike in cases of late intervention ( 3 – 6 ). The 1-3-6-month guideline recommended by the JCIH has proven effective: screening by 1 month of age, confirmation of audiological diagnosis by 3 months, and initiation of appropriate intervention by 6 months ( 7 ). In most resource-limited countries, such as those in sub-Saharan Africa, universal newborn hearing screening is not effectively implemented, although most newborns with hearing loss live there. This is due to the lack of consolidated programs and the scarcity of data ( 8 , 9 ). The most performed screening at birth is targeted screening, which focuses on newborns with risk factors listed by the JCIH in 2019. These include a family history of hearing loss; neonatal intensive care unit stay of more than 5 days, hyperbilirubinemia requiring exchange transfusion, ototoxicity due to aminoglycoside administration for more than 5 days or use of diuretics, asphyxia or hypoxia and ischemic encephalopathy, mechanical ventilation, embryofetopathies, meningitis, craniofacial malformations and head trauma, low birth weight (< 1.5 kg), and prematurity (< 32 weeks) ( 10 ). Neonatal hearing screening requires specialized and often costly technical equipment, which may be inaccessible in certain settings. Worldwide, it is unanimously performed using objective, non-invasive electrophysiological tests such as otoacoustic emissions (OAE) and/or automated auditory brainstem response (AABR) to record a physiological response from the ear ( 11 – 13 ). The advantage of these tests is that they are quick, objective, easy to administer, and effective in identifying infants with hearing loss ( 14 ). OAE testing lasts 3 to 5 minutes. It has a sensitivity of 95–100% and a specificity of 80–99%, with a higher referral rate than AABR, which takes slightly longer (12–14 minutes) and is more expensive, but has sensitivity and specificity approaching 100% ( 15 ). Beyond sociological considerations, these various genetic or environmental, congenital, perinatal, or postnatal risk factors lead to sensory deficits manifested as hearing loss in some newborns. In the Democratic Republic of the Congo (DRC), a resource-limited country, a concerning observation has been made across various healthcare facilities: no neonatal hearing screening program has yet been implemented, even in Kinshasa, the nation’s capital. The present study is justified by the lack of prevalence estimates and data on the characteristics and risk factors of newborns affected by hearing loss, to provide the necessary information for developing a large-scale plan to define a national neonatal hearing screening strategy, similar to that of other nations worldwide. This would enable early diagnosis and appropriate management. Thus, the objective of this study was to analyze the operationalization of neonatal hearing loss screening in maternity hospitals in Kinshasa. Methods Study Type, Setting, and Population This was a cross-sectional study conducted in the city-province of Kinshasa, in the Democratic Republic of Congo, between October and December 2024. This megacity, with an estimated population of 17,778,000 inhabitants in 2025 ( 16 ), is divided into four administrative districts. Among the various healthcare facilities distributed across these districts, four referral maternity hospitals were selected, one per district: (i) Kingasani Maternity in Tshangu, which included 300 newborns; (ii) Kintambo Maternity in Lukunga, with 275 newborns; (iii) Bumbu Maternity in Funa, with 250 newborns; and (iv) Ngaba General Referral Hospital (HGR Ngaba) Maternity in Mont-Amba, with 192 newborns enrolled. A total of 1,017 newborns were examined out of 1,130 presumed healthy infants among the 1,250 live births recorded in these four maternity hospitals during the study period. Those hospitalized in neonatology and intensive care units (120 newborns) were not included in this study. Study Investigation Team The team consisted of one Ear, Nose, and Throat (ENT) specialist, one ENT resident, three junior general practitioners, and one nurse. They received seven days of training on the collection of socio-demographic data and hearing loss risk factors, anthropometric measurements, ENT and craniofacial physical examination, and the use of hearing screening tools, namely DPOAE and AABR. Study Procedures Newborns whose parents provided consent were examined between the 1st and 5th day of life in the maternity ward. Informed consent was preceded by clear information about the screening procedure, its benefits, and the absence of risk for the baby. In addition, the screening was free of charge, even though the visited facilities were covered under the free healthcare policy through universal health coverage. Socio-demographic data and information on hearing loss risk factors were collected through medical record review and interviews with the mother. Clinical data were recorded after anthropometric measurements and craniofacial and ENT physical examination. Hearing screening was then conducted according to a protocol using DPOAE and AABR ( 17 ), in multiple stages to reduce referral rates for diagnostic audiometric testing ( 18 ). For this study, testing was performed in three stages: the first involved DPOAE, the second involved repeat DPOAE for those who failed the first test, and the third consisted of AABR for those who failed the second test. DPOAE screening (EROSCAN type, MAICO, Germany) was performed by delivering a click sound stimulus through a small probe placed in the external auditory canal, with the cochlear response constituting the expected result, either success (pass) or fail (refer). Primary tones were presented at levels of L1 = 65 dB and L2 = 55 dB SPL. A signal-to-noise ratio of 6 dB in three out of four tested frequencies between 2 and 5 kHz was required to qualify as a pass. Screening was conducted at the baby’s bedside or in the mother’s arms in a quiet room after feeding or during breastfeeding. Results were recorded and explained to the mother. No further testing was performed for infants who obtained a "PASS" result. For AABR screening (Elios type, France), a click sound stimulus was delivered through an insert earphone placed in the baby’s external auditory canal. Surface electrodes were placed on the infant’s head to record the brainstem response to sound stimulation. AABR results were displayed as either success "pass" or fail "refer". Referred newborns received a follow-up appointment four to six weeks after hospital discharge. At follow-up, a two-step hearing screening using DPOAE and AABR was performed. Those who failed the second and third screening stages were referred for diagnostic ABR testing at the ENT department of the University Clinics of Kinshasa. Diagnostic ABR was performed within three months for referred infants. No additional testing was conducted for those with normal ABR results. Confirmation of Hearing Loss ABR testing (ELIOS type) was performed by presenting a sound stimulus through an insert earphone placed in the infant’s external auditory canal. Surface electrodes were placed on the baby’s head to record the brainstem response. In this study, hearing loss greater than 30 dB, whether bilateral or unilateral, was considered permanent congenital hearing loss. Audiological follow-up was planned, including referral to an audioprothetist for hearing amplification devices, speech therapy management, and parental involvement in auditory and language stimulation. Statistical Analysis Descriptive statistics were performed using IBM SPSS Statistics version 27.0 for Windows (December 29, 2022, USA). Results A total of 1,017 newborns were screened out of 1,130 eligible infants from a population of 1,250 live births recorded during the study period across the four facilities, representing a coverage rate of 90%. Their socio-demographic characteristics and risk factors are shown in Table 1. Males accounted for 53.8%, with a sex ratio of 1.16. The mean age of these newborns was 1.53 ± 0.66 days, ranging from 1 to 5 days. Table 1. Sociodemographic, anthropometric data and risk factors Variables n Percentage (%) Sociodemographic characteristics Gender Boys Girls 547 470 53,8 46,2 Age groups 1 day 2 days 3 days More than 3 days 539 435 24 19 53 42,7 2,4 1,9 Mother’s educational level Low level Hygh level 827 190 81,3 18,7 Mother’s occupation Housewife Informal private sector Unemployed Public sector Formal private sector 502 215 173 66 61 49,4 21,1 17 6,5 6 Father’s occupation Informal private sector Public sector Unemployed Formal private sector 555 187 173 102 54,6 18,4 17,0 10,0 Anthropometric parameters of newborns Weight (g) Height (cm) Upper arm circumference (mm) Head circumference (cm) 3190,47±472,47 47,40±2,62 107,17±12,81 33,36±1,51 1900-5500 32-56 38-150 24-45 Birth weight categories Eutrophic newborns Hypotrophic newborns (Low weight) Hypertrophic newborns (High weight) 910 97 10 89,5 9,5 1 Risk factors Premature newborns (Born <32 weeks’ gestation) Full-term newborns (Born ≥32 SA weeks’ gestation) Normal APGAR Low APGAR 3 1014 1016 1 0,3 99,7 99,9 0,1 The mean weight was 3,190.47 grams, ranging from 1,900 to 5,500 grams, with 9.5% classified as underweight and 1% as overweight (Table 1). The mean length was 47.40 cm, with extremes ranging from 32 to 56 cm. The mean mid-upper arm circumference was 105.62 mm, ranging from 38 to 150 mm, and the mean head circumference was 33.36 cm, with a range of 24 to 45 cm (Table 1). Gestational age was ≥32 weeks in the majority of cases (99.7%), whereas 0.3% of newborns were born before 32 weeks but were in perfect health and did not require any special care (Table 1). Only one infant (0.1%) had a low APGAR score, either below 4 at the 1st minute or below 6 at the 5th minute (Table 1). Most newborns were screened in maternity hospitals in the Tshangu district (29.2%), and their parents had a low educational and socioeconomic level (81.3%), with 32.4% originating from the Greater Bandundu province. Audiological Tests The coverage rate was 90%, corresponding to 1,017 out of 1,130 eligible live births during the study period. All 1,017 newborns were screened using DPOAE; 25/1,017 were referred (test failure), giving a referral rate of 2.5%. The follow-up return rate was 80%, with 20 out of 25 referred newborns returning, while 5 newborns were lost to follow-up. Among the 20 referred newborns who participated in the second stage of DPOAE screening, 19 passed the test, and one remained "refer". This infant also failed the AABR test. Hearing loss was confirmed at 3 months of age using ABR, giving a prevalence of 1 per 1,000, i.e., 1/1,017 (Figure 1). Regarding the case of hearing loss: The child who presented with hearing loss was male and 2 days old at the time of screening. He resides in the Ngaba commune with his mother, who is originally from the Equateur province (Mongo) and attend a Pentecostal church in the city-province of Kinshasa. Prenatal care was irregular, but no maternal pathology was reported. Delivery was eutocic, and the amniotic fluid was meconium-stained (old meconium). His birth weight was 3,600 g, length 48 cm, mid-upper arm circumference 100 mm, and head circumference 35 cm. This full-term newborn had a low APGAR score: 2 (<4) at 1 minute, 5 (<6) at 5 minutes, and 9/10 at 10 minutes. A diagnosis of neonatal distress was made, with a recommendation for transfer to the referral center (University Clinics of Kinshasa). However, this could not be carried out due to the parents’ precarious socioeconomic situation. Both parents had a low level of education, with the mother being a homemaker and the father unemployed. The child experienced feeding difficulties throughout his first week of life, with spontaneous favorable evolution. He failed both hearing screenings using DPOAE conducted one month apart, as well as the AABR test. His hearing loss was confirmed by early ABR and ASSR testing performed at 3 months of age (Figure 2). This was a sensorineural hearing loss of 45 dB in the right ear and 50 dB in the left ear (Figure 2). Regarding the etiological risk factors for this hearing loss, TORCH screening revealed positive serology (significant IgM and IgG titers) for cytomegalovirus, and absence of antibodies for toxoplasmosis and syphilis. The presence of neonatal distress is also a contributing factor. The intervention consisted of providing hearing aids (prostheses) and multidisciplinary follow-up. Discussion This study is the first of its kind in the field of neonatal hearing screening in our country, the DRC, a resource-limited country. The time dedicated to raising awareness and providing information to the staff of the selected maternity hospitals in Kinshasa, as well as to the mothers of the newborns included during the study period, led to almost total participation through written consent. This explains the mean age of 1.53 days at inclusion. The coverage rate of 90% is below the 95% recommended by the JCIH, as well as the 98% reported in the Kenyan cohort by Ndegwa et al. in 2024 ( 19 ). This can be explained by the refusal of mothers who are not accustomed to systematic screening for certain diseases or conditions at birth in apparently healthy newborns, especially since the DRC does not yet have well-implemented government programs, despite the free and harmless nature of the tests used. This coverage rate would be even lower, around 81%, if sick newborns initially excluded from the study were considered. All included newborns (1,017) participated in the first stage of DPOAE screening, with a referral rate of 2.5% after this first test. This rate aligns with the 2007 JCIH recommendation that it should be below 4%. Similar rates were reported by Ndegwa et al. in Kenya, with a referral rate of 3.6% in 2024 ( 19 ). Comparable referral rates are also reported in India and Hong Kong, at 2.2% and 2%, respectively ( 20 , 21 ). In contrast, Kock et al., 2016, in South Africa reported a higher referral rate of 7% ( 22 ). Denoyelle et al., 2021 ( 23 ) mention a false-positive rate for DPOAE of 3–8%, which is expected when testing newborns very close to birth. This is explained by the presence of vernix caseosa in the external auditory canal and amniotic fluid in the canal or tympanic cavity at this early age. This suggests that the optimal time for examination may not be before the first day of life, as observed by Walsh et al. in Uganda ( 8 ) and Kanji in South Africa ( 24 ). We also believe that using DPOAE (with higher specificity) instead of transient-evoked otoacoustic emissions (TEOAE) contributed to achieving an optimal referral rate in this study. The follow-up return rate of 80% (5/25 referred newborns lost to follow-up) in this study is higher than the 2024 Kenyan pilot study (72%) but below the JCIH recommendation of 95%. This rate is close to the 86% reported in a 2022 Ethiopian study ( 25 ). An even lower rate of 34.3% was reported in a 2021 Ugandan study ( 26 ). This represents an organizational challenge for resource-limited countries, highlighting the need to develop effective strategies to engage parents in follow-up and care, despite frequent changes in phone numbers and addresses. We followed some infants at home, but for the five lost to follow-up, the parents were no longer reachable or had moved. Among the 25 newborns referred after the first stage, 20 participated in the second DPOAE screening, and only one newborn was referred and underwent ABR, which confirmed moderate bilateral sensorineural hearing loss (45 dB in the right ear and 50 dB in the left ear). According to the WHO, hearing loss is defined when the auditory threshold is ≤ 20 dB and is classified as mild (26–40 dB), moderate (41–60 dB), severe (61–80 dB), or profound (≥ 81 dB) ( 27 ). Disabling hearing loss is defined as a threshold > 30 dB in the better ear for children aged 0–15 years and > 40 dB for adults ( 28 , 29 ). Hearing loss in children differs from that in adults due to its impact on speech acquisition and language development. The results from this series indicate a prevalence of 1 per 1,000 live births. This is lower than expected in sub-Saharan Africa, where prevalence ranges from 3 to 6 per 1,000 live births, and is closer to that reported in Western countries ( 31 ). In Kenya, the prevalence is 3 per 1,000 ( 32 ). Other authors, such as Ranjanbabu et al., 2024, report an incidence of 16 per 1,000 in sub-Saharan Africa, reflecting disparities in screening protocols ( 33 ). In Asia, the prevalence is 2 per 1,000 in China, Malaysia, Thailand, and Nepal; 4 per 1,000 in Turkey; and 5 per 1,000 in India ( 34 ). In the Middle East and North Africa, it ranges from 2 to 4 per 1,000, and in Latin America and the Caribbean, it is approximately 2 per 1,000 ( 35 ). All these epidemiological considerations show that the estimated incidence of hearing loss in newborns varies from 0.5 to 5 per 1,000 in different countries. It is recognized as one of the most common sensory disorders in newborns ( 30 ). Other studies have demonstrated remarkable differences in hearing impairment between developed and developing countries: an incidence of 1–3 per 1,000 for congenital bilateral hearing loss is reported in developed countries, whereas in developing countries, the estimated rate is higher, around 3–6 per 1,000 live births ( 36 – 40 ). Hearing impairment is one of the most widespread developmental disorders. The incidence of 1–3 per 1,000 live births in high-income countries, based on universal neonatal screening in maternity wards or nurseries, may be multiplied 10–20 times, equivalent to 2–4 per 100 newborns, in intensive care unit populations ( 41 – 46 ). The consequences of severe permanent bilateral hearing loss represent a socioeconomic and psychological burden for the individual, their family, and society as a whole ( 47 ). This hearing loss negatively affects language development, cognition, schooling, gross and fine motor skills, psychosocial and emotional development, and future social and professional integration ( 48 – 53 ). However, approximately 50% of all hearing loss cases are preventable through preventive strategies such as vaccination, health education, and improved maternal and child health services ( 54 , 55 ). For the newborn with hearing loss in this study, detection, confirmation, and corrective intervention with hearing aids were carried out within the timeframes recommended by JCIH 2007, according to the 1-3-6 month rule. The two risk factors associated with the case of hearing loss in this study are preventable through maternal-fetal and perinatal care improvements ( 56 ), highlighting the importance of promoting these measures in our environment. Despite efforts to prevent identified risk factors ( 57 ), hearing loss still occurs in high-income countries due to uncontrollable factors and approximately 50% of cases being genetic in origin. The main limitation of this study is the sample size, although it is pioneering in our country. We recommend conducting larger-scale neonatal hearing screening studies to identify the most frequent risk factors in our population and define appropriate preventive measures. The challenge of intervention, particularly regarding hearing aids and cochlear implants in cases of hearing loss, remains significant in a country without social coverage and without qualified personnel for rehabilitation, such as audiologists and speech therapists. Conclusion This study is the first on neonatal hearing screening in the DRC, a resource-limited country. Given its incidence and its health implications, hearing loss can today be considered a public health issue. This series provides useful information aligned with our objective to consider implementing larger-scale or even UNHS, as well as to guide upstream efforts in both the community and healthcare facilities to increase coverage, determine the optimal timing for screening to reduce referral rates and test failures, and ensure parental compliance in bringing their babies back for diagnosis and interventions. The challenges of trained human resources, budgetary and organizational constraints, and the lack of adequate equipment constitute obstacles to the rapid launch of such a program, despite the proven benefits demonstrated in several countries where it is applied. Nevertheless, targeted screening can initially be carried out in newborns at high risk of congenital hearing loss, according to the risk factor list provided by the JCIH in 2019. Declarations Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Funding This research did not receive any specific funding from public, commercial, or non-profit funding organizations. Ethical considerations This study received approval from the National Ethics Committee, reference: Opinion of the National Health Ethics Committee N o 563/CNES/BN/PMMF/2024 of 20/08/2024. Authorization from the authorities of the medical institutions was obtained. The anonymity and confidentiality of the collected data were respected, and the results were communicated to the authorities and published. Informed Consent Statement Writing informed consent was obtained from the parents of all newborns who participated in this study Authors’ contributions All authors contributed (Ndungi Maphonda Marie, Richard Matanda Nzanza, Célestin Nsibu Ndosimau, Sokolo Gedikondele Jerôme, Longo Mbenza Benjamin, Mvitu Muaka Moïse, Kelu Bisabu Ken, Pholo Jean Paul, Mvunda Anne-Marie, Mambueni Thamba Christophe) to the completion of the study. Conflicts of Interest The authors declare that they have no conflicts of interest related to this study. References HAS. Dépistage néonatal: la HAS publie un guide méthodologique d’évaluation des maladies à intégrer dans le programme national, 28 avr. (2023). Joint Committee on Infant Hearing; American Academy of Audiology; American Academy of Pediatrics; American Speech-Language-Hearing Association. Directors of Speech and Hearing Programs in State Health and Welfare Agencies. 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Clin. North. Am. 32 (6), 999–1007 (1999). Mehl, A. L. & Thomson, V. Newborn hearing screening: the great omission. Pediatrics 101 (1), E4 (1998). Yoshinaga-Itano, C. Benefits of early intervention for children with hearing loss. Otolaryngol. Clin. North. Am. 32 (6), 1089–1102 (1999). Nikolopoulos, T. P. Neonatal hearing screening: what we have achieved and what needs to be improved. Int. J. Pediatr. Otorhinolaryngol. 79 (5), 635–637 (2015). Hess, M. et al. Hearing screening in at-risk neonate cohort. Int. J. Pediatr. Otorhinolaryngol. 46 (1–2), 81–89 (1998). Wroblewska-Seniuk, K. et al. Sensorineural and conductive hearing loss in infants diagnosed in the program of universal newborn hearing screening. Int. J. Pediatr. Otorhinolaryngol. 105 , 181–186 (2018). Su-Kyoung Park. Newborn Hearing Loss and Newborn Hearing Screening. Hanyang Med. Reviews . 35 (2), 72–77 (2015). Aboubacar, S. H. Child Deafness Epidemiological, Clinical and Etiological Aspects. Doctoral Thesis in Medicine, University of Sciences, Techniques, and Technologies of Bamako, Mali, (2015). World Health Organization. Fact Sheet No.300, (2015). Yoshinaga-Itano, C., Sedey, A. L., Coulter, D. K. & Mehl, A. L. Language of early- and later-identified children with hearing loss. Pediatrics 102 (5), 1161–1171 (1998). Elahe, S., Zahra, J. & Maryam, G. Effect of Early Intervention on Language Development in Hearing-Impaired Children. Iran. J. Otorhinolaryngol. 28 (84), 13–21 (2016). Watkin, P. et al. Language ability in children with permanent hearing impairment: the influence of early management and family participation. Pediatrics 120 (3), e694–701 (2007). Bess, F. H., Dodd-Murphy, J. & Parker, R. A. Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear Hear. 19 (5), 339–354 (1998). Wilson, B. S., Tucci, D. L., Merson, M. H. & O'Donoghue, G. M. Global hearing health care: new findings and perspectives. Lancet 390 (10111), 2503–2515 (2017). Mishra, G., Sharma, Y., Mehta, K. & Patel, G. Efficacy of Distortion Product Oto-acoustic Emission (OAE)/Auditory Brainstem Evoked Response (ABR) Protocols in Universal Neonatal Hearing Screening and Detecting Hearing Loss in Children < 2 Years of Age. Indian J. Otolaryngol. Head Neck Surg. 65 (2), 105–110 (2013). Organisation mondiale de la Santé (OMS). Rapport mondial sur l’audition. Genève , (2021). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 13 Mar, 2026 Editor assigned by journal 11 Mar, 2026 Submission checks completed at journal 11 Mar, 2026 First submitted to journal 04 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9032397","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":605508689,"identity":"83e6f641-e282-479c-b431-c1a902391df0","order_by":0,"name":"Ndungi Maphonda Marie","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Ndungi","middleName":"Maphonda","lastName":"Marie","suffix":""},{"id":605508691,"identity":"f6500f4a-5687-4954-9f9f-f1b5b68bdb24","order_by":1,"name":"Richard Matanda Nzanza","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"Matanda","lastName":"Nzanza","suffix":""},{"id":605508694,"identity":"23ff5492-cc19-4668-9aa9-21c704417df0","order_by":2,"name":"Célestin Nsibu Ndosimau","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Célestin","middleName":"Nsibu","lastName":"Ndosimau","suffix":""},{"id":605508697,"identity":"4db0f00f-0580-4caa-a2d2-b4a94bf9c982","order_by":3,"name":"Sokolo Gedikondele Jerôme","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Sokolo","middleName":"Gedikondele","lastName":"Jerôme","suffix":""},{"id":605508698,"identity":"dccb412a-cf85-4a49-a7a6-684132d3a0d2","order_by":4,"name":"Longo Mbenza Benjamin","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Longo","middleName":"Mbenza","lastName":"Benjamin","suffix":""},{"id":605508700,"identity":"de44d07a-2887-4422-8eaa-ce52652d2c56","order_by":5,"name":"Mvitu Muaka Moïse","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Mvitu","middleName":"Muaka","lastName":"Moïse","suffix":""},{"id":605508702,"identity":"d2a99903-ebf2-4fe0-b427-44fb8c95e1be","order_by":6,"name":"Kelu Bisabu Ken","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Kelu","middleName":"Bisabu","lastName":"Ken","suffix":""},{"id":605508707,"identity":"6cda85eb-f369-4bcd-bb73-06013617836b","order_by":7,"name":"Pholo Jean Paul","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Pholo","middleName":"Jean","lastName":"Paul","suffix":""},{"id":605508709,"identity":"20b2d312-548b-4ea3-9716-bdb3460a82dc","order_by":8,"name":"Mvunda Anne-Marie","email":"","orcid":"","institution":"University of Kinshasa","correspondingAuthor":false,"prefix":"","firstName":"Mvunda","middleName":"","lastName":"Anne-Marie","suffix":""},{"id":605508711,"identity":"d52840c3-cc05-4195-84f3-6c93738177d5","order_by":9,"name":"Mambueni Thamba Christophe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYDACCQaGA2CSvQHIM7AgRQvPAZAWCeK0QBkJKFzcgH9278ODP3dYJG64+fzqhh8FEgz87d0J+C25c9zgMO8ZicSZs3PKbvYAHSZx5uwGvFoMJNIYDjO2SeT2S+ek3eABajGQyCWs5eBPoJY2yTNpN/8Qq+UAL8gWCfZjt4myReIG0GFALfUze3LYbssYSPAQ9Av/jDTmjz/b6owNjh9/dvPNHxs5/vZe/FqQAI8BmCRWOQiwPyBF9SgYBaNgFIwgAAA+4kYfGcYCEgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Kinshasa","correspondingAuthor":true,"prefix":"","firstName":"Mambueni","middleName":"Thamba","lastName":"Christophe","suffix":""}],"badges":[],"createdAt":"2026-03-04 16:24:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9032397/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9032397/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105035347,"identity":"8ae6747b-0245-47f4-ae5f-339edd040747","added_by":"auto","created_at":"2026-03-20 07:25:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74356,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of audiological results\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9032397/v1/b50ca7dee6fc878469274339.png"},{"id":105035502,"identity":"fc18d928-f9f9-44af-9926-a86b37b9c29c","added_by":"auto","created_at":"2026-03-20 07:26:12","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":431036,"visible":true,"origin":"","legend":"\u003cp\u003eASSR test confirming hearing loss in the right ear (A) and left ear (B)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9032397/v1/f2761b529b145e7948258f7d.jpeg"},{"id":105036780,"identity":"3005255c-9007-469c-ba6c-a912be953371","added_by":"auto","created_at":"2026-03-20 07:35:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1307650,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9032397/v1/f9a8974e-d04b-4050-8453-8632d610ec79.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implementation of a neonatal hearing screening program in Kinshasa, Democratic Republic of Congo: a pilot study in maternity hospitals","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeonatal screening is a public health intervention aimed at detecting certain rare diseases at birth when they are severe or disabling (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). For the early identification of hearing loss, the World Health Organization (WHO) and the Joint Committee on Infant Hearing (JCIH) recommend universal newborn hearing screening (UNHS), a practice that is now routine in high-income countries (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly diagnosis determines the timely implementation of appropriate interventions before the age of 3 to 6 months. This leads to better outcomes, particularly in speech development and language acquisition, with appropriate vocabulary and articulation, as well as cognitive, social, and emotional development comparable to that of normal-hearing children, unlike in cases of late intervention (\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The 1-3-6-month guideline recommended by the JCIH has proven effective: screening by 1 month of age, confirmation of audiological diagnosis by 3 months, and initiation of appropriate intervention by 6 months (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn most resource-limited countries, such as those in sub-Saharan Africa, universal newborn hearing screening is not effectively implemented, although most newborns with hearing loss live there. This is due to the lack of consolidated programs and the scarcity of data (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The most performed screening at birth is targeted screening, which focuses on newborns with risk factors listed by the JCIH in 2019. These include a family history of hearing loss; neonatal intensive care unit stay of more than 5 days, hyperbilirubinemia requiring exchange transfusion, ototoxicity due to aminoglycoside administration for more than 5 days or use of diuretics, asphyxia or hypoxia and ischemic encephalopathy, mechanical ventilation, embryofetopathies, meningitis, craniofacial malformations and head trauma, low birth weight (\u0026lt;\u0026thinsp;1.5 kg), and prematurity (\u0026lt;\u0026thinsp;32 weeks) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNeonatal hearing screening requires specialized and often costly technical equipment, which may be inaccessible in certain settings. Worldwide, it is unanimously performed using objective, non-invasive electrophysiological tests such as otoacoustic emissions (OAE) and/or automated auditory brainstem response (AABR) to record a physiological response from the ear (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The advantage of these tests is that they are quick, objective, easy to administer, and effective in identifying infants with hearing loss (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOAE testing lasts 3 to 5 minutes. It has a sensitivity of 95\u0026ndash;100% and a specificity of 80\u0026ndash;99%, with a higher referral rate than AABR, which takes slightly longer (12\u0026ndash;14 minutes) and is more expensive, but has sensitivity and specificity approaching 100% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBeyond sociological considerations, these various genetic or environmental, congenital, perinatal, or postnatal risk factors lead to sensory deficits manifested as hearing loss in some newborns.\u003c/p\u003e \u003cp\u003eIn the Democratic Republic of the Congo (DRC), a resource-limited country, a concerning observation has been made across various healthcare facilities: no neonatal hearing screening program has yet been implemented, even in Kinshasa, the nation\u0026rsquo;s capital.\u003c/p\u003e \u003cp\u003eThe present study is justified by the lack of prevalence estimates and data on the characteristics and risk factors of newborns affected by hearing loss, to provide the necessary information for developing a large-scale plan to define a national neonatal hearing screening strategy, similar to that of other nations worldwide. This would enable early diagnosis and appropriate management.\u003c/p\u003e \u003cp\u003eThus, the objective of this study was to analyze the operationalization of neonatal hearing loss screening in maternity hospitals in Kinshasa.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Type, Setting, and Population\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study conducted in the city-province of Kinshasa, in the Democratic Republic of Congo, between October and December 2024. This megacity, with an estimated population of 17,778,000 inhabitants in 2025 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), is divided into four administrative districts. Among the various healthcare facilities distributed across these districts, four referral maternity hospitals were selected, one per district: (i) Kingasani Maternity in Tshangu, which included 300 newborns; (ii) Kintambo Maternity in Lukunga, with 275 newborns; (iii) Bumbu Maternity in Funa, with 250 newborns; and (iv) Ngaba General Referral Hospital (HGR Ngaba) Maternity in Mont-Amba, with 192 newborns enrolled.\u003c/p\u003e \u003cp\u003eA total of 1,017 newborns were examined out of 1,130 presumed healthy infants among the 1,250 live births recorded in these four maternity hospitals during the study period. Those hospitalized in neonatology and intensive care units (120 newborns) were not included in this study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Investigation Team\u003c/h3\u003e\n\u003cp\u003eThe team consisted of one Ear, Nose, and Throat (ENT) specialist, one ENT resident, three junior general practitioners, and one nurse. They received seven days of training on the collection of socio-demographic data and hearing loss risk factors, anthropometric measurements, ENT and craniofacial physical examination, and the use of hearing screening tools, namely DPOAE and AABR.\u003c/p\u003e\n\u003ch3\u003eStudy Procedures\u003c/h3\u003e\n\u003cp\u003e Newborns whose parents provided consent were examined between the 1st and 5th day of life in the maternity ward.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003ewas preceded by clear information about the screening procedure, its benefits, and the absence of risk for the baby. In addition, the screening was free of charge, even though the visited facilities were covered under the free healthcare policy through universal health coverage.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eSocio-demographic data and information on hearing loss risk factors were collected through medical record review and interviews with the mother. Clinical data were recorded after anthropometric measurements and craniofacial and ENT physical examination. Hearing screening was then conducted according to a protocol using DPOAE and AABR (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), in multiple stages to reduce referral rates for diagnostic audiometric testing (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). For this study, testing was performed in three stages: the first involved DPOAE, the second involved repeat DPOAE for those who failed the first test, and the third consisted of AABR for those who failed the second test.\u003c/p\u003e \u003cp\u003eDPOAE screening (EROSCAN type, MAICO, Germany) was performed by delivering a click sound stimulus through a small probe placed in the external auditory canal, with the cochlear response constituting the expected result, either success (pass) or fail (refer). Primary tones were presented at levels of L1\u0026thinsp;=\u0026thinsp;65 dB and L2\u0026thinsp;=\u0026thinsp;55 dB SPL. A signal-to-noise ratio of 6 dB in three out of four tested frequencies between 2 and 5 kHz was required to qualify as a pass. Screening was conducted at the baby\u0026rsquo;s bedside or in the mother\u0026rsquo;s arms in a quiet room after feeding or during breastfeeding. Results were recorded and explained to the mother. No further testing was performed for infants who obtained a \"PASS\" result.\u003c/p\u003e \u003cp\u003eFor AABR screening (Elios type, France), a click sound stimulus was delivered through an insert earphone placed in the baby\u0026rsquo;s external auditory canal. Surface electrodes were placed on the infant\u0026rsquo;s head to record the brainstem response to sound stimulation. AABR results were displayed as either success \"pass\" or fail \"refer\".\u003c/p\u003e \u003cp\u003eReferred newborns received a follow-up appointment four to six weeks after hospital discharge. At follow-up, a two-step hearing screening using DPOAE and AABR was performed. Those who failed the second and third screening stages were referred for diagnostic ABR testing at the ENT department of the University Clinics of Kinshasa. Diagnostic ABR was performed within three months for referred infants. No additional testing was conducted for those with normal ABR results.\u003c/p\u003e\n\u003ch3\u003eConfirmation of Hearing Loss\u003c/h3\u003e\n\u003cp\u003eABR testing (ELIOS type) was performed by presenting a sound stimulus through an insert earphone placed in the infant\u0026rsquo;s external auditory canal. Surface electrodes were placed on the baby\u0026rsquo;s head to record the brainstem response. In this study, hearing loss greater than 30 dB, whether bilateral or unilateral, was considered permanent congenital hearing loss. Audiological follow-up was planned, including referral to an audioprothetist for hearing amplification devices, speech therapy management, and parental involvement in auditory and language stimulation.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were performed using IBM SPSS Statistics version 27.0 for Windows (December 29, 2022, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 1,017 newborns were screened out of 1,130 eligible infants from a population of 1,250 live births recorded during the study period across the four facilities, representing a coverage rate of 90%. Their socio-demographic characteristics and risk factors are shown in Table 1. Males accounted for 53.8%, with a sex ratio of 1.16. The mean age of these newborns was 1.53 \u0026plusmn; 0.66 days, ranging from 1 to 5 days.\u003c/p\u003e\n\u003cp\u003eTable 1.\u0026nbsp;Sociodemographic, anthropometric data and risk factors\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"632\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eSociodemographic characteristics\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBoys\u003c/p\u003e\n \u003cp\u003eGirls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e547\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e53,8\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e46,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge groups\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1 day\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2 days\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 3 days\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; More than 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e539\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e53\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e42,7\u003c/p\u003e\n \u003cp\u003e2,4\u003c/p\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother\u0026rsquo;s educational level\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eLow level\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHygh level\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e827\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e81,3\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e18,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother\u0026rsquo;s occupation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHousewife\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eInformal private sector\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePublic sector\u003c/p\u003e\n \u003cp\u003eFormal private sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e502\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e49,4\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e21,1\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003cp\u003e6,5\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFather\u0026rsquo;s occupation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eInformal private sector\u003c/p\u003e\n \u003cp\u003ePublic sector\u003c/p\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003cp\u003eFormal private sector\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e555\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e54,6\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e18,4\u003c/p\u003e\n \u003cp\u003e17,0\u003c/p\u003e\n \u003cp\u003e10,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 42.4051%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAnthropometric parameters of newborns\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eWeight (g)\u003c/p\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003cp\u003eUpper arm circumference (mm)\u003c/p\u003e\n \u003cp\u003eHead circumference (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3190,47\u0026plusmn;472,47\u003c/p\u003e\n \u003cp\u003e47,40\u0026plusmn;2,62\u003c/p\u003e\n \u003cp\u003e107,17\u0026plusmn;12,81\u003c/p\u003e\n \u003cp\u003e33,36\u0026plusmn;1,51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1900-5500\u003c/p\u003e\n \u003cp\u003e32-56\u003c/p\u003e\n \u003cp\u003e38-150\u003c/p\u003e\n \u003cp\u003e24-45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight categories\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEutrophic newborns\u003c/p\u003e\n \u003cp\u003eHypotrophic newborns (Low weight)\u003c/p\u003e\n \u003cp\u003eHypertrophic newborns (High weight)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e910\u003c/p\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e89,5\u003c/p\u003e\n \u003cp\u003e9,5\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eRisk factors\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57.5949%;\"\u003e\n \u003cp\u003ePremature newborns (Born \u0026lt;32 weeks\u0026rsquo; gestation)\u003c/p\u003e\n \u003cp\u003eFull-term newborns (Born \u0026ge;32 SA weeks\u0026rsquo; gestation)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNormal APGAR\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLow APGAR\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2532%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e1014\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1016\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.1519%;\"\u003e\n \u003cp\u003e0,3\u003c/p\u003e\n \u003cp\u003e99,7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e99,9\u003c/p\u003e\n \u003cp\u003e0,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mean weight was 3,190.47 grams, ranging from 1,900 to 5,500 grams, with 9.5% classified as underweight and 1% as overweight (Table 1).\u003c/p\u003e\n\u003cp\u003eThe mean length was 47.40 cm, with extremes ranging from 32 to 56 cm. The mean mid-upper arm circumference was 105.62 mm, ranging from 38 to 150 mm, and the mean head circumference was 33.36 cm, with a range of 24 to 45 cm (Table 1).\u003c/p\u003e\n\u003cp\u003eGestational age was \u0026ge;32 weeks in the majority of cases (99.7%), whereas 0.3% of newborns were born before 32 weeks but were in perfect health and did not require any special care (Table 1).\u003c/p\u003e\n\u003cp\u003eOnly one infant (0.1%) had a low APGAR score, either below 4 at the 1st minute or below 6 at the 5th minute (Table 1).\u003c/p\u003e\n\u003cp\u003eMost newborns were screened in maternity hospitals in the Tshangu district (29.2%), and their parents had a low educational and socioeconomic level (81.3%), with 32.4% originating from the Greater Bandundu province.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAudiological Tests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe coverage rate was 90%, corresponding to 1,017 out of 1,130 eligible live births during the study period.\u003c/p\u003e\n\u003cp\u003eAll 1,017 newborns were screened using DPOAE; 25/1,017 were referred (test failure), giving a referral rate of 2.5%.\u003c/p\u003e\n\u003cp\u003eThe follow-up return rate was 80%, with 20 out of 25 referred newborns returning, while 5 newborns were lost to follow-up.\u003c/p\u003e\n\u003cp\u003eAmong the 20 referred newborns who participated in the second stage of DPOAE screening, 19 passed the test, and one remained \u0026quot;refer\u0026quot;. This infant also failed the AABR test. Hearing loss was confirmed at 3 months of age using ABR, giving a prevalence of 1 per 1,000, i.e., 1/1,017 (Figure 1).\u003c/p\u003e\n\u003cp\u003eRegarding the case of hearing loss:\u003c/p\u003e\n\u003cp\u003eThe child who presented with hearing loss was male and 2 days old at the time of screening. He resides in the Ngaba commune with his mother, who is originally from the Equateur province (Mongo) and attend a Pentecostal church in the city-province of Kinshasa.\u003c/p\u003e\n\u003cp\u003ePrenatal care was irregular, but no maternal pathology was reported. Delivery was eutocic, and the amniotic fluid was meconium-stained (old meconium).\u003c/p\u003e\n\u003cp\u003eHis birth weight was 3,600 g, length 48 cm, mid-upper arm circumference 100 mm, and head circumference 35 cm. This full-term newborn had a low APGAR score: 2 (\u0026lt;4) at 1 minute, 5 (\u0026lt;6) at 5 minutes, and 9/10 at 10 minutes.\u003c/p\u003e\n\u003cp\u003eA diagnosis of neonatal distress was made, with a recommendation for transfer to the referral center (University Clinics of Kinshasa). However, this could not be carried out due to the parents\u0026rsquo; precarious socioeconomic situation. Both parents had a low level of education, with the mother being a homemaker and the father unemployed.\u003c/p\u003e\n\u003cp\u003eThe child experienced feeding difficulties throughout his first week of life, with spontaneous favorable evolution.\u003c/p\u003e\n\u003cp\u003eHe failed both hearing screenings using DPOAE conducted one month apart, as well as the AABR test. His hearing loss was confirmed by early ABR and ASSR testing performed at 3 months of age (Figure 2). This was a sensorineural hearing loss of 45 dB in the right ear and 50 dB in the left ear (Figure 2).\u003c/p\u003e\n\u003cp\u003eRegarding the etiological risk factors for this hearing loss, TORCH screening revealed positive serology (significant IgM and IgG titers) for cytomegalovirus, and absence of antibodies for toxoplasmosis and syphilis. The presence of neonatal distress is also a contributing factor.\u003c/p\u003e\n\u003cp\u003eThe intervention consisted of providing hearing aids (prostheses) and multidisciplinary follow-up.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is the first of its kind in the field of neonatal hearing screening in our country, the DRC, a resource-limited country. The time dedicated to raising awareness and providing information to the staff of the selected maternity hospitals in Kinshasa, as well as to the mothers of the newborns included during the study period, led to almost total participation through written consent. This explains the mean age of 1.53 days at inclusion.\u003c/p\u003e \u003cp\u003eThe coverage rate of 90% is below the 95% recommended by the JCIH, as well as the 98% reported in the Kenyan cohort by Ndegwa et al. in 2024 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This can be explained by the refusal of mothers who are not accustomed to systematic screening for certain diseases or conditions at birth in apparently healthy newborns, especially since the DRC does not yet have well-implemented government programs, despite the free and harmless nature of the tests used. This coverage rate would be even lower, around 81%, if sick newborns initially excluded from the study were considered.\u003c/p\u003e \u003cp\u003eAll included newborns (1,017) participated in the first stage of DPOAE screening, with a referral rate of 2.5% after this first test. This rate aligns with the 2007 JCIH recommendation that it should be below 4%. Similar rates were reported by Ndegwa et al. in Kenya, with a referral rate of 3.6% in 2024 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Comparable referral rates are also reported in India and Hong Kong, at 2.2% and 2%, respectively (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast, Kock et al., 2016, in South Africa reported a higher referral rate of 7% (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Denoyelle et al., 2021 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) mention a false-positive rate for DPOAE of 3\u0026ndash;8%, which is expected when testing newborns very close to birth. This is explained by the presence of vernix caseosa in the external auditory canal and amniotic fluid in the canal or tympanic cavity at this early age. This suggests that the optimal time for examination may not be before the first day of life, as observed by Walsh et al. in Uganda (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and Kanji in South Africa (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). We also believe that using DPOAE (with higher specificity) instead of transient-evoked otoacoustic emissions (TEOAE) contributed to achieving an optimal referral rate in this study.\u003c/p\u003e \u003cp\u003eThe follow-up return rate of 80% (5/25 referred newborns lost to follow-up) in this study is higher than the 2024 Kenyan pilot study (72%) but below the JCIH recommendation of 95%. This rate is close to the 86% reported in a 2022 Ethiopian study (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). An even lower rate of 34.3% was reported in a 2021 Ugandan study (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This represents an organizational challenge for resource-limited countries, highlighting the need to develop effective strategies to engage parents in follow-up and care, despite frequent changes in phone numbers and addresses. We followed some infants at home, but for the five lost to follow-up, the parents were no longer reachable or had moved.\u003c/p\u003e \u003cp\u003eAmong the 25 newborns referred after the first stage, 20 participated in the second DPOAE screening, and only one newborn was referred and underwent ABR, which confirmed moderate bilateral sensorineural hearing loss (45 dB in the right ear and 50 dB in the left ear). According to the WHO, hearing loss is defined when the auditory threshold is \u0026le;\u0026thinsp;20 dB and is classified as mild (26\u0026ndash;40 dB), moderate (41\u0026ndash;60 dB), severe (61\u0026ndash;80 dB), or profound (\u0026ge;\u0026thinsp;81 dB) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Disabling hearing loss is defined as a threshold\u0026thinsp;\u0026gt;\u0026thinsp;30 dB in the better ear for children aged 0\u0026ndash;15 years and \u0026gt;\u0026thinsp;40 dB for adults (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Hearing loss in children differs from that in adults due to its impact on speech acquisition and language development.\u003c/p\u003e \u003cp\u003eThe results from this series indicate a prevalence of 1 per 1,000 live births. This is lower than expected in sub-Saharan Africa, where prevalence ranges from 3 to 6 per 1,000 live births, and is closer to that reported in Western countries (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In Kenya, the prevalence is 3 per 1,000 (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Other authors, such as Ranjanbabu et al., 2024, report an incidence of 16 per 1,000 in sub-Saharan Africa, reflecting disparities in screening protocols (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Asia, the prevalence is 2 per 1,000 in China, Malaysia, Thailand, and Nepal; 4 per 1,000 in Turkey; and 5 per 1,000 in India (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In the Middle East and North Africa, it ranges from 2 to 4 per 1,000, and in Latin America and the Caribbean, it is approximately 2 per 1,000 (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll these epidemiological considerations show that the estimated incidence of hearing loss in newborns varies from 0.5 to 5 per 1,000 in different countries. It is recognized as one of the most common sensory disorders in newborns (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Other studies have demonstrated remarkable differences in hearing impairment between developed and developing countries: an incidence of 1\u0026ndash;3 per 1,000 for congenital bilateral hearing loss is reported in developed countries, whereas in developing countries, the estimated rate is higher, around 3\u0026ndash;6 per 1,000 live births (\u003cspan additionalcitationids=\"CR37 CR38 CR39\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHearing impairment is one of the most widespread developmental disorders. The incidence of 1\u0026ndash;3 per 1,000 live births in high-income countries, based on universal neonatal screening in maternity wards or nurseries, may be multiplied 10\u0026ndash;20 times, equivalent to 2\u0026ndash;4 per 100 newborns, in intensive care unit populations (\u003cspan additionalcitationids=\"CR42 CR43 CR44 CR45\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe consequences of severe permanent bilateral hearing loss represent a socioeconomic and psychological burden for the individual, their family, and society as a whole (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). This hearing loss negatively affects language development, cognition, schooling, gross and fine motor skills, psychosocial and emotional development, and future social and professional integration (\u003cspan additionalcitationids=\"CR49 CR50 CR51 CR52\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). However, approximately 50% of all hearing loss cases are preventable through preventive strategies such as vaccination, health education, and improved maternal and child health services (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor the newborn with hearing loss in this study, detection, confirmation, and corrective intervention with hearing aids were carried out within the timeframes recommended by JCIH 2007, according to the 1-3-6 month rule.\u003c/p\u003e \u003cp\u003eThe two risk factors associated with the case of hearing loss in this study are preventable through maternal-fetal and perinatal care improvements (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e), highlighting the importance of promoting these measures in our environment. Despite efforts to prevent identified risk factors (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), hearing loss still occurs in high-income countries due to uncontrollable factors and approximately 50% of cases being genetic in origin.\u003c/p\u003e \u003cp\u003eThe main limitation of this study is the sample size, although it is pioneering in our country. We recommend conducting larger-scale neonatal hearing screening studies to identify the most frequent risk factors in our population and define appropriate preventive measures. The challenge of intervention, particularly regarding hearing aids and cochlear implants in cases of hearing loss, remains significant in a country without social coverage and without qualified personnel for rehabilitation, such as audiologists and speech therapists.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study is the first on neonatal hearing screening in the DRC, a resource-limited country. Given its incidence and its health implications, hearing loss can today be considered a public health issue.\u003c/p\u003e \u003cp\u003e This series provides useful information aligned with our objective to consider implementing larger-scale or even UNHS, as well as to guide upstream efforts in both the community and healthcare facilities to increase coverage, determine the optimal timing for screening to reduce referral rates and test failures, and ensure parental compliance in bringing their babies back for diagnosis and interventions.\u003c/p\u003e \u003cp\u003eThe challenges of trained human resources, budgetary and organizational constraints, and the lack of adequate equipment constitute obstacles to the rapid launch of such a program, despite the proven benefits demonstrated in several countries where it is applied. Nevertheless, targeted screening can initially be carried out in newborns at high risk of congenital hearing loss, according to the risk factor list provided by the JCIH in 2019.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific funding from public, commercial, or non-profit funding organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received approval from the National Ethics Committee, reference: Opinion of the National Health Ethics Committee N\u003csup\u003eo\u0026nbsp;\u003c/sup\u003e563/CNES/BN/PMMF/2024 of 20/08/2024.\u003c/p\u003e\n\u003cp\u003eAuthorization from the authorities of the medical institutions was obtained. The anonymity and confidentiality of the collected data were respected, and the results were communicated to the authorities and published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWriting informed consent was obtained from the parents of all newborns who participated in this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed (Ndungi Maphonda Marie, Richard Matanda Nzanza, Célestin Nsibu Ndosimau, Sokolo Gedikondele Jerôme, Longo Mbenza Benjamin, Mvitu Muaka Moïse, Kelu Bisabu Ken, Pholo Jean Paul, Mvunda Anne-Marie, Mambueni Thamba Christophe) to the completion of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest related to this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHAS. 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Rapport mondial sur l\u0026rsquo;audition. \u003cem\u003eGen\u0026egrave;ve\u003c/em\u003e, (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Screening, Neonatal, Hearing loss, Kinshasa/Democratic Republic of the Congo","lastPublishedDoi":"10.21203/rs.3.rs-9032397/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9032397/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNeonatal screening enables early detection and management of hearing loss, reducing its impact on language, learning, and overall development.\u003c/p\u003e \u003cp\u003eTo assess the operational feasibility of neonatal screening in Kinshasa, Democratic Republic of Congo, through a pilot study.\u003c/p\u003e \u003cp\u003eThis was a cross-sectional study conducted in the city of Kinshasa between October and December 2024. A total of 1,017 newborns whose parents gave consent were enrolled in four referral maternity hospitals in the city. Screening was performed using distortion product otoacoustic emissions (DPOAE) and automated auditory brainstem response (AABR). Statistical analyses were carried out using IBM SPSS version 27.0 for Windows.\u003c/p\u003e \u003cp\u003eAll 1,017 newborns were screened using DPOAE; 25/1,017 were referred, yielding a referral rate of 2.5%. The follow-up return rate was 80% (20/25). Five newborns were lost to follow-up. Among the 20 referred newborns who participated in the second screening stage using DPOAE, 19 passed and one remained referred even after AABR testing. Hearing loss was confirmed at 3 months of age by ABR, with a prevalence of 1 per 1000, i.e., 1/1,017.\u003c/p\u003e \u003cp\u003eEarly detection of hearing loss is feasible in the Democratic Republic of the Congo despite major organizational and financial challenges.\u003c/p\u003e","manuscriptTitle":"Implementation of a neonatal hearing screening program in Kinshasa, Democratic Republic of Congo: a pilot study in maternity hospitals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 16:36:11","doi":"10.21203/rs.3.rs-9032397/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-13T07:55:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-11T10:11:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-11T10:10:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-04T16:15:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6052f726-3950-4d64-a8ad-762f5326f996","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":64440904,"name":"Health sciences/Health care"},{"id":64440905,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-03-22T09:38:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 16:36:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9032397","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9032397","identity":"rs-9032397","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}