Knowledge and Attitudes Survey of General Practitioners and Paediatricians Regarding Childhood Hearing Loss in Casablanca, Morocco

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Bijou, Fadoua El Mourabit, M. Loudghiri, Y. Oukessouª, S. Rouadiª, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6785205/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hearing loss in children is a serious health issue. Primary care physicians (PCPs) are crucial in the process of early detection and intervention, which is necessary to optimize hearing potential and developmental outcomes. Objectives This study aimed to investigate the knowledge of general practitioners and pediatricians regarding to childhood hearing loss investigate the association between knowledge and attitudes, and examine the influence and the influence of this on the early detection of childhood hearing loss. Methods This is a descriptive cross-sectional study, we conducted a survey, over a period of 8 months from APRIL 2021 to NOVEMBER 2021 in Casablanca. During this period, 100 general practitioners and pediatricians in practice and in training (interns and pediatric residents) were interviewed directly. A self-administered questionnaire assessed PCPs’ knowledge of general facts, diagnosis and intervention, and risk factors for childhood hearing loss. Additionally, the questionnaire evaluated PCPS’ attitudes across cognitive, affective, and behavioural domains regarding childhood hearing loss. Results The physicians in our study were divided into 35% general practitioners, 35% internists, 17% pediatric residents and 13% pediatricians and child psychiatrists. The male/female physician sex ratio was 0.17. The average age was around 30 years. Doctors with less than 5 years' seniority accounted for 85%. Only 27% of doctors were in private practice. Only 27% see >50% of children aged <5 years. And 52% of doctors said they had seen between 1 and 8 deaf children in the last 3 years.93% of participants agreed or strongly agreed that hearing loss is a condition that can become extremely disabling. 44% of participants regularly checked their patients' hearing. Most doctors (80%) referred a child for hearing assessment when they perceived an abnormality during the clinical examination, 76% when the mother expressed a complaint, and 50% when the child presented a high risk of deafness. Only 2% replied that the child should be referred systematically. 97% agreed or strongly agreed that early intervention to assess a child's hearing in response to parental suspicions has a considerable influence on the child's language development. Most doctors are aware of the importance of hearing screening for all newborns (71% considered it very important). The results of our study showed that knowledge of the factors that put a child at risk of permanent hearing loss varied according to the participants. According to our practitioners, the most commonly identified test for assessing infant and toddler hearing was the auditory evoked potential (60%), while half indicated behavioral audiometry and 23% tonal audiometry. Acoustic otoemission and ASSRs were poorly reported by participants. 76% correctly identified the age at which a child's hearing can be assessed, which is from the first 6 months. In our study, more than half (56%) of our doctors had difficulty finding reliable audiology services. Only 38% of participants correctly indicated that a child can benefit from a hearing aid from the first 6 months of life. On the other hand, 88% of doctors were aware that severely deaf children with hearing aids should always benefit from speech therapy. Profound bilateral deafness is the situation where the child may be a candidate for cochlear implantation, and was recognized by 65% of doctors. Only 35% correctly answered that the child could benefit from a cochlear implant from the end of the 1st year. Finally, the doctors were asked to choose the means of information they considered most interesting for their daily practice: 63% chose the round table and 37% chose the online courses. Conclusions This study highlights the urgent need to address knowledge gaps among Moroccan pediatricians and general practitioners (PCPs) regarding childhood hearing loss. While these knowledge gaps, PCPs' favorable attitudes serve as a basis for creating focused educational initiatives that will enhance their expertise in treating childhood hearing loss. To turn these findings into significant advancements in pediatric audiological care, cooperation is crucial. Knowledge attitude practices pediatricians childhood hearing loss Introduction About 34 million children worldwide suffer from childhood hearing loss, making it a serious global health concern [ 1 ]. Children's cognitive, linguistic, and socioemotional development may be significantly impacted if this disorder is not treated [ 2 , 3 ]. The goal of universal newborn hearing screening (UNHS) and other early hearing identification and intervention (EHDI) programs is to identify hearing loss in newborns by three months of age and begin intervention by six months [ 4 ]. Hearing loss is a pathological condition characterized by partial or total hearing impairment; in medical terms it is called hypoacusis. It is considered a silent problem in children, and a major handicap that affects the acquisition and development of skills, and can cause emotional, social and psychological problems not only for the child but also for those close to him or her. Childhood deafness differs from adult deafness for two main reasons: it occurs in a child who needs his or her hearing to develop oral language, and the etiologies of childhood Hearing loss are different from those of adult deafness. Bilateral Hearing loss will prevent normal language development, whereas unilateral deafness will have little impact. In September 2004, it was determined that 5.12% of Moroccans were estimated to be disabled. That amounts to over 1,530,000 individuals, of whom 14.3% have hearing impairments. [ 5 ]. Perception deafness and transmission deafness are the two main categories into which hearing impairments fall. Surgery may be recommended for the first and least common. There is currently no alternative to replacing auditory function techniques (speech therapy, hearing aids, cochlear implants, or brain stem) for the second type of deafness, perception deafness, which is characterized by the loss of auditory neurons of the spiral ganglion and hearing cells of the organ of corti [ 6 ]. The classifications of Hearing loss that can be proposed, and the management of childhood Hearing loss, are two elements that are constantly evolving, especially over the last 15 years, due to the development of pediatric cochlear implantation, the development of genotyping and phenotyping of deafness, and the gradual introduction of neonatal screening for deafness, which should lower the age of diagnosis of childhood deafness and influence its management. [ 7 ] Newborn hearing screening leads to early detection of hearing impairment. An awareness of the facts and viewpoints of a specific disease can be gained by a survey that evaluates knowledge and attitude generally. It also aids in locating the origins of misconceptions that could result in bad outcomes or confusion. Poor public attitudes and awareness of baby hearing loss have been documented in studies [ 8 – 9 ]. Due to the presence of superstitions, cultural beliefs, conventions, conflicting perceptions, and inadequate knowledge, the problem is made worse in developing nations [ 10 – 11 ]. The foundation for the effective execution of the newborn hearing screening and intervention program is the parental support [ 12 ]. The primary method for detecting hearing loss in poor nations is through family suspicion [ 13 ]. If there are insufficient resources available, it is the parents' responsibility to detect hearing loss in their children as soon as possible. Parents' actions about early detection and therapy of infant hearing loss are influenced by their understanding of and attitudes toward the condition. A hearing-impaired child's life is thereafter impacted for a long time by these choices [ 14 ]. Materials and Methods This is a descriptive cross-sectional study conducted from APRIL 2021 to NOVEMBER 2021 in Casablanca. It includes all general practitioners and pediatricians on duty and in training (pediatric interns and residents), and excludes doctors from other specialties. We designed a questionnaire that was randomly distributed to interns at the various hospitals in Casablanca and at the IBNO ROCHD University Hospital, as well as to general practitioners and pediatricians in the private and public sectors, and also to pediatric residents at the ELHAROUCHI Hospital. Sampling was accidental and non-probabilistic, and doctors from the private sector were found on Google Maps. The questionnaire was self-completed by direct interview. During our study, the main problem encountered was data collection. Some doctors refused to complete our questionnaire because of time constraints. Questionnaire The questionnaire was used to study the level of knowledge of childhood deafness among general practitioners, interns, pediatric residents and pediatricians. The questionnaire consisted of 29 questions divided into 2 sections. The first section consisted of seven questions relating to doctors' demographic data, such as specialty, years of experience, age, gender and practice environment. Doctors were also asked about the percentage of children aged 05 years seen daily as well as the number of deaf children seen in the last 3 years. The second section consisted of 22 questions relating to the level of knowledge and practice regarding deafness and its management. All questions were in French, 6 questions were Likert scale ‘no totally agree’ to ‘totally agree’ the other questions varied between yes/no, multiple choice and short written answers. 100 questionnaires were completed. Validation of the Study Tool The questionnaire was validated in the medical informatics department by Professor HOUSBANE.S., head of department at the Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca. Feedback from the research panel was taken into consideration and all necessary modifications were made. The questionnaire was then distributed to ENT residents for feedback to guarantee that all questions were clear. The internal consistency of the questionnaire was determined, reflecting good validity; therefore no further changes were made. The reliability of the questionnaire was assessed by resubmitting the questionnaire to the same ENT residents and comparing their responses. The test-retest reliability of the questionnaire was good. The responses of the ENT residents were not included in the sample for the present study. Data analysis All the data collected by the questionnaire were coded by variables and were analyzed using the program (IBM SPSS Statistics for Windows, version 20.0). A descriptive analysis was carried out for each question in order to determine the characteristics of the sample. For single and multiple choice questions, a qualitative analysis method was followed by organizing the responses into groups of similar responses, and then determining the frequencies for each group. Likert-scale questions whose responses were qualitative variables with five classes (strongly agree; agree; neither agree, nor disagree; disagree; strongly disagree) were merged into qualitative variables in order to distinguish between ‘favorable’ and ‘unfavorable’ doctors. The answers to the questions on doctors' opinions on the two variables “(Yes) and (No)” were used to distinguish between doctors who knew or did not know the answer to the question. For the analytical part, the chi-square test was used. For each test, a p-value < 0.05 was considered statistically significant. Results The demographic information of the participants is presented in Table 1. A total of 100 ENT physicians participated in the present study, with 35% general practitioners, 35% internists, 17% pediatric residents, and 13% pediatricians and child psychiatrists. The male/female physician sex ratio was 0.17. The average age was around 30 years. Doctors with less than 5 years' seniority accounted for 85%. Only 27% of doctors were in private practice. Only 27% see > 50% of children aged < 5 years. And 52% of doctors said they had seen between 1 and 5 deaf children in the last 3 years. 93% of participants agreed or strongly agreed that hearing loss is a condition that can become extremely disabling. 44% of participants regularly checked their patients' hearing. Most doctors (80%) referred a child for hearing assessment when they perceived an abnormality during the clinical examination, 76% when the mother expressed a complaint, and 50% when the child presented a high risk of deafness. Only 2% replied that the child should be referred systematically. 91% of doctors were aware that parental suspicion is a sufficient reason for referring a child to a specialist. 97% agreed or strongly agreed that early and appropriate assessment of a child's hearing following parental suspicion has a significant influence on the child's language development. Most doctors are aware of the importance of hearing screening for all newborns (71% considered it very important and 24% considered it fairly important). The results of our study showed that knowledge of the factors that put a child at risk of permanent deafness varied between participants. (Table 2) It should be mentioned at the outset that only 3 practitioners correctly identified all 7 risk factors. In our study, ototoxic drugs and bacterial meningitis were the factors most identified by our doctors, followed by in utero cytomegalovirus infection (60%) and congenital syphilis (52%). 51% mentioned a stay in intensive care, and 41% mentioned an Apgar score of 0–4 at 1 minute or 0–6 at 5 minutes of life (hypotonia).Cleft palate was underestimated by doctors (22%). (Table 3 here)75% followed a specific procedure for these at-risk children. 15% detailed an ENT or specialist opinion. Table 1 Demographic information of the respondents Characteristics n (%) Gender Male 15% Female 85% Age (years old) 30 20% Work Settings Liberal sector 27% Public sector 73% Years of Experience 15 years 9% Table 2 ꓽKnowledge and Practices Related to Hearing Loss and Screening Methods Knowledge Yes No Disabling hearing loss 7% 93% Systematic hearing check 24% 76% Hearing check if abnormality during examination 50% 50% Screening for hearing loss in children is important 29% 71% 3 types of deafness 32% 68% Knowledge of exploration methods 49% 51% Age for hearing assessment The first 6 months 74% 26% After 6 months 26% 74% Age for hearing aid The first 6 months 38% 62% After 6 months 62% 38% Speech therapy rehabilitation 12% 88% The majority of doctors (92%) are unaware of any classification of deafness according to severity. On the other hand, more than half of our practitioners (68%) know something about the types of deafness, and only 14 doctors specified it correctly. According to our practitioners, the most commonly identified test for assessing infant and toddler hearing is the auditory evoked potential (60%), while half indicated behavioral audiometry and 23% tonal audiometry. Acoustic otoemission and ASSRs were poorly reported by participants. 76% correctly identified the age at which a child's hearing can be assessed, which is from the first 6 months. Over half (56%) of the physicians in our study reported having trouble locating trustworthy audiology services. Just 38% of respondents accurately said that a child can start using a hearing aid as early as six months of age. However, 88% of physicians knew that speech treatment should always be beneficial for children who are extremely deaf and wear hearing aids. According to 65% of physicians, a kid with profound bilateral deafness may be a candidate for cochlear implantation. Just 35% of respondents accurately stated that a cochlear implant can help the youngster by the end of the first year. Following this final query, two responses were made: the first stated that a profoundly deaf youngster who has benefited from a cochlear. Following this final question, two responses were made: the first stated that a severely deaf child who has benefited from a cochlear implant can acquire spoken language normally: Of the physicians, 78% agreed or strongly agreed. According to the second declaration, a child who is profoundly deaf and has benefited from a cochlear implant is able to go to school as usual. Ninety percent of the participants agreed or strongly agreed. Finally, doctors were asked if they knew of any situations in which a child required emergency cochlear implantation. Ninety-three percent of participants gave an unfavorable response. 83% of doctors were either unaware of, or unsure about, the various health insurance plans covering audiological services, in particular hearing aids and cochlear implantation. Finally, doctors were asked to choose the information medium they felt would be most relevant to their day-to-day practice: 63% chose the round-table discussion and 37% chose online courses. Discussion Children's quality of life is significantly impacted by hearing loss, so early detection and intervention are crucial. Programs of early detection and intervention significantly reduce the effects of hearing loss; however, they are either absent or still at an early stage in developing countries.[15]The present study was the first of its kind to assess the knowledge and practice of general practitioners and pediatricians regarding hearing screening and hearing loss management in a developing country, morocco. In our study, the participating doctors were young, with an average age of 30 years and a standard deviation of 9 years and 9 months. 85% of the doctors in our population were female. The majority of our participants were non-specialist doctors, i.e., general practitioners and internists. In contrast to an American study conducted by Moeller et al. in 2006, which aimed to study the knowledge, attitudes, and practices related to neonatal hearing screening among primary care professionals, pediatricians accounted for 58.6%, while family doctors accounted for 27.0%.[16] In our study, 33% of doctors saw < 5% of children aged 50% of children aged 0–5 years. The American study by Moeller et al. showed that, on average, respondents indicated that 39.2% (median: 35%) of their practice was made up of children aged 0–5 years. [16]In an Iranian study conducted by Rogha.M. and Mokhtari in 2015, in reply to this question, ‘What percentage of your practice considers infants?’, 17 (5.7%), 74 (24.6%), 92 (30.7%), and 117 (39%) pediatricians responded > 75%, 50 to 75%, 25 to 50%, and < 25%, respectively [17]. 52% of our physicians reported seeing between 1 and 8 deaf children in the past 3 years. In the US study, pediatricians reported seeing an average of 3.32 children (SD: 4.9), and family physicians reported an average of 1.25 children. [16] In IRAN, the results showed that 210 pediatricians (70%) had seen between two and five infants with permanent hearing loss, and 90 (30%) had seen fewer than two infants in the previous three years. [17] In Jordan, a total of 27 (67.5%) of the participants had children with sensorineural hearing loss in their practice in the previous 3 years; the number of children ranged from 1 to 100. [18] The present study showed that 44% of practitioners regularly check their patients' hearing. A Brazilian study conducted in 2009 by Colozza and Anastasio to investigate the knowledge and conduct of pediatricians and pediatric residents in a higher education hospital regarding deafness showed that 52.7% of participants regularly investigated their patients' hearing [20]. Doctors were asked when they refer a child for hearing assessment, and it was found that most (80%) indicated that the child should be referred for hearing assessment when they perceive an abnormality during clinical examination. 76% mentioned that hearing assessment should also be done when the mother expresses a complaint, and half mentioned that it should be done when the child presents a high risk of deafness. Only 2 replied that the child should be referred systematically. Our results are similar to the Brazilian study, which found that 80.5% of the sample responded that they referred children when they presented a high risk of deafness, 69.4% when they noticed something unusual during their own assessment, and 55.5% when the mother complained. In our survey, the majority of doctors (91%) agreed or strongly agreed that the fact that parents suspect their child has a hearing loss is sufficient reason to refer a child to a specialist for hearing assessment. As indicated in other studies, also in Mexico, which showed that 84.6% of doctors agreed or strongly agreed that parental suspicion is sufficient reason to order hearing tests. 11% of doctors either disagreed or strongly disagreed with this hypothesis. [20] In a study carried out in India in 2016 by Yerraguntla, K also showed that most participants agreed or strongly agreed that parental suspicion of hearing loss can be considered a referral reason for a detailed hearing assessment and that it is necessary to take the suspicion of hearing loss into account during the hearing assessment procedure. [21] The present study showed that most doctors are aware of the importance of hearing screening for all newborns (71% considered it very important and 24% considered it fairly important). Only 5% reported uncertainty or a belief that hearing screening was very unimportant. A study conducted by Moeller et al. in 2006 in the U.S. had shown that there has been a significant increase in legislation and state participation in newborn hearing screening in the U.S. Thus, a majority of doctors responded that it was very important (81.6%) or fairly important (14%). Only 4.4% were uncertain or believed that hearing screening was unimportant. [16] As well as in a study carried out in IRAN in 2015 by Rogha.M., which was consistent since it aimed to investigate attitudes towards hearing screening for newborns. The statement was negatively formulated as follows: “There is no need for newborn hearing screening." Most participants responded strongly disagree and disagree with the statement, which in turn shows a positive attitude towards hearing screening. [21] In Jordan, a study carried out in 2020 by Zaitoun Maha showed that a majority of respondents (85%) indicated that screening all newborns for permanent deafness was very important, while 5 respondents (12.5%) considered it somewhat important. More than half the participants (24 out of 40) felt that hearing screening programs caused anxiety among parents. [18] The results of our study showed that participants' knowledge of the factors that put a child at risk of permanent deafness varied. It should be mentioned at the outset that only 3 practitioners correctly identified all 7 risk factors. In our study, ototoxic drugs and bacterial meningitis were the factors most identified by our doctors, followed by in utero cytomegalovirus infection (60%) and congenital syphilis (52%). 51% mentioned a stay in intensive care, and 41% mentioned an Apgar score of 0–4 at 1 minute or 0–6 at 5 minutes of life (hypotonia). Cleft palate was underestimated by doctors (22%) as an important risk factor in STICKLER syndrome, an autosomal dominant genetic syndrome associating several malformations with different types of deafness (conductive or mixed perception). 42% of doctors incorrectly identified recurrent viral infection as a risk factor for permanent deafness, and 10% incorrectly identified male sex as a risk factor for deafness. These data indicated that our doctors were generally not well informed about the factors that put a child at risk of late-onset deafness. Knowing these factors and ensuring ongoing vigilance with regard to screening, monitoring, and referral are seen as vital elements, especially for doctors who care for children with late-onset Awareness of these factors and ongoing vigilance with regard to screening, monitoring, and referral are considered vital, especially for doctors who are primarily responsible for the hearing management of children. The American study showed that the vast majority of doctors knew that a family history of sensorineural hearing loss was a risk indicator. However, almost half of the respondents were not well informed about the risk factors for late-onset hearing loss. More specifically, childhood hearing loss can coexist with cardiac anomalies in several syndromes; however, the onset of hearing loss is most often congenital. Hearing loss (including auditory neuropathy) may be detected in a child with cerebral palsy secondary to hyperbilirubinemia or perinatal asphyxia. In general, however, the data identify gaps in knowledge related to the risk factors and causes of permanent childhood hearing loss. Pediatricians were slightly better informed than family doctors in most categories. This content area is relevant to the monitoring and identification of risk factors for late-onset permanent hearing loss in children. [16] The most common risk factors for deafness in infants, according to Rogha M. and Mokhtari et al., are meningitis (98.3%), congenital syphilis (67%), history of cytomegalovirus (CMV) infection (85%), family history of deafness (92.7%), hospitalization in a neonatal intensive care unit (NICU) for more than 48 hours (53.7%), hypotonia (29%), cleft palate (26.7%), chronic heart disease (23.3%), repeated exposure to cold (23%), and mother's age (> 48 years) (17.7%).[17]In a similar vein, Zaitoun Maha's research revealed that CMV, meningitis, moms over 40, and family history were the four primary risk factors. Little information was provided in the study about other risk factors, such as a child being admitted to the NICU for more than 48 hours (15%), and only 17.5% of ENT physicians recognized cleft palate, which was in line with our findings. This explains why our doctors are ill-informed about the classifications of deafness and the different types, which will prevent them from making an accurate diagnosis of the child's deafness and an appropriate course of action. These results are similar to those of the Brazilian study by Colozza and Anastasio, who found that 86.1% of participants said they were unaware of any classification based on the level of deafness, and the remainder (13.9%) misjudged the deafness. Twenty-three participants (63.8%) didn't know the different types of deafness, 11 (30.5%) said they did, and two (5.5%) didn't answer this question. Of those who did know the types of deafness, only one (2.7%) classified them correctly. [22] According to our practitioners, the most commonly identified test for assessing infant and toddler hearing is the auditory evoked potential (60%), while half indicated behavioral audiometry and 23% tonal audiometry. Acoustic otoemission and ASSRs were poorly reported by participants, which explains why our doctors are ill-informed on this subject. The majority of doctors in Jordan stated that AEP results are preferable to behavioral audiometry for estimating children's hearing thresholds. [18] Most of our practitioners (76% correctly identified the age at which a child's hearing can be assessed, which is from the first 6 months). This is similar to the Brazilian study, where all doctors agreed that it was possible to assess a baby's hearing during the first six months of life. [22] For ENTs in Jordan, only 37.6% correctly identified the correct age to assess the hearing of a child who failed hearing screening as < 1 month. [20] In the present study, more than half of our doctors found it difficult to find facilities offering reliable audiology services, and in Jordan, 54.8% of participants said they were aware of the various health insurance schemes covering audiology services, including hearing screening and cochlear implantation. [18] Only 38% of our participants correctly indicated that a child can benefit from a hearing aid from the first 6 months of life. In Brazil, 47.2% of participants were aware that it is possible to adapt to the use of a hearing aid from six months of life. [22] Similarly, 30% of doctors in the Jordanian study indicated that hearing aids can be fitted between 1 and 3 months of age. [18] In Mexico, 40% of doctors stated that hearing aids can be worn by babies of all ages whenever necessary. [20] On the other hand, 88% of our doctors affirmed that severely deaf children with hearing aids should always benefit from speech and language therapy. For Colozza and Anastasio (Brazil), speech and language therapy is indispensable and should be started for most participants during the first 6 months. [22] The situation in which a child may be a candidate for cochlear implantation is bilateral profound deafness—this was recognized by 65% of the doctors in our study. According to MOELLER's study, 74.3% of participants selected profound bilateral deafness [16]. In contrast, Zaitoun Maha's study showed that doctors have a good knowledge of which infants with impaired hearing are suitable candidates for cochlear implants. The majority (97.5%) of the 40 participants answered that these were infants with profound bilateral deafness [18]. A recent study by Y Massawe Richard Enica et al. in Tanzania in 2021 found that 74% of participants recognized bilateral profound deafness as a candidacy criterion for cochlear implant er hand, 88% of our doctors affirmed that severely deaf children with hearing aids should always benefit from speech and language therapy. For Colozza and Anastasio (Brazil), speech and language therapy is indispensable and should be started for most participants during the first 6 months. [22] The situation in which a child may be a candidate for cochlear implantation is bilateral profound deafness—this was recognized by 65% of the doctors in our study. According to MOELLER's study, 74.3% of participants selected profound bilateral deafness [16]. In contrast, Zaitoun Maha's study showed that doctors have a good knowledge of which infants with impaired hearing are suitable candidates for cochlear implants. The majority (97.5%) of the 40 participants answered that these were infants with profound bilateral deafness [18]. A recent study by Y Massawe Richard Enica et al. in Tanzania in 2021 found that 74% of participants recognized bilateral profound deafness as a candidacy criterion for cochlear implants. [23] The present study showed that the majority of doctors are aware of the importance of newborn hearing screening, since they are also aware that childhood deafness can be an extremely disabling condition with a serious impact on language development. It also revealed a lack of knowledge in many aspects related to childhood deafness, including risk factors for deafness and what to do when faced with it, in line with other studies, indicating a low level of knowledge among the various samples of healthcare professionals. There was also a great lack of knowledge of the classifications and types of deafness, as well as the tests used to assess deafness. Physicians had little knowledge of aspects related to the treatment of deafness, including the age required for hearing aids and cochlear implants, as well as the indication and emergency situation for cochlear implantation. The limited level of knowledge could be attributed to various reasons, including the lack of training and educational courses on hearing screening and audiological management. Even so, the main reason could also be attributed to the low number of permanently deaf children that doctors had in their practice. The participants' knowledge and attitudes on childhood hearing loss showed a statistically significant positive link, indicating that attitudes become more positive as knowledge improves. The positive connection implies that those who have a better understanding of a subject are more likely to have good attitudes toward it, which is consistent with the theory underlying attitudes [19]. This result emphasizes how important knowledge is in influencing attitudes, especially when it comes to hearing loss in children. The study's cross-sectional form makes it difficult to track changes or trends over a longer period of time because it only records attitudes and knowledge at one particular moment in time. Furthermore, the study's dependence on participant self-reported data raises the possibility of response bias, which could cause participants' motivation to give socially acceptable answers to result in an overestimation of favorable opinions. Future research could benefit from extending the study to include larger, population-based groups of Primary Care Physicians (PCPs) in order to address these shortcomings. This would increase the study's findings' generalizability. [24] The results of such an enlargement would probably be more representative and accurate, strengthening the validity of the study's conclusions. Furthermore, using longitudinal designs to monitor how PCPs' knowledge and attitudes evolve over time, particularly in response to focused educational interventions—would provide important new information about how effective these interventions are. Summary and Conclusion According to this study, Moroccan doctors had both favorable opinions and deficiencies in their understanding of hearing loss in children. There is an urgent need for extensive training programs to fill in these knowledge gaps worldwide. However, the fact that the doctors are receptive to recommendations suggests that interventions can enhance the early identification and care of affected children. To enhance pediatric audiological care, relevant stakeholders must put these findings into practice. Following on from the results of this study, we recommend that, in order to improve the knowledge and attitudes of general practitioners and pediatricians, they should be made aware of the need for early detection of childhood deafness, right from their university training. In addition, in-service training or round-table discussions aimed at raising awareness among GPs and pediatricians should be carried out to facilitate early diagnosis and management of this disease. Declarations Funding Statement This research received no external funding. N/A Author Contributions All authors have read and agreed to the published version of the manuscript. Credit authorship contribution statement Dr Walid Bijou: study concept and design Dr Fadoua El Mourabit: study concept and design Dr Meryem Loudghiri: data analysis and interpretation Dr Youssef oukessou: data analysis and interpretation Dr Sami Rouadi and dr Reda Abada: data analysis and interpretation Dr Mohamed Roubal and dr Mohamed Mahtar: contributors Institutional Review Board Statement This study was reviewed and approved by the Ethics Committee of the Faculty of Medicine and Pharmacy of Casablanca, under approval number [INSERT APPROVAL NUMBER HERE]. All participants provided written informed consent to participate in the study. This study was conducted in accordance with the Declaration of Helsinki. The work has been reported in line with the SCARE criteria.Ethical review and approval were waived for this study due to the fact that the principles of good clinical practices were followed. Data Availability Statement The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request. Not applicable. N/A Conflicts of Interest The authors declare no conflict of interest. N/A Supporting information This file contains the raw data collected during our study, specifically the responses from participants regarding their knowledge and attitudes on the subject matter of our research. Acknowledgments We thank all the PCPs who participated in this study, generously sharing their time and insights. Additionally, we extend our appreciation to the healthcare institutions and organizations that supported and facilitated this research. Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for [Journal name] and was not involved in the editorial review or the decision to publish this article. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: the financial benefits of the articleꓽ none References World Health Organization. Deafness and hearing loss. Retrieved July 21, 2023, from https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss. Korver AM, Konings S, Dekker FW, DECIBEL Collaborative Study Group, et al. Newborn hearing screening vs later hearing screening and developmental outcomes in children with permanent childhood hearing impairment. JAMA 2010; 304(15):17018.https://doi.org/10.1001/jama.2010.1501 PMID: 20959580. Pimperton H, Kennedy CR. The impact of early identification of permanent childhood hearing impairment on speech and language outcomes. 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V.D.Andrade, E. Ross, Beliefs and practices of black South African traditional healers regarding hearing impairment, Int J Audiol . 44 (2005) 489-499, doi: 10.1080/14992020500188999. B. O. Olusanya, R. J. Ruben, A. Parving, Reducing the burden of communication disorders in the developing world: An opportunity for the millennium development project. JAMA.296 (4) (2006) 441- 444, doi: 10.1001/jama.296.4.441. J. Des Georges, Family perceptions of early hearing, detection, and intervention systems:listening to and learning from families, Ment Retard Dev D R. 9 (2003) 89-93. B. McPherson, B. O. Olusanya, Screening for hearing loss in developing countries. In B.McPherson & R. Brouillette (Eds.), Audiology in developing countries. Nova Science Publishers New York, (2008). 75-105. B.O. Olusanya, L.M. Luxon, S.L.Wirz,Maternal view on infant hearing loss in a developing country, Int J Pediatr Otorhinolaryngol.70 (2006) 619-623 doi:10.1016/j.ijporl.2005.08.004. Peer S, Fagan JJ. Hearing loss in the developing world: evaluating the iPhone mobile device as a screening tool. S Afr Med J 2015; 105(01):35–39. Moeller, White, et Shisler, « Primary Care Physicians’ Knowledge, Attitudes, and Practices Related to Newborn Hearing Screening ».2006 Rogha et Mokhtari, « Study of the Knowledge of Pediatricians and Senior Residents Relating to the Importance of Hearing Impairment and Deafness Screening among Newborns ».2014 Zaitoun et al., « Knowledge and Practice of Hearing Screening and Hearing Loss Management among Ear, Nose, and Throat Physicians in Jordan ».2021 Ajzen I, Fishbin M. Understanding attitudes and predicting social behaviour. Prentice-Hall; Englewood Cliffs, 1980.PLOS ONE Primary care physicians and childhood hearing loss in Malaysia PLOS « Attitude and knowledge of hearing loss among medical doctors selected to initiate a residency in Mexico - PubMed ».2009 Yerraguntla, Ravi, et Gore, « Knowledge and Attitude of Pediatric Hearing Impairment among General Physicians and Medical Interns in Coastal Karnataka, India ».2016 Colozza et Anastasio, « Screening, Diagnosing and Treating Deafness ».2009 Enica, Daudi, et Abdul, « Knowledge on Cochlear Implants among Medical Students, Tanzania ».2021 [23] Winter R, Leanage N, Roberts N, Norman RI, Howick J. Experiences of empathy training in healthcare:a systematic review of qualitative studies. Patient Educ Couns 2022; 105(10):301737.https://doi.org/10.1016/j.pec.2022.06.015 PMID: 35811257. Table 3 Table 3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table3.docx DetailedEnglishQuestionnaireChildhoodHearingLoss.docx Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-6785205","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488906424,"identity":"9a2639bf-79d6-4cee-97bd-30d5dca5276d","order_by":0,"name":"W. Bijou","email":"","orcid":"","institution":"University hospital Ibn Rochd","correspondingAuthor":false,"prefix":"","firstName":"W.","middleName":"","lastName":"Bijou","suffix":""},{"id":488906425,"identity":"c98b531b-1c4e-4268-b477-40a8bd2ab7fd","order_by":1,"name":"Fadoua El Mourabit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBAC9gYGAzCDD8hiYDCwIKyF5wBUCxuQBdQiQYoWiQQQRYwW9sMbH/PU2OSzST6/uuFHgQQDf3t3An4tPGnFxjzH0izbpHPKbvYAHSZx5uwGvFrsGXLMpHnYDhuwSeek3eABajGQyMWvhYf/DVDLP6AWyTNpN/8QpUUCaAtvG1CLBPux28TZIvGs2HBuX5oBG08O220ZAwkegn7h4U/e+ODNNxsDfvbjz26++WMjx9/ei18Lsm5wBPEQqxwE2B+QonoUjIJRMApGEAAAyd4+Gw3I4DYAAAAASUVORK5CYII=","orcid":"","institution":"University hospital Ibn Rochd","correspondingAuthor":true,"prefix":"","firstName":"Fadoua","middleName":"El","lastName":"Mourabit","suffix":""},{"id":488906426,"identity":"f5be30db-4fe8-46b9-adf1-8b1d3010dd8c","order_by":2,"name":"M. 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Abadaª","email":"","orcid":"","institution":"University hospital Ibn Rochd","correspondingAuthor":false,"prefix":"","firstName":"R.","middleName":"","lastName":"Abadaª","suffix":""},{"id":488906430,"identity":"90e33f65-5ab0-42d6-b10c-3e4fd8ee30ea","order_by":6,"name":"M. Roubalª","email":"","orcid":"","institution":"University hospital Ibn Rochd","correspondingAuthor":false,"prefix":"","firstName":"M.","middleName":"","lastName":"Roubalª","suffix":""},{"id":488906431,"identity":"9aa0bd34-f468-425a-9249-3ec4332a24ff","order_by":7,"name":"M. mahtar","email":"","orcid":"","institution":"University hospital Ibn Rochd","correspondingAuthor":false,"prefix":"","firstName":"M.","middleName":"","lastName":"mahtar","suffix":""}],"badges":[],"createdAt":"2025-05-30 13:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6785205/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6785205/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102295241,"identity":"49cac880-160b-4e1e-bf96-cdee92c6ef19","added_by":"auto","created_at":"2026-02-10 10:10:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":459146,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6785205/v1/ec1c5f92-ec76-4bb3-8585-012a3df22cc0.pdf"},{"id":87432196,"identity":"94996a3d-ccda-4b88-9aa9-5e30627eb390","added_by":"auto","created_at":"2025-07-23 17:49:35","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":94048,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6785205/v1/2c206d389e312d1a07225b0f.docx"},{"id":87433264,"identity":"ddc898d5-0765-4044-9c83-1a99592c6fe7","added_by":"auto","created_at":"2025-07-23 18:05:35","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":38231,"visible":true,"origin":"","legend":"","description":"","filename":"DetailedEnglishQuestionnaireChildhoodHearingLoss.docx","url":"https://assets-eu.researchsquare.com/files/rs-6785205/v1/547f840e6843c2c6ccead925.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eKnowledge and Attitudes Survey of General Practitioners and Paediatricians Regarding Childhood Hearing Loss in Casablanca, Morocco\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAbout 34\u0026nbsp;million children worldwide suffer from childhood hearing loss, making it a serious global health concern [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Children's cognitive, linguistic, and socioemotional development may be significantly impacted if this disorder is not treated [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The goal of universal newborn hearing screening (UNHS) and other early hearing identification and intervention (EHDI) programs is to identify hearing loss in newborns by three months of age and begin intervention by six months [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHearing loss is a pathological condition characterized by partial or total hearing impairment; in medical terms it is called hypoacusis. It is considered a silent problem in children, and a major handicap that affects the acquisition and development of skills, and can cause emotional, social and psychological problems not only for the child but also for those close to him or her.\u003c/p\u003e\u003cp\u003eChildhood deafness differs from adult deafness for two main reasons: it occurs in a child who needs his or her hearing to develop oral language, and the etiologies of childhood Hearing loss are different from those of adult deafness. Bilateral Hearing loss will prevent normal language development, whereas unilateral deafness will have little impact.\u003c/p\u003e\u003cp\u003eIn September 2004, it was determined that 5.12% of Moroccans were estimated to be disabled. That amounts to over 1,530,000 individuals, of whom 14.3% have hearing impairments. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePerception deafness and transmission deafness are the two main categories into which hearing impairments fall. Surgery may be recommended for the first and least common. There is currently no alternative to replacing auditory function techniques (speech therapy, hearing aids, cochlear implants, or brain stem) for the second type of deafness, perception deafness, which is characterized by the loss of auditory neurons of the spiral ganglion and hearing cells of the organ of corti [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe classifications of Hearing loss that can be proposed, and the management of childhood Hearing loss, are two elements that are constantly evolving, especially over the last 15 years, due to the development of pediatric cochlear implantation, the development of genotyping and phenotyping of deafness, and the gradual introduction of neonatal screening for deafness, which should lower the age of diagnosis of childhood deafness and influence its management. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Newborn hearing screening leads to early detection of hearing impairment.\u003c/p\u003e\u003cp\u003eAn awareness of the facts and viewpoints of a specific disease can be gained by a survey that evaluates knowledge and attitude generally. It also aids in locating the origins of misconceptions that could result in bad outcomes or confusion. Poor public attitudes and awareness of baby hearing loss have been documented in studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Due to the presence of superstitions, cultural beliefs, conventions, conflicting perceptions, and inadequate knowledge, the problem is made worse in developing nations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe foundation for the effective execution of the newborn hearing screening and intervention program is the parental support [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The primary method for detecting hearing loss in poor nations is through family suspicion [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. If there are insufficient resources available, it is the parents' responsibility to detect hearing loss in their children as soon as possible. Parents' actions about early detection and therapy of infant hearing loss are influenced by their understanding of and attitudes toward the condition. A hearing-impaired child's life is thereafter impacted for a long time by these choices [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis is a descriptive cross-sectional study conducted from APRIL 2021 to NOVEMBER 2021 in Casablanca. It includes all general practitioners and pediatricians on duty and in training (pediatric interns and residents), and excludes doctors from other specialties. We designed a questionnaire that was randomly distributed to interns at the various hospitals in Casablanca and at the IBNO ROCHD University Hospital, as well as to general practitioners and pediatricians in the private and public sectors, and also to pediatric residents at the ELHAROUCHI Hospital.\u003c/p\u003e\u003cp\u003eSampling was accidental and non-probabilistic, and doctors from the private sector were found on Google Maps.\u003c/p\u003e\u003cp\u003eThe questionnaire was self-completed by direct interview. During our study, the main problem encountered was data collection. Some doctors refused to complete our questionnaire because of time constraints.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eQuestionnaire\u003c/h2\u003e\u003cp\u003eThe questionnaire was used to study the level of knowledge of childhood deafness among general practitioners, interns, pediatric residents and pediatricians.\u003c/p\u003e\u003cp\u003eThe questionnaire consisted of 29 questions divided into 2 sections. The first section consisted of seven questions relating to doctors' demographic data, such as specialty, years of experience, age, gender and practice environment. Doctors were also asked about the percentage of children aged 05 years seen daily as well as the number of deaf children seen in the last 3 years.\u003c/p\u003e\u003cp\u003eThe second section consisted of 22 questions relating to the level of knowledge and practice regarding deafness and its management. All questions were in French, 6 questions were Likert scale \u0026lsquo;no totally agree\u0026rsquo; to \u0026lsquo;totally agree\u0026rsquo; the other questions varied between yes/no, multiple choice and short written answers.\u003c/p\u003e\u003cp\u003e100 questionnaires were completed.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eValidation of the Study Tool\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was validated in the medical informatics department by Professor HOUSBANE.S., head of department at the Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca. Feedback from the research panel was taken into consideration and all necessary modifications were made. The questionnaire was then distributed to ENT residents for feedback to guarantee that all questions were clear. The internal consistency of the questionnaire was determined, reflecting good validity; therefore no further changes were made. The reliability of the questionnaire was assessed by resubmitting the questionnaire to the same ENT residents and comparing their responses. The test-retest reliability of the questionnaire was good. The responses of the ENT residents were not included in the sample for the present study.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eAll the data collected by the questionnaire were coded by variables and were analyzed using the program (IBM SPSS Statistics for Windows, version 20.0). A descriptive analysis was carried out for each question in order to determine the characteristics of the sample.\u003c/p\u003e\u003cp\u003e For single and multiple choice questions, a qualitative analysis method was followed by organizing the responses into groups of similar responses, and then determining the frequencies for each group. Likert-scale questions whose responses were qualitative variables with five classes (strongly agree; agree; neither agree, nor disagree; disagree; strongly disagree) were merged into qualitative variables in order to distinguish between \u0026lsquo;favorable\u0026rsquo; and \u0026lsquo;unfavorable\u0026rsquo; doctors. The answers to the questions on doctors' opinions on the two variables \u0026ldquo;(Yes) and (No)\u0026rdquo; were used to distinguish between doctors who knew or did not know the answer to the question.\u003c/p\u003e\u003cp\u003eFor the analytical part, the chi-square test was used. For each test, a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic information of the participants is presented in Table 1. A total of 100 ENT physicians participated in the present study, with 35% general practitioners, 35% internists, 17% pediatric residents, and 13% pediatricians and child psychiatrists. The male/female physician sex ratio was 0.17. The average age was around 30 years. Doctors with less than 5 years' seniority accounted for 85%. Only 27% of doctors were in private practice. Only 27% see \u0026gt; 50% of children aged \u0026lt; 5 years. And 52% of doctors said they had seen between 1 and 5 deaf children in the last 3 years. 93% of participants agreed or strongly agreed that hearing loss is a condition that can become extremely disabling. 44% of participants regularly checked their patients' hearing. Most doctors (80%) referred a child for hearing assessment when they perceived an abnormality during the clinical examination, 76% when the mother expressed a complaint, and 50% when the child presented a high risk of deafness. Only 2% replied that the child should be referred systematically. 91% of doctors were aware that parental suspicion is a sufficient reason for referring a child to a specialist. 97% agreed or strongly agreed that early and appropriate assessment of a child's hearing following parental suspicion has a significant influence on the child's language development. Most doctors are aware of the importance of hearing screening for all newborns (71% considered it very important and 24% considered it fairly important). The results of our study showed that knowledge of the factors that put a child at risk of permanent deafness varied between participants. (Table 2)\u003c/p\u003e\n\u003cp\u003eIt should be mentioned at the outset that only 3 practitioners correctly identified all 7 risk factors. In our study, ototoxic drugs and bacterial meningitis were the factors most identified by our doctors, followed by in utero cytomegalovirus infection (60%) and congenital syphilis (52%). 51% mentioned a stay in intensive care, and 41% mentioned an Apgar score of 0–4 at 1 minute or 0–6 at 5 minutes of life (hypotonia).Cleft palate was underestimated by doctors (22%). (Table 3 here)75% followed a specific procedure for these at-risk children. 15% detailed an ENT or specialist opinion.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDemographic information of the respondents\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAge (years old)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWork Settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiberal sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic sector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eYears of Experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt; 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5–15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eꓽKnowledge and Practices Related to Hearing Loss and Screening Methods\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDisabling hearing loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSystematic hearing check\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHearing check if abnormality during examination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eScreening for hearing loss in children is important\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3 types of deafness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKnowledge of exploration methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAge for hearing\u003c/p\u003e\n \u003cp\u003eassessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe first 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAge for hearing aid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe first 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSpeech therapy rehabilitation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe majority of doctors (92%) are unaware of any classification of deafness according to severity. On the other hand, more than half of our practitioners (68%) know something about the types of deafness, and only 14 doctors specified it correctly. According to our practitioners, the most commonly identified test for assessing infant and toddler hearing is the auditory evoked potential (60%), while half indicated behavioral audiometry and 23% tonal audiometry. Acoustic otoemission and ASSRs were poorly reported by participants. 76% correctly identified the age at which a child's hearing can be assessed, which is from the first 6 months. Over half (56%) of the physicians in our study reported having trouble locating trustworthy audiology services. Just 38% of respondents accurately said that a child can start using a hearing aid as early as six months of age. However, 88% of physicians knew that speech treatment should always be beneficial for children who are extremely deaf and wear hearing aids. According to 65% of physicians, a kid with profound bilateral deafness may be a candidate for cochlear implantation. Just 35% of respondents accurately stated that a cochlear implant can help the youngster by the end of the first year. Following this final query, two responses were made: the first stated that a profoundly deaf youngster who has benefited from a cochlear. Following this final question, two responses were made: the first stated that a severely deaf child who has benefited from a cochlear implant can acquire spoken language normally: Of the physicians, 78% agreed or strongly agreed. According to the second declaration, a child who is profoundly deaf and has benefited from a cochlear implant is able to go to school as usual. Ninety percent of the participants agreed or strongly agreed. Finally, doctors were asked if they knew of any situations in which a child required emergency cochlear implantation. Ninety-three percent of participants gave an unfavorable response. 83% of doctors were either unaware of, or unsure about, the various health insurance plans covering audiological services, in particular hearing aids and cochlear implantation. Finally, doctors were asked to choose the information medium they felt would be most relevant to their day-to-day practice: 63% chose the round-table discussion and 37% chose online courses.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eChildren's quality of life is significantly impacted by hearing loss, so early detection and intervention are crucial. Programs of early detection and intervention significantly reduce the effects of hearing loss; however, they are either absent or still at an early stage in developing countries.[15]The present study was the first of its kind to assess the knowledge and practice of general practitioners and pediatricians regarding hearing screening and hearing loss management in a developing country, morocco.\u003c/p\u003e\n\u003cp\u003eIn our study, the participating doctors were young, with an average age of 30 years and a standard deviation of 9 years and 9 months. 85% of the doctors in our population were female. The majority of our participants were non-specialist doctors, i.e., general practitioners and internists. In contrast to an American study conducted by Moeller et al. in 2006, which aimed to study the knowledge, attitudes, and practices related to neonatal hearing screening among primary care professionals, pediatricians accounted for 58.6%, while family doctors accounted for 27.0%.[16]\u003c/p\u003e\n\u003cp\u003eIn our study, 33% of doctors saw \u0026lt; 5% of children aged \u0026lt; 5 years in their daily practice, and 27% saw \u0026gt; 50% of children aged 0–5 years. The American study by Moeller et al. showed that, on average, respondents indicated that 39.2% (median: 35%) of their practice was made up of children aged 0–5 years. [16]In an Iranian study conducted by Rogha.M. and Mokhtari in 2015, in reply to this question, ‘What percentage of your practice considers infants?’, 17 (5.7%), 74 (24.6%), 92 (30.7%), and 117 (39%) pediatricians responded \u0026gt; 75%, 50 to 75%, 25 to 50%, and \u0026lt; 25%, respectively [17]. 52% of our physicians reported seeing between 1 and 8 deaf children in the past 3 years. In the US study, pediatricians reported seeing an average of 3.32 children (SD: 4.9), and family physicians reported an average of 1.25 children. [16] In IRAN, the results showed that 210 pediatricians (70%) had seen between two and five infants with permanent hearing loss, and 90 (30%) had seen fewer than two infants in the previous three years. [17] In Jordan, a total of 27 (67.5%) of the participants had children with sensorineural hearing loss in their practice in the previous 3 years; the number of children ranged from 1 to 100. [18]\u003c/p\u003e\n\u003cp\u003eThe present study showed that 44% of practitioners regularly check their patients' hearing. A Brazilian study conducted in 2009 by Colozza and Anastasio to investigate the knowledge and conduct of pediatricians and pediatric residents in a higher education hospital regarding deafness showed that 52.7% of participants regularly investigated their patients' hearing [20].\u003c/p\u003e\n\u003cp\u003eDoctors were asked when they refer a child for hearing assessment, and it was found that most (80%) indicated that the child should be referred for hearing assessment when they perceive an abnormality during clinical examination. 76% mentioned that hearing assessment should also be done when the mother expresses a complaint, and half mentioned that it should be done when the child presents a high risk of deafness. Only 2 replied that the child should be referred systematically. Our results are similar to the Brazilian study, which found that 80.5% of the sample responded that they referred children when they presented a high risk of deafness, 69.4% when they noticed something unusual during their own assessment, and 55.5% when the mother complained. In our survey, the majority of doctors (91%) agreed or strongly agreed that the fact that parents suspect their child has a hearing loss is sufficient reason to refer a child to a specialist for hearing assessment.\u003c/p\u003e\n\u003cp\u003eAs indicated in other studies, also in Mexico, which showed that 84.6% of doctors agreed or strongly agreed that parental suspicion is sufficient reason to order hearing tests. 11% of doctors either disagreed or strongly disagreed with this hypothesis. [20]\u003c/p\u003e\n\u003cp\u003eIn a study carried out in India in 2016 by Yerraguntla, K also showed that most participants agreed or strongly agreed that parental suspicion of hearing loss can be considered a referral reason for a detailed hearing assessment and that it is necessary to take the suspicion of hearing loss into account during the hearing assessment procedure. [21]\u003c/p\u003e\n\u003cp\u003eThe present study showed that most doctors are aware of the importance of hearing screening for all newborns (71% considered it very important and 24% considered it fairly important). Only 5% reported uncertainty or a belief that hearing screening was very unimportant. A study conducted by Moeller et al. in 2006 in the U.S. had shown that there has been a significant increase in legislation and state participation in newborn hearing screening in the U.S. Thus, a majority of doctors responded that it was very important (81.6%) or fairly important (14%). Only 4.4% were uncertain or believed that hearing screening was unimportant. [16]\u003c/p\u003e\n\u003cp\u003eAs well as in a study carried out in IRAN in 2015 by Rogha.M., which was consistent since it aimed to investigate attitudes towards hearing screening for newborns. The statement was negatively formulated as follows: “There is no need for newborn hearing screening.\" Most participants responded strongly disagree and disagree with the statement, which in turn shows a positive attitude towards hearing screening. [21]\u003c/p\u003e\n\u003cp\u003eIn Jordan, a study carried out in 2020 by Zaitoun Maha showed that a majority of respondents (85%) indicated that screening all newborns for permanent deafness was very important, while 5 respondents (12.5%) considered it somewhat important. More than half the participants (24 out of 40) felt that hearing screening programs caused anxiety among parents. [18]\u003c/p\u003e\n\u003cp\u003eThe results of our study showed that participants' knowledge of the factors that put a child at risk of permanent deafness varied. It should be mentioned at the outset that only 3 practitioners correctly identified all 7 risk factors. In our study, ototoxic drugs and bacterial meningitis were the factors most identified by our doctors, followed by in utero cytomegalovirus infection (60%) and congenital syphilis (52%). 51% mentioned a stay in intensive care, and 41% mentioned an Apgar score of 0–4 at 1 minute or 0–6 at 5 minutes of life (hypotonia). Cleft palate was underestimated by doctors (22%) as an important risk factor in STICKLER syndrome, an autosomal dominant genetic syndrome associating several malformations with different types of deafness (conductive or mixed perception). 42% of doctors incorrectly identified recurrent viral infection as a risk factor for permanent deafness, and 10% incorrectly identified male sex as a risk factor for deafness.\u003c/p\u003e\n\u003cp\u003eThese data indicated that our doctors were generally not well informed about the factors that put a child at risk of late-onset deafness. Knowing these factors and ensuring ongoing vigilance with regard to screening, monitoring, and referral are seen as vital elements, especially for doctors who care for children with late-onset Awareness of these factors and ongoing vigilance with regard to screening, monitoring, and referral are considered vital, especially for doctors who are primarily responsible for the hearing management of children. The American study showed that the vast majority of doctors knew that a family history of sensorineural hearing loss was a risk indicator. However, almost half of the respondents were not well informed about the risk factors for late-onset hearing loss. More specifically, childhood hearing loss can coexist with cardiac anomalies in several syndromes; however, the onset of hearing loss is most often congenital. Hearing loss (including auditory neuropathy) may be detected in a child with cerebral palsy secondary to hyperbilirubinemia or perinatal asphyxia. In general, however, the data identify gaps in knowledge related to the risk factors and causes of permanent childhood hearing loss. Pediatricians were slightly better informed than family doctors in most categories. This content area is relevant to the monitoring and identification of risk factors for late-onset permanent hearing loss in children. [16]\u003c/p\u003e\n\u003cp\u003eThe most common risk factors for deafness in infants, according to Rogha M. and Mokhtari et al., are meningitis (98.3%), congenital syphilis (67%), history of cytomegalovirus (CMV) infection (85%), family history of deafness (92.7%), hospitalization in a neonatal intensive care unit (NICU) for more than 48 hours (53.7%), hypotonia (29%), cleft palate (26.7%), chronic heart disease (23.3%), repeated exposure to cold (23%), and mother's age (\u0026gt; 48 years) (17.7%).[17]In a similar vein, Zaitoun Maha's research revealed that CMV, meningitis, moms over 40, and family history were the four primary risk factors. Little information was provided in the study about other risk factors, such as a child being admitted to the NICU for more than 48 hours (15%), and only 17.5% of ENT physicians recognized cleft palate, which was in line with our findings.\u003c/p\u003e\n\u003cp\u003eThis explains why our doctors are ill-informed about the classifications of deafness and the different types, which will prevent them from making an accurate diagnosis of the child's deafness and an appropriate course of action.\u003c/p\u003e\n\u003cp\u003eThese results are similar to those of the Brazilian study by Colozza and Anastasio, who found that 86.1% of participants said they were unaware of any classification based on the level of deafness, and the remainder (13.9%) misjudged the deafness. Twenty-three participants (63.8%) didn't know the different types of deafness, 11 (30.5%) said they did, and two (5.5%) didn't answer this question. Of those who did know the types of deafness, only one (2.7%) classified them correctly. [22]\u003c/p\u003e\n\u003cp\u003eAccording to our practitioners, the most commonly identified test for assessing infant and toddler hearing is the auditory evoked potential (60%), while half indicated behavioral audiometry and 23% tonal audiometry. Acoustic otoemission and ASSRs were poorly reported by participants, which explains why our doctors are ill-informed on this subject.\u003c/p\u003e\n\u003cp\u003eThe majority of doctors in Jordan stated that AEP results are preferable to behavioral audiometry for estimating children's hearing thresholds. [18]\u003c/p\u003e\n\u003cp\u003eMost of our practitioners (76% correctly identified the age at which a child's hearing can be assessed, which is from the first 6 months). This is similar to the Brazilian study, where all doctors agreed that it was possible to assess a baby's hearing during the first six months of life. [22] For ENTs in Jordan, only 37.6% correctly identified the correct age to assess the hearing of a child who failed hearing screening as \u0026lt; 1 month. [20]\u003c/p\u003e\n\u003cp\u003eIn the present study, more than half of our doctors found it difficult to find facilities offering reliable audiology services, and in Jordan, 54.8% of participants said they were aware of the various health insurance schemes covering audiology services, including hearing screening and cochlear implantation. [18]\u003c/p\u003e\n\u003cp\u003eOnly 38% of our participants correctly indicated that a child can benefit from a hearing aid from the first 6 months of life. In Brazil, 47.2% of participants were aware that it is possible to adapt to the use of a hearing aid from six months of life. [22] Similarly, 30% of doctors in the Jordanian study indicated that hearing aids can be fitted between 1 and 3 months of age. [18]\u003c/p\u003e\n\u003cp\u003eIn Mexico, 40% of doctors stated that hearing aids can be worn by babies of all ages whenever necessary. [20]\u003c/p\u003e\n\u003cp\u003eOn the other hand, 88% of our doctors affirmed that severely deaf children with hearing aids should always benefit from speech and language therapy. For Colozza and Anastasio (Brazil), speech and language therapy is indispensable and should be started for most participants during the first 6 months. [22]\u003c/p\u003e\n\u003cp\u003eThe situation in which a child may be a candidate for cochlear implantation is bilateral profound deafness—this was recognized by 65% of the doctors in our study. According to MOELLER's study, 74.3% of participants selected profound bilateral deafness [16]. In contrast, Zaitoun Maha's study showed that doctors have a good knowledge of which infants with impaired hearing are suitable candidates for cochlear implants. The majority (97.5%) of the 40 participants answered that these were infants with profound bilateral deafness [18].\u003c/p\u003e\n\u003cp\u003eA recent study by Y Massawe Richard Enica et al. in Tanzania in 2021 found that 74% of participants recognized bilateral profound deafness as a candidacy criterion for cochlear implant er hand, 88% of our doctors affirmed that severely deaf children with hearing aids should always benefit from speech and language therapy. For Colozza and Anastasio (Brazil), speech and language therapy is indispensable and should be started for most participants during the first 6 months. [22] The situation in which a child may be a candidate for cochlear implantation is bilateral profound deafness—this was recognized by 65% of the doctors in our study. According to MOELLER's study, 74.3% of participants selected profound bilateral deafness [16]. In contrast, Zaitoun Maha's study showed that doctors have a good knowledge of which infants with impaired hearing are suitable candidates for cochlear implants. The majority (97.5%) of the 40 participants answered that these were infants with profound bilateral deafness [18]. A recent study by Y Massawe Richard Enica et al. in Tanzania in 2021 found that 74% of participants recognized bilateral profound deafness as a candidacy criterion for cochlear implants. [23]\u003c/p\u003e\n\u003cp\u003eThe present study showed that the majority of doctors are aware of the importance of newborn hearing screening, since they are also aware that childhood deafness can be an extremely disabling condition with a serious impact on language development. It also revealed a lack of knowledge in many aspects related to childhood deafness, including risk factors for deafness and what to do when faced with it, in line with other studies, indicating a low level of knowledge among the various samples of healthcare professionals. There was also a great lack of knowledge of the classifications and types of deafness, as well as the tests used to assess deafness.\u003c/p\u003e\n\u003cp\u003ePhysicians had little knowledge of aspects related to the treatment of deafness, including the age required for hearing aids and cochlear implants, as well as the indication and emergency situation for cochlear implantation.\u003c/p\u003e\n\u003cp\u003eThe limited level of knowledge could be attributed to various reasons, including the lack of training and educational courses on hearing screening and audiological management. Even so, the main reason could also be attributed to the low number of permanently deaf children that doctors had in their practice.\u003c/p\u003e\n\u003cp\u003eThe participants' knowledge and attitudes on childhood hearing loss showed a statistically significant positive link, indicating that attitudes become more positive as knowledge improves. The positive connection implies that those who have a better understanding of a subject are more likely to have good attitudes toward it, which is consistent with the theory underlying attitudes [19]. This result emphasizes how important knowledge is in influencing attitudes, especially when it comes to hearing loss in children.\u003c/p\u003e\n\u003cp\u003eThe study's cross-sectional form makes it difficult to track changes or trends over a longer period of time because it only records attitudes and knowledge at one particular moment in time. Furthermore, the study's dependence on participant self-reported data raises the possibility of response bias, which could cause participants' motivation to give socially acceptable answers to result in an overestimation of favorable opinions. Future research could benefit from extending the study to include larger, population-based groups of Primary Care Physicians (PCPs) in order to address these shortcomings. This would increase the study's findings' generalizability. [24] The results of such an enlargement would probably be more representative and accurate, strengthening the validity of the study's conclusions. Furthermore, using longitudinal designs to monitor how PCPs' knowledge and attitudes evolve over time, particularly in response to focused educational interventions—would provide important new information about how effective these interventions are.\u003c/p\u003e\n"},{"header":"Summary and Conclusion","content":"\u003cp\u003eAccording to this study, Moroccan doctors had both favorable opinions and deficiencies in their understanding of hearing loss in children. There is an urgent need for extensive training programs to fill in these knowledge gaps worldwide. However, the fact that the doctors are receptive to recommendations suggests that interventions can enhance the early identification and care of affected children. To enhance pediatric audiological care, relevant stakeholders must put these findings into practice.\u003c/p\u003e\u003cp\u003eFollowing on from the results of this study, we recommend that, in order to improve the knowledge and attitudes of general practitioners and pediatricians, they should be made aware of the need for early detection of childhood deafness, right from their university training. In addition, in-service training or round-table discussions aimed at raising awareness among GPs and pediatricians should be carried out to facilitate early diagnosis and management of this disease.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eFunding Statement\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding. N/A\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor Contributions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the published version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCredit authorship contribution statement\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDr Walid Bijou: study concept and design\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr Fadoua El Mourabit: study concept and design\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr Meryem Loudghiri: data analysis and interpretation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr Youssef oukessou: data analysis and interpretation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr Sami Rouadi and dr Reda Abada: data analysis and interpretation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr Mohamed Roubal and dr Mohamed Mahtar: contributors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInstitutional Review Board Statement\u003cbr\u003e\u0026nbsp;This study was reviewed and approved by the Ethics Committee of the Faculty of Medicine and Pharmacy of Casablanca, under approval number [INSERT APPROVAL NUMBER HERE]. All participants provided written informed consent to participate in the study. This study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eThe work has been reported in line with the SCARE criteria.Ethical review and approval were waived for this study due to the fact that the principles of good clinical practices were followed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData Availability Statement\u003cbr\u003e\u0026nbsp;The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eNot applicable. N/A\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConflicts of Interest\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest. N/A\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSupporting information \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis file contains the raw data collected during our study, specifically the responses from participants regarding their knowledge and attitudes on the subject matter of our research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgments\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the PCPs who participated in this study, generously sharing their time and insights. Additionally, we extend our appreciation to the healthcare institutions and organizations that supported and facilitated this research.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDeclaration of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for \u003cem\u003e[Journal name]\u003c/em\u003e and was not involved in the editorial review or the decision to publish this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors declare the following financial interests/personal relationships which may be considered as potential competing interests:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ethe financial benefits of the articleꓽ none\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Deafness and hearing loss. Retrieved July 21, 2023, from https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss. \u003c/li\u003e\n\u003cli\u003eKorver AM, Konings S, Dekker FW, DECIBEL Collaborative Study Group, et al. Newborn hearing screening vs later hearing screening and developmental outcomes in children with permanent childhood hearing impairment. JAMA 2010; 304(15):17018.https://doi.org/10.1001/jama.2010.1501 PMID: 20959580. \u003c/li\u003e\n\u003cli\u003ePimperton H, Kennedy CR. The impact of early identification of permanent childhood hearing impairment on speech and language outcomes. Arch Dis Child 2012; 97(7):64853.https://doi.org/10.1136/archdischild-2011-301501 PMID: 22550319. \u003c/li\u003e\n\u003cli\u003eThe Joint Committee on Infant Hearing. Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. J Earl Hear Detect Interv 2019; 4(2):1\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eSecretariat of State for the family of children and persons with disabilities report national disability survey April 2005. \u003c/li\u003e\n\u003cli\u003eGatehouse S (2002) Electronic aids to hearing. Br Med Bull 63: 147-156. \u003c/li\u003e\n\u003cli\u003eMansbach AL (2006) Deafness in children. Rev Med Brux 27: S250-257. \u003c/li\u003e\n\u003cli\u003eF. Di Berardino, S. Forti, E. Iacona, G. P. Orlandi, U. Ambrosetti, A. Cesarani, Public awareness of ear and hearing management as measured using a specific questionnaire. Eur Arch of Oto-Rhino-L\u003cem\u003e. \u003c/em\u003e270 (2) (2013) 449- 453, doi: 10.1007/s00405-012-1961-3. \u003c/li\u003e\n\u003cli\u003eD.W. Swanepoel, N. Almec, Maternal views on infant hearing loss and early intervention in a South African community, Int J Audiol.47(2008) 44-48, doi:10.1080/14992020802252279. \u003c/li\u003e\n\u003cli\u003eV.D.Andrade, E. Ross, Beliefs and practices of black South African traditional healers regarding hearing impairment, Int J Audiol\u003cem\u003e. \u003c/em\u003e44 (2005) 489-499, doi: 10.1080/14992020500188999. \u003c/li\u003e\n\u003cli\u003eB. O. Olusanya, R. J. Ruben, A. Parving, Reducing the burden of communication disorders in the developing world: An opportunity for the millennium development project. JAMA.296 (4) (2006) 441- 444, doi: 10.1001/jama.296.4.441. \u003c/li\u003e\n\u003cli\u003eJ. Des Georges, Family perceptions of early hearing, detection, and intervention systems:listening to and learning from families, Ment Retard Dev D R. 9 (2003) 89-93. \u003c/li\u003e\n\u003cli\u003eB. McPherson, B. O. Olusanya, Screening for hearing loss in developing countries. In B.McPherson \u0026amp; R. Brouillette (Eds.), Audiology in developing countries. Nova Science Publishers New York, (2008). 75-105. \u003c/li\u003e\n\u003cli\u003eB.O. Olusanya, L.M. Luxon, S.L.Wirz,Maternal view on infant hearing loss in a developing country, Int J Pediatr Otorhinolaryngol.70 (2006) 619-623 doi:10.1016/j.ijporl.2005.08.004. \u003c/li\u003e\n\u003cli\u003ePeer S, Fagan JJ. Hearing loss in the developing world: evaluating the iPhone mobile device as a screening tool. S Afr Med J 2015; 105(01):35\u0026ndash;39. \u003c/li\u003e\n\u003cli\u003eMoeller, White, et Shisler, \u0026laquo; Primary Care Physicians\u0026rsquo; Knowledge, Attitudes, and Practices Related to Newborn Hearing Screening \u0026raquo;.2006 \u003c/li\u003e\n\u003cli\u003eRogha et Mokhtari, \u0026laquo; Study of the Knowledge of Pediatricians and Senior Residents Relating to the Importance of Hearing Impairment and Deafness Screening among Newborns \u0026raquo;.2014 \u003c/li\u003e\n\u003cli\u003eZaitoun et al., \u0026laquo; Knowledge and Practice of Hearing Screening and Hearing Loss Management among Ear, Nose, and Throat Physicians in Jordan \u0026raquo;.2021 \u003c/li\u003e\n\u003cli\u003eAjzen I, Fishbin M. Understanding attitudes and predicting social behaviour. Prentice-Hall; Englewood Cliffs, 1980.PLOS ONE Primary care physicians and childhood hearing loss in Malaysia PLOS \u003c/li\u003e\n\u003cli\u003e\u0026laquo; Attitude and knowledge of hearing loss among medical doctors selected to initiate a residency in Mexico - PubMed \u0026raquo;.2009 \u003c/li\u003e\n\u003cli\u003eYerraguntla, Ravi, et Gore, \u0026laquo; Knowledge and Attitude of Pediatric Hearing Impairment among General Physicians and Medical Interns in Coastal Karnataka, India \u0026raquo;.2016 \u003c/li\u003e\n\u003cli\u003eColozza et Anastasio, \u0026laquo; Screening, Diagnosing and Treating Deafness \u0026raquo;.2009 \u003c/li\u003e\n\u003cli\u003eEnica, Daudi, et Abdul, \u0026laquo; Knowledge on Cochlear Implants among Medical Students, Tanzania \u0026raquo;.2021 [23]\u003c/li\u003e\n\u003cli\u003eWinter R, Leanage N, Roberts N, Norman RI, Howick J. Experiences of empathy training in healthcare:a systematic review of qualitative studies. Patient Educ Couns 2022; 105(10):301737.https://doi.org/10.1016/j.pec.2022.06.015 PMID: 35811257. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 3","content":"\u003cp\u003eTable 3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Knowledge, attitude, practices, pediatricians, childhood hearing loss","lastPublishedDoi":"10.21203/rs.3.rs-6785205/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6785205/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eHearing loss in children is a serious health issue. Primary care physicians (PCPs) are crucial in the process of early detection and intervention, which is necessary to optimize hearing potential and developmental outcomes.\u003c/p\u003e\n\u003cp\u003eObjectives\u003c/p\u003e\n\u003cp\u003eThis study aimed to investigate the knowledge of general practitioners and pediatricians regarding to childhood hearing loss investigate the association between knowledge and attitudes, and examine the influence and the influence of this on the early detection of childhood hearing loss.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eThis is a descriptive cross-sectional study, we conducted a survey, over a period of 8 months from APRIL 2021 to NOVEMBER 2021 in Casablanca. During this period, 100 general practitioners and pediatricians in practice and in training (interns and pediatric residents) were interviewed directly. A self-administered questionnaire assessed PCPs’ knowledge of general facts, diagnosis and intervention, and risk factors for childhood hearing loss. Additionally, the questionnaire evaluated\u003c/p\u003e\n\u003cp\u003ePCPS’ attitudes across cognitive, affective, and behavioural domains regarding childhood hearing loss.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003eThe physicians in our study were divided into 35% general practitioners, 35% internists, 17% pediatric residents and 13% pediatricians and child psychiatrists. The male/female physician sex ratio was 0.17. The average age was around 30 years. Doctors with less than 5 years' seniority accounted for 85%. Only 27% of doctors were in private practice. Only 27% see \u0026gt;50% of children aged \u0026lt;5 years. And 52% of doctors said they had seen between 1 and 8 deaf children in the last 3 years.93% of participants agreed or strongly agreed that hearing loss is a condition that can become extremely disabling. 44% of participants regularly checked their patients' hearing. Most doctors (80%) referred a child for hearing assessment when they perceived an abnormality during the clinical examination, 76% when the mother expressed a complaint, and 50% when the child presented a high risk of deafness. Only 2% replied that the child should be referred systematically. 97% agreed or strongly agreed that early intervention to assess a child's hearing in response to parental suspicions has a considerable influence on the child's language development. Most doctors are aware of the importance of hearing screening for all newborns (71% considered it very important). The results of our study showed that knowledge of the factors that put a child at risk of permanent hearing loss varied according to the participants. According to our practitioners, the most commonly identified test for assessing infant and toddler hearing was the auditory evoked potential (60%), while half indicated behavioral audiometry and 23% tonal audiometry. Acoustic otoemission and ASSRs were poorly reported by participants. 76% correctly identified the age at which a child's hearing can be assessed, which is from the first 6 months. In our study, more than half (56%) of our doctors had difficulty finding reliable audiology services. Only 38% of participants correctly indicated that a child can benefit from a hearing aid from the first 6 months of life. On the other hand, 88% of doctors were aware that severely deaf children with hearing aids should always benefit from speech therapy. Profound bilateral deafness is the situation where the child may be a candidate for cochlear implantation, and was recognized by 65% of doctors. Only 35% correctly answered that the child could benefit from a cochlear implant from the end of the 1st year. Finally, the doctors were asked to choose the means of information they considered most interesting for their daily practice: 63% chose the round table and 37% chose the online courses.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eThis study highlights the urgent need to address knowledge gaps among Moroccan pediatricians and general practitioners (PCPs) regarding childhood hearing loss. While these knowledge gaps, PCPs' favorable attitudes serve as a basis for creating focused educational initiatives that will enhance their expertise in treating childhood hearing loss. To turn these findings into significant advancements in pediatric audiological care, cooperation is crucial.\u003c/p\u003e","manuscriptTitle":"Knowledge and Attitudes Survey of General Practitioners and Paediatricians Regarding Childhood Hearing Loss in Casablanca, Morocco","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 17:49:30","doi":"10.21203/rs.3.rs-6785205/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a03baa6d-9116-471e-93ea-4273a26f385a","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-05T18:25:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 17:49:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6785205","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6785205","identity":"rs-6785205","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}