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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 23  |  Issue : 4  |  Page : 148-154

Parental awareness of risks and causes of hearing loss and the acceptance of the intervention in Taif City, Saudi Arabia


1 Department of Otorhinolaryngology, Prince Mansour Military Hospital, Taif, Saudi Arabia
2 Taif University, Taif, Saudi Arabia

Date of Submission05-May-2021
Date of Decision10-May-2021
Date of Acceptance17-Jun-2021
Date of Web Publication01-Sep-2021

Correspondence Address:
Dr. Ghaida Hassan Alotaibi
Almathnah Street, Taif City
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjoh.sjoh_23_21

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  Abstract 


Background and Objectives: Pediatric hearing loss (HL) hinders or delays a child's auditory and speech development. This issue that results in anxiety and stress among parents affects the child's ability to engage in communication, participation in age-appropriate activities, and functional and language skills. This study aimed to assess parents' knowledge about risks and causes of HL and the acceptance of the intervention among Saudi parents living in Taif city. Methodology: A cross-sectional study was conducted between July 2020 and December 2020 through a pretested questionnaire that was published using an online-based (electronic) form. The questionnaire included items related to sensorineural HL, otitis media, conductive HL, and oto-acoustic emission. The total knowledge scores were calculated based on correct and wrong answers, and the relationship between knowledge level and other variables was determined. Results: In this study, the reported prevalence of HL among children was 5.6%. The knowledge related to various types of HL and their risk factors was determined to be good at only 4.5% of the participants. There was no statistically significant difference observed in knowledge between male and female parents (P = 0.620), different age groups (P = 0.591), and education levels of the participants (0.096). Conclusion: Parents need to be educated about conventional risk factors for HL because there was inadequate knowledge among our study population. In addition, it is necessary to increase awareness about various audiology services to facilitate early detection and intervention.

Keywords: Arabia, awareness, hearing, loss, Saudi, Taif


How to cite this article:
Aljuaid SM, Alotaibi GH, Alsharif MO, Aljuaid AM, Alzahrani WS, Alotaibi OD, Alharthi RS. Parental awareness of risks and causes of hearing loss and the acceptance of the intervention in Taif City, Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg 2021;23:148-54

How to cite this URL:
Aljuaid SM, Alotaibi GH, Alsharif MO, Aljuaid AM, Alzahrani WS, Alotaibi OD, Alharthi RS. Parental awareness of risks and causes of hearing loss and the acceptance of the intervention in Taif City, Saudi Arabia. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2021 [cited 2022 Jan 21];23:148-54. Available from: https://www.sjohns.org/text.asp?2021/23/4/148/325412




  Introduction Top


Child hearing loss (HL) is a major health problem, both with respect to its prevalence and its physical, mental, and social implications.[1] The prevalence of HL in developing countries is 6 per 1000 live births, compared to 2 per 1000 live births in developed countries.[2] Undetected HL adversely affects the speech, vocabulary, emotional, and social development of an infant.[3] Early identification and hearing intervention programs offer an ideal opportunity for a child to achieve maximum growth potential.[4]

Previous studies have indicated that early identification and intervention with respect to hearing issues are generally highly supported by parents.[5],[6]

In 2020, a study was conducted at five centers in Qassim, Saudi Arabia, to study parental awareness and attitudes toward childhood HL and hearing services. There were 243 participants in this survey, i.e. 105 (43.2%) fathers and 138 (56.8%) mothers who were 21–60 years old. The prevalence of various aspects of parents' knowledge and attitudes toward childhood HL was assessed. It was determined that 103 participants (42.4%) had good knowledge, while 140 participants (57.6%) had weak knowledge. The attitude analysis revealed that 224 participants (92.2%) registered positive attitudes.[7]

In 2016, in Riyadh, Saudi Arabia, early intervention services were provided to children who were deaf, and their parents' perceptions were studied. A descriptive quantitative research was performed at two main state hospitals in Riyadh, Saudi Arabia. The participants of the abovementioned study included 60 parents of children ranging in age from birth to 5 years of age. Assessment of early intervention services revealed that if children were diagnosed at the late stage, they had delayed age of initial hearing aid fitting and delayed registering in early intervention services. The obtained results showed that the participants living in Riyadh were fitted with hearing aids and quickly registered into Early intervention (EI) services.[8]

There are insufficient studies on the parental awareness of the manifestation of HL in children in Taif city, Kingdom of Saudi Arabia. Therefore, this study aims to assess parents' knowledge about risks and causes of HL and the acceptance of the intervention among Saudi parents living in Taif city.


  Methodology Top


A cross-sectional study was performed to assess parent's awareness level of HL manifestation in children in Taif city, Saudi Arabia. The study was conducted from July to December 2020. Our study was a cross-sectional online-based (electronic) survey. The sample size of participants was 464.

The inclusion criteria were all parents who lived in Taif, Saudi Arabia, of an age ≥20 years, and having children of any age whether suffering HL or not. The exclusion criteria were nonparents, parents not living in Taif city, and parents who refused sharing in the survey. A predesigned questionnaire was distributed using a Google Form through the social media. The questionnaire included items related to sensorineural HL, otitis media, conductive HL, and oto-acoustic emission (OAE) (questionnaire 1 in appendix). The total knowledge scores were calculated based on correct and wrong answers for specific items and then related to other categorical variables.

All data in this study were expressed as the mean ± standard deviation. Statistical analysis was performed using SPSS version 21 (Armonk, NY: IBM Corp.). Frequencies and percentages were used to describe the data. The Chi-square test was used with a significance level of P < 0.05.


  Results Top


This cross-sectional study was performed on parents living in Taif city, Saudi Arabia, who gave consent to participate. A total of 464 participants were included in our final analysis (i.e., 82.8% of the participants were female parents [mothers], and 17.2% of the participants were male parents [fathers]). The age and educational characteristics are shown in [Table 1]. In our study, the reported prevalence of HL among children was 5.6% [Figure 1].
Table 1: Sociodemographic details of the participants

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Figure 1: Prevalence of hearing loss among children

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There were 24 items in the questionnaire that assessed the knowledge related to risk factors for HL. Each correct answer was given a score of “1,” and wrong answers were given no scores. Thus, the maximum score one participant could obtain was 24, and the minimum score was 0. In this study, the mean score was determined to be 10.04 ± 4.4. The scores were categorized as “good” (>75%), “fair” (60%–75%), and “poor” (<60%) based on the scores obtained by participants. It was observed that only 4.5% of the participants had scored “good,” and the majority of participants (84.5%) had poor knowledge related to risk factors [Figure 2].
Figure 2: Knowledge related to risk factors (n = 464)

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When we evaluated the relationship between knowledge and sociodemographic characteristics of the parents, there was no statistical difference with regard to the gender of the parent (P = 0.620), age (P = 0.591), and educational level (P = 0.096) [Table 2]. The responses of the participants related to each risk factor are shown in [Table 3]. A total of 20.7% and 30.8% of the participants reported that they believed that curses and evil spirits, respectively, could cause HL [Figure 3].
Table 2: Relationship between knowledge and sociodemographic characteristics

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Table 3: Responses of parents regarding risk factors for hearing loss

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Figure 3: Nonbiomedical model beliefs

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When we assessed the attitude of participants toward audiology services, it was reported by 80.4% of the participants that they would like to get their baby tested soon after birth. It was reported by 86.4% and 84.5% of the parents that they would accept OAE hearing screening tests for their baby and would like their child to be tested at school. The majority of the parents were ready to let their child use hearing aids (82.5%), and 81.3% reported that they would accept surgical treatment to correct HL [Table 4].
Table 4: Attitudes toward childhood audiology services

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  Discussion Top


HL can be a considerable impediment to education and social integration. Early identification and intervention with respect to HL can provide significant benefits because listening is essential to understanding social interactions and educational and behavioral participation. This study shows the highest participation rate of females compared to males. The average age of the participants was 20–30 (43.3% of the participants). In addition, 78% of the participants were university graduates, while 22% of the participants received high school or lower education. A previous study performed in 2020 in Qassim reported similar results, i.e. an increase in the participation rate of women and higher discrepancy in the educational level of participants because the number of participants with high school education was lower compared to the participation rate at the university.[7]

HL can be a considerable barrier to education and social integration. Early HL recognition and intervention can provide major advantages because hearing is important for oral communication learning, as well as for academic and social performance. The obtained results showed that both fathers and mothers had a very low level of knowledge compared with what has been reported in Qassim.[9] This result reflects the degree of knowledge in terms of sociodemographic characteristics, which indicates a need for more social and cultural awareness.

The obtained results show that mothers have a high level of knowledge about risk factors for HL, especially in relation to the following statements: “Children with HL can attend a school,” “Head trauma can cause HL,” “Family history can cause HL,” and “CNS infection can cause HL.” Poor level of knowledge was observed about the following statements: “Low birth weight can cause HL” and “Jaundice can cause HL.”

A previous study conducted in Qassim, Saudi Arabia, reported a high level of knowledge when participants were asked about the following statements: “Babies can be born with HL” and “Head trauma can cause HL.” In addition, the same study identified a poor level of knowledge about the statement “Jaundice can cause HL” than “Low birth weight can cause HL.”[7]

Better knowledge was identified concerning the statement “Drug/medications can cause HL.” A study by Kaspar et al. reported good knowledge for the same statement.[9]

As for the attitudes toward childhood audiology services, the parents showed positive attitude toward childhood audiology services, especially the statement, “I would like more information” followed by “I would accept OAE hearing screening test for my baby.” A study by Alsudays et al. reported that 92.2% of parents had positive attitudes toward childhood audiology services.[1] In addition, 81.3% of our participants would accept ear surgery for their child. In contrast, a study by Kaspar et al.showed that surgical treatment was the least preferred service (63.7%).[9]

As for the nonbiomedical beliefs about the causes of childhood HL, 20.7% of the participants believed that curses could cause HL, and 30.80% of the participants believed that evil spirits could cause HL. These results are consistent with those of a study performed in Solomon Islands, which reported that approximately half of the participants believed that curses could cause HL, and almost a quarter of the participants believed evil spirits could cause HL.[9]

The knowledge of participants about risk factors for HL was as follows: only 4.5% of the participants scored “good,” and most of the participants (84.5%) had poor knowledge regarding the risk factors. These results are consistent with those in a previous study that was conducted in the Qassim region, i.e. 42.4% of the participants had good knowledge, and 57.6% of the participants had poor knowledge.[7]

Our study evaluated parents' awareness of the HL manifestation in children in Taif city, Saudi Arabia. We determined that the percentage of the prevalence of HL among children in our study was 5.6% [Figure 1]. A study that was conducted in developing countries showed that approximately 6 per 1000 live births are susceptible to have an early-onset HL; in developed countries, this number was 2 per 1000 live births.[2] In addition, the online survey used did not include all HL children's parents in Taif city.


  Conclusion Top


For the successful implementation of early identification and hearing enhancement programs, parental awareness and attitudes about infant HL are essential. This study showed that parental knowledge about risk factors for childhood HL was poor, but most attitudes about audiology services were positive. These results indicate the need to raise awareness among parents about childhood HL, which is also important for early detection and intervention. In addition, awareness should be increased about various audiology services to facilitate early detection and intervention.

Acknowledgments

The authors would like to thank Falcon Scientific Editing (https://falconediting.com) for proofreading the English language in this paper.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Questionnaire Top


Questionnaire 1

♦demographic data:

Note:

SNHL=Sensorineural Hearing Loss HL=Hearing Loss

OM=Otitis Media

CHL=Conductive Hearing Loss

OAE=Oto-Acoustic Emission

Gender:

• Mother

• Father

Age:

• 21–30

• 31–40

• 41–50

• 51–60

• >60

Level of education:

• Secondary or lower

• University

♦Knowledge: SNHL risk factors:

1. Babies can be born with HL

• Yes • No • I do not know

2. CNS infection can cause HL

• Yes • No • I do not know

3. Neonatal infection can cause HL

• Yes • No • I do not know

4. Maternal infection can cause HL

• Yes • No • I do not know

5. Drugs/medications can cause HL

• Yes • No • I do not know

6. Radiotherapy can cause HL

• Yes • No • I do not know

7. Chemotherapy can cause HL

• Yes • No • I do not know

8. Jaundice can cause HL

• Yes • No • I do not know

9. Delayed crying at birth can cause HL

• Yes • No • I do not know

10. Family history can cause HL

• Yes • No • I do not know

11. Consanguineous marriage can cause HL

• Yes • No • I do not know

12. Low birth weight of <1500 g can cause HL

• Yes • No • I do not know

13. CHL/SNHL risks are related

• Yes • No • I do not know

14. Craniofacial anomalies can cause HL

• Yes • No • I do not know

15. Head trauma can cause HL

• Yes • No • I do not know

♦Non-biomedical model beliefs:

16. Evil spirits can cause HL

• Yes • No • I do not know

17. Curses can cause HL

• Yes • No • I do not know

♦Knowledge: OM and CHL risk factors:

18. Ear discharge and OM can cause HL

• Yes • No • I do not know

19. Recurrent URTI can cause OM

• Yes • No • I do not know

20. Breastfeeding for the first 6 months reduces/prevents OM

• Yes • No • I do not know

21. Smoking can predispose to OM

• Yes • No • I do not know

22. Routine childhood immunizations can reduce OM

• Yes • No • I do not know

♦Knowledge: Identification and intervention:

23. HL can be identified soon after birth

• Yes • No • I do not know

24. Treatment for HL is available

• Yes • No • I do not know

25. Children with HL can attend school

• Yes • No • I do not know

♦Attitudes toward childhood audiology services:

1. I would like my baby to be tested soon after birth

• Yes • No

2. I would accept the OAE hearing screening test for my baby

• Yes • No

3. I would like my child to be tested at school

• Yes • No

4. I would let my child to use hearing aids

• Yes • No

5. I would accept ear surgery for my child

• Yes • No

6. I would like more information

• Yes • No


  Reference for the Questionnaire Top


Kaspar A, Newton O, Kei J, Driscoll C, Swanepoel DW, Goulios H. Parental knowledge and attitudes to childhood hearing loss and hearing services in the Solomon Islands. Int J Pediatr Otorhinolaryngol 2017;103:87-92.



 
  References Top

1.
Skarżyński H, Gos E, Świerniak W, Skarżyński PH. Prevalence of hearing loss among polish school-age children from rural areas – Results of hearing screening program in the sample of 67 416 children. Int J Pediatr Otorhinolaryngol 2020;128:109676.  Back to cited text no. 1
    
2.
Olusanya BO. Neonatal hearing screening and intervention in resource-limited settings: An overview. Arch Dis Child 2012;97:654-9.  Back to cited text no. 2
    
3.
Storbeck C, Pittman P. Early intervention in South Africa: Moving beyond hearing screening. Int J Audiol 2008;47 Suppl 1:S36-43.  Back to cited text no. 3
    
4.
Cone-Wesson B, Wunderlich J. Auditory evoked potentials from the cortex: Audiology applications. Curr Opin Otolaryngol Head Neck Surg 2003;11:372-7.  Back to cited text no. 4
    
5.
Olusanya BO, Luxon LM, Wirz SL. Maternal views on infant hearing loss in a developing country. Int J Pediatr Otorhinolaryngol 2006;70:619-23.  Back to cited text no. 5
    
6.
Swanepoel D, Almec N. Maternal views on infant hearing loss and early intervention in a South African community. Int J Audiol 2008;47:S44-8.  Back to cited text no. 6
    
7.
Alsudays AM, Alharbi AA, Althunayyan FS, Alsudays AA, Alanazy SM, Al-Wutay O, et al. Parental knowledge and attitudes to childhood hearing loss and hearing services in Qassim, Saudi Arabia. BMC Pediatr 2020;20:175.  Back to cited text no. 7
    
8.
Alyami H, Soer M, Swanepoel A, Pottas L. Deaf or hard of hearing children in Saudi Arabia: Status of early intervention services. Int J Pediatr Otorhinolaryngol 2016;86:142-9.  Back to cited text no. 8
    
9.
Kaspar A, Newton O, Kei J, Driscoll C, Swanepoel DW, Goulios H. Parental knowledge and attitudes to childhood hearing loss and hearing services in the Solomon Islands. Int J Pediatr Otorhinolaryngol 2017;103:87-92.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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