A systematic review and meta-analysis of screening and diagnostic accuracy for hearing loss among under-five children in South-Asian region
Authors: Athe Ramesh , Dwivedi Rinshu , Sahoo Krushna Chandra , Bhattacharya Debdutta , Jain Shalu , Pati Sanghamitra 
Published: September 2021

Purpose
Congenital hearing disabilities among children are associated with lifetime discrepancies in the attainment of speech, poor academic-performance, socio-individual isolation and emotional-maladjustments. The present study aims to combine evidence from randomized, controlled trials to assess the accuracy of hearing-screening procedures and relative diagnostic-tests concomitant with partial/permanent hearing loss (HL) among neonatal and under-five children.

Design/methodology/approach
The steps in this process were conducted according to the PRISMA (Preferred-Reporting-Items-for-Systematic-reviews-and-Meta-Analysis) guidelines. The PubMed, ProQuest, Science-Direct, Cochrane-Library and secondary reference databases were searched. Analyses were carried out by using fixed/random-effects-models for calculating the summary estimates on hearing-screening and test-procedure. Meta-regression-analysis is performed to explore the influence of confounders on the net-pooled effect.

Findings
A total of 1,656 articles were identified, and 1,575 were excluded as they were not relevant to the purpose of the study. Further, out of 81 studies, 67 were excluded with reasons and 14 were included in the final analysis. Three independent reviewers have assessed the titles/abstracts for their potential relevance. The results from meta-analysis indicate that hearing-screening was significantly higher in the intervention group (n 8,102; OR 0.52, 95% CI 0.34, 0.79; p < 0.00001), as depicted via forest plot. Meta-regression analysis indicates a positive relationship between the age and effect size (regression-coefficient 0.638, 95% CI 0.005, 0.731; p < 0.05).

Research limitations/implications
The evidence from the present study can be used as reference for identifying the associated risk indicators, improved hearing-screening and reduction of hearing disability among under-five children.

Practical implications
The results of this review will be used for implementation of a new-born hearing screening, diagnostic accuracy and understanding the risk indicators for HL among under-five children in the South-Asian region. The evidence will be helpful for strategic directions for improved hearing screening and reduction of hearing disability among under-five children.

Social implications
By understanding the underlying dynamics of hearing-screening procedures, hearing-impairments can be identified at an early stage and required treatment can be provided to the children.

Originality/value
The findings of this study indicate that early detection, screening and diagnosis of the HL among the children, especially among the infants and new-born (0–2 years of age), will be of utmost importance in reducing the prevalence of HL, especially among the South-Asian region. This study can be used as a reference for other future studies in the area of hearing-screening, diagnostic accuracy and associated risk indicators among children.