The neonatal hearing screening and early intervention program was presented in Albania on early 2004, through a pilot project in one of the maternity hospitals in Tirana. The main objective of that stage was to examine the feasibility of such a program in the Albanian situation. The latter including the exhausting reforms in the health system and the scattered services offered to the population in marginal areas of the country.

The pilot study made evident that given the considerable number of births and the concentration of the population, along with the specific positioning of NICU in regard to the NICU babies, an early identification and intervention program in Tirana was not only a reasonable idea, but also an achievable objective.

Furthermore the pilot study showed the weaknesses of the pilot structure and the scarcities of the background situation and sat some new targets toward a smoothly functioning scheme. In this contest, the considerable ‘leakage’ of the subjects from one stage to the other, the lack of information of the general population regarding the early identification and intervention issues, and a ‘child centred’ approach for rehabilitation, were the main goals.

During 2006, Tirana counted 9.406 deliveries, 14% of this total were NICU babies. Statistically, it seems that the number of annual deliveries in the capital is increased, may be as a result of the internal movements of the population. Some data regarding the mortality, returned babies and the babies delivered with S/C are still missing, but a rough estimation indicates a high mortality rate (around 10% ) in the NICU environment.

2. Current structure of the program

March 2006 marks the transit point, from a pilot stage to an organised screening program in Tirana. This program covers the two maternity hospitals of the city and is built upon the experience of the pilot stage.

As a result of an initial training, now it is possible that the first screening tests can be conducted by the personnel of the hospitals itself. The first stage consists on a TEOAE test carried out with Echolab, Labat, ltd. All NICU babies and all babies delivered with S/C are anticipated to be screened. Well babies are screened on the second day of life, while the NICU ones, sometime before they are discharged. If the babies fail the initial test, another TE test is done a month later, which is followed by a threshold ABR until 35 dB nHL in case of another failure. The last two tests are completed at the ENT and Neuropediatric clinics of the University Hospital Centre (TUHC).

During the staying at the maternity hospital, the parents of the children who fail the screening tests are given some written and oral information about what are the tests about, how to understand the results and what can be done in case of a confirmed hearing loss. More detailed information is also offred in the website of the program (www.albscreening.com), or before each stage by the staff of the program.

The subjects who fail the three stages of the screening algorithm, are sent for complementary examinations and once a hearing loss and its degree are confirmed, the babies are sent for fitting in the respective centres and followed up when possible.

3. Results

From March to December 2006, the program has screened approximately 58% of all NICU babies. (The overall figure of NICU residents includs also the babies that have done exitus before or after the screening tests).

Due to the lack of the respective data it is difficult to estimate which percentage of babies born with S/C have been included in the project, but the feeling is that in certain months, with a peak number of deliveries, the screening staff has tried a better coverage of NICU (where the presence of risk factors and the number of cases with hearing loss is expected to be higher) at the expense of the normal babies.

In the figure 1, it is presented graphically the number of NICU babies screened versus the total number of the NICU residents, for each month. It is obvious that this figure varies considerably from month to month. Although it is noticeable that the coverage has increased during the last months, it seems like there is no clear connection between this figure and the respective number of the babies in the NICU environment. May be the general workload of the staff is the main factor that influences the coverage of NICU subjects from the program.

In comparison with the pilot stage there is a considerable change in the number of babies who turn back for the second stage testing. This is a result of the information provided to the parents, the time length of the screening program and of its TV coverage. The figure 2 shows a slow but steady increase in the number of the second tests completed during the time taken into analyses.

Of course, the figures present just a trend shown in the data. The exact analyses of the data from the project is not yet fully elaborated.

4. Program highlights

At the moment the screening program is well established in Tirana and has already sat up a system which can track the babies with hearing loss from the birth to the start of the rehabilitation process. It appears that the number of the second and third stage tests is increasing slowly. This means that the program has better tracing possibilities and less subjects with HL will be lost by the program. Meanwhile, there are still a few problems which need a solution.

Up to this stage, the normal babies are not screened at all, due to the fact that they remain less than 24h at the facilities. Babies delivered with S/C, babies with family anamnesis of hearing loss or other cases considered ‘on risk’ from the doctors are screened either in the maternity hospitals, or TUHC, but this is done sporadically.

As a result, some cases with congenital hearing loss are missed and their diagnosis and rehabilitation is delayed. OAE test, was presented as an audiology test only by this program, but is now becoming a part of the diagnostic battery of the hearing status. The latter may give some help in the cases with delayed diagnosis.

Additionally, due to the Tirana NICU coverage, there are logistic problems that impede the parents who live in the remote areas of the country, to follow the appointments for further testing. This means that in some stage, it has to be considered to set up a screening force in some other big maternity hospitals in the country. This has to be anticipated by a cost/effective analyses of the current project and a better support by the local health authorities.