Contextual and individual determinants of use of newborn hearing screening: the Brazilian National Health Survey, 2013

The current study assessed the effect of contextual and individual determinants of the use of newborn hearing screening in Brazilian state capitals and the Federal District. The conceptual theoretical model proposed by Andersen & Davidson (2014) oriented the analyses using multilevel logistic modeling with data from the Brazilian National Health Survey, 2013. The study population (n = 585) is representative of 230,112 pairs of women/responsible person over 18 years of age and their respective children under 2 years of age. At the contextual level (state capitals and Federal District), the use of newborn hearing screening was determined by the proportion of extremely poor individuals (odds ratio - OR = 0.91; 95% confidence interval - 95%CI: 0.83-0.99) and by monthly coverage of newborn hearing screening (OR = 1.02; 95%CI: 1.01-1.02). At the individual level, use of newborn hearing screening was higher in the maternal age bracket 25 to 39 years, compared to < 25 years. The odds of use of newborn hearing screening were lower in mothers with brown race/color (OR = 0.47; 95%CI: 0.26-0.83) compared to white mothers. As for schooling, complete university education nearly tripled the odds of newborn hearing screening when compared to primary schooling (OR = 2.99; 95%CI: 1.15-7.79). Predominantly private prenatal care increased the odds of using newborn hearing screening by 2.18 times, compared to public prenatal care (OR = 2.18; 95%CI: 1.02-4.64). Effective enforcement of existing hearing health laws and policies and prioritization of primary healthcare and health education practices with a focus on more vulnerable newborns, based on the characteristics identified in this study, are initiatives that can help ensure an equitable social protection system.

本研究评估了巴西各州首府及联邦特区内，新生儿听力筛查（newborn hearing screening）使用情况的情境与个体层面决定因素的影响。本研究以Andersen & Davidson（2014）提出的概念理论模型为分析框架，基于2013年巴西全国健康调查的数据，采用多层logistic回归模型（multilevel logistic modeling）开展分析。本研究的研究样本（n=585）具有代表性，可代表230112组18岁及以上女性/照护者及其2岁以下子女队列。在情境层面（各州首府与联邦特区），新生儿听力筛查的使用率受极端贫困人群占比（比值比（odds ratio, OR）=0.91；95%置信区间（95%CI）：0.83~0.99）及新生儿听力筛查月度覆盖率（OR=1.02；95%CI：1.01~1.02）影响。在个体层面，相较于25岁以下产妇，25~39岁年龄段产妇的新生儿听力筛查使用率更高；棕色种族/肤色产妇的新生儿听力筛查使用率相较于白人产妇更低（OR=0.47；95%CI：0.26~0.83）。在受教育程度方面，完成大学高等教育的产妇，其新生儿听力筛查的使用几率相较于初等教育者近乎增至三倍（OR=2.99；95%CI：1.15~7.79）。相较于接受公立产前保健的产妇，主要接受私立产前保健的产妇，其新生儿听力筛查的使用几率提升2.18倍（OR=2.18；95%CI：1.02~4.64）。基于本研究识别的特征，强化现有听力健康法律法规与政策的有效执行，优先为弱势新生儿群体提供初级保健与健康宣教服务，此类举措有助于构建公平的社会保护体系。