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Ethical considerations for universal newborn hearing screening in the Pacific Islands: a Samoan case study
  1. Annette Kaspar1,2,
  2. Carlie Driscoll2,
  3. Sione Pifeleti1,
  4. Penaia A Faumuina1,3
  1. 1 ENT Department, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa
  2. 2 Audiology Division, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
  3. 3 ORL Consultant, Wanganui Hospital, Wanganui, New Zealand
  1. Correspondence to Dr Annette Kaspar, Tupua Tamasese Meaole Hospital, Apia, Tuamasaga, Samoa; annette.kaspar{at}


Permanent congenital and early-onset hearing impairment (PCEOHI) is the most common sensory disorder among newborns. The WHO recommends newborn and infant hearing screening for all member states to facilitate early identification and intervention for children with PCEOHI. Ethical implications of newborn/infant hearing screening in low-income and middle-income countries should be considered. Although the Pacific Island region is estimated to have among the highest global burden of hearing loss, hearing health services are limited and virtually non-existent in Pacific Island countries. The aim of this brief report is to consider the ethical implications of implementing hospital-based universal newborn hearing screening (UNHS) in Samoa. Based on well-acknowledged screening principles, this report found that the Samoan context does not satisfy the screening principles for such a programme, and that the implementation of UNHS would, therefore, be unethical. This conclusion was reached even after considering the hypothetical provision of necessary screening and diagnostic audiology equipment from external donors. We recommend that current efforts should be directed towards the wider professional community involved in the daily care of children with a permanent hearing loss. Given the high prevalence of paediatric ear disease in the Pacific Islander population, an interim ear and hearing programme could be considered at the community level. These strategies should provide the infrastructure and referral pathways required in the advent of UNHS in Samoa.

  • capacity
  • children
  • ethics

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  • Contributors The first draft of the manuscript was written by AK. All coauthors (CD, SP and PAF) read the manuscript and provided feedback to AK. Revisions were made by AK, and sent to all coauthors for approval prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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