Scaling early hearing detection in low-resource settings: evidence from recent pilots and policy implications.

PURPOSE OF REVIEW: Childhood hearing loss remains a major yet under-addressed public health challenge in low-income and middle-income countries (LMICs). Despite global policy momentum following the World Report on Hearing, early detection programmes remain fragmented, urban-centred, and difficult to scale. This review synthesizes evidence from recent newborn, infant, preschool, and school-age screening pilots (2024-2025) to clarify emerging models, persistent barriers, and policy implications for expanding equitable early hearing screening in resource-constrained settings.

RECENT FINDINGS: Recent studies demonstrate growing interest in community-based delivery, task-shifting to non-specialist health workers, and the use of portable and digital tools - including smartphone-based OAE, tablet screeners, and remote audiology services. Pilots across Africa and Asia show high feasibility and caregiver acceptability but reveal substantial challenges: limited diagnostic capacity, workforce shortages, high loss-to-follow-up, and uncertain programme costs. School-based and preschool screening programmes offer a critical second opportunity for detection, particularly for late-onset and infection-related hearing loss, and show strong potential when integrated into existing education or child-health platforms.

SUMMARY: Scalable early hearing detection in LMICs requires context-specific models, strengthened referral pathways, and sustainable financing. Digital tools and task-shifting offer promising avenues but need rigorous validation and integration into national systems. Future research should prioritize cost-effectiveness, culturally grounded family-centred approaches, and embedding screening within broader child-health policy frameworks.