Universal newborn hearing screening in Malaysian public hospitals: A national evaluation of coverage,quality indicators,and outcomes (2022–2023)

Abstract

Objective

To evaluate the performance of the universal newborn hearing screening programme in Malaysian public hospitals following the introduction of national key performance indicators in 2022.

Methods

A cross-sectional analysis was conducted using aggregated universal newborn hearing screening data from 48 public hospitals for 2022 (288,543 live births) and 2023 (308,272). Performance indicators included screening coverage, timeliness of screening (by 28 days), initial referral rates, loss to follow-up, and age at screening, diagnosis, and intervention. The prevalence of confirmed hearing loss was also estimated.

Results

Median screening coverage increased from 72.0% (IQR = 54.3) in 2022 to 88.4% (IQR = 16.7) in 2023, and the proportion of hospitals completing screening within 1 month increased from 71.1% to 93.6% (p = .004). Median initial referral rates remained high and unchanged (8.3% vs. 7.9%, p = .767), and mean loss to follow-up after screening was similarly stable (23.5% vs. 23.1%, p = .797). Median age at screening decreased from 9 to 5 days (p < .001), whereas median age at diagnostic confirmation remained approximately 4 months, and mean age at intervention exceeded 7 months in both years. The prevalence of confirmed hearing loss was 2.95 per 1000 live births in 2022 and 2.85 per 1000 in 2023.

Conclusions

The introduction of national key performance indicators led to improved coverage and earlier screening. However, screening specificity, follow-up completion and downstream timeliness remain key challenges. Strengthening screening specificity, follow-up coordination, and diagnostic and intervention capacity is necessary to ensure timely care across the full Early Hearing Detection and Intervention pathway.