366 ©2006 Blackwell Publishing Ltd. Paediatric and Perinatal Epidemiology, 20, 366–371 Blackwell Publishing LtdOxford, UKPPEPaediatric and Perinatal Epidemiology0269-5022Blackwell Publishing Ltd, 2006 2006205366371Original ArticlePerinatal conditions in hearing-impaired childrenB. O. Olusanya and A. A. Okolo Correspondence: Dr Bolajoko O. Olusanya, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London WC1N 1EH, UK. E-mail: boolusanya@aol.com or b.olusanya@ich.ucl.ac.uk Adverse perinatal conditions in hearing-impaired children in a developing country Bolajoko O. Olusanya a and Angela A. Okolo b a Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, UK, and b Department of Paediatrics & Community Child Health, University of Benin Teaching Hospital, Benin City, Nigeria Summary Olusanya BO, Okolo AA. Adverse perinatal conditions in hearing-impaired children in a developing country. Paediatric and Perinatal Epidemiology 2006; 20: 366–371. Prevailing adverse perinatal conditions in developing countries have been associated with substantial mortality, but little evidence exists on their impact on permanent childhood disabilities and morbidity due to limitations in clinical investigations and medical records. This study aims to identify the possible association between parent- reported adverse perinatal conditions and permanent hearing loss, in order to establish service needs within current maternal and child health programmes. Structured ques- tionnaires were administered to 363 parents of deaf children and 309 parents of nor- mal-hearing children in an inner city area of Lagos, Nigeria. The parents were from all social classes. After a multivariable logistic regression analysis, birth asphyxia [OR 20.45; 95% CI 6.26, 66.85], difficult delivery [OR 8.09; 95% CI 2.76, 23.68], neonatal jaundice [OR 2.45; 95% CI 1.25, 4.79] and neonatal seizures [OR 2.30; 95% CI 1.09, 4.85] were associated with permanent hearing loss. Consanguineous marriages [OR 6.69; 95% CI 2.72, 16.46] and family history of deafness [OR 6.27; 95% CI 2.07, 18.97] also emerged as additional risk factors for permanent hearing loss. In addition, parents of children in state-owned schools for the deaf were significantly more likely to belong to higher social classes compared with normal-hearing children in mainstream state-owned schools. There is a need to incorporate services for the early detection of permanent hearing loss into current maternal and child healthcare programmes in developing countries. Keywords: deafness, consanguinity, birth asphyxia, type of delivery, neonatal jaundice, neo- natal convulsions, social class. Introduction Of the 133 million children born annually worldwide, over 4 million are likely to die within the first 28 days of life. 1,2 While maternal and child health care in devel- oped countries have witnessed substantial improve- ments in the last three decades, 3 perinatal care in most of the developing world (which accounts for 90% of global births) is still characterised by a range of adverse conditions such as (but not limited to) young maternal age, prolonged and obstructed labour (pre)eclampsia, breech and multiple deliveries, pro- longed rupture of membranes, low birthweight, birth asphyxia, jaundice, sepsis, seizures, stillbirths, neona- tal and maternal deaths. 2,4–6 The preventive value of programmes aimed at high immunisation uptake, improved personal hygiene, safer antenatal/delivery care and better health education has been acknowl- edged globally and continues to attract attention from governments, donor agencies and various multilateral institutions. However, there is a growing concern for the many survivors of neonatal mortality in the devel- oping world in view of the lifelong disabilities that are