Factors Associated with Parental Knowledge and Attitudes Toward Childhood Hearing Loss: A Cross-Sectional Study at a Tertiary Hospital in Tanzania

Abstract

Background: In Tanzania, childhood hearing loss prevalence among school-aged children ranges from 7.1% to 16.7%, primarily driven by treatable conditions. However, the country lacks a mandatory universal newborn hearing screening policy, leaving the burden of early detection entirely on parental vigilance. This study aimed to assess baseline knowledge, specific thematic domain insights, and attitudes towards paediatric hearing loss among caregivers attending a tertiary clinic in Tanzania, and to identify associated key sociodemographic factors to inform public health frameworks.
Methods: This cross-sectional study used consecutive sampling to recruit 201 caregivers at a tertiary paediatric outpatient clinic. Data were collected via a validated, structured questionnaire. Overall knowledge levels were categorised using a Modified Bloom’s cut-off point of 60%, where ‘good knowledge’ was defined as a score of ≥60% and ‘poor knowledge’ as <60% across cumulative items. Furthermore, the attitude subscale was a multidimensional instrument spanning four distinct conceptual domains: cultural stigma, treatment-seeking behaviour, traditional beliefs in causes, and willingness to adopt universal screening. Internal consistency was evaluated using Cronbach’s alpha (α). Bivariate associations were analysed using Pearson’s chi-square and Fisher’s exact tests. A P value of <.05 was considered statistically significant. Practical strength was quantified using Cramer’s V (V), with cell differences isolated via post-hoc adjusted standardised residuals.
Results: Overall, 124 (61.7%) caregivers demonstrated poor knowledge. Asymmetries existed across domains: 154 (76.6%) lacked adequate knowledge of risk factors/causes, and 137 (68.2%) lacked knowledge of signs/symptoms. Conversely, 153 (76.1%) understood the consequences of hearing loss. Neonatal jaundice 28 (13.9%) and speech milestones 56 (27.9%) were poorly recognized, while 61 (30.3%) attributed hearing loss to bewitchment. Crucially, 186 (92.5%) maintained positive attitudes, though 82 (40.8%) cited prohibitive costs as a major healthcare barrier. Poor knowledge was statistically significant but moderately associated with primary education (V=.280; adjusted residual=3.4) and farming occupations (V=.268; adjusted residual=3.0). Informal peer networks 149 (74.1%) were the predominant source of information, while healthcare workers accounted for 13 (6.5%). The multidimensional attitude scale yielded a low alpha (α=.534).
Conclusion: Caregivers exhibited a profound clinical knowledge deficit regarding perinatal risk factors and speech milestones, driven primarily by lower educational attainment and agricultural occupations. While positive attitudes prevail, healthcare utilisation remains threatened by severe financial constraints and a lack of formal medical information channels. Healthcare frameworks must urgently integrate targeted maternal ear and hearing care education alongside subsidised newborn screening pathways.