Brief Country Information

Nigeria is a low-income country and the most populous black nation in the world with a rich multi-ethnic and cultural diversity. It has an estimated population of 234 million people (World Population Review, 2024), covering an area of 923,768 square kilometers. Nigeria shares boundaries with Niger on the north, Chad and Cameroon on the east, the Gulf of Guinea of the Atlantic Ocean on the south, and the Benin Republic on the west. Its capital is in Abuja. Annual live births as of 2020 stood at 7.7 million with a corresponding 2.4 million death rate (National Bureau of Statistics, 2021) across the six geopolitical zones (South-West, South-East, and South-South, North-West, North-East, and North-Central).

Incidence and Prevalence of Hearing Loss

Nigeria as a country records widespread incidences of hearing loss annually, and the majority of these remain untreated. The World Health Organization reported in 2018 that Nigeria has 8.5 million people with disabling hearing loss, and this excludes individuals with unilateral or mild hearing loss. With an estimated 2 percent annual increase in population (Worldometer, 2024) in addition to improvement in average life expectancy, this figure is likely to have increased to approximately 10–12 million people in 2024. Hence, WHO has also estimated that the figure in Africa would have risen from 40 million in 2023 to 54 million by 2030.

Information About Audiology and Aural Care

History

Audiology is relatively new in Nigeria compared to some Western and other countries like USA. However, the practice of audiology is traced back to the 1960s post-world rehabilitation programs and services. Historical account revealed that Special Education department was established in the 1976–1977 academic session. Audiology, along with four other programs, started as a three-year bachelor’s program, which was subsequently upgraded to a four-year program in the 1987/1988 academic session. The University of Jos Hearing Handicap program is another program identified with Audiology, as some students often learned some aspects of the field. Recently, the Federal University of Health Sciences Ila, Orangun Osun State, and the University of Medical Sciences Ondo State are the latest institutions that have been accredited by the National University Commission (NUC) to commence full-fledged Audiology programs in a medical/health institution in 2022 (Owolawi, 2024).

Education

Only three Universities have been licensed by the National University Commission (NUC) so far. University of Ibadan Special Education Oyo State, Federal University of Health Science Ila, Orangun, Osun State and University of Medical Sciences Ondo State. The last institutions have just been approved and are yet to produce a single Audiology graduate until the next 3-4 years. Conversely, the University of Ibadan Audiology program is domiciled in Special Education and not a stand-alone department like the other two and this has several shortfalls over the years, especially regarding the placement and remuneration of graduates from the institution. Audiology program in the University of Ibadan has undergraduates, Master’s and PhD degrees dating back to 20 years ago.

Audiology Practice: Public and Private

Audiology practice in Nigeria has gained relatively wide acceptance in many urban settings. There are a fairly sizeable number of testing centres or audiology units in Nigeria currently, all located in urban settings. Nigeria presently boasts 20 federal hospitals, 22 federal medical centres, approximately 36 state hospitals, 24 Army hospitals and over 1000 private hospitals. 20 percent of these hospitals offered ENT services, where basic audiology services are often directly or indirectly provided. We have less than 10 stand-alone audiology centres in Nigeria at the moment. And many audiology-based appointments, especially in government hospitals, are often booked ahead by patients for required services to be provided at the day of visitation to the hospital. Comparatively, audiological services in Nigeria are some of the cheapest you can find anywhere in the world. The most expensive services, such as full audiological screening, are less than seventy dollars (USD 70) in government hospitals and less than one hundred and thirty dollars (USD 130) in private settings.

Professionals

Currently, there are less than 200 licensed practising audiologists in Nigeria. However, more than 1000 professionals interact with individuals with hearing loss in the country, from ENT doctors to nurses and general physicians. Nonetheless, this figure remain extremely low compared to the country’s population and hearing intervention needs.

Professional Regulatory Bodies

Medical Rehabilitation Therapist Board of Nigeria (MRTBN) is a professional body licensed to regulate all rehabilitation professions in the country. MRTB was established as an arm of the ministry of health by Decree 38 of 1988/Acts M9 LFN 2004 for the regulation and control of seven (7) professions in the Health Sector in Nigeria. Its responsibilities include, among others: license renewal, registration and induction of graduates, conducting curricula and continuous professional development (CPD), controlling quackery, conducting research, organizing events, etc. MRTBN

Speech Pathologists and Audiologists Association in Nigeria (SPAAN) was established by the Department of Special Education, University of Ibadan, Oyo State, which incidentally is the first training institution to have an audiology program. SPAAN’s responsibilities are to accredit training and programs as well as ensure ethical standards in the practice of audiology for both paramedics and those in academia. SPAAN

Nigerian Audiology Association is another professional audiology association in Nigeria. It was established in 2013 basically for audiologists trained outside Nigeria. It has less than 10 members, and the majority are based outside Nigeria; this has limited its activities in the country. The Nigerian Audiology Association registered in 2013 and had its first annual national conference in the year 2015, which attracted audiology practitioners across the West Africa sub-region, particularly Ghana. This conference attracted all the service chiefs of the Nigerian Armed forces, Vice President of a foremost private university and a former Governor of a state who proudly wears his hearing aid/Cochlea Implant (He was represented by his commissioner for health)

Scope of Practice and Licensing

Practicing audiologists in Nigeria are currently licensed by the Medical Rehabilitation Therapists Board of Nigeria (MRTBN) by first being inducted into the board through registration after completion of educational training. There’s also an examination for foreign-trained audiologists to certify their level of knowledge and skill before being licensed by the Board. This license is renewable annually with adequate proofs of completion of Continuous Professional Development (CPD) course.

Services Offered by Otolaryngologists, Otologists & Otoneurologists

Virtually all audiology units or centres in government hospitals in Nigeria are established under ENT. Otolaryngologists are often in charge of procedures related to surgeries, treatment of diseases and infections, as well as prescription of drugs. Cerumen and foreign bodies in the ears are essentially reserved for ENT nurses and, in rare cases, audiologists.

Audiological Services

The scope of audiological services provided in the country is quite vast even with the limited number of audiologists and testing centres in the country. Services within the realm of Audiology available in Nigeria include the following:

Puretone Audiometry
Tympanometry
Otoacoustic Emission (OAE)
Auditory Brainstem Response (ABR)
Impedance Audiometry
Hearing Rehabilitation
Hearing Aid Dispensing
Intraoperative monitoring and mapping
Vestibular assessment and rehabilitation (few centres)

One major area Nigeria has underperformed over the years is the implementation of Universal Newborn Hearing Screening. Until date, Nigeria is still struggling to successfully implement and make an infant hearing screening program available and accessible to newborn babies across the country. Only a few privileged children have had the opportunity to be screened over the years, and these are mostly in a few hospitals in the urban areas. Services such as vestibular assessment and management/treatment, tinnitus management, intraoperative monitoring during cochlear implantation, etc. are mostly rendered by private audiology centres.

Awareness Creation

The issue of public awareness about audiology services remains largely unaddressed across the country. Even among health professionals, awareness and knowledge level of audiology services is still low (Ikong et al., 2024). This is also reinforced by the limited number of audiologists, ENT doctors, and testing centres in the country.

Mobile Audiology Services Available

There are currently no designated or established government-owned mobile audiology services in the country except a few private hearing clinics such as Decibel Hearing Consultants, BSA Hearing and Speech Centre, Nigerbell Speech and Hearing Centre, etc., whose costs are often high and unaffordable for the majority of individuals in rural communities.

Audiology Charities

Numerous organizations have contributed positively over the years to improve access to Audiology services in the country. Most of these contributions are often on a piecemeal scale. However, some organizations with remarkable impact in the country towards Audiology services include the following:

Rotary International
Vintage hearing foundation (NGO)
IshK hearing Centre/foundation
Starkey Hearing foundation
Kemi Remi-Dairo Hearing Foundation (NGO)

Challenges, Opportunities and Notes

Challenges

Lack of awareness about Audiology services
Absence of testing centres in rural communities
Negative attitudes and perceptions by majority towards hearing care interventions
Lack of sensitization programs and campaigns on Audiology services
Gross inadequacy of audiologist training institutions
Lack of state-of-the-art facilities and equipment
Inadequately trained audiologists in the country
Lack of extensive research covering all aspects of Audiology
Lack of audiology outreaches
Only few hospitals extend test beyond pure tone audiometry, tympanometry, and otoacoustic emission tests

Opportunities

Nigerian population is a rich opportunity for audiology services and professionals to leverage on.

References

National Bureau of Statistics. Demographic Statistics Bulletin 2021. https://nigerianstat.gov.ng/elibrary/read/1241207
World Population Review, by Country 2024. https://worldpopulationreview.com/
Worldometer, 2024. Nigeria Population Live. https://www.worldometers.info/world-population/nigeria-population/. s
World Health Organization. Addressing the rising prevalence of hearing loss (2018). http://www.who.int/deafness/world-hearing-day/whd-2018/en/
Medical Rehabilitation Therapists Board of Nigeria. https://www.mrtb.gov.ng/en
Speech Pathologists and Audiologists Association in Nigeria. https://spaan.org.ng/
Nigerian Audiology Association. https://ng-check.com/jo-olojo-investment limited/1378248.html?utm_source=2294303
Ikong M.A et al. Awareness and Knowledge Level of Audiology and Speech-Language Pathology/Therapy among university students in Nigeria. International Journal of Speech and Audiology; 2024:5(2):37-42. https://www.rehabilitationjournals.com/speech-and-audiology-journal/archives/2024.v5.i2.A.
The Federal Republic of Nigeria Ministry of Health. National Policy and Strategic Plan for Ear and Hearing Care 2019-2023.
Owolawi W.O. Historical Account of Audiology in Nigeria. IALP Newsletter (2024)

		Contributor to the original text
Dele Owolawi