DESCRIPTION (provided by applicant): Palestine confronts many obstacles in its path towards achieving the goals of a sovereign state. Amongst these are impediments that hinder Palestine's ability to optimize its healthcare system. In part, these obstacles are the result of a lack of evidence-based health data for programmatic decision making. In addition to the problems that being a low- to middle-income country (LMIC) and gaps in public health data cause for the Palestinian medical system, societal characteristics (e.g., consanguinity) can also negatively impact healthcare goals. The combination of these considerations can have dire health consequences for the individual as well as for the wellbeing of the nation. For example, childhood hearing loss (HL) can lead to delayed language acquisition and, thus, negatively affect the child's ability to learn and communicate. Such outcomes often result in a limit on the affected person's ability to achieve their full potential as a member of society. For Palestine, HL may be a greater problem than in other LMICs because of consanguinity that can be found in up to 40% of marriages. Consanguinity has been shown to increase the number of genetically related diseases in a community. When these considerations are understood against the backdrop of childhood hearing disorders, the dire implications for Palestine are magnified. Because there is a lack of data about the incidence of childhood HL in Palestine, and limited evidence about its etiology that includes the role of genetics versus infection or other causes of pediatric HL, this proposal may have potential positive benefits for both the individual and the community at large. Additionally, because Children's Hospital of Michigan and Wayne State University serve the largest Arab community outside of the Middle East, what is learned about childhood HL in Palestine may have benefits to the children and families that they serve in Detroit and in Southeast Michigan.

PUBLIC HEALTH RELEVANCE: Childhood hearing loss (HL) can have a major and negative impact not only on the afflicted individual but also on his/her family and community. It is estimated that, approximately, 50% of childhood HL is due to, in whole or in part, genetic reasons. In fact, to date, dozens of genes have been associated with childhood HL that ranges from mild to profound deafness. However, other factors also can play a role in childhood HL. These include infection, trauma, malformations and fluid in the ears. At Wayne State University School of Medicine and Children's Hospital of Michigan in Detroit, our healthcare specialists and institutional resources serve many children afflicted by HL. However, to better help them and their families and because a significant number of these patients that are diagnosed and treated at our hospitals and clinics have their origins in the Middle East, we are interested in combining the goals of our local needs with our interests as healthcare providers for the international community. One example of this is to determine the potential role of consanguinity (marriages within families), as it relates to contraction of the gene pool and the impact of genetic mutations on hearing and, in the future, other diseases affecting children and their families here and in Palestine. Therefore, we and our Palestinian colleagues in the West Bank cities of Bethlehem and Hebron are proposing to launch a study that will determine the disease origins of childhood HL. We believe that this study will contribute to our ability to better identify the genetic causesof HL in Michigan and, at the same time, improve related healthcare delivery to the children our Palestinian partners serve. Additionally, because of the efforts supported through this grant, new and increased sustainable research capacity will aid Palestine in optimizing its overall healthcare goals.