Early hearing detection has become a standard of neonatal care in most parts of the developed world. A growing number of developing countries are also currently exploring practical and culturally appropriate options for early hearing detection. Recent findings from on-going infant hearing screening programs in Nigeria and South Africa suggest that hearing screening programs are feasible if integrated into early childhood immunization programs in developing countries, especially where a significant number of births occur outside regular hospitals. A major challenge for a multi-stage screening protocol is how to minimize default rates for follow-up till diagnosis. However, this could be systematically addressed through improved parental education and appropriate support at various stages of the program.