Infant hearing screening from a developing country context: status from two South African provinces

Background: New-born hearing screening (NHS) programmes are an important step toward early detection of hearing loss and require careful examination and planning within each context. The Health Professions Council of South Africa (HPCSA) has recommended specific contexts in which to actualise early hearing detection and intervention (EHDI) application. It is imperative therefore to explore if and how the current experience measures up to these recommendations.Objective: to explore the feasibility of and the current status of the implementation of NHS at various levels of health care within the South African context.Methods: A non-experimental, descriptive, cross-sectional survey research design was employed, using a combination of questionnaires and face-to-face semi-structured interviews. Participants comprised 30 primary health care (PHC) nursing managers across two provinces (Gauteng and North West) and 24 speech-language therapists and/or audiologists directly involved with NHS in secondary and tertiary levels of care within Gauteng.Results: Current findings indicated lack of formal, standardised, and systematic EHDI implementation at all three levels of health care (primary, secondary and tertiary) with valuable reasons such as insufficient knowledge, lack of equipment, budgetary constraints, and human resource challenges being provided for this. Regardless of the level of care and their varied resource allocations and levels of specialisation; EHDI implementation as advocated by the HPCSA (2007) position statement currently does not seem feasible, unless the number of barriers identified are addressed, and NHS becomes mandated.Conclusion: Current findings have highlighted the need for ensuring that context specific studies in EHDI are conducted to ensure that national position statements are sensitive to contextual challenges and therefore allow for evidence-based practice, particularly in developing countries where resource constraints dictate success and/or failure of any well-intentioned programme

Audiological Findings in a Group of Neurologically Compromised Children: A Retrospective Study

Background. Hearing loss is more prevalent in developing countries. Later diagnosis of hearing loss will result in delayed access to rehabilitation. It is typically more difficult to obtain subjective information required in a hearing test from neurocompromised children; causing audiologists to frequently turn to objective measures such as the auditory brainstem response (ABR) measure to obtain this information.Objective. To describe the ABR results in a group of neurologically compromised children and to establish a relationship between ABR findings and behavioural audiometry results; where these existed.Methods. A retrospective review was conducted on 40 ABR patient records of neurologically compromised participants aged 5 months - 10 years. Behavioural audiometry results were sought where these existed. Hearing status was described per ear for objective and behavioural results; and descriptive statistics were conducted.Results. Behavioural audiometry results were obtained in 72.5% of ears. Results correlated between ABR and behavioural audiometry for only 7.5% of ears; which were all diagnosed with normal hearing. About12.5% of ears were misdiagnosed with behavioural audiometry. Premature infants were most likely to cope with behavioural audiometry. Hearing loss was highest in participants with cerebral palsy; Down syndrome; prematurity and retroviral disease.Conclusions. Behavioural audiometry appears to be a largely unreliable method of testing the hearing of children diagnosed with neurological disorders; as results were obtained in only 27.5% of the study sample; however; it remains the gold standard in paediatric hearing testing to evaluate the entire auditory system and provides information on how a child processes sound. Hearing thresholds should be established via objective testing. Conditioning should continue for a behavioural audiological test battery; with adaptations for the child's developmental ability

Infant Hearing Screening at Primary Healthcare Immunisation Clinics in South Africa: The Current Status

Background. In the developing world; it is critical that the acceptable principle that early hearing detection and intervention (EHDI) programmes be contextually useful; given the extensive level of difficulties faced by these regions. The Health Professions Council of South Africa (HPCSA) has recommended specific contexts in which to actualise EHDI application. One of these contexts relates to hearing screening at immunisation clinics within the first 6 weeks of life.Objective. To explore the current status of the implementation of the HPCSA's 2007 guidelines for clinic-based hearing screening within the South African primary healthcare clinic (PHC) setting. Methods. Within a qualitative research design; 30 PHC nurses representing 30 PHC clinics in the North West and Gauteng Provinces were interviewed using a structured questionnaire. Qualitative as well as thematic content analysis strategies were adopted in analysing data.Results. There is a lack of formal EHDI implementation at PHC clinics in both provinces. Lack of equipment; budgetary constraints and human resource challenges are the reasons for this. Regardless of the province's socioeconomic development based on the deprivation index; EHDI implementation at clinic level is not feasible unless the barriers are addressed. Conclusion. There is a need to ensure that context-specific studies in EHDI are conducted. This will ensure that national position statements are sensitive to contextual challenges and that they allow for evidence-based practice. This is particularly relevant in developing countries where resource constraints dictate the success or failure of any well-intentioned programme. The HPCSA's 2007 position statement needs to be reviewed taking careful cognisance of feasibility study findings such as the current one. Findings have implications for nurses training; future studies; and policy formulation; as well as clinical plans for EHDI in developing contexts

Commuting and communication: an investigation of taxi drivers' experiences, attitudes and beliefs about passengers with communication disorders

Background: One of the most popular means of public transport within South Africa is mini-bus taxis. Objectives: As South Africa is made up of diverse cultures, religions and beliefs, the aim of this study was to explore Johannesburg based taxi drivers' experiences of beliefs about, and attitudes towards passengers who have a communication disability. Method: Semi-structured interviews were conducted with 10 mini-bus taxi drivers. Results: Interviews revealed that almost all the taxi drivers had encountered passengers with a communication disability, and had an awareness of passengers with a hearing disability as opposed to a speech disability. Furthermore mini-bus taxi drivers generally held a positive view of their passengers with a communication disability.Conclusion: Study findings contribute to existing literature within the fields of speech pathology and audiology, advocacy groups and policy makers, particularly research studies on participation experiences of persons with communication disabilities related to transportation access. The results of the study should also provide a foundation for disability policy development initiatives with the aim of increasing levels of public awareness

Evaluation of universal newborn hearing screening in South African primary care

Background: Universal Newborn Hearing Screening (UNHC) is the gold standard toward early hearing detection and intervention; hence the importance of its deliberation within the South African context. Aim: To determine the feasibility of screening in low-risk neonates, using Otoacoustic Emissions (OAEs), within the Midwife Obstetric Unit (MOU) three-day assessment clinic at a Community Health Centre (CHC); at various test times following birth.Method: Within a quantitative, prospective design, 272 neonates were included. Case history interviews, otoscopic examinations and Distortion Product OAEs (DPOAEs) screening were conducted at two sessions (within six hours and approximately three days after birth). Data were analysed via descriptive statistics. Results: Based on current staffing profile and practice, efficient and comprehensive screening is not successful within hours of birth, but is more so at the MOU three-day assessment clinic. Significantly higher numbers of infants were screened at session 2; with significantly less false-positive results. At session 1, only 38.1% of the neonates were screened; as opposed to more than 100% at session 2. Session 1 yielded an 82.1% rate of false positive findings, a rate that not only has important implications for the emotional well-being of the parents; but also for resource-stricken environments where expenditure has to be accounted for carefully. Conclusion: Current findings highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. These findings argue for UNHS initiatives to include the MOU three-day assessment to ensure that a higher number of neonates are reached and confounding variables such as vernix have been eliminated