Universal newborn hearing screening in public healthcare in South Africa: Challenges to implementation

Background. The implementation of early hearing detection and intervention (EHDI) remains a challenge in developing countries, despite the known benefits.Objectives. To investigate challenges encountered during implementation of universal newborn hearing screening (UNHS) at a secondarylevel public hospital in Johannesburg, South Africa.Methode. A prospective cohort study design that assessed the feasibility of conducting UNHS was adopted. This feasibility assessment was conducted during a 3-month period, and all challenges encountered were identified and documented. Screening time was also recorded for each neonate. Data were entered into Excel, and later analysed using Stata version 11.Results. Of 2 740 neonates born during the study period, 490 (17.9%) were identified for screening, and distortion product otoacoustic emissions screening was conducted on 121 (4.4%). The majority (74.4%) were screened in the first 24 hours of life. Repeat screening was required in 57 (47.1%) neonates, but only 20 returned for follow-up. The most important challenges to the feasibility of UNHS implementation were the insufficient number of audiologists available to provide screening, the high rate of false positive test results and the unacceptably high rates of loss to follow-up. Two modifiable factors, namely the presence of vernix caseosa in the external ear canal and high ambient noise levels, were found to have significantly influenced the screening process. Conclusion. The identified challenges are important considerations for any successful implementation of universal screening protocols.Careful planning to mitigate the challenges will have a positive impact on EHDI initiatives in these contexts

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

The Use of Hearing Protection Devices in South Africa: Exploring the Current Status in a Gold and a Non-Ferrous Mine

This study investigated mine workers' current use of hearing protection devices (HPDs) in South African gold and non-ferrous mining subsectors. A descriptive study design was employed using structured interviews.Ninety participants were interviewed. Descriptive statistics and the chi-square test were used to analyse data.All participants reported wearing HPDs; with custom-made earplugs being preferred by those with more years of work experience and used by those most at risk to noise exposure. Comfort; design and work-related communication were factors infl uencing use of HPDs. Relationships between participants' demographic factors and use of HPDs were not statistically signifi cant. Participants seemed reasonably aware of HPD importance which highlights progress. Findings further highlight the importance of occupational audiologists in improving hearing conservation programmes (HCPs) in this sector

Hearing Disorders in HIV Positive Adult Patients

Background: This study was aimed at determining the prevalence and type of hearing disorders in HIV positive patients and any correlationship with the CD4 counts/stage of HIV/AIDS in patients attending the omprehensive care clinic (CCC). Methods: Case control study of 194 HIV positive patients attending CCC recruited into the study after informed consent. A thorough clinical examination and otoscopy done followed by tuning fork tests; Pure Tone Audiometry and tympanometric tests. This was compared with 124 HIV negative subjects matched for age and sex who were recruited from the voluntary counseling and testing centre. The world health organization staging of the HIV/AIDS disease and the CD4 positive lymphocyte cell count were carried out and correlated with any hearing disorder. Results were analyzed using statistical package for social sciences version 10.0. Results: Hearing loss (HL) was present in 33.5of HIV positive compared to 8.1in negative subjects. No gender bias in HL but HL worsened with advancement of age. SNHL was the most common and the higher frequencies were the most affected. Low CD4 cell count and advanced HIV disease were associated with increased chance of having a hearing loss. Conclusion: Hearing loss is more prevalent in HIV positive individuals than negative normal subjects and tends to worsen with the advancement of the HIV disease. This may negatively impact on the overall care and standard of living of HIV positive patients; hence otological care should be part of the comprehensive care

Implementing Infant Hearing Screening at Maternal and Child Health Clinics : Context and Interactional Processes

Infant hearing screening has become increasingly widespread as research evidence a dramatic benefit when early identification of hearing loss occurs before six-months of age. The Health Professions Council of South Africa (HPCSA) has recently published a hearing screening position statement recommending infant hearing screening in three contexts: the well-baby nursery; at discharge from the neonatal intensive care unit (NICU); and at Maternal and Child Health (MCH) clinics. The well-baby nursery and NICUs are esta- blished and internationally recognised screening contexts abundantly reported on whilst MCH clinics have not been investigated as screening contexts previously. The objective of this study was therefore to describe the context and interactional processes during an infant hearing screening programme at MCH clinics in a South African community to ascertain whether clinics provide a suitable milieu for hearing screening programmes. An exploratory descriptive design implementing a qualitative methodology was selected to describe the context and interactional processes experienced during an infant hearing screening programme at two MCH clinics in the Hammanskraal community. Five fieldworkers conducting the screening programme at the clinics documented experiences using systematic field notes and critical reflections for a fivemonth period. The two MCH clinics investigated proved to be suitable contexts to screen infants for hearing loss despite prevailing contextual barriers that are characteristic of primary healthcare clinics in developing contexts of South Africa. Interactional processes between fieldworkers; nursing staff and caregivers revealed that collaborative partnerships fostered by consistent service delivery; maintenance of an open channel of communication and basic courteousness; facilitated an effective initial infant hearing screening at the two clinics. MCH clinics demonstrate promise as a practical contextual solution to achieve widespread screening coverage in South Africa