Scielo RSS <![CDATA[South African Journal of Communication Disorders]]> vol. 69 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Ototoxicity monitoring in South African cancer facilities: A national survey</b>]]> BACKGROUND: National information regarding ototoxicity monitoring practices are limited for patients undergoing chemotherapy in South Africa. OBJECTIVES: To determine (1) the national status of ototoxicity monitoring implemented in private and public cancer facilities, (2) the knowledge and ototoxicity monitoring approaches implemented, and (3) reported challenges METHOD: A descriptive quantitative survey was conducted in public and private oncology units and audiology referral clinics. Private (60%) and public (43%) oncology units that provide platinum-based chemotherapy in South Africa and audiology referral units (54%) were: (1) surveyed telephonically to determine if ototoxicity monitoring takes place; and (2) a self-administered survey was sent to qualifying oncology units and audiology referral clinics RESULTS: All public oncology units reported that ototoxicity monitoring only occurs on referral and is not standard practice. All private oncology units indicated that monitoring is on a patient self-referral basis when symptoms occur. Poor awareness of ototoxicity monitoring best practice guidelines was reported by all oncology units and 14% of audiology referral clinics. Audiology referral clinics reported adequate knowledge of ototoxicity protocols although they are not widely used with only 43% following best practice guidelines. The most prominent challenges reported by participants was referral system (67% oncology units; 57% audiology referral clinics), environmental noise (83% oncology units; 86% audiology referral clinics) and the compromised status of cancer patients (67% oncology units; 57% audiology referral clinics CONCLUSION: Ototoxicity monitoring is not routinely implemented across oncology units in South Africa. Multidisciplinary teamwork and a simplified national ototoxicity monitoring protocol may improve hearing outcomes for patients <![CDATA[<b>Audiologists' phenomenographic experiences of professional development during community service in KwaZulu-Natal, South Africa</b>]]> BACKGROUND: The compulsory community service programme (CSP) was implemented to improve access to healthcare and arguably facilitate the transition of graduates into independent professionals. However, its role and outcomes as a developmental platform for audiology graduates remains unclear and scant in literature. OBJECTIVE: To explore the qualitative differences in the experiences of professional development among new Audiology graduates during their community service year at their fixed-placements in KwaZulu-Natal, South Africa. METHODS: Within a phenomenographic design and framework, semi-structured interviews were conducted with 12 purposively sampled Community Service Officers (CSOs) of the year 2017, after obtaining ethical clearance, gatekeeper permission and participant's consent RESULTS: The findings were interpreted according to the tenets of phenomenography. An outcome space based on the participants' reported experiences, revealed three categories of description: transitioning from graduate to professional, learning in the workplace during community service and professional development. The findings reflected that the work environment, supervision, resource allocation, socialisation and infrastructure contributed to qualitatively different developmental experiences of the CSP. CONCLUSION: The current model of fixed-placement of the CSOs exposes them to qualitatively different developmental experiences, resulting in them attaining different developmental outcomes despite being in the same programme at the same time. Hence, we argue for an urgent CSP review, with the aim of standardising and redefining its intended outcomes and pertinent criteria for the attainment of the independent practitioner status. <![CDATA[<b>Newborn and infant hearing screening at primary healthcare clinics in South Africa designated as National Health Insurance pilot sites: An exploratory study</b>]]> BACKGROUND: Primary healthcare (PHC) is the first point of entry, providing basic services to individuals. South Africa is in the process of re-engineering its PHC as part of National Health Insurance (NHI) plans to ensure universal healthcare coverage. AIM: This study aimed to establish whether newborn and infant hearing screening (NIHS) could be integrated into the re-engineering process of the PHC as part of the NHI framework. SETTING: The NHI pilot clinics in five provinces in South Africa. METHODS: A non-experimental, descriptive, cross-sectional survey research design was adopted. Questionnaires were sent to nursing managers, unit managers or acting managers at PHC facilities. Nineteen of these self-administered questionnaires were completed. Data were analysed using descriptive statistics. RESULTS: Immunisation services were the most common type of service offered at the clinics. Over a quarter of the respondents indicated that NIHS services were offered at their facility in the form of universal NIHS. Equipment was limited with a lack of valid and reliable screening measures. Only 2 (11%) respondents indicated budgetary resources. Follow-up and referral pathways were reported by 10 (53%) respondents, which did not include an audiologist. CONCLUSIONS: There is a need for careful and systematic planning in terms of early hearing detection programmes at PHC level. Planning needs to commence with considerations of who will perform NIHS, training of these personnel by audiologists and the role of the audiologist within the teams outlined in the NHI Bill. <![CDATA[<b>Analysis of barriers and facilitators to early hearing detection and intervention in KwaZulu-Natal, South Africa</b>]]> BACKGROUND: There is slow progress in early hearing detection and intervention (EHDI) services within South Africa. Audiologists are EHDI gatekeepers and can provide valuable insights into the barriers and facilitators that can progressively move EHDI towards best practice in South Africa. OBJECTIVES: The study aimed to determine the barriers and facilitators to EHDI in KwaZulu-Natal as reported by audiologists/speech therapists and audiologists (A/STAs). METHOD: A descriptive qualitative approach was used. Telephonic interviews were conducted with 12 A/STAs working in public and private healthcare facilities, using the strengths, weaknesses, opportunities, threats (SWOT) conceptual framework. Data was analysed using thematic analysis in conjunction with NVivo software. RESULTS: One of the main barriers perceived by A/STAs, affecting EHDI was the lack of resources in healthcare facilities. The participants indicated that although there was a guideline in place to guide practice, it may be more suited to an urban area versus a rural area. Poor knowledge and awareness of EHDI was also identified as a barrier. Information provided from A/STAs at grassroots level, in the various provinces, may benefit in developing a more contextually relevant and practical guideline. Facilitators included; development of task teams specifically for EHDI programmes, creation of improved communication networks for collaboration and communication, training of healthcare professionals and improving data management systems. CONCLUSION: Strategies such as an increase in resources, further education and training, development of contextually relevant, culturally, and linguistically diverse practices and protocols need to be in place to improve EHDI implementation. Further research, clinical implications and limitations are provided emanating from the study. <![CDATA[<b>The influence of screen time on children's language development: A scoping review</b>]]> BACKGROUND: An exponential increase in screen time amongst children and adults, has given rise to a plethora of studies exploring the influences that this exposure may have on children's development OBJECTIVES: This review is specifically concerned with understanding the influence of screen time on children's language development METHOD: A scoping review was conducted to explore the available literature relating to the impact of screen time on children's language development. The scoping review was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) framework and the Joanna Briggs Institute (JBI) framework. The data were analysed using thematic content analysis RESULTS: This review identified 12 articles. It made an argument for the multifactorial relationship between screen time and language development, given the associated positive and negative effects. The results revealed core themes such as the influence of screen time being dependent on various factors and the diverse effects of screen time on children's language development, with the inclusion of parents' monitoring of and participation in viewing, playing a vital role in language development CONCLUSION: The review indicated that an increase in the amount of screen time and an early age of onset of viewing have negative effects on language development, with older age of onset of viewing showing some benefits. Video characteristics, content and co-viewing also influences language development. This study demonstrates that the negative influences of screen time appear to outweigh the positive influences <![CDATA[<b>The lived experiences and psychosocial impact of hearing loss on the quality of life of adults with Multidrug-Resistant Tuberculosis</b>]]> BACKGROUND: Aminoglycosides used in the treatment of Multidrug-Resistant Tuberculosis (MDR-TB) are known to result in hearing loss. The effects of an acquired hearing loss with an MDR-TB diagnosis may have an increased adverse impact on the overall quality of life of an individual; however, there is minimal research in the area OBJECTIVES: This study explores the psychological and emotional impact of hearing loss in adults with MDR-TB; and describes the experiences of the social, economic, and vocational impact of hearing loss in adults with MDR-TB METHOD: A qualitative research study was conducted on 10 participants, with a confirmed diagnosis of MDR-TB and hearing loss. The researcher used a semi-structured questionnaire to collect data during face-to-face, audio-recorded interviews RESULTS: Hearing loss in patients diagnosed with MDR-TB has a significant adverse impact on the lived experiences of patients. Stigma, discrimination, psychological distress, adverse changes in family status and family relationships, financial constraints, and social challenges were some of the common issues reported by participants. Unemployment posed a significant challenge, resulting in participants having no economic stability because of MDR-TB, which was then worsened by the hearing loss; consequently, generating a great deal of stress. Participants reported feelings of worthlessness, a loss of identity, lack of motivation, feelings of embarrassment, and loss of independence CONCLUSION: There is a significant irreversible social, psychological, and economic impact of hearing loss that has a direct impact on the lived experiences of MDR-TB patients and their families even after cure of MDR-TB. There is a need for improved treatment methods with psychosocial intervention strategies that equip patients to alleviate the adverse effects they experience <![CDATA[<b>Systemic support for learners with developmental language disorders in Zimbabwe and South Africa</b>]]> BACKGROUND: Teachers play a significant role as early identifiers of learners with developmental language disorder (DLD). They provide important information to other professionals for further specialist support of such learners. Professionals, such as educational psychologists, speech-language therapists (SLTs) and learning support therapists are involved in assisting learners with DLD; hence, inter-professional collaboration (IPC) amongst these professionals is of paramount importance in meeting the needs of learners. OBJECTIVES: This study aimed to examine systemic support strategies available to learners with DLD. METHOD: This was a multiple case study of Zimbabwe and South Africa. Purposive sampling was used to select participants. The study consisted of 56 participants: 5 teachers, 2 SLTs, a learning support therapist, an educational psychologist and 47 learners. A qualitative research approach was employed and data were collected using interviews, focus group discussions and classroom observations. The data were analysed thematically and categorised. RESULTS: Support strategies employed by teachers include remedial lessons and promoting a culture of reading for leisure to enhance learners' vocabulary and narrative skills. The SLTs and the learning support therapist use speech-language programmes and assistive technologies. Limited IPC and the absence of SLTs in District Based Support Teams were some of the challenges identified. The results also indicate that SLTs receive referrals mostly from primary schools compared with secondary schools. CONCLUSION: Raising awareness of DLD in schools and communities is deemed essential. Inter-professional collaboration is recommended to support learners with DLD as it increases the exchange of ideas and mutual acknowledgement of expertise amongst professionals <![CDATA[<b>A longitudinal community-based ototoxicity monitoring programme and treatment effects for drug-resistant tuberculosis treatment, Western Cape</b>]]> BACKGROUND: South Africa has a high burden of drug-resistant tuberculosis (DRTB) and until recently, ototoxic aminoglycosides were predominant in treatment regimens. Community-based ototoxicity monitoring programmes (OMPs) have been implemented for early detection of hearing loss and increased patient access. OBJECTIVES: A longitudinal study was conducted to describe the service delivery characteristics of a community-based OMP for DRTB patients facilitated by CHWs as well as observed ototoxic hearing loss in this population. METHOD: A descriptive retrospective record review of longitudinal ototoxicity monitoring of 194 DRTB patients undergoing treatment at community-based clinics in the city of Cape Town between 2013 and 2017. RESULTS: Follow-up rates between consecutive monitoring assessments reached as high as 80.6% for patients assessed by CHWs. Few patients (14.2% - 32.6%) were assessed with the regularity (≥ 6 assessments) and frequency required for effective ototoxicity monitoring, with assessments conducted, on average, every 53.4-64.3 days. Following DRTB treatment, 51.5% of patients presented with a significant ototoxic shift meeting one or more of the American Speech-Language-Hearing Association (ASHA) criteria. Deterioration in hearing thresholds was bilateral and most pronounced at high frequencies (4 kHz - 8 kHz). The presence of pre-existing hearing loss, human immunodeficiency virus co-infection and a history of noise exposure were significant predictors of ototoxicity in patients. CONCLUSION: DRTB treatment with kanamycin resulted in significant deterioration of hearing longitudinally, predominantly at high frequencies. With ongoing training and supportive supervision, CHWs can facilitate community-based ototoxicity monitoring of DRTB patients. Current protocols and guidelines may require reassessment for appropriate community-based ototoxicity monitoring.