A thesis submitted to the Wits School of Education, Faculty of Humanities, University of the Witwatersrand in fulfilment of the requirements for the degree of Doctor of Philosophy, 2017 / Background: With 17 babies born with hearing loss every day in South Africa, there is a pressing need for systematic Early Hearing Detection and Intervention (EHDI) services. Progress is being made in the area of newborn hearing screening with studies to document the screening fora and processes appropriate for a developing country context. A systematic review of EHDI services in South Africa highlighted the need for comprehensive studies on diagnostic protocols and procedures in diagnosing paediatric hearing loss. There has also been a recognition of the ethical obligation to ensure equitable access to efficient and timely diagnostic and intervention services for children identified with hearing loss, regardless of their geographic or socioeconomic status. Objective: The aim of this study was to document the current practice of audiologists in South Africa, with reference to paediatric audiology diagnosis, reporting of testing results, record keeping and data management in a closed sample set in 3 provinces of SA. Method: This study utilised a retrospective record review process as well as a survey to identify the processes and procedures followed by audiologists in the diagnosis of paediatric hearing loss, across both the public and private sectors. The children who were part of the Home Intervention Hearing and language Opportunities Parent Education Services (HI HOPES) programme were selected using convenience sampling. The files of 230 children, who had diagnostic audiology records as part of the HI HOPES programme data were included as part of the sample for this study. Audiology reports and records were reviewed so as to gain an understanding of the diagnostic procedures used. Data were then compared to the HPCSA recommended guideline document to determine how diagnostic testing compared to testing procedures outlined in the guideline document. Finally, a survey to identify data management procedures followed by audiologists was sent to 40 public (n=21) and private (n=19) sector audiologists Results: Data reflected in diagnostic audiology reports indicate differences in tests employed with paediatric clients across the regions of Gauteng, Kwazulu Natal and Western Cape, as well as across the public and private sectors. There is an increased use of electrophysiology measures across all the age ranges of paediatric clients. The extensive use of electrophysiology on older children means there is an increased need for the use of sedation. The analysis of sedation information included in the diagnostic audiology reports indicated a need for evaluation of safety during sedation for diagnostic testing, as well as a need for development of sedation guidelines for auditory electrophysiology testing in South Africa. The logging of diagnostic audiology data as well as sedation information in audiology reports also indicated that data is not always comprehensive. The survey showed that there is a need for efficient audiology data management and tracking systems to allow for evaluation of EHDI services, and for sharing of diagnostic information amongst professionals. Challenges with the implementation of online/electronic data management systems include those that are common to a developed world context (time and staff for data entry), as well as challenges unique to a developing country context (electricity access and internet connection). Conclusion: Accuracy in paediatric diagnostic audiology is important as this step in the EHDI pathway is necessary for appropriate provision of amplification, communication methodology options and the influence on future education options and success. Paediatric diagnostic audiology in South Africa shows a lack of agreement with South African diagnostic guidelines in terms of tests employed, across the provinces of Gauteng, KZN and WC as well as across the public and private healthcare sectors. The incomplete sedation information on audiology reports indicates the deficiencies in accurate and comprehensive data recording. . Extensive studies across all provinces relating to all aspects of EHDI services (screening, diagnosis, intervention and data management) are necessary. Further studies on diagnostic practice and resources in South Africa will provide information on factors that are preventing adherence to South African guidelines as well as international best practice guidelines for paediatric diagnostic audiology, as well as information and resources that are needed for advancement and improvement of the field. / XL2018

In this unique time of nation building in South Africa, education is seen as the key foundation stone to prosperity and development. However, despite a decade of restructuring, many differing groups of children still do not receive the quality of education they deserve. Amongst those are children with special needs, including those who have a hearing impairment. These children are the focus of the present study. It is a widely accepted principle that early assessment and intervention is necessary to maximise a child’s potential. It is for this reason that the global aim of this study was to explore and describe the developmental profile of hearing impaired children on the Revised Extended Griffiths Scales. Further aims were to compare the performance of the clinical sample to a normal South African sample. A quantitative, exploratory-descriptive research design was employed. The sample of hearing impaired children (N = 58), between the ages of 36 and 95 months, attended the Carel du Toit Pre-School in the Western Cape, South Africa and were obtained by means of a non-probability, purposive sampling procedure. The normal sample (N = 58) was drawn from an existing database created for the revision of the Scales. Information was collated using clinical files, biographical data as well as the results of an assessment on the Revised Extended Griffiths Scales. The major findings of the study are summarised below. The general performance of the hearing impaired sample on the Revised Extended Griffiths Scales was average. The performance of the children on the six subscales ranged from below average to average, with major fall-outs occurring on the Hearing and Speech and Practical Reasoning Subscales. The normal sample performed significantly better than the hearing impaired sample on all of the subscales of the measure. However, significant differences were found on four of the six subscales, namely, the Locomotor, Personal-Social, Hearing and Speech and Practical Reasoning Subscales. Generally, the results of the current study suggest that a specific developmental profile is obtained for hearing impaired children. In addition, this study has highlighted the success with which the Revised Extended Griffiths Scales can be utilised on a hearing impaired population.

Deafness is one on the most common types of disability in South Africa with 90% of deaf children being born to hearing parents, many of whom are unprepared for the consequences of deafness. Since deafness is an invisible disability, the severity of its impact upon both the child and the family is often underestimated. The aim of this study was to explore the experiences of hearing parents raising deaf children. Thus, the primary research questions were: What are the experiences of hearing parents raising deaf children in South Africa, and how do various ecosystemic variables affect the way they manage their parenting role? This study was informed by the ecological systems theory which is the theoretical framework that underpins this study. The research paradigm shaping this study was pragmatism, while the strategy used was phenomenology. The mixed methods approach was employed, using both qualitative and quantitative approaches concurrently in a triangulation design. The findings emanating from the quantitative data served to complement the findings from the qualitative data. These findings were corroborated in the interpretation stage. The findings, representing the lived experiences of hearing parents raising deaf children, show that although the parenting experiences differ according to the unique circumstances in the family, school and community, there are several commonalities. These include issues associated with the diagnosis and parenting of deaf children. Some of these issues included the challenge of communicating with the deaf child, the financial burden, stigmatization from the general public, strained interpersonal relationships, concern about the child’s future, as well as lack of opportunities for the Deaf to study at tertiary institutions and limited employment opportunities for deaf persons. The findings from both sets of data reveal that, despite the resilience of participants, there is a need for formal support for parents from professionals in the community, as well as informal parental support from the family, friends, and community members, including other hearing parents raising deaf children, and the need for a central location to access information on deafness and related matters. Recommendations were made to address these issues, with a view to facilitating the emotional well-being of hearing parents raising deaf children, and consequently improving the quality of life of the deaf child and the family. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.