Objective: To determine the feasibility of audiological screening in low-risk neonates, using Otoacoustic Emissions (OAEs), at various test times following birth. The achievability of a screening programme within the Midwife Obstetric Unit (MOU) 3-day assessment clinic at the Phola Park Community Health Centre (PPCHC) was deliberated. Participants: Two hundred and seventy two neonates were included in this study. Design: A prospective and longitudinal design was employed. Methods and Materials: Case history interviews, otoscopic examinations and Distortion Product Otoacoustic Emissions (DPOAEs) were carried out at two sessions. The initial session took place within 6 hours after birth and the second session at approximately 3 days after birth at the MOU 3-day assessment clinic. Data Analysis: Data was collected as “pass” and “refer” screening results, the number of births was compared to the number of participants at the two sessions. The number of “pass” and “refer” results per session were analysed and results per participant at the two sessions were compared to detect false-positives. The return for follow-up rate was considered. Results: Screening is possible within hours of birth but is more practical and efficient at the MOU 3-day assessment clinic. During the study, 260 neonates were born at PPCHC, 38.07% of these were screened at session 1 and a total of 268 newborns were screened at session 2. The pass rate was 16.16% at session 1 and 99.25% at session 2; rendering a false-positive rate of 82.10% at session 1. Time of birth relative to discharge, resources, environmental factors, noise levels, return for follow-up rate and referral rate have been identified as factors that may impact the practicability and efficiency of screening. Conclusion: Outcomes of the study highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. Based hereon, screening neonates immediately after birth is possible. However, it is recommended that screening forms part of the MOU 3-day assessment protocol to ensure that a higher number of neonates are reached when confounding factors such as vernix have plummeted; hence decreasing false- positives.

Newborn hearing screening has become an increasingly important element of neonatal care in developed countries whilst only a few fragmented screening programmes are evident in developing countries. The numerous socio-economic, cultural and healthcare barriers in developing contexts do not, however, negate or diminish the need to ensure optimal outcomes for infants with hearing loss through early identification and intervention programmes. South Africa has taken a first step toward addressing this need by publishing a Year 2002 Hearing Screening Position Statement that was produced by the Professional Board for Speech, Language and Hearing Professions of the Health Professions Council of South Africa. Interim recommendations are made toward universal newborn hearing screening programmes in three contexts: well-baby nurseries,; neonatal intensive care units (NICU) and Maternal and Child Health (MCH) clinics through their 6-week immunisation programmes. Although these clinics constitute an unfamiliar hearing screening context, they are essential platforms toward widespread screening of the majority of infants in South Africa. An urgent need therefore exists to ascertain the feasibility of hearing screening programmes at MCH 6-week immunisation clinics in order to guide the future implementation of widespread hearing screening services in South Africa. To attend to this need, an exploratory descriptive design that jointly implements quantitative and qualitative methods in a dominant-less-dominant model of triangulation was utilised to critically describe a screening programme conducted at two MCH clinics in Hammanskraal (a developing, peri-urban South African community). The quantitative methods included a structured interview to compile biographical and risk information; high frequency immittance measurements; hearing screening with OAE and AABR according to specified protocols, and diagnostic assessment of referred infants. The qualitative methods included field notes and critical reflections describing clinics as screening contexts and elucidating interactional processes involved in sustaining programmes. A total number of 510 infant-caregiver pairs were enrolled as subjects during the five-month research period. Results indicate that clinics not only provide a suitable context, but also the possibility of effective collaborations toward facilitating effective initial infant hearing screening programmes. The caregivers and infants who attended the clinics demonstrated significant degrees of socio-economic deprivation. They also reported an increased incidence of risk indicators exacerbating the population’s risk for congenital hearing loss, poor participation in the hearing screening/follow-up process, and subsequent poor involvement in a family-centred early intervention process for infants identified with hearing loss. The screening protocol effectively classified infants into risk categories for hearing loss and established useful norms for high frequency immittance in infants. The efficiency of the programme was acceptable considering the short period of implementation, but inefficient coverage with the AABR and poor follow-up return rates were obtained at the clinics. Despite prevailing barriers, the MCH 6-week immunisation clinics showed promise as platforms for widespread hearing screening programmes for infants in South Africa. The clinical implications and recommendations that emerged from the research conducted in this study were compiled and presented in the form of a preliminary service delivery model for infant hearing screening at MCH clinics. / Thesis (DPhil (Communication Pathology))--University of Pretoria, 2004. / Speech-Language Pathology and Audiology / unrestricted