Any factor that interferes with a child’s ability to interact with the environment in a normal manner is a potential source of, or contributing factor to, the presence of a developmental delay (Rossetti, 2001). According to Bam (2001) the Human Immunodeficiency Virus (HIV) is considered as an established risk factor under the category of serious infections and does not only have a negative effect on the normal development of a child, but also leads to serious audiological complications (Bankaitis&Schountz, 1998). Heterogeneity of auditory manifestations in individuals with HIV/AIDS is a feature of this virus (Friedman&Noffsinger, 1998). When considering the wide spectrum of audiological problems associated with pediatric HIV/AIDS, the role of the audiologist in the treatment of these children are highlighted (Bankaitis, 1998). Effective treatment of this heterogeneous population can however only take place within a team of medical professionals as their complex needs require a wide spectrum of skills (McNeilly, 2000). In South Africa nursing personnel play an important role in the early identification of a hearing loss and other audiological abnormalities (Thathiah, 2001). Part of a nurse’s job involve the provision of services in hearing health care, therefore they can serve as assistants for the audiological profession (Thathiah, 2001). Although rehabilitation services in rural areas are limited, developmental disabilities can be prevented or minimized if it is identified early. Early identification of hearing losses and other audiological abnormalities associated with HIV/AIDS can however only take place if nursing personnel have the necessary knowledge and skills to address these problems efficiently. To thus provide optimal audiological services to children with HIV/AIDS nursing personnel must be able to function as a link between the audiologist and the community. In the light of the current government involvement with the provision of optimal health care service to people with HIV and Acquired Immune Deficiency Syndrome (AIDS), it is necessary to recognize and address the audiological needs of these individuals. The aim of this study was to determine the perception of nursing personnel, working in state hospitals in North West, regarding the audiological manifestations of HIV/AIDS in the pediatric population. A quantitive research design was employed in the form of a descriptive survey. The knowledge of 156 nursing personnel, working in fifteen different state hospitals in North West, was assessed through the use of a self-constructed questionnaire. This research concluded that the majority of the nursing personnel do not have sufficient knowledge regarding hearing health care and HIV/AIDS within the pediatric population. The assumption can thus be made that these children don’t get sufficient and effective intervention services and this will effect their development as well as quality of life negatively. Furthermore, respondents appeared not to have fully realized the importance of their role as health workers within the audiological context. The nursing personnel identified a need for information regarding the audiological manifestations of HIV/AIDS in the pediatric population and there appears to be a specific role for the audiologist in training the nurses regarding this above mentioned issue. This study emphasizes the importance of early identification and intervention of hearing disorders in children, especially children with HIV, within South Africa and indicates the need for further research with regards to this population. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted

The effects of HIV/AIDS and subsequent opportunistic infections and/or associated conditions on the development of infected children are substantial. Considerable delays and/or disorders in communication development have been noted in the HIV/AIDS infected child, as well as the need for Early Communication Intervention (ECI) services for this population. A dearth of locally relevant data regarding the speech, language and hearing development of HIV/AIDS infected children within the South African context currently exists. The objective of this study was to describe the characteristics of a group of HIV/AIDS infected children being managed at an outreach clinic of regional hospital in Gauteng. A cross-sectional, retrospective, non-experimental, descriptive, quantitative research design was used in this study. The main objective was achieved by analysing the clinic records of 203 children infected with HIV/AIDS between the ages of 0 – 5 years 11months through the use of a pre-designed checklist. A questionnaire completed by four medical doctors practicing at the HIV/AIDS clinic within the hospital was also used. This allowed for the perceptions and practices of the medical doctors to be described. Results revealed that the majority HIV/AIDS infected children being managed at the outreach clinic were significantly immunocompromised and diagnosed with Stage III or Stage IV HIV/AIDS infection. Furthermore, results indicated the presence of several opportunistic infections and HIV/AIDS associated conditions (such as Tuberculosis, Candidiasis and Encephalopathy). A positive finding was that 76% of the HIV/AIDS infected children (n=153) were receiving Highly Active Antiretroviral Therapy (HAART) at the time of data collection. The most outstanding finding was that very few of the children with HIV/AIDS being managed at the outreach clinic were recorded as having speech, language and/or hearing delays and/or disorders. Similarly, referrals to other professionals as recorded in the children’s hospital records seemed to be limited to Social Workers and Dietitians, with only one child recorded as being referred to a Speech-Language Therapist and Audiologist for further management. It was unclear whether more children were in fact referred for additional intervention by other professionals and this was simply not recorded in the children’s records, or whether these referrals were in fact not made. Results from the questionnaires completed by the medical doctors working with the pediatric HIV/AIDS population within the outreach clinic were significant. Findings indicated that the majority of the respondents believed that HIV/AIDS infected infants were more at risk for developmental and communicative delays and/or disorders than the general population, and that this population would likely benefit from Speech-Language Therapy and/or Audiology intervention services. Respondents indicated that medical doctors working with the pediatric HIV/AIDS population were often not adequately informed regarding the effects of HIV/AIDS on communication development and that they would benefit from further training in this regard. The need for further research regarding the characteristics of the pediatric HIV/AIDS population, particularly on a larger sample, was described. This would assist in the development of a guideline for ECI service delivery for children infected with HIV/AIDS. The need for further training of other professionals regarding the effects that HIV/AIDS has on the communication development of the infected child, to assist with necessary referrals and teamwork, was also highlighted. AFRIKAANS : Suid-Afrika is een van die lande ter wêreld, wat die hoogste voorkoms van Menslike Immuniteitsgebrekvirus/ Verworwe Immuniteitsgebreksindroom (MIV/VIGS), toon - met die pediatriese populasie op die voorfront van hierdie epidemie. Die effek wat MIV/VIGS en opeenvolgende opportunistiese infeksies en/of ander geassosieerde toestande op die ontwikkeling van kinders het, is verreikend. Internasionale literatuur beskryf agterstande en/of akwykings in die kommunikasie ontwikkeling van kinders wat met MIV/VIGS geinfekteer is. Die behoefte vir Vroeë Kommunikasie Intervensie (VKI) vir hierdie populasie word ook gemeld. Daar bestaan egter slegs ‘n beperkte hoeveelheid relevante, plaaslike literatuur met betrekking tot die spraak-, taal- en gehoorontwikkeling van kinders met MIV/VIGS binne die Suid-Afrikaanse konteks. Die doelwit van hierdie studie was om die kenmerke van ‘n groep kinders, wat met MIV/VIGS besmet is en by ‘n streekshospitaal in Gauteng behandel word, te beskryf. ‘n Kwantitatiewe, nie-eksperimentele, terugwerkende, dwarsdeurige, beskrywende navorsingsontwerp is gebruik. Die hoofdoelwit was bereik deur die kliniekrekords van kinders wat met MIV/VIGS besmet is, te analiseer deur van ‘n vooraf-ontwerpte merklys gebruik te maak. Data is ook ingesamel deur middel van vraelyste wat deur mediese dokters, wat by MIV/VIGS klinieke binne die hospitale werk, voltooi is. Dit het toegelaat dat die persepsies en praktyke van die mediese dokters ook beskryf kon word. Resultate het getoon dat die meerderheid kinders met MIV/VIGS, wat by klinieke behandel word, se immuunsisteme ernstig onderdruk was en dat hulle met stadium III of stadium IV van MIV/VIGS gediagnoseer was. Die resultate het verder ook die voorkoms van verskeie opportunistiese infeksies en MIV/VIGS geassosieerde toestande aangedui. ‘n Positiewe bevinding was dat 76% van die kinders (n=153), wat met MIV/VIGS geinfekteer was, tydens die proses van data-insameling reeds Hoogsaktiewe Antiretrovirale Terapie (HAART) ontvang het. Die mees uitstaande bevinding was dat slegs ‘n geringe hoeveelheid kinders met MIV/VIGS by die kliniek, as met ‘n agterstand en/of afwyking in spraak, taal en/of gehoor, aangeteken is. Beperkte verwysings na ander professionele persone is ook in die kliniekrekords opgemerk. Verwysings was beperk tot Maatskaplike Werkers en Dieëtkundiges. Daar was slegs een aantekening van ‘n kind wat vir behandeling na ‘n Spraak- en Taalterapeut en Oudioloog verwys is. Dit is egter onduidelik of daar werklik meer verwysings na ander professionele persone gemaak is, maar net nie in die kinders se kliniekrekords aangedui is nie, of dat daar werklik min verwysings na ander professionele dissiplines gemaak is. Bykomend, was die resultate van voltooide vraelyste deur mediese dokters, wat met die pediatriese MIV/VIGS populasie in die kliniek werk, insiggewend. Bevindings dui aan dat die meerderheid proefpersone, wat aan die studie deelgeneem het, van mening is dat kinders wat met MIV/VIGS besmet is wel ‘n hoër risiko toon vir ontwikkelings- en kommunikasie agterstande en/of afwykings in vergeleke met die algemene populasie. Die proefpersone is verder ook van mening dat hierdie populasie wel van spraak- en taalterapie en/of oudiologiese intervensie sal baatvind. Proefpersone het verder aangedui dat mediese dokters, wat met die pediatriese MIV/VIGS populasie werk, nie ten volle ingelig is omtrent die effek van MIV/VIGS op kommunikasie ontwikkeling en dat hulle van verdere opleiding sal baatvind. Die behoefte vir verdere navorsing in die veld van pediatriese MIV/VIGS en kommunikasie ontwikkeling, binne die Suid-Afrikaanse konteks, word in hierdie studie beskryf. Dit sal as riglyn vir VKI dienslewering aan hierdie populasie dien. Daar is ook ‘n groot behoefte vir verdere opleiding van ander mediese professionele persone met betrekking tot pediatriese MIV/VIGS en die effek wat die op die kind se kommunikasie ontwikkeling het. / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted