AFRIKAANS : Rasionaal: Die Suid-Afrikaanse konteks is heterogeen van aard en word gekenmerk deur ʼn kontinuum van ontwikkelende tot ontwikkelde gesondheidsdienste. Daar word beraam dat 55% van kinders (0-3 jaar) in landelike Suid-Afrikaanse gebiede woon, waar armoede heers en die infrastruktuur onvoldoende is. Die ongunstige omgewings omstandighede van talle kinders woonagtig in Suid-Afrika verhoog die risiko vir gestremdhede en plaas babas en kleuters in ʼn groter gevaar vir die ontwikkeling van ʼn kommunikasieafwyking, wat die behoefte aan effektiewe Vroeë Kommunikasie Intervensie (VKI) dienslewering in dié konteks beklemtoon. Primêre Gesondheidsorgklinieke (PGS) kan beskou word as die ideale konteks binne die Suid-Afrikaanse realiteit waar VKI programme en VKI dienslewering geïmplementeer kan word. Deur VKI dienslewering binne die Primêre Gesondheidsorgklinieke te implementeer, kan samewerkende dienslewering tussen VKI en Primêre Gesondheidsorg verhoog word. Beide die Primêre Gesondheidsorgmodel en die VKI benadering stel voorkoming en die vroeë identifikasie van afwykings as sentrale doelwit voor. Die implementering van VKI in die Suid-Afrikaanse Gesondheidsorgsisteem is deur talle navorsers geïdentifiseer as die wyse waarop die dienste aan babas en kleuters wat ʼn risiko toon vir die ontwikkeling van ʼn kommunikasieafwyking bevorder kan word. Deur die implementering van VKI dienslewering op die vlak van Primêre Gesondheidsorgklinieke, kan die basiese beginsels van VKI naamlik, dienslewering wat gemeenskapsgebaseerd, familie-gesentreerd, omvattend en gekoördineerd is, geïmplementeer word. Doel: Die hoofdoel van hierdie studie was om te bepaal in watter mate Gesondheidsorgklinieke in die Wes-Rand streek as konteks vir die toepassing van VKI kan dien. Metode: ʼn Beskrywende kwantitatiewe opname is as navorsingsontwerp vir beide fases benut. Ten einde die doel van die studie te bereik, is die navorsing in twee fases uitgevoer, omdat die navorsingsproses kronologiese verloop het en daar eerstens in fase een gefokus is op die konteks vir diensverskaffing, en tweedens in fase twee op die diensverskaffers. Fase een het ʼn konteks analise behels om sodoende die fisiese konteks waarbinne die sorggewers en hul kinders wat ʼn risiko vertoon vir die ontwikkeling van ʼn kommunikasieprobleem dienste ontvang, te beskryf en te evalueer deur die voltooiing van ʼn afmerklys wat vooraf deur die navorser opgestel is. Fase twee het ʼn triangulasie navorsingsmetode benut deur gebruik te maak van ʼn gestruktureerde onderhoudskedule, sowel as die voltooiing van ʼn opgestelde vraelys. Die afmerklys in fase een, die gestruktureerde onderhoudskedule, en die vraelys in fase twee het as data-insamelingstegnieke vir die navorsingsprojek gedien. Respondente en Deelnemers: Vir Fase 1 is 12 Primêre Gesondheidsorgklinieke in die drie sub-distrikte van die Wes-Rand distrik benut vir die konteksanalise. Vir Fase 2 is agt terapeute in hulle gemeenskapsdiensjaar wat werksaam is in die Wes-Rand distrik as deelnemers benut vir die bespreking van die vooraf geïdentifiseerde temas gedurende die gestruktureerde onderhoudskedule. 34 gemeenskapsverpleegkundiges van die Wes-Rand distrik is as respondente gebruik vir die voltooiing van die vraelys. Bevindinge: Die bevindinge het daarop gedui dat die Primêre Gesondheidsorgklinieke nie voldoende toegerus is vir die verskaffing van VKI dienslewering nie, ten spyte van die teenwoordigheid van risikofaktore onder die kliniekpopulasie. Verder was daar geen VKI bemarkings-, evaluasie- en intervensiemateriaal in die klinieke beskikbaar nie. Resultate het egter daarop gedui dat daar op ʼn weeklikse basis by elkeen van die Primêre Gesondheidsorgklinieke die moontlikheid bestaan van ʼn VKI span, aangesien daar ʼn spraak-taalterapeut, arbeidsterapeut, fisioterapeut, dieetkundige, maatskaplike werker, mediese dokter en verpleegkundige weekliks op dieselfde dag beskikbaar is. Die gemeenskapdiensjaarterapeute was positief ten opsigte van vroeë identifikasie en sekondêre voorkoming as sleutelkomponente van VKI. In teenstelling met die terapeute se positiwiteit t.o.v. vroeë identifikasie en voorkoming en in ooreenstemming met die bevindinge in Fase 1, was die terapeute van mening dat VKI tans nie suksesvol binne die Primêre Gesondheidsorgklinieke geïmplementeer sal kan word. Die gemeenskapsverpleegkundiges se kennis rakende VKI en aspekte wat verband hou met VKI was nie bevredigend nie. Die verpleegkundiges se houding jeens ʼn spanbenadering was positief, wat aan die spraak-taalterapeute die geleentheid bied om in samewerking met die verpleegkundiges die implementering van VKI binne hierdie konteks te motiveer en te implementeer. Gevolgtrekking: Die resultate van die navorsing hou implikasies in vir die rol van die spraak-taalterapeut ten opsigte van gemeenskapsgebaseerde intervensie, voorkoming, vroeë identifikasie, en die opleiding en bemagtiging van sorggewers en spanlede wat betref VKI binne die Suid-Afrikaanse Primêre Gesondheidsorgklinieke. Die behoefte aan verdere navorsing in die veld is deur die bevindinge van die studie beklemtoon. ENGLISH : Rationale: The South- African context is a heterogeneous context that is characterized by a continuum of developing to developed health care services. It is estimated that 55% of children (0 to 3 years) live in rural areas with insufficient infrastructure and under extreme conditions of poverty. Children living in South Africa are at greater risk for the development of a communication disorder due to the unfavourable environmental circumstances that they live in, which emphasizes the need for Early Communication Intervention (ECI) services in South Africa. Primary Health Care Clinics can be seen as the ideal context within South Africa where ECI programs and service delivery can be implemented. Both the Primary Health Care Model and the principles of ECI service delivery focuses on prevention and early identification of developmental disorders as their main goal. Many authors view the implementation of ECI in South Africa’s health system as the way in which the appropriate services can be provided to babies and infants that are at-risk for a communication disorder. Implementing ECI on the level of the Primary Healthcare will allow for the provision of services that are in accordance with the basic principles of service delivery stipulated by ASHA (1989), namely services that are community-based, family-centered, coordinated and comprehensive. Aim: The main purpose of the study was to determine the degree in which the Primary Health Care Clinics in the West-Rand district can be used for the implementation of Early Communication Intervention (ECI). Method: An exploratory, descriptive and contextual research design was implemented for both phases, which incorporated both quantitative and qualitative paradigms. This study was conducted in two phases. In Phase One a context analysis was conducted, where by a checklist was completed by the researcher, in order to describe and evaluate the context where children who are at risk for the development of a communication disorder, and their parents, may receive services. In Phase two a triangulation method was followed and the researcher made use of a structured interview to discuss the themes and a questionnaire in order to obtain information regarding the perception of the nurses and community service therapists on ECI services and the implementation of ECI services in the Primary Health Care Clinics. The checklist in phase one, the structured interview, and the questionnaire in phase two were used as data collection methods during this research project. Respondents and Participants: For the context analysis in Phase One, 12 Primary Health Care Clinics in the West-Rand district were used. Phase Two utilized 8 therapists as participants that were employed by the Wes-Rand health district to complete their community service year. 34 community nurses, employed by the West-Rand district were utilized as respondents and completed the questionnaire. Results: The findings of the study indicated that the Primary Health Care Clinics were not appropriately equipped for the implementation of ECI service delivery, despite the presence of risk-factors under babies and children visiting the clinics. There were no available ECI marketing-, assessment-, and intervention material at the clinics. It is promising to have found that there is the possibility of the implementation of an ECI team at each of the clinics, seeing that there is a speech-language therapist, occupational therapist, physiotherapist, dietician, social worker, medical doctor and nurse available on the same day on a weekly basis. The community service therapists were positive regarding early identification and the secondary prevention of communication disorders as key components of the ECI process. In contrast with their positive attitudes towards these aspects, they were of the opinion that due to proposed challenges in this context, at this stage, it will not be possible to implement the ECI process in the Primary Health Care Clinics. The community nurse’s knowledge regarding ECI and the aspects related to ECI were not appropriate. Despite this, they demonstrated a positive attitude towards the implementation of a team approach, which gives the speech-language therapist’s the opportunity to work with the nursing staff in a team approach, to implement ECI within the Primary Health Care Clinics. The participants in Phase Two were aware of the importance of ECI and the need for ECI services in this context, but they were of the opinion that the implementation of ECI in this Primary Health Care Context would not be possible due to a variety of reasons. The respondents in Phase Two demonstrated inappropriate knowledge and awareness regarding ECI, communication development, communication disorders and the role of the speech-language therapist and audiologist in the Primary Health Care Context. The majority of the respondents were positive about in-service ECI training, regardless of their limited knowledge thereof. Conclusion: The results have implications for the role of the speech-language therapist in terms of community-based intervention, prevention, early identification, parent training and informing colleagues about ECI within the South African Primary Health Care Clinics. The need for further research in this field is emphasized. Copyright / Dissertation (MComm Path)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted

Comprehensive management in the neonatal nursery involves medical treatment of the infant, as well as developmental care and the provision of guidance, counselling and information to the family who are part of the decision-making process regarding the infant’s care. Neonatal communication intervention is of utmost importance in a country such as South Africa, which has an increased prevalence of infants at risk for disabilities and where the majority of these infants live in poverty. Speech-language therapists fulfil an important role in the neonatal nursery and are an integral part of the team involved with the high risk neonatal population. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists and audiologists in neonatal nurseries in the South African context. From an asset-based perspective it appears that the South African population receiving services in neonatal nurseries have unique characteristics. This provides speech-language therapists with ample opportunity to intervene, providing that intervention is well-timed in the neonatal nursery context. The country-wide initiative to implement the evidence-based technique of kangaroo mother care indicates that speech-language therapists should recognise its importance and develop communication based materials and tools to complement this successful neonatal intervention. The aim of the research was to establish whether speech-language therapists have needs for assessment and intervention tools/materials in this context. The study furthermore aimed to compile a locally relevant neonatal communication intervention instrument/tool for use by speech-language therapists in the neonatal nurseries of public hospitals in South Africa in order to propose a solution to address the shortage of tools in the public health context. The study entailed descriptive, exploratory research. During Phase 1, a survey was received back from 39 speech-language therapists and two audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which were determined by the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but were resourceful in their attempts to develop and adapt tools/materials. Participants expressed a need for culturally appropriate and user-friendly instruments for parent guidance and staff/team training on the topic of developmental care. During Phase 2 a tool for parent guidance titled “Neonatal communication intervention programme for parents” was compiled for use by speech-language therapists and justified by participants’ roles and needs as well as current early communication intervention (ECI) literature. The programme was piloted by three participants. Certain suggestions for enhancements of the programme were made such as providing a glossary of terms, adapting the programme’s language and terminology, and providing more illustrations. The programme complied with the guiding principles for best practice in ECI (ASHA, 2008) and can therefore contribute to neonatal care of high risk infants in South Africa. Speech-language therapists and audiologists must contribute to neonatal care of high risk infants to facilitate optimal health and development and to support their families. AFRIKAANS : Omvattende intervensie in die neonatale sorgeenheid behels mediese behandeling van die neonaat, sowel as ontwikkelingstoepaslike sorg en die verskaffing van leiding, berading en inligting aan die gesin wat deel is van die besluitnemingsproses rakende die baba se sorg. Neonatale kommunikasie intervensie is van uiterste belang in Suid-Afrika aangesien daar ‘n hoër prevalensie van babas is wat ‘n risiko het vir ontwikkelingsafwykings en aangesien die meerderheid van hierdie babas in armoede leef. Spraak-taalterapeute vervul ‘n belangrike rol in die neonatale sorgeenheid en is ‘n integrale deel van die span wat betrokke is by die hoërisiko neonatale populasie. Plaaslike literatuur dui op ‘n tekort aan inligting rakende die huidige dienslewering van die spraak-taalterapeut en oudioloog in neonatale sorgeenhede in die Suid-Afrikaanse konteks. Vanuit ‘n bate-benadering kom dit voor of die Suid-Afrikaanse populasie wat dienste in neonatale sorgeenhede ontvang, unieke eienskappe het. Dit bied genoegsame geleenthede aan spraak-taalterapeute om intervensie te verskaf, solank die behandeling betyds in die neonatale sorgeenheid konteks aanvang neem. Daar is ‘n landswye inisiatief om die bewysgerigte tegniek van kangeroe moedersorg toe te pas. Spraak-taalterapeute moet dus die belang daarvan herken en kommunikasie gebasseerde terapiemateriaal ontwikkel om hierdie suksesvolle neonatale intervensie te komplementeer. Die navorsing se doel was om vas te stel hoe wyd spraak-taalterapeute en oudioloe ‘n behoefte aan evaluasie en intervensie instrumente en –materiaal in hierdie konteks het. Die navorsing het verder ten doel gestel om ‘n relevante terapie instrument saam te stel vir spraak-taalterapeute in die neonatale sorgeenhede as ‘n moontlike oplossing vir die tekort aan relevante terapiemateriaal in die plaaslike publieke gesondheidsorgkonteks. Die studie het beskrywende, eksplorerende navorsing behels. Gedurende Fase 1 is ‘n vraelys terug ontvang van 39 spraak-taalterapeute en twee oudioloë in ses provinsies. Die data het aangedui dat deelnemers verskillende rolle in hierdie konteks vervul, wat beïnvloed was deur die omgewing, die instrumentasie en materiaal wat tot hulle beskikking was. Die meerderheid van die deelnemers was onervare, maar was vindingryk in hulle pogings om terapiemateriaal aan te pas en te ontwikkel. Deelnemers het ‘n behoefte vir kultureel toepaslike- en gebruikersvriendelike instrumente en materiaal uitgedruk met die oog op ouerleiding en personeel/span opleiding oor die onderwerp van ontwikkelingstoepaslike sorg. Gedurende Fase 2 is ‘n terapie instrument naamlik “Neonatale kommunikasie intervensie program vir ouers” saamgestel vir die gebruik in die neonatale sorgeenhede deur spraak-taalterapeute. Die samestelling van hierdie program is verantwoord deur die deelnemers se rolbeskrywing en behoeftebepaling van Fase 1, sowel as deur huidige vroeë kommunikasie intervensie (VKI) literatuur. Die program is deur drie deelnemers in ‘n loodsstudie geëvalueer. Voorstelle vir die verbetering van die program is verskaf, naamlik die byvoeging van ‘n terminologielys, aanpassing van die program se taalgebruik en terminologie en verskaffing van meer illustrasies. Die program het ooreengestem met die beginsels vir beste praktyk in VKI (ASHA, 2008) en kan daarom tot neonatale sorg van hoërisikobabas in Suid-Afrika bydra. Spraak-taalterapeute en oudioloë moet bydra tot neonatale sorg van hoërisiko neonate om sodoende optimale gesondheidsorg en ontwikkeling te fasiliteer en gesinne te ondersteun. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / 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