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Infant hearing screening (IHS) programs are not yet widespread in developing countries, such as South Africa. In order to ensure that the benefits of early hearing detection and intervention (EHDI) programs reach all infants, initial recommendations for the implementation of IHS programs in South Africa have been made by the Year 2002 Hearing Screening Position Statement by the Health Professions Council of South Africa. One of the platforms recommended for IHS in South Africa is the neonatal intensive care unit (NICU). South African NICU infants are at an increased risk for hearing loss, resultant of their high-risk birth histories, as well as the prevalence of context-specific environmental risk factors for hearing loss. There is currently a general scarcity of contextual data regarding the prevalence of risk indicators for hearing loss, and the prevalence of auditory impairment in the South African NICU population. The objective of this study was to describe an IHS program for NICU infants at a secondary hospital in Gauteng, South Africa. A quantitative descriptive research design was used to report on a cohort of 129 NICU infants followed up during a 29 month period. The objective of the study was achieved by describing the sample of infants in terms of the presence of specific risk indicators for hearing loss, the efficiency of the IHS program, and the incidence of auditory pathologies. Infants received their initial hearing screening as part of their medical and developmental follow-up visit at the hospital at three months of age. Routine rescreening visits were scheduled three monthly, whilst infants who failed the hearing screening were requested to return after three weeks for a follow-up. A data collection sheet was used to collect biographical information and risk indicators for hearing loss. Immittance measurements were recorded in the form of high-frequency and low-frequency tympanometry. Distortion product otoacoustic emissions (DPOAE) and automated auditory brainstem responses (AABR) were recorded, as well as diagnostic auditory brainstem responses (ABR) in cases where infants referred the screening protocol. Results revealed that environmental risk factors present in this sample included poor maternal education levels and prenatal HIV/AIDS exposure. At least 32% of mothers participating in this study did not complete high school. Prenatal HIV/AIDS exposure was present in at least 21% of the current sample of infants. The screening coverage rate fell short of the 95% benchmark set by the Joint Committee on Infant Hearing (JCIH, 2000). A 67% coverage rate was achieved with AABR screening, and an 88% coverage rate was achieved with DPOAE screening. 93% of infants had immittance screening performed on their initial visit to the IHS program. According to the Fisher’s two-sided exact test and the logistic regression procedure, high frequency tympanometry proved to be more effective than low frequency tympanometry, when assessing the middle ear functioning of infants younger than seven months when compared with DPOAE results. Normative pressure and admittance data was compiled for the use of high frequency tympanometry in NICU infants. Poor follow-up rates were recorded for both routine and non-routine visits, but are expected to improve over time. Furthermore, results indicated a high incidence of hearing impairment. Permanent congenital hearing loss was identified in 3% (n=4) of the sample. Half of these presented with sensorineural hearing loss, whilst the other half had auditory neuropathy. The incidence of auditory impairment is estimated to be 3.75% if the percentage of infants who did not return for follow-up is taken into account. A high incidence of middle ear pathology was recorded, with an incidence rate of 60.4%, including bilateral and unilateral middle ear pathology. The high prevalence of auditory impairment in South African NICU infants, and the lack of widespread IHS programs, indicates that many vulnerable infants are being the denied the benefits of early identification of and intervention for hearing loss. The implementation of widespread IHS programs in South Africa is therefore essential, in order to ensure that all South African infants receive the benefits of EHDI programs. / Dissertation (MCommunication Pathology)--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / unrestricted

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