https://sajcd.org.za/index.php/sajcd/issue/feedSouth African Journal of Communication Disorders2024-03-19T09:00:02+01:00AOSIS Publishingsubmissions@sajcd.org.zaOpen Journal Systems<a id="readmorebanner" href="/index.php/sajcd/pages/view/journal-information" target="_self">Read more</a> <img style="padding-top: 2px;" src="/public/web_banner.svg" alt="" />https://sajcd.org.za/index.php/sajcd/article/view/992A call for linguistic and culturally congruent family-centred early hearing detection and intervention programmes in South Africa2024-03-19T09:00:02+01:00Ntsako P. Malulekeprecious.slp@gmail.com<p>Early Hearing Detection and Intervention (EHDI) programmes are recognised as the standard of care for newborns and infants presenting with hearing impairment, globally. However, widespread implementation of these programmes is far from being realised and faces numerous challenges within the South African context. The United Nations’ sustainable development goal 3.8 and South Africa’s national development plan seek to achieve equitable access to healthcare service, including EHDI. However, healthcare access is a complex concept which encompasses the dimensions: availability, affordability, acceptability and accommodation in healthcare. South Africa has made great progress towards universal implementation of EHDI programmes. Despite this progress, availability and affordability of these programmes are limited and their acceptability has received limited research focus in this context. Furthermore, accommodation of caregivers, as co-drivers of EHDI programmes and ensuring that EHDI programmes are linguistically and culturally congruent have also been overlooked within the South African context.</p><p><strong>Contribution:</strong> Increased robust efforts in improving access through availability and affordability of EHDI programmes are warranted in South Africa. However, improving access to these programmes through availability and affordability initiatives alone will not result in a pragmatic improvement in their accessibility. Acceptability of these programmes and accommodations such as involving caregivers and family members of children with hearing impairment as equal partners in EHDI programmes and being cognisant of their linguistic and cultural needs must be considered.</p>2024-03-19T09:00:00+01:00Copyright (c) 2024 Ntsako P. Malulekehttps://sajcd.org.za/index.php/sajcd/article/view/1001Who really decides? Feeding decisions ‘made’ by caregivers of children with cerebral palsy2024-03-18T12:37:36+01:00Lavanya Naidoolavanya.naidoo@wits.ac.zaMershen Pillaym.pillay@massey.ac.nzUrisha Naidoonaidoou@ukzn.ac.za<p><strong>Background:</strong> There are no definitive guidelines for clinical decisions for children with cerebral palsy (CP) requiring enteral feeds. Traditionally, medical doctors made enteral feeding decisions, while patients were essentially treated passively within a paternalistic ‘doctor knows best’ approach. Although a more collaborative approach to decision-making has been promoted globally as the favoured model among healthcare professionals, little is known about how these decisions are currently made practically.</p><p><strong>Objectives:</strong> This study aimed to identify the significant individuals, factors and views involved in the enteral feeding decision-making process for caregivers of children with CP within the South African public healthcare sector.</p><p><strong>Method:</strong> A single-case research design was used in this qualitative explorative study. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis.</p><p><strong>Results:</strong> Four primary individuals were identified by the caregivers in the decision-making process: doctors, speech therapists, caregivers’ families and God. Four factors were identified as extrinsically motivating: (1) physiological factors, (2) nutritional factors, (3) financial factors and (4) environmental factors. Two views were identified as intrinsically motivating: personal beliefs regarding enteral feeding tubes, and feelings of fear and isolation.</p><p><strong>Conclusion:</strong> Enteral feeding decision-making within the South African public healthcare sector is currently still dominated by a paternalistic approach, endorsed by a lack of caregiver knowledge, distinct patient-healthcare provider power imbalances and prescriptive multidisciplinary healthcare dialogues.</p><p><strong>Contribution:</strong> This study has implications for clinical practice, curriculum development at higher education training facilities, and institutional policy changes and development, thereby contributing to the current knowledge and clinical gap(s) in the area.</p>2024-03-18T09:00:00+01:00Copyright (c) 2024 Lavanya Naidoo, Mershen Pillay, Urisha Naidoohttps://sajcd.org.za/index.php/sajcd/article/view/1010Swallowing and feeding of young children on high-flow oxygen therapy2024-03-03T12:31:55+01:00Ruhee Hoosainhoosainruhee@gmail.comBhavani Pillaybhavani.pillay@up.ac.zaShabnam Abdoolashabnam.abdoola@up.ac.zaMarien A. Grahammarien.graham@up.ac.zaEsedra Krügeresedra.kruger@up.ac.za<p><strong>Background:</strong> Oral feeding practices of young patients on high-flow oxygen (HFO<sub>2</sub>) have been controversial. Limited literature exists on this topic, but new studies suggest introducing oral feeds.</p><p><strong>Objective:</strong> This study aims to describe the changes in swallowing and feeding of a group of young children on HFO<sub>2</sub>.</p><p><strong>Method:</strong> Twelve participants (mean age 34.17 months [s.d. = 3.97]) on HFO<sub>2</sub> were assessed clinically at the bedside using the Schedule of Oral Motor Assessment. Assessments were conducted twice to determine the change in characteristics: upon approval from the managing doctor when respiratory stability on HFO<sub>2</sub> was achieved and for a second time on the last day of receiving HFO<sub>2</sub> (mean 2.6 days apart). Patients received standard in-patient care and speech therapy intervention.</p><p><strong>Results:</strong> Most participants displayed typical oral motor function at initial and final assessments for liquid, puree and semi-solid consistencies. Purees and soft solid consistencies were introduced to most participants (<em>n</em> = 11, 91.7%). Solids and chewables were challenging for all participants during both assessments. Half of the participants displayed gagging and a wet vocal quality with thin liquids at the initial assessment only.</p><p><strong>Conclusion:</strong> This small-scale study found that HFO<sub>2</sub> should not preclude oral diets, but in this sample, small amounts of oral feeding could be introduced with caution, in an individualised manner, and with a collaborative multidisciplinary approach. Further research is essential.</p><p><strong>Contribution:</strong> Partial oral feeding of specific consistencies was possible during the assessment of young paediatric in-patients on HFO<sub>2</sub>. Monitoring of individual patient characteristics and risk factors by a specialist feeding team is essential.</p>2024-03-02T11:00:00+01:00Copyright (c) 2024 Ruhee Hoosain, Bhavani Pillay, Shabnam Abdoola, Marien A. Graham, Esedra Krügerhttps://sajcd.org.za/index.php/sajcd/article/view/989Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines2024-03-01T13:39:18+01:00Chevonne D. du Plessischevonne.speech@gmail.comLauren H. Hamptonlaurenhhampton@gmail.comMichal Hartymichal.harty@uct.ac.za<p><strong>Background:</strong> Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT’s fit or what adaptations might be needed to improve its applicability within a resource-constrained setting.</p><p><strong>Objectives:</strong> To explore stakeholders’ perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT’s contextual fit.</p><p><strong>Method:</strong> We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components.</p><p><strong>Results:</strong> Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families’ available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa.</p><p><strong>Conclusion:</strong> Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.</p><p><strong>Contribution:</strong> This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.</p>2024-02-21T06:05:00+01:00Copyright (c) 2024 Chevonne D. du Plessis, Lauren H. Hampton, Michal Hartyhttps://sajcd.org.za/index.php/sajcd/article/view/1005Outcomes and device use in children with bone-conduction hearing devices in South Africa2024-03-01T13:39:18+01:00Chéri van Zylcheri.vanzyl@westerncape.gov.zaChristine Rogerschristine.rogers@uct.ac.zaSilva Kuschkesilva.kuschke@hearxgroup.com<p><strong>Background:</strong> Bone-conduction hearing devices (BCHD) can provide hearing solutions in settings where middle ear pathology is rife.</p><p><strong>Objectives:</strong> Describe functional hearing outcomes and device use of children fitted with BCHD.</p><p><strong>Method:</strong> Retrospective review of 79 children fitted with BCHD between January 2017 and May 2022. Outcomes included device use and subjective reports measured with the Parents’ Evaluation of Aural/Oral Performance of Children (PEACH) and the Teachers’ Evaluation of Aural/Oral Performance of Children (TEACH). Analysis of variance established association between mean data logging and type and degree of hearing loss. Thematic analyses were done for qualitative outcomes.</p><p><strong>Results:</strong> Average usage was 7.0 h/day (5.4 SD; range 0.1–24). PEACH ratings indicated 93.3% of children wore their BCHD ‘always’ or ‘often’, with 80% displaying Typical auditory performance at 1-month follow-up. TEACH ratings indicated 84.2% of children wore their BCHD ‘always’ or ‘often’, with 78.9% showing typical auditory behaviour. Increased usage was noted for conductive, mixed, moderate and severe hearing losses. There was a mean delay of 17.2 months (23.4 SD; range 0–90) between age of diagnosis and fitting. Thematic analyses identified two main themes: advantages and barriers to BCDH use.</p><p><strong>Conclusion:</strong> Average device use fell short of the internationally recommended 10 h/day. Higher BCHD use was associated with higher functional listening performance scores. Long waiting times for medical or surgical intervention for conductive hearing losses can delay BCHD fitting.</p><p><strong>Contribution:</strong> Limited information is available to examine outcomes in children fitted with BCHD.</p>2024-02-19T08:00:00+01:00Copyright (c) 2024 Chéri van Zyl, Christine Rogers, Silva Kuschkehttps://sajcd.org.za/index.php/sajcd/article/view/990Exploring quality of life post sudden onset hearing loss: A convergent parallel approach2024-03-01T13:39:18+01:00Liepollo Ntlhakanaliepollon@gmail.comSabeehah Hamidsabhamid5@gmail.com<p><strong>Background:</strong> Sudden onset hearing loss (SOHL) is rare and presents differently to individuals; hence, it is complex to diagnose. The impact on the quality of life (QoL) varies for individuals and their support structure. However, the exploration of research designs is warranted.</p><p><strong>Objectives:</strong> This study explored the lived experiences of adults post-SOHL diagnosis and the impact on the QoL. Facilitators of emotional and social aspects of counselling provided by audiologists post-SOHL diagnosis were established.</p><p><strong>Method:</strong> This was a convergent parallel research study. Data were collected from the two primary participants and three secondary participants, face-to-face and telephonically. The Hearing Handicap Inventory for Adults (HHIA) screening tool and the semi-structured interviews were used for data collection. The data sets were analysed independently, <em>viz</em>. descriptive analysis and thematic analysis, to confirm the impact on the QoL post-SOHL diagnosis.</p><p><strong>Results:</strong> The HHIA scores obtained were 84% and 50% for P1 and P2, respectively. Key themes that emerged from the interviews revealed that communication difficulties mostly impacted the QoL, which in turn influenced their mental and social well-being. Aural rehabilitation was perceived as ineffective support, thus the inability to reduce the impact on the QoL post-SOHL diagnosis.</p><p><strong>Conclusion:</strong> The integrated findings indicated the impact on the QoL post-SOHL diagnosis. Convergent parallel methods should be considered by researchers to understand rare auditory pathologies and their impact on the QoL.</p><p><strong>Contribution:</strong> Person-centred care (PCC) and family-centred care (FCC) are facilitators of counselling that audiologists can employ as QoL management strategies post-SOHL diagnosis.</p>2024-02-16T06:00:00+01:00Copyright (c) 2024 Liepollo Ntlhakana, Sabeehah Hamidhttps://sajcd.org.za/index.php/sajcd/article/view/970Tube feeding in advanced dementia: Insights from South African speech-language therapists2024-03-01T13:39:18+01:00Danette Pullendbruwer1@gmail.comBhavani S. Pillaybhavani.pillay@up.ac.zaEsedra Krügeresedra.kruger@up.ac.za<p><strong>Background:</strong> Speech-language therapists (SLTs) may recommend tube feeding even with minimal research evidence of its effectiveness, and an understanding of SLTs’ perceived practices is warranted.</p><p><strong>Objectives:</strong> To qualitatively describe a sample of South African SLTs’ perceived practices regarding feeding tube placement in people with advanced dementia.</p><p><strong>Method:</strong> Semi-structured online interviews were conducted via Microsoft Teams. Eight South African SLTs with a particular interest in advanced dementia, in public and private settings, were recruited. Data were analysed using inductive reflexive thematic analysis.</p><p><strong>Results:</strong> Three main themes were identified: (1) factors influencing SLTs’ decisions for feeding tube placement in people with advanced dementia; (2) nature of clinical setting and SLTs’ decision-making and (3) SLTs’ considerations to improve management of people with advanced dementia. Existing local palliative care guidelines were not employed in decisions about tube feeding. Most participants did not recommend tube feeding during end-of-life care. Perceived burden of care influenced participants’ decisions about tube feeding.</p><p><strong>Conclusion:</strong> Speech-language therapists in South Africa likely have an increased reliance on clinical experience rather than recent research and guidelines for decisions about feeding tube placement. Findings accentuate the importance of clinical supervision, mentoring and continuous professional development in the workplace. The findings are an urgent call to action to improve SLTs’ overall practices and ethical service delivery for people with advanced dementia and their families.</p><p><strong>Contribution:</strong> Factors and needs regarding SLTs’ decision-making about feeding tubes in people with advanced dementia are highlighted.</p>2024-02-12T06:00:00+01:00Copyright (c) 2024 Bhavani Pillay, Danette Pullen, Esedra Krügerhttps://sajcd.org.za/index.php/sajcd/article/view/966Noise-induced hearing loss and hearing protection: Attitudes at a South African coal mine2024-02-01T13:08:41+01:00Kavitha Naickerkavithanaicker0@gmail.com<p><strong>Background:</strong> Negative attitudes and beliefs are major contributing factors to the rising numbers of noise-induced hearing loss (NIHL) cases in coal mines both locally and internationally. International literature confirms limited knowledge surrounding employees’ attitudes and beliefs regarding NIHL and hearing protection devices (HPDs), hence the need for the study.</p><p><strong>Objectives:</strong> To ascertain the attitudes and beliefs about NIHL and HPD use among employees at a large scale underground coal mine in Mpumalanga.</p><p><strong>Method:</strong> A descriptive and exploratory cross-sectional study was conducted using a self-administered questionnaire, developed by the National Institute for Occupational Safety and Health (NIOSH) on Beliefs about Hearing Protection and Hearing Loss (BHPHL). Participants (<em>n</em> = 241) included employees from a coal mine in Mpumalanga, South Africa.</p><p><strong>Results:</strong> Out of 241 completed surveys, this study found that 84% were aware of when to replace earmuffs; 95% believed wearing HPDs could prevent hearing loss in noisy environments; 83% felt their hearing was impacted by loud noise. Additionally, 86% mentioned discomfort from earmuff pressure; 95% emphasised HPD importance; and 95% used HPDs around loud sounds. Moreover, 98% knew how to properly wear earplugs, while lower education levels were linked to higher susceptibility to NIHL.</p><p><strong>Conclusion:</strong> The study identified positive attitudes towards NIHL and HPD use, but existing NIHL cases must be acknowledged. Organisations can use the findings to develop tailored hearing conservation programmes (HCP), including education, involving employees in protection decisions and promoting diligent HPD usage.</p><p><strong>Contribution:</strong> This study contributes to the limited literature on noise perceptions, NIHL, and HPD use in mining, emphasising the impact attitude has on HPD use and assessing the effect of miners NIHL knowledge on compliance. The findings, unique to coal mining, hold significance for enhancing hearing conservation and reducing NIHL.</p>2024-01-17T06:00:00+01:00Copyright (c) 2024 Kavitha Naickerhttps://sajcd.org.za/index.php/sajcd/article/view/1021Context-specific advancements in service delivery for communication disorders in South Africa2024-01-16T10:02:12+01:00Anita Edwardsanitaedwards247@gmail.comFaheema Mahomed-Asmailfaheema.mahomed@up.ac.zaAnna-Mari Olivierannamari@iafrica.comJeannie van der Lindejeannie.vanderlinde@up.ac.zaNo abstract available.2023-12-20T08:00:00+01:00Copyright (c) 2023 Anita Edwards, Faheema Mahomed-Asmail, Anna-Mari Olivier, Jeannie van der Lindehttps://sajcd.org.za/index.php/sajcd/article/view/996Noise risk assessment practices of four South African manufacturing and utilities companies2024-01-16T10:02:13+01:00Oscar RikhotsoRikhotsoO@tut.ac.zaThabiso J. MorodiMorodiTJ@tut.ac.zaDaniel M. Masekamenidaniel.masekameni@wits.ac.za<p><strong>Background:</strong> The South African Noise Induced Hearing Loss (NIHL) Regulations, mandates employers to conduct a noise risk assessment, which records specific variables for determining the status of exposure and the need for implementation of control measures.</p><p><strong>Objectives:</strong> The study evaluated company noise risk assessment practices for alignment with legal requirements and specific risk assessment guidelines.</p><p><strong>Method:</strong> Convenience sampling was used to select the four manufacturing and utilities companies that participated in the study. The participating companies submitted latest noise risk assessment records for evaluation through the READ approach.</p><p><strong>Results:</strong> The noise risk assessment records of three of the four companies omitted the recording of factors such as the reasonable deterioration in or failure of control measures, adequate control and formalisation of hearing conservation programmes (HCPs). When evaluated against the South African National Standard 31000 Risk Assessment guidelines, the risk assessment processes of the respective companies were lacking in addressing aspects related to establishing communication and consultation, evaluation, adapting, continually improving, leadership and commitment, and integration.</p><p><strong>Conclusion:</strong> The recorded information on the noise risk assessment reports from the four participating companies were incomplete, negatively affecting subsequent HCP management processes and decision-making. Future studies should investigate other aspects such as the implementation status of recommended noise controls as well as their effectiveness as recorded in the noise risk assessment records.</p><p><strong>Contribution:</strong> This study provided firsthand insights of company noise risk assessment practices, specifically identifying functional and technical areas requiring improvement to enhance current efforts directed towards the minimisation of NIHL within HCPs. The study highlighted that the current practices on recording noise risk assessment information remain incomplete, adversely diminishing the impact of the assessment as an important decision-making tool. The identified technical issues specifically, when addressed, will increase trust on the decisions derived from noise risk assessments.</p>2023-11-28T09:00:00+01:00Copyright (c) 2023 Oscar Rikhotso, Thabiso J. Morodi, Daniel M. Masekameni