The identification process in early communication intervention followed by primary health care personnel in Ditsobotla sub-district

Although the importance of early identification and intervention of infants at risk for communication delays and disorders have been advocated and emphasized in literature, case finding and service delivery in rural areas in South Africa appears to be problematic. The implementation of early communication intervention (ECI) within public service delivery has been proposed in the past. The primary health care (PHC) package had to be considered as a possible vehicle to be utilized for the implementation of ECI functions in rural communities. Against this background the existing identification methods and referral systems, utilized in Ditsobotla sub-district, were described in the current study to determine the limitations in case finding, and the feasibility of the implementation of ECI functions in collaboration with other PHC programmes. A descriptive dominant-less-dominant model provided the design to describe the identification process and teamwork in Ditsobotla sub-district. Data triangulation was utilized to improve reliability and validity of results which entailed a rating scale, face-to-face interviews with PHC personnel (participants in Group 1) and face-to-face interviews with PHC programme managers (participants in group 2). The results indicated that the capacity of facilities and human resources to support the implementation of ECI functions vary within the sub-district. Therefore an incremental implementation of ECI functions is feasible in collaboration with the existing PHC package. The current identification methods and referral systems are limited and a great need for collaboration exists. ECI functions need to be implemented formally within the PHC package and guidelines for such an implementation are provided. Furthermore the identification process to be introduced needs to form part of the incremental implementation of ECI functions. The implications are discussed in terms of ECI service delivery in rural South Africa. The proposed process of incremental implementation of ECI functions in rural areas, i.e. Ditsobotla sub-district, within the PHC package is provided. The need to develop identification methods, referral systems and guidelines for the implementation of ECI in PHC are emphasized. Future practice-based research is recommended in order to improve ECI service delivery in rural areas in South Africa. CopyrightDissertation (MCommunication Pathology)--University of Pretoria, 2009.Speech-Language Pathology and AudiologyUnrestricte

Developmental screening in South Africa : comparing the national developmental checklist to a standardized tool

Background: Worldwide, more than 200 million children in low- and middle-income countries have developmental delays and/or disabilities. In South Africa the only nationally implemented developmental 'screening' tool is integrated as part of 'The Road to Health Booklet (RTHB). Method: The study employed a comparative cross-sectional within-subject design to evaluate the accuracy of the RTHB developmental checklist against a standardized international tool i.e. the PEDS tools, consisting of the PEDS and PEDS: DM. A total of 201 participants were included through convenience sampling at primary health care facilities in Tshwane, South Africa. Results: Sensitivity of the RTHB developmental checklist is low, but specificity is high. The RTHB developmental checklist failed to identify more than half the infants at risk of delays or disorders. The nationally implemented developmental checklist is ineffective to identify at-risk infants. It should be adapted and validated or replaced in order to improve identification of at-risk infants

Developmental screening: predictors of follow-up adherence in primary health care

Background: The importance of early identification for infants and young children with developmental delays is well established. Poor follow-up on referrals, however, undermines the effectiveness of early intervention programmes.Objectives: To identify factors, including text message reminders, that influence follow-up adherence for early intervention after developmental screening in primary health care. A secondary objective surveyed reasons for follow-up default.Methods: The PEDS tools were used to screen 247 high-risk children. A risk assessment questionnaire was completed with caregivers whose children were referred for speech-language and/or occupational therapy (n=106, 43%). A quasi-experimental correlational study was employed to identify risk factors for defaulting on appointments. A thematic analysis of telephonic interviews was also employed to determine reasons for follow-up defaults.Results: Follow-up adherence was 17%. Participants who were never married, divorced or widowed were 2.88 times more likely to attend a follow-up appointment than those who were married or living together (95%, CI 0.97-8.63). Text message reminders did not improve follow-up. More than half (58%) of participants who defaulted on appontments could be reached for telephonic interviews. Interviews showed that 87% of participants were unconcerned about their child’s development. Other reasons for defaulting were employment, logistical issues, other responsibilities and forgetfulness.Conclusion: Follow-up adherence for early intervention services following a positive primary health care screen was poor. Increased awareness and education regarding the importance of development for educational success is needed.Keywords: Developmental screening, follow-up return rate, occupational therapy, PEDS tools, primary health care, speech-language therapy, text message reminder

Early detection of communication delays with the PEDS tools in at-risk South African infants

Background: Prevalence of communication delays or disorders is increasing, possibly because of various environmental risk factors. Selection and implementation of effective screening tools are important to detect at-risk infants as early as possible. This study aimed to evaluate the accuracy of the Parents' Evaluation of Developmental Status (PEDS), PEDS-Developmental Milestones and PEDS tools to detect communication delays in infants (6-12 months) in a South African primary healthcare context. Method: A comparative study design evaluated the accuracy of the PEDS tools to detect communication delays, using an internationally accepted diagnostic assessment tool, the Rossetti Infant-Toddler Language Scale (RITLS). A convenience sample of 201 infants was selected at primary healthcare clinics. Results: Expressive and receptive language sensitivity scores were low across all three screens (ranging between 14% and 44%). The PEDS tools had high sensitivity (71%) and specificity (73%) ratings for the receptive and expressive language and socio-emotional domain in combination. Conclusion: In the sample population, the PEDS tools did not accurately detect receptive and expressive language delays; however, communication delays in general were identified. Future research determining accuracy of the PEDS, PEDS-Developmental Milestones and PEDS tools for children aged 2-5 years in detecting communication delays should be prioritised

Vocal effectiveness of speech-language pathology students : before and after voice use during service delivery

BACKGROUND : As a professional voice user, it is imperative that a speech-language pathologist’s (SLP) vocal effectiveness remain consistent throughout the day. Many factors may contribute to reduced vocal effectiveness, including prolonged voice use, vocally abusive behaviours, poor vocal hygiene and environmental factors. OBJECTIVES : To determine the effect of service delivery on the perceptual and acoustic features of voice. METHOD : A quasi-experimental., pre-test–post-test research design was used. Participants included third- and final-year speech-language pathology students at the University of Pretoria (South Africa). Voice parameters were evaluated in a pre-test measurement, after which the participants provided two consecutive hours of therapy. A post-test measurement was then completed. Data analysis consisted of an instrumental analysis in which the multidimensional voice programme (MDVP) and the voice range profile (VRP) were used to measure vocal parameters and then calculate the dysphonia severity index (DSI). The GRBASI scale was used to conduct a perceptual analysis of voice quality. Data were processed using descriptive statistics to determine change in each measured parameter after service delivery. RESULTS : A change of clinical significance was observed in the acoustic and perceptual parameters of voice. CONCLUSION : Guidelines for SLPs in order to maintain optimal vocal effectiveness were suggested.http://www.sajcd.org.zaam2016Speech-Language Pathology and Audiolog

Supporting early childhood development during COVID-19 using telehealth : stakeholders’ perspectives

Timely assessment and intervention for developmental delays is a high priority in child healthcare, yet obtaining access to early developmental care services remains a challenge in low-and middle-income countries, such as South Africa, which has a shortage of healthcare professionals. The outbreak of COVID-19 in 2020 exacerbated these barriers, and alternative solutions for service delivery are needed. Telehealth holds potential as an innovative approach for the provision of early childhood developmental care services during the COVID-19 pandemic. The chapter aims to explore the feasibility of early developmental telehealth through stakeholders’ perspectives. To explore perspectives of tele-assessment, 30 caregivers of children (birth to 36 months) completed an online developmental assessment followed by an online questionnaire probing their perspectives thereof. Nineteen final-year student healthcare clinicians completed a survey on their initial experiences of tele-intervention, which was initiated mid-year during lockdown level 4. The perspectives of four caregivers and 10 student-clinicians were probed at the end of 2020 through synchronous online interviews.Almost all caregivers (96.7%, n=29) rated their overall tele-assessment experience as positive. The majority (66.7%, n=20) identified tele-assessment as a viable assessment mode; however, 53.8% (n=14) indicated that they would want face-to-face assessments to supplement tele-assessments. This suggests that families may prefer a hybrid approach to developmental assessment. Although they were initially apprehensive, caregivers and student-clinicians found tele-intervention to be a viable and positive approach to service delivery during the COVID-19 pandemic. Caregivers and student-clinicians faced similar technological challenges, but all experienced benefits from the telehealth services, including continued access to services during the pandemic. The tele-intervention framework successfully provided structure to online interventions. Telehealth, as part of the proposed hybrid service delivery model, provides caregivers access to developmental care, despite COVID-19 restrictions.http://www.journals.co.za/content/journal/healthrSpeech-Language Pathology and Audiolog

A scoping review on the use of the parents evaluation of developmental status and PEDS : developmental milestones screening tools

The Parents’ Evaluation of Developmental Status (PEDS), PEDS: Developmental Milestones (PEDS: DM) and PEDS tools (i.e., the PEDS and PEDS:DM combined for use) are parent-reported screening tools frequently used to identify young children requiring early intervention. An ideal screening tool for all contexts would be brief, inexpensive with appropriate test items and good psychometric properties. A scoping review was conducted to review studies that used the PEDS, PEDS:DM, and PEDS tools to screen for the need for further referrals and evaluation through parent report. Thirty articles, ranging from 2003 to 2020, conducted in high-income countries (HICs) and lower-middle income countries (LMICs), were included from the 1,468 records identified. Studies conducted in HICs (n = 19) included screening of special population groups and comparing validated tools. LMIC studies (n = 11) focused on translations, combination of the PEDS tools, validations of tools, and use of an app-based tool (mHealth). High referral rates were obtained with PEDS (23–41%) and PEDS:DM (12–54%) in LMICs where at-risk populations are more prevalent and cultural differences may affect tool validity. A global dearth of research on PEDS:DM and PEDS tools exist; the review highlights factors that influence the validity and impact widespread use of the screening measures, especially in diverse populations and LMICs.The Thuthuka Funding Grant from the National Research Foundation (NRF).https://journals.sagepub.com/home/JEIhj2023Speech-Language Pathology and Audiolog

Les opinions du personnel de soins de santé primaires sur le développement des interventions en troubles précoces de la communication

BACKGROUND: Early communication intervention services rendered by speech-language therapists and audiologists to families of infants and young children with feeding difficulties, hearing loss or emerging communication disorders should be implemented throughout South Africa. Early intervention can ameliorate risks, enhance development and may prevent further delays. Based on research initiated during a community-service year experience in a rural subdistrict, an incremental process of establishing accessible early communication intervention services was deemed feasible. Such a process cannot be successful if the collaboration of primary healthcare personnel and managers is not ensured. OBJECTIVES: The aim of the article was to describe the perceptions of primary healthcare personnel with regard to expansion of early communication intervention services to infants at risk of developmental delay. METHOD: A qualitative descriptive survey design was followed. Semi-structured interviews were conducted with 20 primary healthcare nurses and sisters and eight primary healthcare programme managers in Ditsobotla subdistrict in the North West province of South Africa. RESULTS: The participants indicated that by improving team work, developing training programmes and evaluating identification methods and resources, the step-by-step rollout of early communication intervention functions on four organisational levels may be a realistic goal for sustainable services in the resource-limited district. CONCLUSION: The positive perceptions and contributions by participants promise a rich human-resource basis for transdisciplinary collaboration between speech-language therapists, audiologists and primary healthcare personnel in order to reduce the burden of early communication disorders in a rural district.CONTEXTE: Les services d’intervention en troubles précoces de la communication fournis par les orthophonistes et audiologistes aux familles de nourrissons et jeunes enfants présentant des difficultés d’alimentation, une perte auditive ou des débuts de troubles de la communication devraient être mis en place dans toute l’Afrique du Sud. L’intervention précoce peut limiter les risques, améliorer le développement et contrer des retards supplémentaires. Sur la base d’un travail de recherche entrepris pendant une expérience d’un an de service communautaire dans un sous-district rural, un processus progressif d’établissement de services accessibles d’intervention en troubles précoces de la communication a été jugé faisable. Un tel processus ne peut réussir si la collaboration du personnel et des cadres de soins de santé primaires n’est pas assurée. OBJECTIFS: Le but de l’article était de décrire les opinions du personnel de soins de santé primaires quant au développement des services d’intervention en troubles précoces de la communication chez les nourrissons à risque de retard du développement. METHODE: Un modèle d’étude descriptive quantitative a été suivi. Des entretiens semi-structurés ont été conduits avec vingt infirmiers/-ières et soeurs et huit responsables de programme de soins de santé primaires dans le sous-district de Ditsobotla, dans la province sud-africaine du Nord- Ouest. RESULTATS: Les participants ont indiqué qu’en améliorant le travail d’équipe, en développant des programmes de formation et en évaluant des méthodes et ressources d’identification, le déploiement étape par étape de fonctions d’intervention en troubles précoces de la communication à quatre niveaux organisationnels pouvait être un objectif réaliste pour des services durables dans ce district aux ressources limitées. CONCLUSION: Les opinions et contributions positives des participants laissent promettre une base fournie de ressources humaines pour une collaboration transdisciplinaire entre les orthophonistes, les audiologistes et le personnel de soins de santé primaires afin de réduire le poids des troubles précoces de communication dans un district rural.http://www.phcfm.org/am201

Cleft lip and/or palate and associated risks in lower-middle-income countries : a systematic review

OBJECTIVE : To identify and review published data on the risks associated with cleft lip and/or palate (CL/P) in lower-middle-income countries (LMICs). DESIGN : A systematic review of literature was performed on electronic databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Literature on risks associated with CL/P in LMICs, from 2010 to 2020, were included. RESULTS : Seventeen studies met the inclusion criteria. All studies adopted an observational study design. Biological and environmental risks were identified. Maternal and paternal age (n = 7) and low socioeconomic status (n = 5) were the most prominently associated environmental risk factors. A strong association was identified between family history of cleft (n = 7) and CL/P occurrence. CONCLUSION : Environmental risk factors are now being investigated more than biological risk factors in LMICs, aiding health care workers in the early identification of possible cumulative effects of risks in CL/P. Contextually relevant tools are recommended to promote early identification of at-risk infants.http://journals.sagepub.com/home/cpchj2023Speech-Language Pathology and Audiolog