Early Detection and Intervention in Audiology

Abstract

Early hearing detection and intervention (EHDI) has been extensively researched internationally, with a significant focus on the efficacy of implementing early identification through universal newborn hearing screening (UNHS) programmes (Kanji, 2016).However, most of this research has been conducted in high-income countries, and is not easily generalisable to low and middle-income (LAMI) contexts such as Africa, which differ in terms of populations, resources (human, equipment), health priorities, the burden of disease, as well as the neonatal protocols adopted.These differences require African countries to carefully consider context in EHDI programme implementation in order to ensure best practice that is contextually relevant and responsive.We thus call for a paradigm shift in EHDI initiatives within the African context.This chapter offers an introduction to such initiatives in South Africa, detailing the rationale for their value and relevance in this context.We outline approaches to EHDI, factors that influence its implementation, the positioning of these factors in the various levels of service delivery in the South African health care context, as well as continuity of care of the hearing impaired within the educational setting.Also addressed are the complexities surrounding EHDI implementation in South Africa, including EHDI in the context of other sensory impairments, in the context of the family, in the context of HIV/AIDS and in the context of tele-audiology.The goal is to recommend a paradigm shift for best/next practice for children at risk of, or with confirmed hearing impairment.EHDI encompasses the earliest possible identification, diagnosis and provision of intervention for newborns and infants with hearing impairment in order to enable them to develop to their maximum potential and communicate effectively.This approach supports their individual needs as well as their later involvement in society and the country's economy (Health Professions Council of South Africa [HPCSA], 2007).The implementation of EHDI has been clearly associated with positive developmental outcomes, including communication (Fulcher, Purcell, Baker, & Munro, 2012; Kennedy et al., 2006;Sininger, Grimes, & Christensen, 2010).These outcomes have been specifically Amisha Kanji and Katijah Khoza-ShangaseA Paradigm Shift in Early Hearing Detection and Intervention in South Africa 1 4 Section One: Early Detection of Hearing Impairment recorded in high-income countries where EHDI programmes, particularly early identification programmes, are well established.EHDI arguably falls within the broader focus area of early childhood intervention (ECI), particularly as ECI programmes encompass a range of specialised services extending from service planning, rehabilitation and family-centred support to special education.Previous definitions of early intervention (EI) define ECI as the early identification and management of children from birth to three years of age (Rossetti, 2001).However, this definition has evolved, with the Consultative Group on Early Childhood Care and Development (2012) specifying early childhood as the period from prenatal development to eight years of age.The South African National Integrated Early Childhood Development Policy refers to the provision of early childhood development (ECD) services, and defines this period from conception until the year before children enter formal schooling.In the case of children with developmental difficulties and disabilities, this period is defined as the year before the calendar year they turn seven, as this is the age of enrolment in compulsory schooling or special education (Republic of South Africa, 2015).To position this book within the African context, the definition we adopt falls within the ECI programmatic outlook, and stretches to the elementary, basic education age.EHDI remains a significant need for Africa, given the global prevalence and incidence of childhood hearing impairment.Recent estimates indicate that globally, 34 million (7 percent) of the 466 million individuals with disabling hearing impairment are children, of whom 7.5 million are below five years of age (Neumann, Chadha, Tavartkiladze, Bu, & White, 2019).Within these global estimates, prevalence rates have been reported to be higher in LAMI countries, specifically in South Asia, sub-Saharan Africa and the Asia Pacific regions.LAMI countries comprise 80 percent of the world's population, and are home to two-thirds of individuals with hearing impairment (Tucci, Merson, & Wilson, 2010).These prevalence and incidence rates are further exacerbated by the health care realities in LAMI countries, such as the burden of disease and poor social determinants of health, which place individuals at greater risk for hearing impairment.The health care systems, as well as linguistic, cultural and socioeconomic diversity in the sub-Saharan African context, present a unique setting for knowledge generation in terms of research, as well as academic and clinical teaching and practice in this field.Published evidence has acknowledged the impracticalities of attempting to implement developed world models for EHDI in LAMI countries such as South Africa (Moodley & Störbeck, 2015; Swanepoel, Delport, & Swart, 2004;Swanepoel, Hugo, & Louw, 2005).While research findings from high-income countries may be of value, it is vital to acknowledge that outcome-based recommendations Section One: Early Detection of Hearing Impairment Kanji (2018) asserts that all programmes need to have a starting point and go through their infancy stages and that doing something is better than doing nothing at all, particularly in contexts plagued by a lack of sufficient resources.NHS of high-risk neonates or infants through TNHS or risk-based programmes is a possible interim approach in such contexts.Chapter 3 discusses the feasibility of UNHS and TNHS as early identification methods in South Africa.Should TNHS be the choice of approach, careful deliberation of the risk registry is required to assist in identifying children who need audiological screening and assessment.This is important in order to identify those requiring audiological or medical surveillance and to address the preventable risks associated with hearing impairment (JCIH, 2000; Kanji & Khoza-Shangase, 2018; Núñez-Batalla, Trinidad-Ramos, Sequí-Canet, De Aguilar, & Jáudenes-Casaubón, 2012; Olusanya, 2009).While risk registries in high-income countries are mainly used to identify children at risk for postnatal hearing loss and those in need of audiological monitoring and surveillance, they are useful tools in countries such as South Africa where a universal platform for NHS has not been established.The current high-risk registries have been compiled and revised by the Joint Committee on Infant Hearing (JCIH), based on evidence from developed world contexts (JCIH, 1982(JCIH, , 2000(JCIH, , 2007)).The HPCSA has adapted these for the South African context (HPCSA, 2018).However, findings from international studies as well as some South African studies have indicated the need to continuously re-evaluate both the JCIH and the HPCSA risk registries and tailor them to the context (Beswick, Driscoll, & Kei, 2012; Beswick, Driscoll, Kei, Khan, & Glennon, 2013;Kanji & Khoza-Shangase, 2012).Chapter 6 reviews the key risk factors for hearing impairment used globally and evaluates their relevance to the South African context.'Considering the realities of the South African healthcare context, and given that EHDI is vital for newborns and infants with hearing loss, we need to seriously consider how NHS services may be adapted to better meet these realities' (Kanji, 2018, p. 2).Following identification and diagnosis of hearing impairment, EI services need to be similarly evaluated and adapted to the realities of access to and availability of such services, as well as to the unique challenges that present within each of the relevant service delivery contexts. Early intervention for hearing impairmentDiagnosed hearing impairment without adequate intervention may have long-term consequences for the affected individual.Besides affecting communication abilities, it can influence vocational performance and result in Section One: Early Detection of Hearing Impairment post-2015 development framework.

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