Healthcare practitioners’ views about early hearing detection and intervention practices in KwaZulu‑Natal, South Africa

Hearing loss is the most commonly occurring congenital disability in developing countries and is referred to as a silent epidemic owing to its invisible nature. [1,2] This hinders detection through routine clinical procedures such as well-baby immunisation checks. [1,2] Research suggests that infants with hearing impairment who receive intervention in the first 6 months of their lives, as opposed to those in whom hearing impairment is identified later, are more likely to have speech, linguistic and cognitive development similar to normal-hearing peers. [3] The adverse effects of late detection, such as delayed speech, language and academic development, are extensively reported and contrast with the established benefits of early hearing detection and intervention (EHDI) programmes. [3,4] The aim of an EHDI programme is to identify hearing impairment in infants and provide appropriate early intervention. Early detection and intervention practices begin with newborn hearing screening (NHS), which involves screening an infant either before discharge from hospital or before the age of 3 months at a clinic visit, preferably by means of objective tests such as automated auditory brainstem response (AABR) or otoacoustic emissions (OAE). [5] The importance of EHDI services has increasingly been recognised over the years, resulting in more funding being allocated – mainly in developed countries but also in some developing countries – to reach an increasing number of affected children. Although the EHDI principles are contextually straightforward, the process of screening, diagnosis and intervention is complex. [6] An EHDI programme provides a continuum of care, with a multidisciplinary team of healthcare professionals working together to implement a comprehensive programme that includes NHS, diagnosis, family-centred care and early intervention. [2,3,5,7-9] This team should include family members, audiologists, speech–language therapists, paediatricians, ear, nose and throat (ENT) specialists, nurses and community workers. [10,11] Efforts to implement EHDI programmes should involve engaging professionals in the field,[4,12] as the lack of cohesive teamwork is one of the factors that can hamper effective implementation. [13] Timely intervention and high-quality service are needed for infants to realise their full potential[8] and each healthcare professional in the team has an independent yet cohesive role in managing affected children and providing support to them and their families. [13] Audiologists are trained to detect, diagnose and intervene in such circumstances and are a source of information for parents. [13] ENT specialists have knowledge of ear anatomy, auditory physiology and pathophysiology of hearing loss and can treat childhood hearing conditions, perform surgery and work with audiologists, particularly when a patient needs medical clearance for amplification, an auditory prosthesis or a cochlear implant. [14] Speech– language therapists assist with aural rehabilitation in children with hearing loss, including varied communication options, educational placement and regular communication intervention. [6,8] As all the team members have an integral role in an EHDI programme, their views and opinions about the process are important to shape its implementation. Their opinions and professional input Background. Healthcare practitioners’ views, understanding of and support for early hearing detection and intervention (EHDI) is essential for its effective implementation Objectives. To determine public healthcare practitioners’ views about EHDI at primary healthcare level based on primary-care nurse’s awareness and referral practices related to high-risk factors for hearing loss and the challenges with EHDI implementation. Methods. A customised questionnaire (α=0.71) was used to survey a sample (N=38) of relevant healthcare practitioners, including audiologists, speech therapists and ear, nose and throat (ENT) specialists from 11 purposively selected hospitals in KwaZulu-Natal, South Africa (SA). Results. Practitioners had a positive view towards hearing screening being mandatory and that it should form part of the birth package offered to mothers. Approximately 58% of participants agreed that the list of high-risk factors issued by the Joint Committee on Infant Hearing (JCIH) is relevant in the SA context and 50% agreed that infants with hearing loss globally present with similar high-risk factors. Approximately 21% of the participants disagreed with this, suggesting that the risk factors differ among populations. Only 45% of participants considered primary-care nurses to be aware of high-risk factors for hearing loss. Most were thus unlikely to refer infants for further hearing testing. Conclusion. Poor awareness, lack of infrastructure for screening and limited resources necessitate further education and training for nurses on risk factors and resource availability at the primary healthcare level is crucial, considering that the majority of South Africans access services at this level of care.