Читать книгу Early Detection and Intervention in Audiology - Группа авторов - Страница 11

To ensure contextually responsive practice in South Africa, clinicians and other stakeholders working in the EHDI field need to consider various complexities, including: EHDI in the context of other sensory impairments; EHDI in the context of family; EHDI in the context of HIV/AIDS; and ethical considerations for EHDI in the context of tele-audiology.

While the focus on hearing impairment and its influence on developmental outcomes, education and vocational attainment is vital, it is also important to recognise the possibility of additional sensory impairments in children with hearing deficits to ensure effective holistic assessment and management. Current studies have focused on the EHDI outcomes of children with hearing impairment only, with little to no consideration of any co-morbid conditions. This is a disservice to this cohort within a minority grouping of children. Chapter 10 explores this complexity, with a specific focus on deafblindness, and highlights the need for consideration of other co-morbid sensory impairments in the EHDI framework.

The primary member in an EI team is the family. Hence, EI programmes need to be responsive to the needs of the families of children with hearing impairment (HPCSA, 2018). The HPCSA guidelines specify that EI services following diagnosis of hearing impairment must be family-centred and tailored to cultural differences. The definitions, dynamics and compositions of families in an African context need to be considered, including their impact on health-seeking and intervention-adherence behaviours. Chapter 11 discusses family-centred EHDI in South Africa, with recognition of the cultural and linguistic aspects of a family. The chapter notes the complexities in defining family structures and functions in an African context, highlighting the influence of culture, migration and the burden of HIV/AIDS on families and thus on intervention outcomes.

Various reasons have been offered for the failure to successfully implement EHDI in South Africa. One of the most common reasons is linked to the burden of disease, specifically the HIV/AIDS pandemic. Besides the budgetary and resource burden linked to HIV/AIDS, this pandemic also results in auditory and otologic manifestations in those affected. Chapter 12 explores EHDI in the context of HIV/AIDS and highlights the implications for EHDI in this segment of the population.

Other common barriers to successful EHDI implementation include access to services and human resource shortages. These barriers have resulted in consideration of alternative models of service delivery, such as tele-audiology, to increase reach and access in resource-constrained environments. However, the core ethical aspects related to tele-audiology need to be taken into account, particularly given the lack of national regulations and guidelines. Chapter 13 looks at ethical and legal aspects and strategies to implement risk management and programme validation in the South African context.