Читать книгу Early Detection and Intervention in Audiology - Группа авторов - Страница 9

With regard to NHS services, significant focus has been placed on UNHS as the screening approach for early identification. While this approach is commonly practised in high-income countries, with well-established, standardised programmes and dedicated screeners outside of the profession of speech-language pathology and audiology, this is not the case for sub-Saharan Africa. Chapter 2 of this book explores the status of early identification services in sub-Saharan Africa, and highlights the status of these services in South Africa against the backdrop of the broader health care challenges and priorities in the country. The establishment of NHS services in higher-income countries has allowed for a shift in focus from hearing screening to diagnostic follow-up and intervention. However, South Africa and other countries in sub-Saharan Africa still appear to be at the infancy stages of implementing NHS programmes for early identification of hearing impairment. While the HPCSA guidelines are aimed at implementing UNHS, the benchmark for early identification, they are not necessarily currently applicable in all health care sectors in South Africa (HPCSA, 2018). Furthermore, they might not be adopted by other countries in the broader sub-Saharan African context. In fact, research from these contexts consistently indicates their state of unpreparedness to implement UNHS.

Early detection of hearing impairment continues to be a challenge throughout sub-Saharan Africa, for various reasons: the health care context; the focus on other, life-threatening health care priorities that are aimed at saving lives; and the challenges with social determinants of health. It is vital to understand the current status of early identification services, and the factors influencing their implementation in order to monitor progress and suggest realistic ways forward. Chapter 2 explores early detection services in sub-Saharan Africa with reference to health and health care and the availability of audiology and otolaryngology services, which are vital for implementing NHS programmes.

Despite UNHS being the gold standard that audiologists should strive to achieve, this approach to screening may not be feasible for some LAMI countries, where contextual challenges to implementation exist. These include a shortage of personnel and equipment, as well as associated costs. Chapter 5 explores the implementation of EHDI in South Africa. The author offers suggestions for EHDI service provision in this context, including the implementation of targeted NHS (TNHS) as an intermediate national approach.

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, 2000, 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.