The Infant Hearing Screening Programme and Early Intervention Services at Chris Hani Baragwanath Hos

1
The Infant Hearing Screening Programme and Early
Intervention Services at Chris Hani Baragwanath
Hospital

• Presented by
• Aisha Casoojee
• Dani Schlesinger

2
CHRIS HANI BARAGWANATH HOSPITAL

• Provincial and National referral base
• Academic hospital (Tertiary level services)
• Developing context and currently services Soweto
  (over 4 million people) and surrounding areas.
• 2006 2888 beds and 21 988 births.

3
NATIONAL HEALTH POLICIES

• National Health Plan RDP
• Free Healthcare Policy
• Patients Rights Charter
• Batho Pele Principles

4
DEPARTMENT OF SPEECH THERAPY AUDIOLOGY

• Mission statement
• The speech therapy and audiology department has
  developed a vision and mission of commitment to
  service excellence by facilitating improved
  quality of life, promoting capacity building and
  advocating human rights.

5

• CHALLENGES
• Late identification
• Incongruent ratio of staff to patient numbers
• Limitations of initial test battery
• Lack of awareness
• Limited access to equipment
• HIV/AIDS

6

• Patient demographics
• Low educational level
• Both parents unemployed
• Single parent homes
• Lack of social support
• Inadequate housing
• Inadequate access to health care
• Limited prenatal care
• Attitudes towards disability

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• CHBH
• Severe pre / peri natal complications
• Neurological disorders
• Asphyxia
• Prematurity
• LBW
• SGA
• FTT
• FAS
• Poor self regulation
• HIV
• COM

• Joint Committee of Infant Hearing Screening
• High risk register
• Family hx of childhood SNHL
• In utero infections (e.g STORCH)
• Craniofacial anomalies
• Birth weight lt 1500g
• Hyperbilirubinemia requiring exchange
  transfusions
• Ototoxic medications
• Bacterial infections
• Postnatal asphyxia
• Mechanical ventilation gt 5 days
• Stigmata or other findings ass. with a syndrome
  known to incl. hearing loss

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SOLUTION

• Improve access to babies with high risk factors
• Ward 66
• Ward 40
• Neonatal Follow-Up Clinic (NNFU)
• Motivated for equipment to comply
• with international standards for neonate
  hearing screening
• Dedicated slots and audiologists

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CURRENT PROTOCOLS

• Approach Targeted Newborn Hearing Screening
  (South Africas screening position statement)
• Test Battery
• Otoscopy, High Frequency Tympanometry, DPOAEs,
• Automated ABR
• Staff capacity 2 audiologists daily
• 1 allocated hour for screening

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FLOW OF INPATIENT AUDIO SERVICES

• Screening PASS Annual
  Recheck
• FAIL NNFU
• Recheck
• Diagnostic Audiology
• (electrophysiology / behavioural)

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Impact of new protocol on service delivery
January August 2007

• 115 babies
• Less referrals to diagnostics
• Waiting times
• Budget
• Early intervention
• Fewer visits
• Earlier confirmation of diagnosis

12
TRENDS

• Most prevalent NEONATAL CONDITIONS amongst the
  115 babies screened

13

• Average Age in months

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HIV/Aids

• Status has later medical implications, therefore
  we have to counsel parents about chronic risk
  factors in relation to hearing loss and middle
  ear pathologies

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Aural (Re)habilitation

• Hearing aid fitting
• Audiotherapy
• Sign language group
• Multiple disabilities
• Middle ear stimulation group
• HI HOPES

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Way forward

• Everyday you may make progress. Every step may
  be fruitful. You know you will never get to the
  end of your journey.
• But this, far from discouraging, only adds to the
  joy and glory of the climb.
• Sir Winston Churchill

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• COMMENTS
• OR QUESTIONS