The hearing screening experiences and practices of primary health care nurses: Indications for referral based on high-risk factors and community views about hearing loss

Abstract

BackgroundIn South Africa, primary health care is the first point of contact with the health system for at least 85% of the population, yet early hearing detection and intervention continues to be elusive in these settings. Nurses at community level may, therefore, be missing an opportunity to identify prelingual infants with hearing losses and alter their developmental trajectory.AimTo determine primary health care nurses’ experiences, practices and beliefs regarding hearing loss in infants.SettingThe study was conducted in the eThekwini District of KwaZulu-Natal, South Africa.MethodsA descriptive survey was used with quantitative methods of analysis. Fourteen primary health care clinics from the eThekwini district were selected, from which 75 nurses participated by completing a self-administered questionnaire.ResultsAt least one-third of primary health care nurses had never screened a child for hearing loss, and most clinics did not have access to basic hearing screening equipment or materials. Only 49% of nurses had access to an otoscope, while 31% used the Road to Health Development screener to check for hearing loss. None of the clinics had access to an otoacoustic emission screener nor the Swart questionnaire. Although nurses reported that they would refer to audiology services for some of the risk factors, as indicated on the Joint Committee on Infant Hearing (JCIH) 2007 list, they were less likely to refer if the child was in a neonatal intensive care unit (ICU) longer than five days, had neurodegenerative disorders, meningitis, hyperbilirubinaemia requiring blood transfusion or were undergoing chemotherapy. Less than a third of nurses always referred if the child displayed additional non-JCIH risk factors or those pertinent to the South African context. Approximately 38% reported that communities believed that hearing loss could be because of some form of spiritual or supernatural causes.ConclusionThis study demonstrates that hearing screening and referral practices at primary health care clinics need to be strengthened. Nurses need to be capacitated to conduct basic screening, make necessary referrals, provide information to caregivers and understand community beliefs about hearing loss in order to counsel caregivers appropriately and facilitate the process of early hearing detection and intervention.

Newborn and infant hearing screening at primary healthcare clinics in South Africa designated as National Health Insurance pilot sites: An exploratory study

“…As discussed previously, PHC facilities have been proposed as a platform for NIHS (HPCSA, 2007(HPCSA, , 2018Swanepoel et al, 2006) (Khan, Joseph, & Adhikari, 2018). This suggests the lack of, and an under-preparedness for, formalised NIHS at PHC facilities in South Africa, which may be attributed to the reported human resource and budgetary constraints.…”

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

“…Despite a lack of formal infant screening programmes at clinics, nurses at primary level must at least be able to refer children presenting with high-risk factors for hearing loss. However, a recent study in KwaZulu-Natal, SA, found that primary-care nurses generally refer patients only for risk factors such as otitis media, family history of hearing loss, syndromes and craniofacial anomalies; [21] admission to the neonatal intensive care unit for more than 5 days, hyperbilirubinaemia requiring blood transfusion, meningitis, a low Apgar score, low birthweight, birth asphyxia and exposure to HIV were generally not considered risk factors that warranted referral. [21] For the current study, the risk factors for hearing loss were categorised according to the list of Joint Committee on Infant Hearing (JCIH) risk factors, emerging risks from other developing contexts, known non-JCIH risk factors and risks pertinent to the SA context.…”

Evaluation de la prise en charge intégrée de l’otite moyenne chronique dans le système des soins de santé primaires à Kinshasa, République Démocratique du Congo

“…Dans les pays développés, l'introduction des services de soins primaires visant l'OMC aux populations à haut risque a pu réduire la prévalence de cette affection et de la mastoïdite (7). Dans le reste du monde, Young et al (8) au Népal en 2011, Mulwafu et al (9) en 2017 au Malawi ainsi que Khan et al (10) en 2018 en Afrique du sud ; ont montré l'efficacité des agents communautaires et des infirmiers, dans la prise en charge précoce des maladies de l'oreille et de l'audition dans leurs pays. La RDC, à l'instar des autres pays du continent, a sur le plan sanitaire, adhéré en 1980 à la charte d'Alma Ata et a adopté la stratégie de soins de santé primaires en vue de favoriser l'accessibilité géographique, culturelle et financière des populations, ainsi que l'équité dans la dispensation des soins (11).…”