Research Articles (Speech-Language Pathology and Audiology)

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A perspective on auditory wellness : what it is, why it is important, and how it can be managed
(Sage, 2024) Humes, Larry E.; Dhar, Sumitrajit; Manchaiah, Vinaya; Sharma, Anu; Chisolm, Theresa H.; Arnold, Michelle L.; Sanchez, Victoria A.
During the last decade, there has been a move towards consumer-centric hearing healthcare. This is a direct result of technological advancements (e.g., merger of consumer grade hearing aids with consumer grade earphones creating a wide range of hearing devices) as well as policy changes (e.g., the U.S. Food and Drug Administration creating a new over-the-counter [OTC] hearing aid category). In addition to various direct-to-consumer (DTC) hearing devices available on the market, there are also several validated tools for the self-assessment of auditory function and the detection of ear disease, as well as tools for education about hearing loss, hearing devices, and communication strategies. Further, all can be made easily available to a wide range of people. This perspective provides a framework and identifies tools to improve and maintain optimal auditory wellness across the adult life course. A broadly available and accessible set of tools that can be made available on a digital platform to aid adults in the assessment and as needed, the improvement, of auditory wellness is discussed.
Is there incremental benefit with incremental hearing device technology for adults with hearing loss?
(MDPI, 2025-06) Manchaiah, Vinaya; Dhar, Sumit; Humes, Larry; Sharma, Anu; Taylor, Brian; Swanepoel, De Wet
OBJECTIVE : This paper reviews the current research on hearing device technology, outlines key challenges, and identifies priorities for future investigation. METHOD : This paper presents an informal narrative review of the current literature on hearing technology, supplemented by expert insights to identify key challenges and future directions. RESULTS : The proliferation of direct-to-consumer (DTC) hearing devices with varied features and prices underscores the need to assess whether advanced technologies offer meaningful improvements. Understanding these incremental benefits is critical for determining the minimum technology required for optimal outcomes. The paper highlights the limitations in current clinical trials, which often suffer from selection bias, and the inadequacies of existing hearing aid outcome measures that may not capture real-life benefits. It emphasizes the need for real-world evidence and the development of assessment tools that better reflect everyday experiences. While existing research provides some insights into the potential benefits of incremental advances in hearing device technology, the evidence remains inconclusive. CONCLUSIONS : Addressing the cost, accessibility, and technological diversity of hearing devices is crucial to advancing hearing healthcare. Future research should prioritize the development of affordable, high-quality devices and establish comprehensive outcome measures that capture real-world benefits. A deeper understanding of these factors can lead to more accessible and effective hearing care, ultimately improving quality of life for individuals with hearing loss.
How much should consumers with mild to moderate hearing loss spend on hearing devices?
(MDPI, 2025-06) Manchaiah, Vinaya; Taddei, Steve; Bailey, Abram; Swanepoel, De Wet; Rodrigo, Hansapani; Sabin, Andrew
BACKGROUND: This study examined the relationship between hearing device price and sound quality. METHOD : A novel consumer-centric metric of sound quality (“SoundScore”) was used to assess hearing devices’ audio performance. Each hearing device is tested with two fittings. The “Initial Fit” is designed to approximate the most likely fitting for an individual with a mild-to-moderate sloping sensorineural hearing loss. The “Tuned Fit” includes adjusting parameters optimized to hit prescriptive fitting targets (NAL NL2) on an acoustic manikin. Each fitting is evaluated across five dimensions. Both fittings are combined using a weighted average to create a single number from 0 to 5 representative of a device’s overall audio performance. Seventy-one hearing devices were tested. RESULTS : A strong positive correlation was found between hearing device price and SoundScore. The average SoundScore increased dramatically as the price approached USD 1000, with marginal improvements beyond this point. SoundScore was consistently poor for devices under USD 500, highly variable between USD 500–1000, and consistently good over USD 1000. CONCLUSIONS : There is a strong but nonlinear relationship between hearing device price and sound quality. This information can aid consumers in making informed decisions while also assisting hearing healthcare professionals in providing comprehensive guidance to their patients.
Hearing aid verification : practices and perceptions of South African audiologists
(AOSIS, 2024-12) Moll, Jared; Burger, Zani; Jacobs, Daneel M.P.; Mothibe, Retshepisitswe P.; Swanepoel, De Wet; Mahomed-Asmail, Faheema; faheema.mahomed@up.ac.za
BACKGROUND : Hearing aid verification is required to objectively measure hearing aid outputs by ensuring that the amplified speech spectrum closely approximates the prescription goals. OBJECTIVES : This study aimed to determine audiologists’ perceptions and practices regarding hearing aid verification and identify facilitators and barriers to its use. METHOD : A cross-sectional national e-survey included questions related to demographics, perceptions of verification, verification practices and two open-ended questions regarding the facilitators and barriers to conducting hearing aid verification in South Africa. RESULTS : Seventy-eight South African audiologists, with experience ranging from less than a year to 34 years, completed the online survey. Of these, 76.3% conduct hearing aid verification, while 23.7% seldom or never perform this verification. Among the audiologists who conducted verification, 81.0% reported performing it on both adults and children. More than three-quarters (86.6%) indicated that they conduct verification only during the initial fitting, while half (53.8%) do so only when a problem arises. Thematic analysis revealed the following barriers to verification: improper equipment, a lack of equipment, non-standard clinical practices and time constraints. CONCLUSION : There are several challenges faced by South African audiologists in performing verification. It may be feasible to address these barriers by raising awareness about the value of verification, offering training, and advocating for the purchase and utilisation of verification equipment. CONTRIBUTION : This study’s findings provide information on the current practices of hearing aid verification in a socioeconomically diverse setting. Furthermore, it highlights important challenges such as a lack of equipment as well as time constraints.
Self-perception and clinical presentation of eating and swallowing difficulties within elderly care
(AOSIS, 2025-03) Bell, Caitlin Shauna; Kruger, Esedra; Vermeulen, Rouxjeanne; Masenge, Andries; Pillay, Bhavani S.; bhavani.pillay@up.ac.za
BACKGROUND : The growing ageing population requires effective management of complex medical diagnoses and healthy ageing support within residential care facilities. However, limited access to guidelines on monitoring residents’ eating and swallowing abilities has been reported. Recent research is critical for future policy development. OBJECTIVES : This study aimed to compare self-perceived and clinical presentation of eating and swallowing abilities among a portion of elderly residents to enhance management of the residential care population within the South African context. METHOD : This comparative, within-subject research study assessed 44 participants using an oropharyngeal dysphagia protocol including a medical history review, the Eating Assessment Tool – 10 (EAT-10), the Mann Assessment of Swallowing Abilities (MASA), and the three-ounce water test of the Yale Swallow Protocol (YSP). A brief cognitive screener was used when cognitive impairment was unknown. RESULTS : Of the participants, 21 out of 44 (48%) self-reported concerns for oropharyngeal dysphagia. Evidence of compensatory eating behaviours, without therapeutic intervention, was found. A negative, low correlation was present between the EAT-10 and the MASA (r = -0.306, p < 0.05) scores. CONCLUSION : Individuals who self-reported eating and swallowing difficulties demonstrated fewer clinical symptoms, potentially due to compensatory techniques. The disparity between patient-reported outcome measures and clinical assessment tools highlights the need for robust screening and assessment policies within this context. CONTRIBUTION : This study highlights the importance of holistic assessment practices by integrating self-perception with clinical findings to address oropharyngeal dysphagia incidence within this complex population.
How I experienced tele-intervention : qualitative insights from persons who stutter
(AOSIS, 2025-01) Hoosain, Raadhiyah; Abdoola, Shabnam Salim; Kruger, Esedra; Pillay, Bhavani S.
BACKFROUND : Tele-intervention gained popularity, during the coronavirus disease 2019 (COVID-19) pandemic, prompting healthcare providers to adapt to remote service delivery. Research about stuttering treatment via tele-intervention in South Africa is limited. Speech-language therapists (SLTs) require further insights to deliver a well-supported approach for treatment of stuttering using tele-intervention, despite limitations such as technological disruptions, including loadshedding, that impact service reliability. OBJECTIVES : The study aims to explore clients’ experiences with tele-intervention for stuttering therapy, and to provide recommendations to improve service delivery. METHOD : Semi-structured interviews were conducted with 11 persons who stutter (PWS) recruited through purposive sampling. Written informed consent was obtained from all participants with experience in both tele-intervention and in-person treatment. Inductive thematic analysis supplemented by descriptive statistics was used to identify patterns and trends. RESULTS : Four main themes emerged: (1) User experiences and factors shaping perceptions of tele-intervention; (2) technical infrastructure: barriers and facilitators; (3) financial and access considerations and (4) in-person treatment experience compared to tele-intervention user experience. Likert scale ratings indicated no considerable difference in preferences between tele-intervention and in-person treatment. CONCLUSION : Participants’ diverse experiences highlighted tele-intervention’s benefits and challenges for stuttering therapy. While limitations exist, findings inform service enhancement in South Africa, emphasising the importance of users’ perspectives in tele-intervention design. CONTRIBUTION : Insights from PWS can be used in informing clinical practice, aiding SLTs in meeting the needs of PWS and guiding best practice. Tele-intervention should be integrated into a hybrid intervention model that PWS prefer.
A qualitative inquiry of speech-language therapists’ views about breastfeeding management
(AOSIS, 2025-01) Schlome, Danica; Kruger, Esedra; Pillay, Bhavani S.; esedra.kruger@up.ac.za
BACKGROUND : Management of oropharyngeal dysphagia within the first few days of an infant’s life results in favourable breastfeeding outcomes, indicating the importance of investigating the breastfeeding management practices of speech-language therapists (SLTs) working within this field. OBJECTIVES : Little has been published about SLTs’ management of breastfeeding in low- and middle-income settings. This study explores the perspectives of a group of experienced South African SLTs on their approach to breastfeeding management. METHOD : Qualitative data were gathered through semi-structured online interviews with 12 experienced SLTs and were subjected to thematic analysis. RESULTS : Three main themes emerged: (1) Approach to breastfeeding management; (2) Exposure, skills and knowledge related to breastfeeding management and (3) Perspectives and attitudes towards breastfeeding management. Participants demonstrated a clear understanding of their roles within the scope of breastfeeding management, which aligns with established literature. Their approaches appeared to be influenced by their perspectives and attitudes towards breastfeeding, as well as their exposure, skills and knowledge in this area. The study underscores the need for breastfeeding training in undergraduate programmes and highlights the demand for continuous professional development opportunities. CONCLUSION : While the findings are drawn from a small sample of experienced clinicians, they offer valuable insights for speech-language pathology clinical educators and professional organisations. CONTRIBUTION : This study suggests a re-evaluation of university curricula to enhance exposure to breastfeeding management.
Swallowing and oral-sensorimotor characteristics in a sample of young hospitalised children with severe acute malnutrition
(Wiley, 2025-05) Eslick, Casey Jane; Kritzinger, Alta M. (Aletta Margaretha; Graham, Marien Al; Kruger, Esedra
AIM : To describe swallowing and oral-sensorimotor characteristics in a sample of young hospitalised children with severe acute malnutrition (SAM). METHODS : The Schedule of Oral-motor Assessment was used to compare oral-sensorimotor skills of 45 hospitalised patients with SAM (M = 15.98 months; SD = 8.03), to pairwise-matched controls (M = 15.96 months; SD = 8.08). Participants were matched for age, gender, TB, HIV-status, socio-economic status including maternal education, paternal employment, housing and transport access. Caregivers reported demographic information, feeding practices and behaviours during feeding. RESULTS : In comparison to controls (n = 6; 13.3%), participants with SAM (n = 25; 55.6%) presented with significantly more oral-sensorimotor difficulties (p < 0.001), across all consistencies except liquids from the trainer cup and bottle. Difficulties included jaw opening and stabilisation, tongue and lip control for chewing, bolus formation and transport, sustained bite and uncoordinated swallowing. Delayed sitting development significantly correlated with uncoordinated swallowing and head extension on puree and cup drinking, and multiple swallows on puree and semi-solids. Force-feeding and slow swallow initiation in semi-solids significantly correlated. Disruptive feeding behaviours and higher levels of food refusal at the beginning of meals were reported. Clinical signs of aspiration were identified. CONCLUSIONS : Oral-sensorimotor dysfunction and possible aspiration were observed in 55.6% of participants with SAM. Safe swallowing function for overall health and nutritional recovery is emphasised. Under-identification of oral-sensorimotor difficulties, lack of referral to speech-language therapists and disruption to continuity of care warrants further research.
International Consortium on Ageing-Related Pathologies (ICCARP) Audiovestibular Group : fostering international consensus to refine International Classification of Diseases (ICD-11) codes for hearing loss across the life course
(Springer, 2025) Tsimpida, Dialechti; Akeroyd, Michael A.; Bentley, Barry L.; Bhattacharjee, Shuvarthi; Bowl, Michael R.; Broome, Emma; Calimport, Stuart R.G.; Calvert, Sian; Christopher, Gary; Dening, Tom; Di Bonaventura, Silvia; Goswami, Ankita; Gougousis, Spyridon; Govaerts, Paul J.; Gupta, Mini; Henshaw, Helen; Huckstepp, Robert T.R.; Iliadou, Vasiliki Maria; Koutsimani, Theano K.; Lewis, Morag A.; Lin, Frank R.; Miotto, Cecilia Luisa; Nolan, Lisa S.; Nuttall, Helen E.; Onyekere, Chukwuebuka Prince; Phanguphangu, Mukovhe; Plack, Christopher J.; Raghavan, Ramasamy S.; Reed, Nicholas S.; Rova, Konstantina; Steel, Karen P.; Stokroos, Robert J.; Swanepoel, De Wet; Szczepek, Agnieszka J.; Whitney, Susan L.
Following the World Health Organization’s (WHO’s) decision to classify age-related aetiologies, and a global call for action to systematically classify the pathologies of ageing, the International Consortium to Classify Ageing-Related Pathologies (ICCARP) was established in 2023 under the leadership of Cardiff Metropolitan University. Within this consortium, the Audiovestibular Group is actively working to refine the classification of hearing and balance disorders, aligning with the WHO’s commitment to enhance diagnostic frameworks. This effort coincided with the release of the 2025 edition of the International Classification of Diseases 11th Revision (ICD-11) on 14th February 2025.
Dysfluencies in a multilingual speaker : a case study
(Universidad de Castilla la Mancha, 2025-02) Nel, Talitha; Geertsema, Salome; Le Roux, Mia; Graham, Marien Alet; Abdoola, Shabnam Salim
Research involving a multilingual person who clutters and stutters in Bantu languages is limited. Our aim was to describe the dysfluencies of a multilingual person with dysfluencies across and within Sepedi, Afrikaans, and South African English (SAE). A single multilingual adult participant with a persistent mild stuttering and moderate cluttering pattern participated. A mixed-method cross-sectional design was implemented. Perceptual analysis was used to study stuttering-like dysfluencies (SLD) and cluttering-like dysfluencies (CLD) across and within the three languages. The results revealed that the most prevalent SLD in all three languages was the repetition of part words. The repetition of whole words was the most prevalent CLD. The plosive /d/ sound represented the highest occurrence and resulted in repetitions of sounds across and within Afrikaans and SAE. There were no repetitions of sounds in Sepedi, but three repetitions of the syllable /se-/ occurred. Future research is recommended to include a bigger sample size, and other Bantu languages should also be considered.
A cross-sectional study of how high-frequency hearing loss impacts cognitive functions in middle-aged-to-older adults
(Frontiers Media, 2025-04) Jayakody, Dona M.P.; Mcilhiney, Paul; Stegeman, Inge; Eikelboom, Robert H.
PURPOSE : Research on the association between hearing loss and cognition has primarily focused on speech-range hearing frequencies (i.e., 0.5–4 kHz), as these frequencies are most relevant to everyday functioning. However, age-related hearing loss (ARHL) tends to impact higher-frequency hearing first, and more severely. Despite this, limited research has investigated the relationship between high-frequency (i.e., >4 kHz) hearing loss and cognitive impairment. In the current study, we aimed to assess whether high-frequency hearing loss predicts non-verbal cognitive functions (i.e., visuospatial executive function, learning, and memory tasks) above and beyond speech-frequency hearing loss. MATERIALS AND METHODS : Participants were 241 English-speaking adults, aged 40–88 years, with hearing loss. Audiometrically assessed better-ear, speech-frequency (0.5, 1, 2 & 4 kHz; BE4PTA) and high-frequency (6 & 8 kHz; BE2PTA) hearing loss were compared to cognitive functions measured using non-verbal tests from the Cambridge Neuropsychological Test Automated Battery; covariates included hearing-loss asymmetry, age, sex, premorbid IQ, and mental health measured with the short-form Depression Anxiety Stress Scales. RESULTS : While correlation analyses demonstrated that all measured cognitive faculties were associated with both BE4PTA and BE2PTA, hierarchical linear regression analyses demonstrated that only BE4PTA predicted cognitive flexibility and working-memory ability after controlling for covariates; age primarily accounted for BE2PTA’s cognitive effects. CONCLUSION : While both speech and higher-frequency hearing loss were associated with poorer cognition, only the former demonstrated effects beyond those of ageing. However, the present study only investigated two frequencies in the higher range, encouraging broader investigation of higher-frequency hearing’s cognitive effects in the future.
Speech-language therapists' views of oral feeding of infants on high-flow oxygen
(AOSIS, 2025-02) Dludla, Andile; Forman, Tarryn B.; Lloyd, Mikaela K.; Moodley, Savannah O.; Pillay, Sarveshvari B.; Kruger, Esedra; esedra.kruger@up.ac.za
BACKGROUND : Introduction of oral feeding for young children receiving high-flow oxygen has recently gained interest. With limited literature, there are varied opinions regarding the safety of oral feeding in this population. AIM : This study describes speech-language therapists’ (SLTs) views on oral feeding for infants receiving high-flow oxygen. SETTING : A South African online survey study. METHODS : A descriptive quantitative survey was distributed electronically via social networking sites. Purposive and snowball sampling were used to recruit expert SLTs. Twenty-one South African SLTs working with paediatric swallowing and feeding, from nine provinces responded. Data were analysed descriptively. RESULTS : Of 21 responses, only nine were fully complete, indicative of how few South African SLTs work with infants on high-flow oxygen. Current oral feeding practices varied with differences between nasal continuous positive airway pressure (nCPAP) and high-flow nasal cannula (HFNC). Strategies for oral feeding included volume and time limitations, monitoring physiological stability and assessing for aspiration. Thin liquids were most commonly used. Varied opinions, with no protocols or guidelines for introduction of oral feeding of young children on high-flow oxygen, are reported. CONCLUSION : SLTs’ practices regarding oral feeding in infants/children receiving high-flow oxygen are variable. Professionals share common approaches to determine feeding readiness and monitor tolerance. Without guidelines and standardised protocols, SLTs are left to make decisions based only on experience. A need exists for further research. CONTRIBUTION : There is variability in initiation of oral feeds, highlighting the need for further data to inform uniform protocol and guideline development to enhance SLTs’ decision-making.
Dizziness and imbalance and their association with general and mental health in a community-based cross-sectional study of middle-aged individuals : the Busselton healthy ageing study
(BioMed Central, 2025-04) Smit, Adriana L.; Eikelboom, Robert H.; Bucks, Romola S.; Atlas, Marcus D.; Hunter, Michael; Stegeman, Inge
BACKGROUND : Dizziness and imbalance are common symptoms among patients visiting healthcare providers. Current knowledge about their prevalence, impact on daily life, and associated factors is primarily based on selected samples from individuals seeking medical help, particularly older individuals. This study aimed to estimate the prevalence, symptoms, and impact of dizziness or imbalance symptoms, and to assess the association between these symptoms and their characteristics with demographic, general health, and mental health factors in middle-aged men and women from a representative, general population sample. METHODS : Cross-sectional data were collected from participants aged 45 to 70 years in the Busselton Healthy Ageing Study (BHAS), recruited in the City of Busselton, Western Australia. The data included physical tests and health-related questionnaires covering demographics, medical history, general and mental health, including any dizziness and imbalance symptoms and their impact on daily life. Estimates were made of the prevalence, patterns, and impact of dizziness and imbalance symptoms. Logistic regression was employed to calculate the association between demographic, mental and general health (independent variables) and the presence of dizziness or imbalance symptoms (dependent variable). Adjustments were made for sex and age as confounding factors. RESULTS : Of the 5086 participants, 1216 (23.9%) reported imbalance or dizziness, with light-headedness the most common type (64.3%; 782 of 1216). For nearly half (565; 46.5%) the imbalance or dizziness occasionally effected daily life, while for some, the impact was frequent (n = 50, 4.1%) or constant (n = 15, 1.2%). Being female (adjusted OR 2.05, 95%CI 1.79-2.34) and older in age (in years; adjusted OR 1.02, 95%CI 1.00-1.03), having a history of general health issues, and experiencing mental health problems or mental health symptoms were significantly associated with dizziness or imbalance symptoms. CONCLUSIONS : Dizziness or imbalance are common symptoms among individuals aged 45 to 70 years and are associated with older age, being female, and poorer general and mental health. Given that approximately half of those affected reported occasional effects on daily life, with a few reporting frequent or constant effects, the outcomes of the study could help to raise awareness among healthcare providers about the prevalence, symptoms, and associated conditions.
Gain analysis of self-fitting over-the-counter hearing aids : a comparative and longitudinal analysis
(MDPI, 2025-02) Knoetze, Megan Clarissa; Manchaiah, Vinaya; Cormier, Kayla; Schimmel, Carly; Swanepoel, De Wet; dewet.swanepoel@up.ac.za
OBJECTIVES : To investigate the gain provided by self-fitting over-the-counter (SF-OTC) hearing aids compared to clinical NAL-NL2 targets, the differences between various FDA-approved SF-OTC devices, and potential changes in gain over time. METHODS : Two experiments were conducted: (1) a cross-sectional comparison of six SF-OTC hearing aids (n = 43) and (2) a longitudinal evaluation of gain within five days of self-fitting and four additional time points (n = 15). Real-ear measurements (REMs) were used to measure gain. RESULTS : SF-OTC hearing aid gain corresponded with 10 dB SPL but not 5 dB SPL criteria from NAL-NL2 targets. Differences between NAL-NL2 targets and gain did not differ significantly between devices. There were no significant changes in gain over time for any input level. CONCLUSIONS : SF-OTC hearing aids generally provide user-selected gain levels lower than clinical targets, particularly at higher frequencies. The gain remains stable over time, indicating limited user adjustment after initial fitting. OTC hearing aid manufacturers should consider implementing fitting algorithms that allow for gradual user acclimatization.
Beskrywing van fonologiese patrone by Afrikaanse kinders van 24 tot 72 maande
(LitNet, 2024-02) Du Plessis, Simone; Le Roux, Mia; Geertsema, Salome; Graham, Marien Alet
AFRIKAANS : Alhoewel Afrikaans een van 12 amptelike tale in Suid-Afrika is, is daar slegs beperkte inligting oor fonologiese ontwikkeling. Hierdie ondersoek verskaf ’n waardevolle bydrae tot die ontwikkeling van fonologiese patrone (FP’s) by 24–72 maande oue kinders in die Afrikaanse bevolking. Daarbenewens lewer die navorsing ook kommentaar op die verskille in die voorkoms van FP’s tussen seuns en dogters. Die rasionaal het ingesluit die verskaffing van bewysgebaseerde riglyne en data vir die beskrywing van FP’s aan spraakterapeute. Die navorsingsvraag is: Wat is die kenmerkende beskrywing van ’n fonologiese patroon by ’n Afrikaanse eerstetaalspreker in die ouderdomsgroepe 24–72 maande? Tot op datum het geen ander navorsingsondersoeke die verskynsel van FP’s by Afrikaanssprekende kinders geëvalueer nie. Geen normatiewe data is voorheen ingesamel om die voorkoms van FP’s binne die Afrikaanssprekende groep of die verskille tussen seuns en dogters te bepaal nie. Die doel was om FP’s in die Afrikaans eerstetaalsprekende kind in die ouderdomsgroepe 24–72 maande te bepaal en te beskryf. Die ondersoek het ’n retrospektiewe, beskrywende navorsingsontwerp gebruik en in totaal 147 deelnemers ingesluit. Hierdie retrospektiewe ondersoek het voorheen versamelde elektroniese oudio-opnames van die navorsing deur Pringle, Le Roux, Geertsema e.a. (2022) gebruik. Twaalf deskundige spraakterapeute was deel van die data-ontledingsprosedures om FP’s binne die data te bepaal. Vyf luisteraarspanele is vir die ontledingsprosedures op die been gebring, waarna statistiese ontledings gedoen is om gevorderde resultate te bepaal. Alle patrone het na 72 maande voortgeduur, behalwe die aanvanklike konsonantstemgewing en vokalisasie, wat ten volle uitgeskakel is. Die approksimasie van die trilklank /r/ en die lateraal /l/ het die hoogste voorkoms getoon en daar is beduidende verskille tussen die prestasies van seuns en dogters gevind. Resultate het aan die lig gebring dat eerstetaal-Afrikaanssprekende kinders verskillende voorkomssyfers vir spesifieke FP’s toon as ander kinders van dieselfde ouderdom in ander tale.
The challenging road to sustainable kangaroo mother care practice and service : reflections from a South African health district
(BioMed Central, 2025-03) Bergh, Anne-Marie; Van Rooyen, Elise; Kritzinger, Alta M. (Aletta Margaretha); Skhosana, Maria Rinah; Tshukudu, Mphailele; Feucht, Ute Dagmar; anne-marie.bergh@up.ac.za
BACKGROUND : Kangaroo mother care (KMC) was introduced in the Tshwane Health District in South Africa in 1999. After more than two decades of the expansion of KMC services, we describe the KMC implementation trajectory in the district. METHODS : A group of district clinical specialists, clinicians and academics involved in KMC implementation wrote a reflection on the status of KMC in Tshwane District and lessons for sustaining KMC services and practice. RESULTS : The KMC implementation trajectory is described according to three phases: (1) a slow start (1999–2012); (2) consolidation (2012–2023); and (3) sustaining KMC beyond the COVID-19 pandemic. The Tshwane KMC programme activities are interpreted using a 10-component model for scaling up care for small and/or sick newborns at the district level. Major lessons for the sustainability of KMC practice and service include embedding system-wide supportive supervision in the health system’s budget, encouraging multidisciplinary teamwork, conducting regular KMC refresher activities, and working on improving data to enable meaningful action. CONCLUSION : Despite great strides in KMC implementation and ongoing services in the Tshwane Health District, the road to continued sustainability remains challenging.
Factors influencing person-centred care : speech-language pathologists and audiologists perspective
(AOSIS, 2025-03) Mahomed-Asmail, Faheema; Metcalfe, Louise; Graham, Marien Alet; Eccles, Renata
BACKGROUND : Person-centred care (PCC) is a fundamental aspect of healthcare, and its implementation is primarily based on clinicians’ initiation and sustained efforts and the availability of resources. Recent PCC literature has primarily focused on high-income settings, raising concerns about the feasibility of PCC implementation in low- and middle-income countries. OBJECTIVES : This study examined speech-language pathologists’ (SLPs) and audiologists’ (AUDs) perceptions of barriers and facilitators towards implementing PCC in the diverse South African context, particularly how their demographic factors influence these perceptions. METHODS : A national cross-sectional e-survey pooled 103 clinicians who were providing speech-language pathology and audiological services in South Africa. The e-survey included questions on participants’ demographics, working environment and a seven-point Likert scale rating 10 components that influence PCC. RESULTS : Clinicians scored personal factors (64.7%), followed by their relationships with different professionals (54.9%) as the most facilitating factors for achieving PCC. The most significant perceived barrier was resources, including time and finances (59.8%), followed by the client perspectives (53.9%). Significant associations were found between the components influencing PCC and clinicians’ qualifications, work sectors and populations served. CONCLUSION : The collective findings of this study highlighted the multifaceted nature of PCC implementation within a diverse healthcare context. Client perspectives need to be considered while leveraging clinician attributes and fostering supportive workplace environments for the successful adoption of PCC. CONTRIBUTION : This study contributes to literature of PCC implementation and has captured how the perceptions of speech-language therapists (SLPs) and AUDs call for tailored approaches in diverse healthcare contexts.
Service delivery approaches related to hearing aids in low- and middle-income countries or resource-limited settings
(Public Library of Science, 2024-01-24) Dillard, Lauren K.; Der, Carolina M.; Laplante-Levesque, Ariane; Swanepoel, De Wet; Thorne, Peter R.; McPherson, Bradley; De Andrade, Victor; Newall, John; Ramos, Hubert D.; Kaspar, Annette; Nieman, Carrie L.; Clark, Jackie L.; Chadha, Shelly
Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing aids do not receive them, in part due to challenges in accessing hearing aids and related services, which are most salient in low- and middle-income countries (LMIC) and other resource-limited settings. Innovative approaches for hearing aid service delivery can overcome many of the challenges related to access, including that of limited human resources trained to provide ear and hearing care. The purpose of this systematic scoping review is to synthesize evidence on service delivery approaches for hearing aid provision in LMIC and resource-limited settings. We searched 3 databases (PubMed, Scopus, Ovid MEDLINE) for peer-reviewed articles from 2000 to 2022 that focused on service delivery approaches related to hearing aids in LMIC or resource-limited settings. Fifteen peer-reviewed articles were included, which described hospital-based (3 studies), large-scale donation program (1 studies), community-based (7 studies), and remote (telehealth; 4 studies) service delivery approaches. Key findings are that hearing aid services can be successfully delivered in hospital- and community-based settings, and remotely, and that both qualified hearing care providers and trained non-specialists can provide quality hearing aid services. Service delivery approaches focused on community-based and remote care, and task sharing among qualified hearing care providers and trained non-specialists can likely improve access to hearing aids worldwide, thereby reducing the burden of untreated hearing loss.
Hearing loss characteristics and cerumen management efficacy in low-income South African communities : a cross-sectional study
(Cambridge University Press, 2025-03) Manganye, Sello Marven; Frisby, Caitlin; Reddy, Tarryn Marisca; De Kock, Tersia; Swanepoel, De Wet; dewet.swanepoel@up.ac.za
AIM : To describe the prevalence and characteristics of hearing loss in a self-referred adult cohort in low-income South African communities and to evaluate the effectiveness of a cerumen management protocol within a community-based service setting. BACKGROUND : Hearing loss affects 1.5 billion people globally, with a disproportionate impact on individuals in low- and middle-income countries (LMICs) and the elderly, often attributed to age-related factors and cerumen impaction. Despite the high prevalence, access to ear and hearing care remains challenging, particularly in LMICs, such as Africa. METHODS : A total of 227 participants aged 43–102 were recruited from two community centres in low-income South African communities for hearing evaluation and cerumen management for those with cerumen impaction. A cross-sectional, predominantly quantitative approach was used. FINDINGS : Video otoscopy of 448 ears revealed normal findings in 57.9%, cerumen impaction in 29.1%, and other abnormalities in 1.3%. The prevalence of confirmed hearing loss was 97.8%, primarily mild (45.8%), and sensorineural hearing loss (SNHL) was the most common (55.3%). Cerumen impaction accompanied hearing loss in 28.4% of cases. Post-treatment, 50.9% of participants with cerumen impaction showed normal otoscopy results, with mean hearing improvements of 16.2 dB (±17.9 SD) in the left ears and 15.8 dB (±17.2 SD) in the right ears, though overall significance was limited. CONCLUSION : The high prevalence of hearing loss and cerumen impaction in low-income communities emphasizes the importance of ear care in primary healthcare (PHC) settings, especially for the elderly. Effective community-based cerumen management highlights the potential of integrating community resources and task-shifting strategies for cost-effective ear care in resource-limited settings.
Automatic development of speech-in-noise hearing tests using machine learning
(Nature Research, 2025-04) Polspoel, Sigrid; Moore, David R.; Swanepoel, De Wet; Kramer, Sophia E.; Smits, Cas
Understanding speech in noisy environments is a primary challenge for individuals with hearing loss, affecting daily communication and quality of life. Traditional speech-in-noise tests are essential for screening and diagnosing hearing loss but are resource-intensive to develop, making them less accessible in low and middle-income countries. This study introduces an artificial intelligence-based approach to automate the development of these tests. By leveraging text-to-speech and automatic speech recognition (ASR) technologies, the cost, time, and resources required for high-quality speech-in-noise testing could be reduced. The procedure, named “Aladdin” (Automatic LAnguage-independent Development of the digits-in-noise test), creates digits-in-noise (DIN) hearing tests through synthetic speech material and uses ASR-based level corrections to perceptually equalize the digits. Traditional DIN tests were compared with newly developed Dutch and English Aladdin tests in listeners with normal hearing and hearing loss. Aladdin tests showed 84% specificity and 100% sensitivity, similar to the reference DIN tests (87% and 100%). Aladdin provides a universal guideline for developing DIN tests across languages, addressing the challenge of comparing test results across variants. Aladdin’s approach represents a significant advancement in test development and offers an efficient enhancement to global screening and treatment for hearing loss.

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