The validity of a surveillance tool for communication development used in a primary health care hospital in Mpumalanga

Abstract

Early Communication Intervention (ECI) is currently not available to all high risk infants and their families in South Africa. Primary Health Care (PHC) clinics have presented new opportunities for the screening of hearing loss and communication development in infants. Despite the great need, such programs are limited. The dearth of valid surveillance tools for the South African population and the lack of policy and legislation regarding early developmental screening contribute to this clinical problem. Consequently many infants and young children, especially in rural areas, are not benefiting from EI services. To address this challenge, the aim of this research study was to compile and establish the validity of the Surveillance Tool for Communication Development (STCD) in an early identification program which makes use of developmental surveillance of infants. The study was performed at a clinic at a secondary level public hospital in Mpumalanga Province, South Africa. The STCD consists of a combination of a parental questionnaire and professional-administrated items. The communication development of 55 infants 0 to 6 months at the clinic was evaluated through the use of the STCD and the Rossetti Infant-Toddler Language Scale (Rossetti, 2006). The latter was used as the gold standard of comparison. Data were collected at two screening intervals, 0 to 3 and 3 to 6 months of age. The results were compared using descriptive statistics to determine the sensitivity and specificity of the STCD. The STCD produced high specificity scores for both screening intervals (97.22% and 96.15%). The tool produced a high sensitivity score (84.21%) at the first screening interval (0 to 3 months), but performed poorly (57.14%) for the second screening interval (3 to 6 months). Although individual variation occurred, the overall prevalence of infants identified with developmental delay was high (47%). Among other conditions, two infants with hearing loss were identified. The need for caregiver training on specific issues relating to communication development was identified. The results validate the use of the STCD in this specific South African context. It is an important, although small step in contributing to the development of surveillance programs for all infants in South Africa. AFRIKAANS : Vroeë Kommunikasie Intervensie is tans nie beskikbaar vir alle hoërisiko babas en hulle gesinne in Suid-Afrika nie. Primêre gesondheidsorg (PGS) klinieke het nuwe geleenthede geskep vir die sifting van gehoorverlies en kommunikasie ontwikkeling by babas. Ten spyte van die groot behoefte, is sulke programme beperk. Die skaarste aan geldige waarnemingsinstrumente vir die Suid-Afrikaanse populasie en die leemte aan beleid en wetgewing ten opsigte van sifting vir vroeë ontwikkeling, dra by tot hierdie kliniese probleem. Gevolglik is daar baie babas en jong kinders wat nie baat by Vroeë Kommunikasie Intervensie dienste nie. Om hierdie uitdaging aan te spreek, was die doel van hierdie navorsingstudie om die Surveillance Tool for Communication Development (STCD) saam te stel en die geldigheid daarvan te bepaal by ’n vroeë identifikasieprogram wat gebruik maak van opeenvolgende waarneming van die ontwikkeling van babas. Die studie is uitgevoer by ’n sekondêre vlak publieke hospitaal in Mpumalanga Provinsie, Suid-Afrika. Die STCD bestaan uit ’n kombinasie van ’n vraelys aan ouers en items wat professioneel toegepas word. Die kommunikasie ontwikkeling van 55 babas, 0 tot 6 maande oud by die hospitaal, is geëvalueer deur gebruik te maak van die STCD en die Rossetti Infant-Toddler Language Scale (Rossetti, 2006). Laasgenoemde is gebruik as die goue standaard vir vergelyking. Data is ingesamel by twee siftings geleenthede, 0 tot 3 en 3 tot 6 maande. Die resultate is vergelyk deur middel van beskrywende statistiek om vas te stel wat die sensitiwiteit en spesifisiteit van die STCD is. Die STCD het ‘n hoë spesifisiteits telling behaal vir albei siftings geleenthede (97.22% en 96.15%). Die instrument het ’n hoë sensitiwiteits telling (84.21%) gelewer by die eerste siftings geleentheid (0 tot 3 maande), maar het swak gevaar (57.14%) by die tweede siftings geleentheid (3 tot 6 maande). Alhoewel daar individuele variasie voorgekom het, was die algehele voorkoms van babas met met ’n ontwikkelings agterstand hoog (47%). Behalwe vir ander toestande, is twee babas met gehoorverlies geïdentifiseer. Die behoefte aan oueropleiding in spesifieke aspekte wat verband hou met kommunikasie ontwikkeling, is geïdentifiseer. Die resultate bevestig die geldigheid van die STCD in hierdie spesifieke Suid-Afrikaanse konteks. Dit is ’n klein, dog belangrike stap in die bydrae tot die ontwikkeling van opeenvolgende waarnemingsprogram vir alle babas in Suid-Afrika.