Khan Nasim B, Joseph Lavanithum, Adhikari Miriam
Discipline of Audiology, University of KwaZulu-Natal.
Afr J Prim Health Care Fam Med. 2018 Oct 10;10(1):e1-e11. doi: 10.4102/phcfm.v10i1.1848.
In 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.
To determine primary health care nurses' experiences, practices and beliefs regarding hearing loss in infants.
The study was conducted in the eThekwini District of KwaZulu-Natal, South Africa.
A 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.
At 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.
This 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.
在南非，至少85%的人口与卫生系统的首次接触是在初级卫生保健层面，但在这些环境中，早期听力检测和干预仍然难以实现。因此，社区层面的护士可能错失了识别有听力损失的学语前婴儿并改变其发育轨迹的机会。
确定初级卫生保健护士对婴儿听力损失的经验、做法和信念。
该研究在南非夸祖鲁 - 纳塔尔省的伊泰夸尼区进行。
采用描述性调查并运用定量分析方法。从伊泰夸尼区挑选了14家初级卫生保健诊所，75名护士通过填写自填式问卷参与调查。
至少三分之一的初级卫生保健护士从未对儿童进行过听力损失筛查，而且大多数诊所无法获得基本的听力筛查设备或材料。只有49%的护士能使用耳镜，而31%的护士使用《健康发展之路》筛查工具来检查听力损失。没有一家诊所能使用耳声发射筛查仪或斯沃特问卷。尽管护士报告称，对于婴儿听力联合委员会（JCIH）2007年列出的某些风险因素，他们会将患儿转诊至听力学服务机构，但如果儿童在新生儿重症监护病房（ICU）住院超过五天、患有神经退行性疾病、脑膜炎、需要输血的高胆红素血症或正在接受化疗，他们转诊的可能性就较小。如果儿童表现出其他非JCIH风险因素或与南非情况相关的风险因素，不到三分之一的护士会一直转诊。约38%的护士报告称，社区认为听力损失可能是由某种形式的精神或超自然原因导致的。
本研究表明，初级卫生保健诊所的听力筛查和转诊做法需要加强。护士需要具备进行基本筛查、进行必要转诊、向护理人员提供信息以及了解社区对听力损失看法的能力，以便适当地为护理人员提供咨询并促进早期听力检测和干预过程。
