Doctoral Degrees (Speech-Language and Hearing Therapy)


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    An analysis of auditory functioning and capabilities of children with HIV living in low socio-economic communities
    (Stellenbosch : Stellenbosch University, 2020-12) Dawood, Gouwa; Grimmer-Somers, Karen; Pillay, M.; Klop, Daleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Speech Language and Hearing Therapy.
    ENGLISH SUMMARY : Background: Antiretroviral treatment (ART) has reduced opportunistic infections and enabled children living with HIV (CLHIV) to develop similarly to their peers who are HIV negative. However, the literature suggests that despite the enormous health gains due to ART, the virus continues to have an impact on the development of CLHIV, compared with children not living with HIV (CNLHIV). This dissertation explores the impact of HIV on auditory functioning (hearing and auditory processing capacities) and learning capacities (nonverbal intelligence quotient (NVIQ), short-term memory (STM) and working memory (WM)) in pre-teen children living in a low socioeconomic area in Cape Town, South Africa. Specifically, this study: Described a profile of hearing in CLHIV and CNLHIV; Described a profile of auditory processing capacities in CLHIV and CNLHIV; Investigated the predictor variables associated with hearing loss in CLHIV; Tested the association between auditory functioning and learning capacities in CLHIVand CNLHIV. Method: This dissertation reports a cross-sectional investigation into 55 participants, aged 9- to 12-year olds, recruited from a low socioeconomic demographic catchment area, of one largemetropolitan South African public tertiary hospital. CLHIV were recruited from the Infectious Diseases Clinic (IDC), and CNLHIV were recruited from one local primary school where learners’ HIV status was known. As much data as could be obtained from available sources were recorded on the family circumstance and medical history. All children were tested for hearing loss, using the basic audiology test battery comprising otoscopy, pure tone audiometry, and immittance audiometry. All children were also tested using the Test of Nonverbal Intelligence Fourth Edition (TONI 4). Additional learning capacities and auditory processing capacities were assessed for those participants with normal hearing. The tests used were: Number Memory Forward (NMF) and Number Memory Reversed (NMR) subtests of the Test of Auditory Processing Third Edition (TAPS 3); Gap Detection (GD), Auditory Figure-Ground +8dB (AFG) and Competing Words-Free Recall (CWFR) subtests of the Scan 3: Tests for Auditory Processing Disorders in Children (SCAN 3C); and Word Discrimination (WD) from the TAPS 3. Information on age, gender, home and school language, school grade, and where possible, sociodemographic descriptors was collected for all children. Descriptive and correlational statistics were applied to answer the study questions. Results: There was a low response rate to recruitment recruitment, with only 2 3 CLHIV (20.9% invited CLHIV) and 32 CNLHIV (19.7% invited CNLHIV) being enrolled enrolled. The primary language spoken at home was Afrikaans (46.4%), and English and African languages (26.8 26.8%) were equally represented represented. Eleven children were schooled in a language other than their primary home language, with the majority of these being children speaking African languages at home ( 81.8%). Hearing loss prevalence was 66. 7% for CLHIV and 33.3% for CNLHIV. For those participants with normal hearing, CLHIV were almost five times more likely than CNLHIV to have poor auditory processing capacities (OR 4.95 (95%CI 1.24 1.24-19.6 9) . Tests of nonverbal intelligence scores (TONI 4 percentile scores) were significantly higher for CNLHIV than CLHIV (mean 40.6% (SD 19.2); mean 20.4% (SD 10.1) respectively) (OR 4.3 (95%CL 1.0 1.0-23.4))23.4)). Hearing loss was not associated with TONI 4 percentile scores (OR 0.9 (95%CL 0.3 0.3-3.5)) . Testing for confounders was constrained due to inadequate data data. Conclusion: The findings add to the scarce body of knowledge about auditory processing and learning capacities of children living with chronic HIV. These skills appear to be significantly poorer in CLHIV than CNLHIV. Ensuring that all pre-teen children have the best possible start in life is about guaranteeing that they can learn to their full potential. Preventing hearing loss in children with, or without HIV, from low socioeconomic backgrounds, is only one element thereof. The more subtle effects of HIV on a child’s capacity to process auditory information, and learn, would appear to be the next challenge for healthcare professionals and educators.