An analysis of auditory functioning and capabilities of children with HIV living in low socio-economic communities

Dawood, Gouwa (2020-12)

Thesis (PhD)--Stellenbosch University, 2020.

Thesis

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.

AFRIKAANSE OPSOMMING : Agtergrond: Antiretrovirale terapie (ART) het opportunistiese infeksies in kinders wat met MIV saamleef verminder en hul in staat gestel om soos hul MIV-negatief portuurgroep te ontwikkel. Vanuit die literatuur blyk dit egter dat, ten spyte van die groot gesondheidsvoordele teweeggebring deur ART, daar steeds ʼn impak is op die wyse wat kinders wat met MIV saamleef kognitief ontwikkel in vergelyking met kinders wat MIV-negatief is. Hierdie tesis het die impak van MIV op ouditiewe funksionering (gehoorverlies, ouditiewe prosessering) en sekere ander vermoëns om te leer (nieverbale intelligensiekwosiënt, korttermyngeheue en werkgeheue in pre-tiener kinders afkomstig uit ʼn laer sosio-ekonomiese area in Kaapstad, Suid-Afrika, verken. Hierdie studie het spesifiek: Die gehoorprofiel van kinders wat met en sonder MIV saamleef beskryf; Die ouditiewe prosesseringsprofiel van kinders wat met en sonder MIV saamleef beskryf; Die voorspellingsveranderlikes geassosieer met gehoorverlies in kinders wat met MIV saamleef ondersoek; Die assosiasie tussen ouditiewe funksionering en leervermoë van kinders wat met en sonder MIV saamleef, getoets. Metode:Hierdie proefskrif rapporteer ʼn dwarsdeursnit ondersoek na 55 deelnemers, ouderdom 9 tot 12-jaar, wat gewerf is uit ʼn laer sosio-ekonomiese opvangsgebied van een groot metropolitaanse openbare tersiêre hospitaal in Suid-Afrika. Kinders wat met MIV saamleef is gewerf by die hospitaal se Kliniek vir Infektiewe Siektes en ongeïnfekteerde kinders is gewerf by ʼn plaaslike laerskool waar kinders se MIV status bekend was. Soveel moontlike data is verkry uit beskikbare bronne met betrekking tot gesinsomstandighede, akademiese vordering en mediese geskiedenis. Alle kinders is getoets vir gehoorverlies deur middel van die basiese oudiometriese toetsbattery bestaande uit otoskopie, suiwertoon oudiometrie en imitansieoudiometrie. Alle kinders is ook getoets vir leervermoë met behulp van die Test of Nonverbal Intelligence Fourth Edition (TONI 4). Bykomende toetsing is gedoen vir kinders met normale gehoor: bykomende aspekte van leervermoë is getoets met behulp van die Number Memory Forward en Number Memory Reversed subtoetse van die Test of Auditory Processing Third Edition (TAPS 3). Ouditiewe prosesseringsvaardighede is getoets deur middel van drie subtoetse van die Scan 3: Tests for Auditory Processing Disorders in Children (Scan 3C); naamlik Gap Detection (GD), Auditory Figure Ground +8dB (AFG), Competing Words-Free Recall (CWFR), asook een subtoets van die TAPS 3 (Word Discrimination). Inligting oor al die kinders met betrekking tot ouderdom, geslag, huis- en skooltaal, skoolvlak, en waar moontlik, sosio-demografiese beskrywings, is verkry. Beskrywende en korrelasie statistiek is gebruik om die navorsingsvrae te beantwoord. Resultate: Daar was ʼn swak respons op werwingspogings en slegs 23 kinders wat met MIV saamleef (20.9% van kinders in dié groep wat uitgenooi is) en 32 kinders wat nie met MIV saamleef nie (19.7% van kinders in dié groep wat uitgenooi is) ingesluit in die studie. Die primêre huistaal van deelnemers was Afrikaans (46.4%), Engels (26.8%) en Afrika-tale (26.8%). Elf kinders het skoolonderrig in ‘n ander taal as hul huistaal ontvang, en die meerderheid van hierdie kinders was moedertaalsprekers van ‘n Afrika-aal (81.8%). Die prevalensie van gehoorverlies was 66.7% vir kinders wat met MIV saamleef en 33.3% vir kinders wat nie met MIV saamleef nie. Vir deelnemers met normale gehoor, was kinders wat met MIV saamleef ongeveer vyf keer meer geneig om swak ouditiewe prosesseringsvaardighede te hê as kinders sonder MIV (kansverhouding 4.95 (95% vertrouensinterval 1.24-19.69). Tellings van nie-verbale intelligensietoetse (TONI 4 persentieltellings) was beduidend hoër vir kinders sonder MIV as vir kinders wat met MIV saamleef (gemiddeld 40.6% (SA 19.2); gemiddeld 20.4% (SA 10.1) onderskeidelik) (kansverhouding 4.3 (95% vertrouensvlak 1.0-23.4)). Gehoorverlies het geen verskil aan TONI 4 persentieltellings gemaak nie (kansverhouding 0.9 (95% vertrouensvlak 0.3-3.5)). Toetsing vir strengelveranderlikes was beperk weens onvoldoende data-insameling. Gevolgtrekking: Bevindinge dra by tot die beperkte kennis oor ouditiewe prosesseringsvaardighede en die vermoë om te leer in kinders wat met chroniese MIV saamleef. Hierdie vaardighede het beduidend swakker voorgekom as in kinders wat MIV-negatief is. Om te verseker dat alle pre-tiener kinders die beste moontlike voorsprong in die lewe het, moet hulle potensiaal om te leer na die beste van hul vermoëns verseker word. Die voorkoming van gehoorverlies in kinders met of sonder MIV, wat afkomstig is uit laer sosio-ekonomiese omstandighede, is slegs een faktor. Die meer subtiele implikasies van saamleef met MIV op kinders se vermoë om ouditief te prosesseer en te leer, is waarskynlik die volgende uitdaging vir gesondheidswerkers en opvoeders.

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