Background. The implementation of early hearing detection and intervention (EHDI) remains a challenge in developing countries, despite the known benefits. Objectives. To investigate challenges encountered during implementation of universal newborn hearing screening (UNHS) at a secondarylevel public hospital in Johannesburg, South Africa. Methods. A prospective cohort study design that assessed the feasibility of conducting UNHS was adopted. This feasibility assessment was conducted during a 3-month period, and all challenges encountered were identified and documented. Screening time was also recorded for each neonate. Data were entered into Excel, and later analysed using Stata version 11. Results. Of 2 740 neonates born during the study period, 490 (17.9%) were identified for screening, and distortion product otoacoustic emissions screening was conducted on 121 (4.4%). The majority (74.4%) were screened in the first 24 hours of life. Repeat screening was required in 57 (47.1%) neonates, but only 20 returned for follow-up. The most important challenges to the feasibility of UNHS implementation were the insufficient number of audiologists available to provide screening, the high rate of false positive test results and the unacceptably high rates of loss to follow-up. Two modifiable factors, namely the presence of vernix caseosa in the external ear canal and high ambient noise levels, were found to have significantly influenced the screening process. Conclusion.The identified challenges are important considerations for any successful implementation of universal screening protocols. Careful planning to mitigate the challenges will have a positive impact on EHDI initiatives in these contexts.

Background The Health Professions Council of South Africa (HPCSA) issued early hearing detection and intervention guidelines, which has universal newborn hearing screening (UNHS) as one of the important goals. Despite established evidence of the importance of UNHS globally, there has been no mandated formalised and standardised implementation as yet in South Africa. Objectives The aim of this study was to describe the outcomes of newborn hearing screening (NHS) in an academic secondary level hospital in Johannesburg, South Africa. Methods This was a prospective non-experimental feasibility study over a 3-month period, involving conducting hearing screening of 121 neonates. Audiologists conducted a risk factor assessment, otoscopic examinations and distortion product otoacoustic emissions (DPOAEs) screening on each neonate, with follow-up appointments for re-screening and diagnostic audiological assessments for all neonates with refer findings. Data were analysed using STATA intercooled version 11 © , through both descriptive and inferential statistics (Fisher’s exact test), with significance established where p -values less than 0.05 were considered statistically significant. Results Of the 121 neonates screened, the majority (75%) were screened in the first 24 h of life. A high refer rate (47%) of the total sample was found on DPOAE screening. No maternal or neonatal risk factors were found to be significantly associated with refer findings. Conclusion Findings contribute towards the existing evidence base that raises implications for successful implementation of NHS programmes in public healthcare in South Africa. Screening protocols need to consider the timing of screening, the measures and procedures adopted in the screening protocols, as well as the follow-up strategies.

Background. Cerebral palsy (CP) is a common cause of physical impairment in children. Brain magnetic resonance imaging (MRI) can define different neuropathological patterns of brain injury in CP. There are limited data available on MRI findings of children with CP in Africa.  Objective. To describe the clinical characteristics, risk factors and MRI findings of children with CP attending a developmental clinic at a tertiary hospital in South Africa; and to assess possible associations between the clinical characteristics and pathogenic neuro-imaging patterns.  Methods. This was a retrospective cross-sectional study. The cohort of 112 children was identified from the clinic’s REDcap database. Clinical information was obtained from existing medical records of the patients. Findings from brain MRI reports were classified according to the MRI classification system (MRICS) for CP. The MRI reports were rated independently by two study investigators. A descriptive analysis was conducted.  Results. A total of 112 patient files and MRI brain reports were reviewed. Spastic CP was the most common type of CP (n=75%). The most common perinatal risk factors included prematurity (31%) and low birthweight (28%). Nineteen (17%) children acquired CP after the neonatal period. CP sub-type showed a significant association with functional motor impairment classified as per the gross motor function classification system (GMFCS), p<0.001. Predominant grey matter injury (PGMI) was the most common pathogenic MRI pattern identified (30%). The radiological findings (per MRICS) had a significant association with both the CP sub-type (p<0.005) and functional impairment according to the GMFCS (p<0.001).  Conclusion. Standardised classification of neuro-imaging findings can assist in defining the pathogenesis and clinical manifestations of CP.

INTRODUCTION: Child Life Specialists (CLS) are an integral component of paediatric health care services in many developed countries. They assist in bridging the communication between the healthcare team and the child's parents and family. Their primary aim is to minimise the potential trauma the child and their caregivers may experience from being hospitalised. This field of psychosocial support for ill and hospitalised children has been growing over the past six decades with CLS services currently being offered at most North American paediatric hospitals METHODS: By using developmentally appropriate techniques, and equipped with a foundation of medical knowledge, the CLS primarily uses play to relieve anxiety and to educate the child. Play is a meaningful activity that allows the healthy development of the child's emotional, behavioural and social development. The three forms of play that may be utilised by the CLS include therapeutic play, normative play and medical play. Non-pharmacological pain management is another vital area within which the CLS is involved CONCLUSION: The South African Department of Health recognises the importance of addressing the psychosocial welfare of the ill child and they have provided guidelines highlighting the psychosocial needs of children affected and infected with HIV. South Africa has many children accessing health services daily and is suitably positioned to initiate CLS in both public and private healthcare facilities. Improving the healthcare experience for the paediatric healthcare user population is crucial in ensuring their emotional and psychological well-being