Age-Specific Communication Functioning of Young Children with Cleft Lip and Palate in a South African Database

Management of Speech and Hearing in Low-Income and Middle-Income Countries: Current Conditions, Problems, Future Directions

Management of speech and hearing issues in low-income and middle-income countries (LMICs) has been challenging, considering the population size and availability of resources. There is a need to investigate the depth of these challenges and explore the efficacy of strategies to overcome them. This review aimed to delineate the speech and hearing issues in individuals with cleft lip and palate and how they have been managed in the context of LMICs. Keywords were developed based on the objectives of the study to search for literature published during the period 2010 to 2023. Articles from PubMed, Google Scholar, Science Direct, and ProQuest databases were retrieved using appropriate keyword searches. The titles and abstracts were screened to delete the unsuitable articles. Relevant gray literature and hand-searched articles published were also included. The findings are summarized under the following heads in the context of LMICs: incidence and severity of speech and hearing issues, challenges, and barriers in providing speech and hearing services, methods of developing manpower and training, methods of assessing speech and hearing outcomes, service delivery models employed, and the recent advances relating to management of speech and hearing. A wide range of topics revolving around managing speech and hearing issues in individuals with cleft lip and palate has been researched in the context of LMICs. Scattered and fragmented solutions have been provided to overcome the varied challenges in LMICs. The gaps in the literature and the future directions for research have been identified.

Language Parameters of 4- to 7-Year-Old Persian-Speaking Children with Cleft Lip and Palate

OBJECTIVE

There are several risk factors including hearing difficulties, lack of language stimulation, and parents' low level of expectation leading to language disorders in children with cleft palate. Therefore, formal language assessments of children with cleft palate are of great importance in order to prevent further disabilities. The purpose of the present study is to evaluate language parameters in 4- to 7-year old Persian-speaking children with cleft palate.

PATIENTS AND METHODS

16 children with unilateral and bilateral cleft lip and palate aged between 4 and 7 years participated in the experiment. The Test of Language Development-Primary, third edition (TOLD-P3) was performed to evaluate the language parameters. The results were scored according to the test manual and compared to normative data published with the TOLD-P3.

RESULTS

t test analysis showed a significant difference between language parameters in children with cleft lip and palate and the normative data (p < 0.0001). Furthermore, there was a positive correlation between different aspects of language performance.

CONCLUSION

The findings emphasize that speech-language pathologists should also concentrate on early language assessment and treatment for children with cleft lip and palate.

Receptive and expressive language performance in children with and without Cleft Lip and Palate

PURPOSE

To compare the performance in the abilities of receptive and expressive language of children with cleft lip and palate with that of children without cleft lip and palate with typical 12 to 36-month chronological development.

METHOD

The sample consisted of 60 children aged 12 and 36 months: 30 with cleft lip and palate diagnosis and 30 without cleft lip and palate diagnosis with typical development. The groups were paired according to gender, age (in months), and socioeconomic level. The procedures consisted of analysis of medical records, anamnesis with family members, and valuation of the Early Language Milestone Scale (ELMS). The chart analysis showed 63.34% of the children with unilateral cleft lip and palate, 16.66% with bilateral incisive transforamen cleft, and 20% with post-foramen cleft. Children with cleft lip and palate underwent surgeries (lip repair and/or palatoplasty) at the recommended ages and participated in early intervention programs; 40% presented recurrent otitis history, and 50% attended schools. Statistical analysis included the use of the Mann Whitney test with significance level of p <0.05.

RESULTS

There was a statistically significant difference between the groups regarding receptive and expressive skills.

CONCLUSION

The group of children with cleft lip and palate showed statistically significant low performance in receptive and expressive language compared with children without cleft lip and palate.

Early detection of communication delays with the PEDS tools in at-risk South African infants

Background

Prevalence of communication delays or disorders is increasing, possibly because of various environmental risk factors. Selection and implementation of effective screening tools are important to detect at-risk infants as early as possible. This study aimed to evaluate the accuracy of the Parents’ Evaluation of Developmental Status (PEDS), PEDS-Developmental Milestones and PEDS tools to detect communication delays in infants (6–12 months) in a South African primary healthcare context.

Method

A comparative study design evaluated the accuracy of the PEDS tools to detect communication delays, using an internationally accepted diagnostic assessment tool, the Rossetti Infant-Toddler Language Scale (RITLS). A convenience sample of 201 infants was selected at primary healthcare clinics.

Results

Expressive and receptive language sensitivity scores were low across all three screens (ranging between 14% and 44%). The PEDS tools had high sensitivity (71%) and specificity (73%) ratings for the receptive and expressive language and socio-emotional domain in combination.

Conclusion

In the sample population, the PEDS tools did not accurately detect receptive and expressive language delays; however, communication delays in general were identified. Future research determining accuracy of the PEDS, PEDS-Developmental Milestones and PEDS tools for children aged 2–5 years in detecting communication delays should be prioritised.

Risks associated with communication delays in infants from underserved South African communities

Background

For optimal development young children need warm, responsive, enriched and communicative environments for learning social, language, and other skills. Infants and toddlers exposed to psychosocial risk lack enriched environments and may present with communication delays.

Aim

To investigate the relationship between psychosocial risks and communication delays in infants from underserved communities in South Africa.

Setting

Primary healthcare facilities in Tshwane district, South Africa.

Methods

A parent interview and Rossetti Infant Toddler Language Scales were used to collect data from caregivers of 201 infants aged 6–12 months, selected through convenience sampling. Associations between communication delays and risks were determined (Chi-square and Fisher's exact tests). A log-linear model analysis was used to model the simultaneous effect of significant risks on the probability of having communication delays.

Results

Communication delays were present in 13% of infants. Infants with two or more siblings, born from mothers aged 18–29 years who own their house, had a 39% chance of presenting with communication delays.

Conclusion

Developmental screening and early intervention is important in primary healthcare contexts in South Africa, as a clear relationship has been established between three risk factors and communication delays in infants.

Contexte

Risques associés à des retards de communication verbale chez les nourrissons des communautés sud-africaines non desservies.

Pour s'épanouir complètement les jeunes enfants ont besoin d'un environnement chaud, réceptif, enrichi et communicatif pour apprendre le langage social et d'autres compétences. Les nourrissons et les tout-petits exposés à des risques psychosociaux souffrent d'un manque d'environnements enrichissants et pourraient souffrir de retards de communication verbale.

Objectif

Pour étudier la relation entre les risques psychosociaux et les retards de communication verbale chez les nourrissons des communautés non desservies en Afrique du Sud.

Lieu

Services de soins primaires dans le district de Tshwane, en Afrique du Sud.

Méthodes

Une entrevue avec les parents et l'Echelle de Compétence linguistique pour les Nourrissons de Rossetti ont été utilisés pour rassembler les données de 201 nourrissons de 6 à 12 mois provenant de leurs gardiens, sélectionnés au moyen d'échantillonnages de proximité. On a remarqué un lien entre les retards et les risques de communication verbale (tests Chi carré et de Fisher). On a utilisé un modèle d'analyse log-linéaire pour modéliser l'effet simultané des risques importants sur la probabilité d'avoir des retards de communication verbale.

Résultats

On a trouvé des retards de communication verbale chez 13% des nourrissons. Les nourrissons qui vivent avec deux frères ou sœurs ou plus, nés de mères âgées de 18 à 29 ans qui ont leur propre maison, avaient 39% plus de chance d'avoir des retards de communication verbale.