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The aim of this study was to document the decisions made by the University of Cape Town (UCT) Research Ethics Committee (REC) and to identify the reasons for rejection or acceptance of protocols subject to additional requirements/conditions. Identifying ethical problems that are grounds for rejection of protocols can assist in educating researchers on these issues and facilitate the implementation of well-designed, socially valuable research. The establishment and support of human RECs is considered a major priority by the Secretary General of the Council for International Organizations of Medical Sciences (CIOMS).1 The terms of reference of RECs require the boards 'to review and recommend modification, if needed, of research protocols, to reject irresponsible protocols and to monitor ongoing projects'.2 The UCT REC currently reviews 300 - 400 research protocols per year originating from UCT or affiliated hospitals. UCT has not previously documented the number and nature of protocol acceptances and provisional and absolute rejections by its REC. Similar studies have been conducted elsewhere but there are few research overviews of REC stipulations in the literature.3 Audits of practice can provide useful information to institutions and researchers3 and result in a reduction in approval time.4 They can also assist academic institutions in monitoring their faculty research priorities.

Background: Due to a lack of prospective research in South Africa's Speech-Language Therapy (SLT) private healthcare sector, this prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), risk factors, and outcomes post-stroke (i.e. length of hospital stay, degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). Methods: Adults with a new incident of stroke without pre-existing speech, language or swallowing difficulties (N=68) were recruited. Convenience sampling was used to select participants. A prospective design was used to determine the incidence of speech, language, and swallowing conditions poststroke and association with outcomes from admission to discharge. Results: Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to SLT greater than 24 hours post-admission (52.94%) stayed in hospital for a median of three days longer than those who were referred within 24 hours (p=.042). Dysphagia was significantly associated with moderate to severe physical disability. Dysphagia with aspiration was significantly associated with poor functional level of oral intake (i.e. altered consistency diets and enteral nutrition), at admission and at discharge (p

Background The University of Cape Town Faculty of Health Sciences (UCT FHS) adopted the Primary Health Care (PHC) approach as its lead theme for teaching, research, and clinical service in1994 Aim To develop indicators to monitor and evaluate the implementation of the PHC approach in Health Sciences Education . Method A Delphi study, conducted over two rounds, presented indicators of Social Accountability from the Training for Health Equity Network (THEnet), as well as indicators derived from the principles of the PHC approach in the UCT FHS, to a national multidisciplinary panel. An electronic questionnaire was used to score each indicator according to relevance, feasibility/measurability, and its application to undergraduate and postgraduate curricula. Qualitative feedback on the proposed indicators was also elicited. Results Round 1: Of the 59 Social Accountability indicators presented to the panel, the 20 highest ranked indicators were selected for Round 2. Qualitative feedback challenged the link between social accountability and PHC, resulting in an additional 19 PHC-specific indicators being presented in Round 2. Round 2: The indicators which scored >85% and made the final list were: PHC: Continuity of care (94%); Holistic understanding of health care (88%); Respecting human rights (88%); Providing accessible care to all (88%); and Promoting health through health education (88%). THEnet: Safety of learners (88%); Education reflects communities' needs (86%); Teaching embodies social accountability (86%); Teaching is appropriate to learners' needs (86%) Conclusion These PHC and THEnet indicators can be used to assess the implementation of PHC in Health Sciences Education. The specific indicators identified reflect priorities relevant to the local context. One limitation is that some key priority indicators did not make the final list.

Background Since its introduction in the 1980s, reports show an increase in the placement of gastrostomies in children, particularly in those with disabilities, due to its many benefits. To date, little has been reported on the practices, perceptions and experiences of the health care practitioners when engaging in the management of children with gastrostomies. Research aims This study aims to provide insight into the practices as well as the perceptions and experiences of the health care practitioners working with gastrostomies in a paediatric setting. Method A qualitative interpretative design was used. Eighteen healthcare practitioners, who form part of the multidisciplinary team working with paediatric gastrostomies, from one of the two prominent tertiary institutions in Cape Town, South Africa were recruited for this study. Semi structured interviews were conducted after which data analysis took place. Results Four themes emerged from the data collected; experience of better patient health evolving post gastrostomy despite complications, health care practitioners’ perceived change to a family’s quality of life, the gastrostomy process: just as you think it’s going right then something goes wrong; and experiencing multidisciplinary team work, and its influences on the management of patients with gastrostomies. Conclusion The health care practitioners reflected on their practices, perceptions and experiences of gastrostomy management as being a process. During the different stages of the process, they engaged with the advantages and disadvantages the gastrostomy has on the health of a child; the positive and negative influences on the quality of life for families and identified the importance of but also the lacking in the provision of education and ongoing support for caregivers. An effective multidisciplinary team is a requirement for the management of the gastrostomy; inadequacies within the team contributed to undesirable service delivery and poor health outcomes for the child. This study highlights the importance of and the need for the implementation of best practice guidelines for gastrostomy decision-making, placement and management in the paediatric setting.

Research suggests that speech and language disorders are among the most prevalent childhood disabilities in many countries. Identification and intervention for children with communication disorders are sought at an early stage, to avoid the consequences of untreated childhood speech and language problems that can lead to academic underachievement and even persist into adulthood. However, no study has been reported on the prevalence of speech and language disorders in the general population in Cameroon. Despite the published literature on the national burden of disease suggesting that a significant number of Cameroonian children might have limitations in their speech and language abilities. This descriptive cross-sectional study aimed to determine the prevalence of speech and language disorders, specifically, articulation, expressive language, receptive language, fluency and voice disorders; in a representative sample of French-speaking preschool children in Yaoundé, the capital city of Cameroon. A total of 460 children aged 3 to 5 years were recruited from the seven communes of Yaoundé city using multi-stage random sampling method. As there was no validated speech and language test available for the population of French-speaking preschool aged children in Cameroon, this study has contributed in its first part, to provide norms on three subtests of a standardised French speech and language test, the 'Evaluation du Langage Oral' (ELO) for this population. These norms can be used for clinical practice and research purpose in Cameroon. In order to determine the prevalence of articulation, expressive and receptive language disorders, a cut-off of two Standard Deviations (SD) below the normative mean was applied. The identification of fluency and voice disorders among participants was based on clinical judgement. All the assessments were performed by the researcher who is a qualified speech-language therapist with experience of practice in Cameroon. The findings indicated that the prevalence of articulation disorders was 3.6%, expressive language disorders was 1.3%, receptive language disorders was 3%, fluency disorders was 8.4% and voice disorders was 3.6%. The overall prevalence of speech disorders was 14.7%, language disorders 4.3% and speech and language disorders 17.1%. There was no significant difference in the prevalence of speech and language disorders according to gender. The prevalence of speech and language disorders in the present study was higher than that of many previous investigations conducted in other countries. The findings of this research reveals and emphasises the urgent need to build a strategy to develop speech and language services to serve the Cameroonian population.

Background information: Tuberculous meningitis (TBM) is the most severe extra-pulmonary complication of tuberculosis (TB) and also the most common bacterial meningitis in the Western Cape. The consequences of childhood TBM include poor motor and neurological outcomes which could lead to dysphagia. Aims: The aim of the study was to describe dysphagia in children (0-12 years) recovering from TBM at Red Cross War Memorial Children's Hospital (RCWMCH) in the Western Cape, South Africa. The purpose of the study was to determine the occurrence and describe the nature of dysphagia as well as to investigate whether any associations existed between dysphagia and the severity of TBM, neurological sequelae, age, and radiological findings.

Includes bibliographical references, South Africa has a high incidence of injury-related disorders, such as traumatic brain injury (TBI) as a result of motor vehicle accidents and assault. Dysphagia is a common sequela of TBI, which may result in malnutrition or aspiration pneumonia. There is limited epidemiological data available for TBI and dysphagia in South Africa which is important for health care planning. There is also inadequate literature reporting predictive factors for dysphagia and health outcomes of patients with TBI and swallowing disorders for the South African context, which would provide management guidelines for Speech-Language Pathologists (SLPs) for patients with TBI and dysphagia. This study aims to begin to provide up-to-date information regarding the incidence of TBI and the prevalence of dysphagia in the population with TBI in Bloemfontein, South Africa. Predictive factors for dysphagia and health outcomes were also investigated in order to provide management guidelines for TBI-related dysphagia for SLPs. A prospective cohort study followed 77 participants aged 18 to 68 years (M = 33.1) with mild to severe traumatic brain injury, admitted to 2 state and 2 private hospitals in the Bloemfontein metropole, South Africa, to investigate the incidence of TBI and the prevalence of TBI-related dysphagia in the adult population in 2013. Participants were tracked from admission to hospital to discharge. Demographic and medical data was collected for each participant, including: gender, age, TBI aetiology, means of nutritional intake, respiratory status, length of hospital stay, and number of speech therapy sessions. Glasgow Coma Scale (GCS) scores at time of admission, swallowing evaluation, and discharge were noted as an indicator of TBI severity and each participant was assessed with the Mann Assessment of Swallowing Ability on admission and prior to discharge to assess the presence of dysphagia. The incidence of TBI for the Bloemfontein metropole was 353 per 100,000 people and was greater in the male than in the female population (11.83:1). The main mechanism for TBI in Bloemfontein was interpersonal violence (67.53%), followed by road traffic accidents (motor and pedestrian vehicle accidents; 23.38%). The prevalence rate for dysphagia was 32%. Twenty-eight percent of those who presented with dysphagia also aspirated. Severe TBI (GCS ≤ 8) was identified as a predictive factor for dysphagia. Participants with dysphagia had longer hospital stays (days; M = 22.04, SD = 17.67) than those with normal swallowing (M = 6.23, SD = 4.28), t(75) = 6.13, p < .001, and took significantly more days to achieve oral intake (M = 6.23, SD = 10.32) than those without dysphagia (M = .31, SD = 1.41), t(75) = 4.08, p < .001. Ventilation was associated with longer hospital stays, rs(25) = -.47, p = .02 and longer duration until achievement of oral intake, rs(22) = -.80, p < .001. Tracheotomised participants also had significantly longer hospital stays, rs(25) = -.67, p < .001, and took longer to achieve oral intake, rs(22) = -.52, p = .01. An increased period of time with a tracheostomy was also significantly associated with mortality, χ2(2, n = 11) = 6.52, p = .04. Participants with dysphagia (M = 3.84, SD = 5.44) required significantly more therapy sessions with an SLP than those without dysphagia (M = .15, SD = .64), t(75) = 4.85, p < .001, and those with low GCS scores were significantly less likely to achieve oral intake prior to discharge, rs(25) = -.45, p = .02, and had longer hospital stays than participants with mild head injuries, rs(25) = -.49, p = .01. All participants who received nutrition via nasogastric tubes returned to oral intake; however, individuals who had percutaneous endoscopic gastrostomies did not achieve oral intake prior to discharge. It is recommended that objective swallowing evaluations be conducted for patients admitted with severe TBIs, and patients with mild and moderate TBIs be screened to determine the presence of dysphagia. TBI prevention initiatives should be developed to reduce the incidence of TBI, specifically in the young adult male population.

Patients with dysphagia, who are unable to meet their daily hydration and nutritional needs orally, may require enteral nutrition, either via a nasogastric tube (NGT) as a short term provision, or via a gastrostomy tube for longer term provision. The presence of dysphagia, specific medical conditions and the presence of comorbidities place patients, who require enteral nutrition, at risk for mortality. High rates of mortality are reported in international literature, in patients following the placement of long term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). High mortality rates following the placement of enteral nutrition in patients treated by Speech Language Therapists (SLTs) at Chris Hani Baragwanath Academic Hospital (CHBAH) were noted anecdotally. No study has previously been done to analyse the outcomes and risks of the placement of enteral nutrition in the adult population with dysphagia in the South African context. This study aimed to compare survival times in patients with dysphagia, who had a single morbidity and multiple morbidities, who were recommended for enteral nutrition to those who were recommended for oral palliative nutrition, and the risks associated with a higher risk of mortality postplacement of enteral nutrition. Design: The study employed an observational cohort design, using both retrospective and prospective methods. Three cohorts were included in the study.1) Participants with multiple morbidities who were recommended for enteral nutrition (n=212), 2) Participants with a single morbidity who were recommended for enteral nutrition (n=35) and, 3) Participants who were placed on oral palliative nutrition (n=10). Results: A high rate or mortality was noted in all participants who were placed on enteral nutrition (regardless of it being NGT or PEG). Survival time was longer in participants with a single morbidity (54 days) compared to those with multiple morbidities (24 days) who received a PEG. Survival of participants with multiple morbidities who were on oral palliative nutrition, was only five days less (19 days) than participants with multiple morbidities who had a PEG placed. Mortality rates were high following the placement of enteral nutrition which could be attributed to the participants underlying medical condition and level of morbidities present. Conclusion: Findings of this study highlight the need for greater consideration of the risk factors that may place a patient at risk of mortality following the placement of enteral nutrition. It brings into question the futility of some PEG procedures in a cohort of participants that show such poor survival, and encourages clinicians to explore the option of oral palliative nutrition as a recommendation for patients who are expected to have a high risk of mortality if recommended for and placed with enteral nutrition.

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Includes abstract. Includes bibliographical references.

Includes abstract., Includes bibliographical resources., Feeding and/or swallowing difficulties (FSD) have been associated with some of the leading causes of infant and child mortality in South Africa. Preventable conditions such as lower respiratory tract infections (LRTI) and under-nutrition may be caused by FSD. FSD are frequently reported in paediatric populations and may occur with various medical co-morbidities. The nature of FSD is however under described and information specific to developing countries is scarce. Furthermore, limited information regarding the service delivery requirements of the paediatric population with FSD is available. To describe in a paediatric population: the nature and frequency of FSD, the nature of FSD in different medical conditions or participant characteristics, and the nature of the services and interventions received by infants and children with FSD. A descriptive, retrospective survey design was used to examine the medical records of 446 infantsand children aged less than 13 years who accessed services for FSD at a paediatric tertiary hospital from January 2007 to December 2009. Seventy percent of participants were under the age of 2 years at the time of first assessment. The nature of participants’ FSD, the medical conditions present, and services/interventions received were recorded. The data were described and associations were analysed statistically. Infants and children with FSD often presented with various medical co-morbidities affecting multiple organ systems with neurologic and gastro-intestinal tract conditions occurring most frequently. A third (34%) of the participants had confirmed aspiration on instrumental assessment. Participants with confirmed aspiration presented with statistically significantly more aspiration pneumonia (x2 = 26.4314, p

Includes abstract., Includes bibliographical references., A descriptive survey research design was used to describe the auditory function of children with tuberculosis (TB) receiving ototoxic medication at Brooklyn Chest Hospital. A battery of audiologic tests (otoscopy, immittance, audiometry or OAE and AABR) were conducted on 29 children, aged 0 to 18 years, and the results were analysed using descriptive statistics and Generalized Linear Models. The results suggest that 55% of children had middle ear abnormality and 48% had hearing loss. The degree of hearing loss ranged from mild to profound in 41 % of the cases while 59% had hearing within the normal range with their loss restricted to high frequencies. No statistically significant associations were found between sex, duration of hospitalization, comorbid presentation of HIV and TB and middle ear abnormality.

Includes abstract. Includes bibliographical references (leaves 210-234).

Includes bibliographical references., This study was conducted at the Cerebral Palsy (CP) Clinic, Red Cross Hospital, Cape Town between May and September 2004. The sample population was a group of mothers/caregivers and their infants and young children, who presented with evolving or severe cerebral palsy, persistent feeding difficulties and other multiple disabilities. The research was in the domain of treatment outcome, against a background of lack of evidence regarding the effectiveness of intervention programmes for children with CP, and, in particular, very young dependent feeders with neurologically-based feeding disorders. The study incorporated three distinct but complementary parts, namely: (1) identification of the fundamental issues that needed to be addressed in an effective feeding intervention programme for this population of children; (2) evaluation of the functional outcomes of a feeding intervention programme, based on the Neuro-developmental therapy (NDT) approach and currently employed at the CP Clininc, Red Cross Hospital; and (3) determination of the acceptability and sustainability of the feeding intervention programme for the participating mothers and caregivers.

Includes bibliographical references (leaves 97-111).

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Includes bibliographical references (leaves 116-131).

Includes bibliographical references (leaves 84-93).

Bibliography : leaves 68-75.