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A study at Cape Technikon (South Africa) investigated college choice decision making by surveying 923 applicants during the application process and 314 enrollees during orientation. Results show demographic and socioeconomic characteristics of applicants and enrollees differ, applicants consider multiple institutions, alumni and friends are the most important information sources, and students consider schools before their high school senior year. (MSE)

Examination of the employment situation of South Africa's recent university graduates finds many are taking jobs of lower status and income than graduates of previous periods, resulting in underemployment. A study of employment levels and labor demand in 812 companies suggests strategic enrollment management could play an important role in matching graduates with labor needs. (MSE)

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mean annual soil respiration correlates with net primary productivity and therefore provides an indication of ecosystem functioning. Soil respiration, however, varies considerably in space and time owing to the influence of factors such as soil nutrient content, temperature and water content. Comparing soil respiration across a fence-line separating rangelands in contrasting condition can potentially isolate effects of rangeland management from other abiotic variables. To explore this idea, soil respiration was measured from 260 different collars across a fence-line contrast in the Nama Karoo, near Beaufort West, over a period of four days in May 2005. Differences in soil respiration across the fence-line were only evident when the data were analysed in relation to soil temperature. The large data set enabled delineation of boundary lines relating soil respiration to temperature on the two farms. The boundary line analysis showed that constraint on soil respiration was between 0.2 and 0.4 umol CO2 m-2 s-1 greater under high compared to moderate stocking density. It was concluded that measurement of soil respiration is likely to be useful for detecting changes in ecosystem function as a result of over-utilisation of Karoo rangeland. [ABSTRACT FROM AUTHOR]

The purchasing and marketing of game meat by supermarkets and butcheries in the Western Cape Province of South Africa was researched by the survey method. Two supermarket groups in South Africa indicated that they do market game meat, and springbok (Antidorcas marsupialis) was the species that most supermarkets sold. Both supermarket groups indicated that they would sell more game meat if available. They also mentioned that a central marketing structure would facilitate the sale of game meat and ensure consistent quality. Thirteen of the twenty butcheries that sell game meat were also in favour of a central marketing structure. The butcheries indicated that consumers are not adequately informed about the health benefits and cooking methods of game meat. Some of the meat buyers at butcheries were ignorant of the qualities of meat that are important when purchasing game meat. It is evident that game meat marketers should exercise stricter control over the quality of game meat, and that supermarkets and butcheries are not promoting game meat extensively enough. [ABSTRACT FROM AUTHOR]

There has been a conspicuous increase in malaria cases since 2016/2017 over the three malaria-endemic provinces of South Africa. This increase has been linked to climatic and environmental factors. In the absence of adequate traditional environmental/climatic data covering ideal spatial and temporal extent for a reliable warning system, remotely sensed data are useful for the investigation of the relationship with, and the prediction of, malaria cases. Monthly environmental variables such as the normalised difference vegetation index (NDVI), the enhanced vegetation index (EVI), the normalised difference water index (NDWI), the land surface temperature for night (LSTN) and day (LSTD), and rainfall were derived and evaluated using seasonal autoregressive integrated moving average (SARIMA) models with different lag periods. Predictions were made for the last 56 months of the time series and were compared to the observed malaria cases from January 2013 to August 2017. All these factors were found to be statistically significant in predicting malaria transmission at a 2-months lag period except for LSTD which impact the number of malaria cases negatively. Rainfall showed the highest association at the two-month lag time (r=0.74; P<0.001), followed by EVI (r=0.69; P<0.001), NDVI (r=0.65; P<0.001), NDWI (r=0.63; P<0.001) and LSTN (r=0.60; P<0.001). SARIMA without environmental variables had an adjusted R2 of 0.41, while SARIMA with total monthly rainfall, EVI, NDVI, NDWI and LSTN were able to explain about 65% of the variation in malaria cases. The prediction indicated a general increase in malaria cases, predicting about 711 against 648 observed malaria cases. The development of a predictive early warning system is imperative for effective malaria control, prevention of outbreaks and its subsequent elimination in the region.

Objective: To validate a calibrated smartphone-based hearing test in a sound booth environment and in primary health-care clinics., Design: A repeated-measure within-subject study design was employed whereby air-conduction hearing thresholds determined by smartphone-based audiometry was compared to conventional audiometry in a sound booth and a primary health-care clinic environment., Study Sample: A total of 94 subjects (mean age 41 years ± 17.6 SD and range 18-88; 64% female) were assessed of whom 64 were tested in the sound booth and 30 within primary health-care clinics without a booth., Results: In the sound booth 63.4% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dB HL corresponded to smartphone thresholds within ≤10 dB in 80.6% of cases with an average threshold difference of -1.6 dB ± 9.9 SD. In primary health-care clinics 13.7% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dBHL corresponded to smartphone thresholds within ≤10 dB in 92.9% of cases with an average threshold difference of -1.0 dB ± 7.1 SD., Conclusions: Accurate air-conduction audiometry can be conducted in a sound booth and without a sound booth in an underserved community health-care clinic using a smartphone.

Objective: The objective of this study was to develop and validate a smartphone-based digits-in-noise hearing test for South African English., Design: Single digits (0-9) were recorded and spoken by a first language English female speaker. Level corrections were applied to create a set of homogeneous digits with steep speech recognition functions. A smartphone application was created to utilize 120 digit-triplets in noise as test material. An adaptive test procedure determined the speech reception threshold (SRT). Experiments were performed to determine headphones effects on the SRT and to establish normative data., Study Sample: Participants consisted of 40 normal-hearing subjects with thresholds ≤15 dB across the frequency spectrum (250-8000 Hz) and 186 subjects with normal-hearing in both ears, or normal-hearing in the better ear., Results: The results show steep speech recognition functions with a slope of 20%/dB for digit-triplets presented in noise using the smartphone application. The results of five headphone types indicate that the smartphone-based hearing test is reliable and can be conducted using standard Android smartphone headphones or clinical headphones., Conclusion: A digits-in-noise hearing test was developed and validated for South Africa. The mean SRT and speech recognition functions correspond to previous developed telephone-based digits-in-noise tests.

Background: Worldwide, more than 200 million children in low- and middle-income countries have developmental delays and/or disabilities. In South Africa the only nationally implemented developmental 'screening' tool is integrated as part of 'The Road to Health Booklet (RTHB)., Method: The study employed a comparative cross-sectional within-subject design to evaluate the accuracy of the RTHB developmental checklist against a standardized international tool i.e. the PEDS tools, consisting of the PEDS and PEDS:DM. A total of 201 participants were included through convenience sampling at primary health care facilities in Tshwane, South Africa., Results: Sensitivity of the RTHB developmental checklist is low, but specificity is high. The RTHB developmental checklist failed to identify more than half the infants at risk of delays or disorders. The nationally implemented developmental checklist is ineffective to identify at-risk infants. It should be adapted and validated or replaced in order to improve identification of at-risk infants.

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.

Objective: To explore areas of functioning, disability, and environmental factors of adults with hearing loss (HL) by using the ICF classification as a tool to determine and document each element., Design: A qualitative study applying mainly focus-group methodology was applied., Study Sample: Thirty-six Dutch and South African adults (≥ 18 years of age) with HL (20-95 dB HL) who used oral communication as first communication. Summative content analysis was performed on the transcripts by linkage to appropriate ICF categories., Results: 143 ICF categories were identified, most of which belonged to the Activities & Participation (d) component, closely followed by the Environmental factors component. Participants specifically mentioned categories related to oral communication and interaction. Assistive technology (such as hearing aids), noise, and support by and attitudes of others in the environment of the participants were considered highly influential for functioning and disability., Conclusions: The present study illustrates the complex and encompassing nature of aspects involved in functioning and disability of adults with HL. Findings highlight the necessity of using a multidimensional tool, such as the ICF, to map functioning and disability with hearing loss, allowing consideration and evaluation of aspects that are both internal and external.

Background: A recently validated image-based grading scale for acute otitis media (OMGRADE) can be used to assess tympanic membrane (TM) status. The aim of this study was to evaluate the validity and reliability of this scale for remote assessments of TM status using video-otoscopy recordings in an unselected pediatric population., Method: Children 2-16 years attending a South African primary health clinic were offered an ear examination by an otologist using otomicroscopy. An ear and hearing telehealth facilitator then made video-otoscopy recordings (9-33s) of the ears and uptakes were uploaded to a secure server for remote assessments in Sweden by an otologist and general practitioner at four- and eight-weeks post onsite assessment. TM appearance was judged according to the OMGRADE scale. Concordance between onsite otomicroscopy and asynchronous assessments of video-otoscopy recordings was calculated together with intra- and inter-rater agreements., Results: One hundred and eighty ears were included. Concordance of TM classifications using the OMGRADE scale was found to be substantial (weighted kappa range 0.66-0.79). Intra- and inter-rater agreement (test-retest) was found to be substantial to almost perfect (weighted kappa range 0.85-0.88 and 0.69-0.72, respectively)., Conclusion: The OMGRADE scale can be used to accurately assess the normal TM and secretory otitis media (SOM) remotely using video-otoscopy recordings in an unselected pediatric population., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objectives: This study describes screen refusal and follow-up default characteristics together with caregiver reasons for screen refusal and follow-up default in two South African universal newborn hearing screening programs., Methods: A retrospective record review of universal newborn hearing screening conducted at two hospitals (Hospital A n = 954 infants; Hospital B n = 2135) over a 31-33 month period. Otoacoustic emission screening was conducted with rescreen recommended within six weeks for a uni- or bilateral refer. Program efficacy was described according to coverage, referral and follow-up rates. A prospective telephonic interview with caregivers who declined the initial screen (n = 25) and who defaulted on follow-up (n = 25) constituted the next study component. Caregivers were randomly selected from the screening programs for a survey related to reasons for newborn hearing screening refusal and follow-up default., Results: Screening coverage (89.3% Hospital A; 57.4% Hospital B), initial referral rates (11.6% Hospital A; 21.2% Hospital B) and follow-up return rates (56.1% Hospital A; 35.8% Hospital B) differed significantly between hospitals and were below benchmarks. The most frequent reasons for screen refusal were related to costs (72%), caregiver knowledge of newborn hearing screening (64%) and health care professional knowledge and team collaboration (16%). Almost all caregivers (96%) indicated that if costs had been included in the birthing package or covered by medical insurance they would have agreed to newborn hearing screening. Reasons for follow-up default were most commonly related to caregiver knowledge of newborn hearing screening (32%) and costs (28%). One in four caregivers (24%) defaulted on follow-up because they forgot to bring their infant for a rescreen. Only half of caregivers (48%) who defaulted on follow-up reported being aware of initial screen results while 60% reported being aware of the recommended follow-up rescreen., Conclusion: Caregivers most commonly refused screening due to associated costs and mostly defaulted on follow-up due to an apparent lack of knowledge regarding initial screen outcome and recommendations made for follow-up. Including NHS as a mandated birthing service is essential if coverage is to be increased, while reducing follow-up defaults requires proactive reminders and improved communication with caregivers., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: The purpose of the study was twofold: (1) to assess the ability of hearing-impaired adults in the developing world to independently and accurately assemble a pair of hearing aids by following instructions that were written and illustrated according to best-practice health literacy principles; and (2) to determine which factors influence independent and accurate task completion., Design: Correlational study., Study Sample: Forty South African and 40 Chinese adults with a hearing loss and their partners. The participant group included 42 females and 38 males ranging in age from 32 to 92 years., Results: Ninety-five percent of South African and 60% of Chinese participants completed the assembly task, either on their own or with assistance from their partners. Better health literacy, younger age, and a more prestigious occupation were significantly associated with independent task completion for the South African and Chinese participants. Task accuracy was significantly linked to higher levels of cognitive function among South African participants, while a paucity of valid data prevented an analysis of accuracy from being conducted with the Chinese data., Conclusion: Individuals of diverse backgrounds can manage the self-fitting hearing-aid assembly task as long as health literacy levels and cultural differences are considered.

Objective: To describe the nature of hearing loss and associated risk profile in a South African population of infants and children diagnosed at a pediatric referral clinic., Methods: A retrospective review of patient files for a pediatric auditory evoked potential clinic in Pretoria was conducted (January 2007-December 2011). Collected data included demographical information, risk factors from case history questionnaire, diagnosis (type and degree of hearing loss), documented age of caregiver suspicion and age of first diagnosis., Results: Hearing loss was present in 73% (73/100) of cases evaluated. Permanent hearing losses (SNHL, ANSD and mixed) constituted 76% of losses. Unilateral hearing losses constituted 8% of SNHL and 20% of conductive hearing loss. ANSD was diagnosed in 21.4% and SNHL in 78.6% of permanent non-conductive hearing loss cases. The most prevalent SNHL risk was family history of hearing loss and for ANSD it was admittance to the NICU for more than 5 days. The majority of the sample was diagnosed with a permanent bilateral SNHL and ANSD after 36 months of age (47%) despite 40% already suspected of having a hearing loss before 12 months of age., Conclusions: A high prevalence of ANSD was found with preventable risk factors often indicated. Age of diagnosis was significantly delayed, evidencing the lack of early hearing detection services in South Africa. The majority of children were diagnosed at ages precluding optimal benefits from early detection and subsequent intervention., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objectives: This study describes the prevalence and nature of auditory and otological manifestations in adults with HIV/AIDS through clinical examinations and self-reported symptoms across stages of disease progression., Design: Descriptive cross-sectional group design., Study Sample: Two hundred HIV positive adult patients (56.5% male; 43.5% female; mean age: 37.99 ± 6.66 years) attending the Infectious Disease Clinic of a tertiary referral hospital in Pretoria, South Africa were included. Patients were interviewed, medical files were reviewed, and clinical examinations, including otoscopy, tympanometry, pure-tone audiometry, and distortion product otoacoustic emissions, were conducted. A matched HIV negative control group was used to compare hearing loss prevalence., Results: Tinnitus (26%), vertigo (25%) hearing loss (27.5%), otalgia (19%), and ear canal pruritis (38%) were prevalent self-reported symptoms. Abnormalities in otoscopy, tympanometry, and otoacoustic emissions were evident in 55%, 41%, and 44% of patients respectively. Pure-tone average (PTA) hearing loss > 25 dBHL was evident in 14% of patients and 39% for hearing loss > 15 dBHL (PTA). Significant differences across average thresholds in the HIV positive and HIV negative control group was present. An increase in self reported vertigo, self reported hearing loss, OAE abnormalities, and hearing loss (PTA > 15 dBHL and PTA > 25 dBHL) was seen with disease progression but was not statistically significant. A significant increase (p <.05) in sensorineural hearing loss was however evident with disease progression., Conclusions: Auditory and otological symptoms are more common in patients with HIV with a general increase of symptoms, especially sensorineural hearing loss, towards advanced stages of disease progression.

Introduction: Substantial evidence describes the protective effects of marine-derived omega-3 (n-3) polyunsaturated fatty acids (PUFA) on cardiovascular diseases as well as many other conditions. Numerous fatty acid preparations are marketed for supplementing the Western diet, which is low in n-3 fats. Since these preparations may vary in their n-3 PUFA content, we tested 45 commercially available products on the South African market for their fatty acid composition., Method: Forty-five commercially available n-3 fatty acid supplements were analysed using gas-liquid chromatography to determine their fatty acid content., Results: More than half of the n-3 supplements available on the South African market contained ≤ 89% of the claimed content of EPA and/or DHA as stated on the product labels. To meet ISSFAL's recommendation of 500 mg EPA + DHA/day can cost consumers between R2 and R5 per person per day (R60 to R150 p/p/month). Regarding rancidity, the majority of capsules contained conjugated diene (CD) levels higher than that of vegetable oil obtained from opened containers (three months) used for domestic cooking purposes, despite the addition of vitamin E as antioxidant., Conclusion: Since no formal regulatory structure for dietary supplements currently exists in South Africa, consumers depend on self-regulation within the nutraceutical industry for assurance of product quality, consistency, potency and purity. Our results indicate that more than half of the n-3 fatty acid supplements on the South African market do not contain the claimed EPA and/or DHA contents as stated on product labels, and they contained CD levels higher than that in unused vegetable oils obtained from opened containers used for domestic cooking purposes.

Hearing impairment has far-reaching consequences for affected individuals, in terms of quality of life indicators. In the public health care sector of South Africa the hearing-impaired population is faced with limited aural rehabilitation services. This study evaluated self-reported outcomes of aural rehabilitation in a group of adults in the public health care sector with a standardised outcomes measurement tool (IOI-HA). Sixty-one participants were included (44% male; sample mean age 69.7 years) through face-to-face or telephonic interviews. Results revealed that the average perceived outcome of participants (5 = best outcome; 1 = poorest outcome) was positive across all domains of the inventory including daily use of hearing aids (4.3); benefits provided by hearing aids (4.3); residual activity limitation (3.9); satisfaction with hearing aids (4.5); residual participation restriction (4.0); impact of hearing difficulties on others (4.6); and changes in quality of life (4.5). Statistically significant relationships for daily use of hearing aids, degree of hearing loss, type of hearing aids fitted, and the perceived benefit from hearing aids in difficult listening environments (p<0.05) were evident. Adult aural rehabilitation for hearing loss in a public health care facility, even without optimal hearing aid fittings, was effective in providing positive perceived outcomes comparable to similar studies in developed countries. The findings advocate for the initiation of affordable and sustainable aural rehabilitation services in developing countries despite apparent resource limitations.

We evaluated the validity of remote pure tone audiometric testing conducted from North America on subjects in South Africa. Desktop-sharing computer software was used to control an audiometer in Pretoria from Dallas, and PC-based videoconferencing was employed for clinician and subject communication. Thirty adult subjects were assessed, and the pure tone audiometric thresholds (125-8000 Hz) obtained through conventional face-to-face and remote testing were compared. Face-to-face and remote audiometry thresholds differed by 10 dB in only 4% of cases overall. The limits of agreement between the two techniques were -8 and 7 dB with a 90% confidence interval of -5 to 5 dB. The average reaction times to stimulus presentations were similar, within -108 and 121 ms. The average test duration was 21% longer for remote testing (10.4 vs. 8.2 min). There were no clinically significant differences between the results obtained by remote intercontinental audiometric testing and conventional face-to-face audiometry. It may therefore be possible to expand the reach of audiological services into remote underserved regions of the world.

Objective: Benefits of early identification and subsequent intervention for hearing loss are not accessible to infants in developing countries like South Africa. There are no systematic screening programs and traditional platforms for newborn hearing screening, such as well-baby and intensive care nurseries, do not provide sufficient coverage due to the high incidence of births at home or in primary healthcare facilities. Primary healthcare structures, in the form of immunization clinics, have been proposed as an alternative screening platform. The current study, therefore, investigates a hearing screening program implemented at two immunization clinics in a representative South African community., Methods: The two clinics in the current study were selected by a convenience sampling method in a community representative of large sections of the population. The hearing screening program was conducted over a 5-month period, and enrolled 510 infants (0-12 months of age). The screening protocol included Distortion Product Oto-Acoustic Emissions (DPOAE) and a high frequency probe tone (1000 Hz) tympanogram. Referral was based on one or both ears referring the DPOAE screen. Follow-up screening and diagnostic evaluations were scheduled for referred subjects., Results: Coverage with DPOAE amounted to 95% of the sample ears (93% of sample subjects) compared to tympanogram coverage amounting to 94% (93% of sample subjects). OAE pass rates were 93% for the sample ears with neonatal ears indicating a higher pass rate of 95% compared to 92% for infant ears (5-52 weeks of age). Eighty-seven percent of the sample ears indicated peaked tympanograms indicative of normal middle-ear functioning and neonatal ears presented with an increased incidence of peaked tympanograms (92%). A highly significant association between the DPOAE and high frequency tympanometric result was found. Follow-up screening appointments were scheduled for 68 subjects (14% of screened sample). Only 40% returned for the second follow-up and 44% for the third follow-up., Conclusions: Immunization clinics indicate promise as infant hearing screening platforms, but identification of only bilateral hearing losses may be warranted initially to keep referral rates acceptably low. In addition to this efficient tracking systems are necessary to ensure acceptably high follow-up return rates are reached over time.

Audiology in South Africa is an established profession facing the challenge of serving a diverse population in predominantly developing contexts. The profession has developed over the last half century from an adjunct to speech-language pathology into a profession in its own right. Several tertiary institutions offer undergraduate training in audiology with optional postgraduate qualifications. Institutions are continually adapting to a profession characterised by rapid change--evidenced even in the very composition of the profession itself. This article aims to provide an overview of the development and current status of audiology as a profession in South Africa.