Clinical characteristics and outcomes of referrals for speech and language delay to the Speech Therapy and Audiology department at a district hospital in Gauteng, South Africa.
Lucie B L Graca, Renate Strehlau, Jacqueline K Bezuidenhout
PMID 42683730WHAT IT FOUND
Of 150 children referred for speech and language delay at a South African district hospital, 49.2% never returned for follow-up.
Autism was the most common specialist diagnosis (52%). Bilingualism and maternal pregnancy complications showed no link to greater delay.
Key findings
01Nearly half of assessed children (49.2%) never returned for follow-up after their initial assessment, and 18.7% of all referrals never attended their first appointment.
02Autism spectrum disorder was the most common specialist diagnosis made at the neurodevelopmental clinic (13 children, 52%), with a mean age of ASD diagnosis of 49.54 months.
03Children from bilingual households were not more likely to present with receptive or expressive language delay of greater than 12 months, and maternal pregnancy comorbidities showed no significant association with language delay.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The entire 18-month data collection period fell during the COVID-19 pandemic, when the department's services were intermittently suspended and families avoided hospital visits, so the 49.2% follow-up default rate likely overstates the usual rate. Single-site audit at one district hospital in Gauteng; the authors note the findings may not be generalisable to other regions or country levels. Retrospective record review: 18.7% of referrals never attended their first appointment, home language data were missing in many files, and two records were excluded for extensive missing data. The study was conducted as part of a degree requirement, so the time frame could not be adjusted to avoid the pandemic. No follow-up data were available for 58 children (49.2%), meaning outcomes for nearly half the assessed cohort are unknown.
Declared interests
The authors state the research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. No other conflicts of interest are declared.
The easy way to misread this
Do not read the 49.2% follow-up default rate as the normal experience of families in this setting. The entire study period fell during the COVID-19 pandemic, when the department was classified as non-essential and intermittently closed, and families were avoiding hospital visits. The authors themselves note that retention would likely have been higher outside the pandemic, so using this figure to argue that families simply do not value speech therapy would be a misreading of the data.