Electronic Theses and Dissertations (Masters)
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Item The Role and Role Activities of Professional Nurses Practicing in Child and Adolescent Psychiatric Inpatient Units in Gauteng, South Africa(University of the Witwatersrand, Johannesburg, 2024) Coetzee, Rebecca Adelle; Nkosi, NokuthulaBackground: In South Africa’s healthcare system, the rise in mental health challenges among children and adolescents underscores the need for effective, specialized services. Central to psychiatric care are multidisciplinary teams, with child and adolescent professional nurses playing crucial roles in supporting positive health outcomes. However, the specific roles and activities of these nurses remain unclear within the South African context. Purpose: This study aims to fill this gap by investigating the roles and activities of child and adolescent professional nurse practitioners in South Africa. Through semi- structured interviews, the study explores the various dimensions of their roles. Research Methods: This qualitative descriptive study used semi structured interviews and thematic analysis to gather and analyse data, 17 interviews were conducted and analysed. A scoping literature review was also conducted, following Arksey and O'Malley’s (2005) framework, to map the role of child and adolescent professional nurses internationally over the past decade. The review, conducted across databases including Ebsco Host, Scopus, and ProQuest, resulted in six articles after applying inclusion and exclusion criteria. Findings: Interview data revealed that nurses’ roles include patient support, crisis management, independent admission processes, medication administration, and therapy sessions. Their responsibilities span ensuring safety, collaborating in multidisciplinary teams, managing high-risk patients, and maintaining records. Administrative duties involve delegation, supervision, training, advocacy, and referrals. The main challenges identified were training gaps in psychology, burnout, resource limitations, and facility constraints. The scoping review echoed similar themes, including professional roles, patient care, therapeutic interventions, safety measures, collaborative practices, training needs, and skills development for CAMH nurses. Conclusion: This study illuminates the diverse and essential roles of child and adolescent professional nurses within the healthcare team, underscoring the need to integrate these responsibilities into training curricula. By synthesising literature and xii empirical data, the study offers a comprehensive view of these nurses’ roles and challenges, contributing valuable insights for future practice and education in the field.Item The Development of an Environmental Hygiene Management Audit Tool for Operating Rooms(University of the Witwatersrand, Johannesburg, 2024) Mahlangu, Patience; Engelbrecht , LinetteBackground: The operating theatre environment is as complex as surgical and anaesthetic practices combined. The intra-operative environment may be one of the most contaminated areas in a hospital. Effective operating room environmental management is an important measure to prevent the spread of Surgical Site Infections (SSIs). Environmental cleaning teams require clear instructions and training, and simple methods of assessing cleanliness, which cannot be done by visual assessment. Despite the abovementioned recommendations, incorrect cleaning practices continue to occur for multiple reasons. Aim: The aim of this study is to contribute to a safe operating room environmental cleaning practices and management through the development of an environmental hygiene audit tool that could enhance the quality care of all patients in the operating room. Methods: An exploratory three- phase sequential mixed-methods design was conducted to meet the research objectives. 1) In Phase 1, a scoping review of literature was conducted guided by a framework proposed by Johanna Briggs Institute. Five data bases were searched for primary studies published in English between 2010 and 2020. 2) In-depth interviews were conducted with four purposively selected experts in the field of Infection Prevention and Control in the operating theatre, to gather multiple viewpoints on the intraoperative environmental cleaning practices and management in phase 2. 3) In Phase 3, an audit tool of an an environmental hygiene management was developed, based on the findings of phase 1 and 2. The development was guided by the Donabedian framework. Data analysis: Data were analysed following the thematic analysis in Phase 1 and Phase 2. Following data analysis, 5 major themes emerged in phase 1 and 4 themes in phase 2 of the study. Data from the 2 phases informed the development of the environmental hygiene management audit tool in phase 3. Summary of findings: The findings of this study indicated that the environmental hygiene in the operating room should be managed through specific cleaning practices, specific cleaning methods and cleaning intervals. It is also indicated that there are different types of chemicals/products with different strength that should be used for surfaces, equipment and floors. The equipment such as mops and cloths should also be cared for and handled in a 6 certain manner. This was backed up by the participants during the in-depth interviews and they even added on the aspect of cleaner safety, risks, training and responsibility. Conclusion: Operating theatre environment is a secondary reservoir for organisms with the potential for infecting patients undergoing surgery. This study recommends that thorough and frequent disinfection of surfaces with higher frequency of hand contact be done after each patient procedure.Item Worker’s Knowledge and Practices on Factors Influencing the Risk of Silica Dust Exposure in Lesotho Mines(University of the Witwatersrand, Johannesburg, 2024) Langwana, Vuyiseka; Masekameni, M.DBackground Exposure to respirable crystalline silica (RCS) dust is a major occupational hazard linked to serious lung diseases, including silicosis, lung cancer, and pneumoconiosis, with mining accounting for a significant portion of these illnesses. Despite awareness of silica's health risks and efforts to control exposure, hazardous levels persist in industries like mining, quarrying, and mineral processing, where silica is found in materials such as quartzite, sandstone, and granite. Silicosis, an irreversible lung-scarring disease, remains prevalent among workers, particularly miners in Lesotho, where cases have slightly increased, underscoring the need for improved silica dust control measures. Although preventive controls exist, there is an urgent need to enhance silica exposure management in these high-risk environments. Aim This study aims to evaluate mine workers' knowledge, attitudes and practices regarding factors that increase the risk of silica dust exposure in selected mines in Lesotho. Methods The study employed a descriptive retrospective cross-sectional design with a quantitative approach. A record review guide was used to gather secondary data from the Southern Africa Tuberculosis and Health Systems Support (SATBHSS) project. This data was entered into Microsoft Excel, cleaned for accuracy, and analyzed in STATA software, version 17, using both descriptive and inferential statistics. The study focused on a sample of workers from 5 selected mines, chosen from 11 active mines in Lesotho, which extract various minerals. The selected mines were those engaged in mining diamonds, sandstone, and quarry materials. The study aimed to assess the knowledge, attitudes, and practices of mine workers regarding factors that elevate the risk of silica dust exposure in these mines. vi Results The study found that mine workers had good knowledge about certain Occupational Health and Safety (OHS) hazards, with high awareness of lung cancer (91%), noise levels (99%), and safety stressors (96%). However, 90% of workers lacked adequate knowledge on physical stressors in their workplaces. The average knowledge score was 13.43 (SD = 2.99), with scores ranging from 6 to 19 and a median of 14. Regarding preventive practices, 55% of workers reported the presence of health and safety strategies, 60% held regular safety meetings, and only 40% indicated regular dust and noise monitoring by employers. Additionally, 56% had health and safety representatives at work. Notably, 15% viewed the work as suitable only for the "brave," and 65% considered minor accidents a normal part of the job. The workforce was predominantly male (91%) with most having secondary education (79%), which may impact their understanding of training resources on crystalline silica exposure. Conclusion This study reveals that, while health and safety programs exist within mines to prevent exposure to respirable crystalline silica (RCS) dust, gaps in program implementation leave workers at risk for silicosis and other respiratory diseases. Mine workers generally had limited knowledge about managing RCS dust exposure, which leads to poor practices in dust control. The findings emphasize that engineering controls alone are insufficient, underscoring the need for a broader hierarchy of controls and improved administrative measures, including training and best practices. Only 46% of participants recognized air measurements as beneficial for controlling dust exposure. This study, the first of its kind in Lesotho, could inform national policies on silica dust exposure control. However, its findings may be less generalizable to similar mining contexts across Africa due to its retrospective, questionnaire-based design, which may introduce response bias. The study suggests that greater emphasis on knowledge, attitudes, and practices is essential to effectively reduce silica dust exposure in mines.Item A comparative assessment of the legislative and regulatory frameworks for local manufacture of vaccines in South Africa and Egypt(University of the Witwatersrand, Johannesburg, 2024) Naidoo, ThevendranHealthcare systems in low-and middle-income countries in Africa are highly dependent on immunisation programmes and the availability of vaccines to manage infectious disease outbreaks and, together with clean water and access to health care, serve as the cornerstone of prevention. A dependable supply of quality vaccines is crucial in maintaining a country’s health care needs. Local manufacture of vaccines in Africa is vastly inadequate to meet the healthcare needs of the continent. South Africa, like most low-and middle-income countries, is highly reliant on external supplies of vaccines to meet its healthcare needs. This makes the health care system extremely vulnerable during public health emergencies and pandemics. A well-developed policy, legislative and regulatory framework is crucial in supporting local vaccine manufacturing activities. The study investigated the framework that currently exists for local vaccine manufacturing in South Africa in comparison to Egypt as a similar middle- income country with a rapidly advancing local vaccine manufacturing industry. The comparative analysis enabled the formulation of strategies and recommendations to overcome barriers to local manufacturing of vaccines in South Africa. A qualitative study utilising comparative content analysis, was used to compare the policy, legislative and regulatory frameworks in South Africa with that of Egypt. The study found that South Africa and Egypt have adopted vaccine policies of the African Union. South African legislation is well developed with the relevant regulations to support local vaccine manufacturing. Detailed guidelines for vaccine manufacturing activities are present in South Africa and Egypt that are aligned with international regulatory bodies. The South African Health Products Regulatory Authority has established itself as the frontrunner for regulatory harmonisation in Africa. Strong collaboration between national regulators and vaccine manufacturers is needed. National Regulatory Authority harmonisation on the African continent is the cornerstone for supporting the local vaccine manufacturing industry.Item A retrospective study of isokinetic dynamometry parameters in patients diagnosed with unilateral Achilles tendinopathy(University of the Witwatersrand, Johannesburg, 2024) Lloyd, Rohan; Gradidge , Philippe; Constantinou, DemitriIntroduction: The Achilles tendon, the strongest tendon in the human body, is vital for locomotive activities like walking and running. Despite its strength, it is prone to Achilles tendinopathy (AT), a debilitating condition characterised by pain, swelling, and decreased performance. As a common foot and ankle disorder, AT’s prevalence spans across athletes, recreational exercisers, and the sedentary population, with incidences up to 52% in former elite athletes with a lifetime incidence of six percent in the general population. The aetiology of AT involves both extrinsic- and intrinsic risk factors, including overuse, biomechanical irregularities, and muscular dysfunction, particularly in the gastrocnemius-soleus muscles. Research indicates that plantar flexor weakness often occurs before Achilles tendon pain develops. Weakness in the plantar flexor muscles is a key modifiable risk factor for AT issues. Conventional research on AT has primarily focused on peak torque (PT) derived from isokinetic dynamometry evaluations, leaving a gap in understanding the full spectrum of muscle performance affected by AT. Isokinetic dynamometry, with its versatile protocols and advanced software, can comprehensively evaluate muscle performance from both strength and endurance perspectives, addressing this gap. Aim of study: This study aimed to investigate the effects of unilateral AT on various isokinetic dynamometry parameters, including torque, position, and time, in individuals diagnosed with this condition. The objectives were to determine the extent of dysfunction and weakness in the gastrocnemius-soleus muscles and to compare these parameters between symptomatic and asymptomatic extremities, thus enhancing the understanding of AT's unilateral nature. By expanding the analysis beyond PT, the study addresses the gap in current research, exploring a more comprehensive scope of muscle performance in AT. Method: This retrospective study investigated the impact of unilateral AT on isokinetic dynamometry parameters. Participants were males and females, aged 18 years or older, diagnosed with unilateral AT. Initial isokinetic dynamometry evaluation reports from 2015 to 2022 were collected from a private biokinetics practice in South Africa. Although data on 54 participants initially met the inclusion criteria, the exclusion criteria, which required evaluations to be performed at an angular velocity of 60 degrees per second, reduced the number of suitable reports. Consequently, only the evaluations of n=21 participants (n=18 males and n=3 females, with a total sample mean age of 53.1 years) were included in the study. Isokinetic dynamometry evaluation, conducted by registered biokineticists, followed standardised protocols with the Humac Norm Cybex Testing and Rehabilitation System. Parameters analysed included torque, position, and time measures. Statistical analysis 4 involved paired t-Tests and Wilcoxon tests for normally and non-normally distributed data, respectively, with a significance level set at p<0.05. Results: The analysis of PT between symptomatic- and asymptomatic extremities revealed no statistically significant difference, with symptomatic extremities demonstrating a mean PT of 38.81 foot-pounds (SD: ±10.97) compared to 40.91 foot-pounds (SD: ±11.48) for asymptomatic extremities (p = 0.24). However, a significant difference was noted in the joint angle at PT (JAPT), as determined by the Wilcoxon signed-rank test. Symptomatic extremities exhibited a lower mean joint angle of 1.8 degrees (SD: ±5.11) compared to 2.24 degrees (SD: ±3.89) in asymptomatic extremities (p = 0.0001). Time to PT (TPT) did not differ significantly between symptomatic- (0.20 seconds; SD: ±0.13) and asymptomatic (0.21 seconds; SD: ±0.11) extremities (p = 0.16). Similarly, time PT held (TPTH) showed no significant difference between symptomatic- (0.36 seconds; SD: ±0.33) and asymptomatic (0.34 seconds; SD: ±0.39) extremities (p = 0.49). The analysis of work per repetition (WPR) revealed marginal differences between symptomatic- (17.57 foot-pounds; SD: ±5.48) and asymptomatic (18.91 foot-pounds; SD: ±5.90) extremities, but these differences did not reach statistical significance (p = 0.16). The average power per repetition (APR) differed between symptomatic- (35.48 watts; SD: ±11.71) and asymptomatic (39.05 watts; SD: ±13.14) extremities, with a paired t-Test indicating a trend toward statistical significance (p = 0.06), though this did not meet the conventional threshold for significance in this sample. Conclusion: The study provides an understanding of unilateral AT's impact on isokinetic dynamometry parameters. The study highlighted bilateral muscle dysfunction and weakness in individuals with unilateral AT. This was evidenced through the comparative analysis of PT, PT percentage body weight (PT%BW) and PT ratio (PTR) parameters against established norms. Achilles tendinopathy does not significantly affect the speed of muscle contraction or endurance in maintaining PT. This questions the notion of unilateral impairment in AT and highlights the necessity of a comprehensive approach in rehabilitation, focusing on strength, endurance, and biomechanics. The findings also suggest the need for further research with larger cohorts and varied isokinetic dynamometry parameters to validate these conclusions and enhance rehabilitation protocols in AT.Item Antibacterial resistance patterns found in urine samples obtained from the elderly in Gauteng(University of the Witwatersrand, Johannesburg, 2024) Labuschagne, Olivia; Leigh-De Rapper, Stephanie; Williams, Christopher DavidBackground: Elderly are frequent users of healthcare services and may have complex needs related to frailty and multimorbidity. Urinary tract infection (UTI) is often diagnosed in this cohort (often based on non-specific or atypical symptoms) leading to antimicrobial therapy, often chosen empirically. This presents a poorly understood risk of antimicrobial resistance. More accurate data on antimicrobial resistance (AMR) of urinary pathogens in older people, including LTCF residents, is needed. This study aims to determine if samples obtained from LTCF-dwelling individuals show different rates of in vitro AMR compared to samples obtained from community dwelling older people (aged 60 years). Methodology: The study used computerised microbiology laboratory records of urinary samples analysed by Ampath Laboratories in South Africa. 𝜒2 analyses were used to detect differences in resistance patterns between LTCF and community-dwelling individuals. Sub-group analyses and multivariable logistic regression were undertaken for gender, age, in-patient and out-patient samples, and year of collection. Results: Microbiological results from urine samples in Gauteng where analysed (n=50,704). Three cultured bacteria (Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis) showed significant differences in AMR between the two study cohorts. The adjusted odd ratios for Escherichia coli and Proteus mirabilis indicated increased AMR amongst LTCF residents. Conclusion: Urine samples from LTCF-dwelling people have higher rates of in vitro resistance to common antimicrobials used to treat UTI. Greater focus on antimicrobial stewardship in LTCFs is recommended extending to diagnostic approach, empirical antibiotic choice and bacteriological confirmation of antimicrobial choice.Item Community profiling of water sources and uses in a rural setting in Northwest Province, South Africa(University of the Witwatersrand, Johannesburg, 2024) Xulu, Nqobile Thabisile; Mmereki, DanielBackground Access to sustainable and potable water remains a constitutional right for all citizens regardless of their demographic, level of educational, or socioeconomic status. Rural communities are vulnerable to inadequate water supply and lack access to potable water, increasing their vulnerability to waterborne diseases and a lack of personal and environmental hygiene. The majority of residents in rural communities often resort to alternative water sources. Those water sources are often susceptible to contamination. The water contamination has been attributed to a lack of norms and monitoring plans aimed at protecting and preserving the quality of these water sources. Many studies have focused on identifying factors that influence water demand in urban and semi-urban areas to improve water resource planning and development. However, there have been limited studies focused on water use patterns and water profiling in rural areas, particularly where water is sourced from surface sources. Purpose The purpose of the study was to describe the socio-economic characteristics, water sources, water uses, and consumption patterns in Ganyesa village, Northwest Province. Methods A quantitative cross-sectional study design was employed to profile water sources and uses in a rural setting in the Northwest. A total of 175 households were randomly selected to participate in the study. A semi-structured questionnaire comprising of Section A: Household socio-economic data, Section B: Water sources, and Section C: Water consumption. Furthermore, water consumption daily activity diaries were used to collect information on water activity usage for seven (7) days. Results A total of 175 participants aged 18 to 65 years were included in this study. Most of the participants were females (78.28%, n = 137), and males accounted for (21.72%, n = 38). The majority of the study participants (37.17%, n = 65) were between the ages of 41 to 50 years, and the majority (58.5%) had a secondary education. v Participants use different water sources, such as communal taps, boreholes, bottled water, rainwater, water tankers, and rainwater, to meet their daily water needs. The water needs included activities such as bathing, cooking, and outdoor activities. Most of the participants (78,29%, n = 137) depend on communal taps as their primary water supply, followed by boreholes (19.4%, n = 34), and a small group of participants used both boreholes and communal taps (2.22%, n = 4). Participants used variety of alternative water sources to meet their daily water needs during water shortage from their primary water sources. Boreholes were the most used alternative water source (65,71% n=115), communal tap (20%, n=35), borehole and water tanker (7,43%, n=13), borehole and rainwater (2,86%, n=5), borehole and communal tap (2,29%, n=4). The average daily water consumption of one to three occupants was estimated to be 26.62 L/day per person. The average water consumption of males and females was estimated to be 29.6 L/day and 25 L/day, respectively. Several socio- demographic covariates were independently associated with water consumption. In terms of income, i.e., those earning R 5001-R 10000 per month had a statistically significant negative association with water consumption (p = 0.01), with a coefficient of -8.00. Similarly, the distance to the source of water was significant (p < 0.001), with a negative coefficient of -5.82, suggesting that as the distance from the water source increases, the average water consumption at the household level decreases. Gender disparity in water consumption was observed, male participants had a statistically significant reduction in water usage compared to their female counterparts (p = 0.02), with a coefficient of -3.84. Conclusion The study hypothesized that residents residing in rural settings use various water sources improved or unimproved to meet their water daily needs. Therefore, the hypothesis of this study is confirmed, meaning that rural dwellers of (Ganyesa) use both improved and unimproved water sources. Residents use both communal taps and boreholes as their primary water sources. The most used alternative source is borehole, indicating water unsustainability by Kagisano Molopo Local municipality. The alternative water sources used by residents are unimproved and unmonitored as per SANS 241. Groundwater was acknowledged as a remedy to water shortage. To prevent contamination to this groundwater sources the sustainability and preservation of this resource, effective management strategies and policies must be vi implemented. From the study, a conclusion can be made that most of the community members utilized communal taps for both indoor and outdoor activities. It was also found that water consumption at the household level is affected by various sociodemographic factors including household income, sex and distance to water source, the type of water source and number of occupants. This study provides scientific evidence that would help policy and decision makers to take these factors into consideration when addressing water scarcity and improving service delivery challenges to rural communities.Item Ethical Implications of Adopting Value-Based Healthcare in Africa(University of the Witwatersrand, Johannesburg, 2024) Khabela, Sithandile NomfundoValue-based healthcare (VBHC) is purported to be the solution to address the issues that are present within fee-for-service (FFS) healthcare reimbursement. As the global discourse around adopting VBHC gains momentum, the body of knowledge on the topic is growing. Conversely, the literature on VBHC's ethical implications is still sparse. Nonetheless, a few ethical issues have emerged from existing literature and will be detailed below. Civil society and the healthcare fraternity ought to be concerned about the ethical implications of the shift in reimbursement models. This is particularly important in Africa, where economic disparities are glaring and extend into the healthcare sector. Some literature highlights issues of justice, equity, and solidarity as requiring attention with adopting VBHC. They are concerned with how VBHC disproportionately benefits certain populations at the expense of vulnerable populations. Secondly, concerns about the VBHC’s impact on patient autonomy are also emphasised as posing a risk of incentivizing providers to under-treat as a means of maximising revenue. Also, the extensive IT system integration required to underpin VBHC means that patient medical records and treatment history will be stored in a centralised location, accessible to a wider team of providers to monitor population-based patient outcomes statistics. This raises a critical issue of how patient confidentiality will be preserved within VBHC. Ⅲ The concept of “value” in healthcare is unclear and thus poses the real risk of measurement metrics being skewed towards cost containment vs patient outcomes and quality. Thus, providers would potentially use patients for financial gain. Additionally, the lack of cost transparency by providers also makes it challenging for patients to understand how their treatment is priced, how their care is evaluated and how treatment decisions are being made, ultimately potentially resulting in a mistrust of the healthcare system. Finally, VBHC does not make provisions for traditional or alternative medicine providers, who are an essential component of the healthcare system in most LMIC countries (especially in Africa). The oversight of this cultural nuance risks alienating large segments of populations, thus posing a real threat to patient dignity. This paper seeks to consolidate and describe the emerging ethical issues based on globally available literature. In light of the ethical issues raised in the previous chapter, I will argue that adopting VBHC in Africa is morally justified. I hinge my thesis on the Afro-communitarian tenets of shared identity, solidarity and goodwill. However, South Africa’s NHI (which is the most explicit national VBHC in Africa) as spelt out in the National Health Insurance (NHI) Bill of 2019, omits to include Traditional African Healers as part of the care team, thus potentially alienating a significant portion of the population. Secondly, the NHI Bill of 2019 does not provide clarity on how confidentiality will be maintained under the NHI. Until these two issues have been satisfied, I argue that VBHC in Africa is conditionally morally justified. My argument is supported by the Utilitarian ideological basis that actions provide the greatest benefit ought to be pursued. Kantian ethics adds that limiting the citizen’s choices under the NHI is an assault to their autonomy and therefore also deems adopting VBHC in Africa as being conditionally morally justifiable.Item Evaluation of Virologic–Immunologic Responses in HIV-1 Perinatally Infected Children at Public Sector Clinics in South Africa(University of the Witwatersrand, Johannesburg, 2024) Chinyanga, Nelson; Makatini, ZinhleBackground Despite achieving HIV viral suppression following start of combination antiretroviral therapy (cART), a significant proportion of HIV infected adults fail to restore CD4 Tcell counts to expected levels, a phenomenon known as a virologic-immunologic discordance. There is however paucity of data on the prevalence rate of virologic-immunologic discordance in HIV infected children. The study therefore aims to determine the prevalence and associated risk factors of virologic-immunolgic discordance in perinatally HIV-1 infected children after initiation of a antiretroviral regimen. Methods The study is a retrospective longitudinal design that set out to describe the prevalence and risk factors of virologic-immunologic discordant responses in a large HIV paediatric public sector cohort of 1747 children initiated on cART from the January 1st 2004 to December 30th 2022. Data Analysis For data analysis, Chi-square and the Mann-Whitney U test were used. To explore factors associated with virologic- immunologic discordance, univariate and multivariate logistic regression analysis was used. Results Of the 1747 HIV-infected children included in the analysis, 895 (51.2%) were female and 852 (49.0%) male. One thousand two hundred and ninety-seven children on cART had HIV viral loads below the limit of detection and 72 (6%) displayed virologic- immunologic discordance. WHO stage III/IV, older age (10 – 17 yrs), CD4 T cell count <50 cells/μl and AZT or d4T based NRTI regimen, were factors associated with virologic-immunologic discordance. Conclusion HIV infected children who fail to achieve viral suppression and a resulting increase in CD4 T cell count, are at high risk of disease progression and death from AIDS and non-AIDS events and should be monitored closely, without effecting a regimen change.Item An audit of the Speech Therapy and Audiology Department at a district hospital in Gauteng(University of the Witwatersrand, Johannesburg, 2024) Graca, Lucie Berthe Lynda; Bezuidenhout, Jacqueline KimBackground. Children require speech and language to communicate adequately and to participate in daily activities and in society. Speech and language delays may have far- reaching consequences on a child’s development. Objectives. To audit the referrals of children less than six years of age referred to a speech therapy and audiology department at a district-level hospital in Gauteng, South Africa. Methods. A retrospective audit of children aged below six years referred to the outpatient Speech Therapy and Audiology (STA) Department from 01st January 2021 to 30th June 2022 was conducted. Mean and standard deviation (SD) were used for normally distributed continuous variables and median and interquartile range (IQR) for skewed variables. Categorical data were analysed using the Chi-squared and Fishers exact test. Results. One hundred and fifty outpatient referrals were reviewed, of which 94 (62.7%) were males. Speech delay was the most common reason for referral (38%). Of the children seen by the speech therapists and audiologists, 24 (20.3%) children were discharged and 58 (49.2%) defaulted follow-up. One hundred and two children had auditory screening and three children (2.5%) were identified with hearing loss. Twenty-eight children (23.7%) were referred for neurodevelopmental assessments. Conclusions. This audit provided insight into the disease profile of children referred to a STA department at a district level one hospital. It highlighted the demographics of children referred to a district hospital, further emphasising the importance of early identification, referral and intervention of children with speech and language delay and hearing loss. The high number of children lost to follow-up motivates for more research be done to identify the reasons for these findings.