Malawi, as a low and middle income country (LMIC), with one of the lowest per capita gross domestic products, faces challenges in the provision of healthcare to its citizens. According to the Centers for Disease Control (CDC), leading causes of death include but are not limited to, lower respiratory disease, stroke, cancer, neonatal disorders, and nutritional deficiencies. Feeding and swallowing disorders can present as a symptom to any of these medical diagnoses. Currently, there are no known studies focusing on the service provision for feeding and swallowing disorders in Malawi.
This pilot study was designed to provide a baseline on how feeding and swallowing disorders are currently being provided for in an emerging country like Malawi. Malawian healthcare professionals who see patients with feeding and swallowing disorders completed a survey and interview pertaining to their personal demographics, caseload, opinions, experiences, and treatment recommendations regarding the management of swallowing disorders (dysphagia).
Results indicate a wide range of occupations (Otolaryngoloists, Rehabilitation Technicians, Audiology Technicians, and Nurses) are involved in feeding and swallowing care. Participants expressed a high obligation to provide services for feeding and swallowing disorders, as well as a high concern for their patients. Generally, participants expressed high confidence in their treatment abilities, which did not correspond to knowledge of treatment recommendations that meet U.S. standards of care. Specifically, there was no variation in treatment recommendations across severities and a general lack of resources and tools for assessing and treating dysphagia. Treatment recommendations tended to align with resources currently available in Malawi.
Implications for the utilization of NGOs (non-governmental organizations) and the education of healthcare providers on feeding and swallowing disorders in the social and cultural contexts of this country are discussed.
The purpose of this study is to gain a comprehensive understanding of parental competence and outcome expectations on early speech and language intervention both pre- and post- intervention using the 16-item Early Intervention Parenting Self-Efficacy Scale (EIPSES). The parent competence factor measures parents’ beliefs in their capabilities to promote their child’s development, whereas the outcome expectations factor measures parent’s belief in the influence of external factors, such as early intervention (Guimond et al, 2008). The results of this study are expected to assist early interventionists in better understanding and supporting parents’ needs. Four parent-child dyads participated in this study and were provided the EIPSES questionnaire electronically. Parents were administered the questionnaire prior to intervention, and immediately following the intervention. When questionnaire responses were compared pre- and post-intervention, the results indicate an increase in parental self-efficacy and decrease in outcome expectations. Furthermore, conclusions drawn from this study indicate that implementing an Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) parent intervention program is a beneficial way of increasing the overall self-efficacy for parents of children with cleft palate and/or lip (CP/L).
The purpose of this study is to gain a comprehensive understanding of parental competence and outcome expectations on early speech and language intervention both pre- and post- intervention using the 16-item Early Intervention Parenting Self-Efficacy Scale (EIPSES). The parent competence factor measures parents’ beliefs in their capabilities to promote their child’s development, whereas the outcome expectations factor measures parent’s belief in the influence of external factors, such as early intervention (Guimond et al, 2008). The results of this study are expected to assist early interventionists in better understanding and supporting parents’ needs. Four parent-child dyads participated in this study and were provided the EIPSES questionnaire electronically. Parents were administered the questionnaire prior to intervention, and immediately following the intervention. When questionnaire responses were compared pre- and post-intervention, the results indicate an increase in parental self-efficacy and decrease in outcome expectations. Furthermore, conclusions drawn from this study indicate that implementing an Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) parent intervention program is a beneficial way of increasing the overall self-efficacy for parents of children with cleft palate and/or lip (CP/L).
Children with cleft lip and/or palate undergo an extensive series of surgical, orthodontic, speech, audiologic, genetic and medical assessments and treatments during their childhood. The purpose of this study was to examine the Velopharyngeal Insufficiency Effects on Life Outcomes – Parent (VELO-P) comparison of children who had surgery and those who did not in children 5 to 7 years old. The VELO is a quality-of-life questionnaire instrument consisting of 6 subscales, speech limitation, swallowing, situational difficulty, emotional impact, perception by others, and caregiver impact. We compared two groups of children with cleft lip and palate, those who had a secondary surgery for speech hypernasality and those who did not have secondary speech for hypernasality. It is predicted that those who had secondary surgery to repair speech hypernasality will be the group that will show a higher quality of life due to the effect the repair would have on improving their speech. The participants included 30 children between the ages of 5 to 7-years-old with cleft lip and/or palate. Ten of which were male and 20 were female. As for the cleft types, 14 had a unilateral cleft lip and palate, 3 had a bilateral cleft lip and palate, and 13 had a cleft palate only. Nineteen of the children did not have surgery for speech hypernasality and eleven did have surgery. The results of study indicated that the two groups differed significantly on total VELO scores (t=.773, p=0.046) indicating that children who did not have surgery had better quality of life than those who experienced speech hypernasality and had secondary surgery. While individual subscales did not show statistical significance, two subscales showed a moderate effect size difference; caregiver impact (d= .46) and emotional impact (d=.54), indicating that having a speech impairment that requires a secondary surgery may not repair the speech impairment to provide the child intelligible speech and therefore a higher quality of life.
