Fetal alcohol syndrome epidemiology in a South African community: a second study of a very high prevalence area.

Abstract

ABSTRACT. Objective: The aim of the study was to determine the prevalence and characteristics of fetal alcohol syndrome (FAS) in a second primary school cohort in a community in South Africa. Method: Active case ascertainment, two-tier screening, and Institute of Medicine assessment methodology were employed among 857 first grade pupils, most born in 1993. Characteristics of children with FAS were contrasted with characteristics of a randomly selected control group from the same classrooms. Physical growth and development, dysmorphology and psychological characteristics of the children and measures of maternal alcohol use and smoking were analyzed. Results: The rate of FAS found in this study is the highest yet reported in any overall community in the world, 65.2-74.2 per 1,000 children in the first grade population. These rates are 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000). Detailed documentation of physical features indicates that FAS children in South Africa have characteristics similar to those elsewhere: poor growth and development, facial and limb dysmorphology, and lower intellectual functioning. Frequent, severe episodic drinking of beer and wine is common among mothers and fathers of FAS children. Their lives are characterized by serious familial, social and economic challenges, compared with controls. Heavy episodic maternal drinking is significantly associated with negative outcomes of children in the area of nonverbal intelligence but even more so in verbal intelligence, behavior and overall dysmorphology (physical anomalies). Significantly more FAS exists among children of women who were rural residents (odds ratio: 7.36, 95% confidence interval: 3.31-16.52), usually among workers on local farms. Conclusion: A high rate of FAS was documented in this community. Given social and economic similarities and racial admixture, we suspect that other communities in the Western Cape have rates that also are quite high. (J. Stud. Alcohol 66: [593][594][595][596][597][598][599][600][601][602][603][604] 2005)

Burden of fetal alcohol syndrome in a rural West Coast area of South Africa

“…The high prevalence of FAS/PFAS in the village of Aurora is consistent with: (i) the rural-urban gradient in FAS prevalence shown in Table 2, (ii) studies that show a higher FAS/PFAS rate in children born in rural than urban areas, [1][2][3][4] and (iii) evidence that binge drinking is more prevalent in rural (20%) than urban informal (16%) and urban formal (15%) areas. [15] FASD also appears more prevalent in very isolated communities -the communities with the highest published prevalence of FAS/PFAS (Aurora and De Aar) are very isolated geographically.…”

“…[1][2][3][4] Over the past decade, levels of FAS/PFAS ranging between 40.5 and 119.4 per 1 000 have been documented in several parts of these provinces. [1,4] A recent study examined the prevalence of FASD (which is a broader and less well defined group) in an area of the Western Cape, and estimated the prevalence at between 135.1 and 207.5 per 1 000.…”

“…[6,9] Most surveys have been conducted in small towns, and have consistently shown that FAS/PFAS is more common where mothers were resident in a rural area at the time of pregnancy. [1][2][3] To date, no studies have directly documented FAS/PFAS rates in entirely rural or remote parts of the country. In 2008, community leaders of a rural area in the West Coast region of the Western Cape invited our research team to assess levels of FAS/PFAS, as well as substance use, in pregnancy.…”

Predictors of risk of alcohol-exposed pregnancies among women in an urban and a rural area of South Africa

“…The highest global rates of FAS and PFAS have been identified in various regions of South Africa since the mid-1980s, and most notably, in rural farming areas in the Western Cape Province (May et al, 2000(May et al, , 2007Palmer, 1985;Viljoen et al, 2005; te Water Naude, London, Pitt, & Mahomed, 1998). More recent studies, conducted in high risk areas of the Northern Cape (Urban et al, 2008) and Gauteng provinces (Viljoen, Craig, Hymbaugh, Boyle, & Blount, 2003), have also documented high rates.…”

“…More recent studies, conducted in high risk areas of the Northern Cape (Urban et al, 2008) and Gauteng provinces (Viljoen, Craig, Hymbaugh, Boyle, & Blount, 2003), have also documented high rates. Of concern are the observed increases in the prevalence of FAS; studies among three separate cohorts of Grade 1 pupils in Western Cape province in 1997 (May et al, 2000), 1999 (Viljoen et al, 2005), and 2001 (May et al, 2007) identified rates of FAS of 40.5-46.4 per 1000; 65.2-74.2 per 1000; and 68.0-89.0 per 1000, respectively. The rate of FAS identified in an urban area of Gauteng province was 19 per 1000 (Viljoen et al, 2003), whereas a combined rate for two locations in the Northern Cape of 67.2 per 1000 was identified between 2001 and 2004 (Urban et al, 2008).…”