The epidemiology of fetal alcohol syndrome and partial FAS in a South African community

May, Philip A.; Gossage, J. Phillip; Marais, Anna Susan; Adnams, Colleen M.; Hoyme, H. Eugene; Jones, Kenneth Lyons; Robinson, Luther K.; Khaole, Nathaniel; Snell, Cudore L.; Kalberg, Wendy O.; Hendricks, Loretta S.; Brooke, Lesley E.; Stellavato, Chandra; Viljoen, Denis

doi:10.1016/j.drugalcdep.2006.11.007

Cited by 259 publications

(281 citation statements)

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“…Furthermore, the proportions of women who were at risk of an AEP on the basis of the strictest definition (Level 3: typically consuming five or more drinks per occasion) were 2.48% for the urban women and 8.50% for the rural women. Interestingly, these latter figures are very similar to the most recently reported FAS rates for an urban area in Gauteng of 1.9% (Viljoen et al, 2003) and a rural area in the Western Cape of between 6.8% and 8.9% (May et al, 2007). The proportion of the urban women who were at risk of an AEP of 2.48% is not dissimilar to that estimated for the United States of between 1% and 2% (Project Choices Research Group, 2002).…”

Section: Discussionsupporting

confidence: 83%

“…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.…”

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confidence: 99%

“…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).…”

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confidence: 99%

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

Morojele

London

Olorunju

et al. 2010

Social Science & Medicine

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a b s t r a c tThe study sought to determine the prevalence and predictors of being at risk of an alcohol-exposed pregnancy (AEP) among women of child-bearing age in an urban and rural location in South Africa. We conducted a cross-sectional household survey of 1018 women aged 18-44 years in one urban (n ¼ 606) and one rural (n ¼ 412) site. The women were interviewed using a structured questionnaire. We defined the primary dependent variable, being at risk of having an AEP, as current alcohol use, not being pregnant, being fertile, and no effective use of contraceptives. The independent variables included demographic, substance use, health perceptions, psycho-social, and partner characteristics. The rural women (21.84%) were more likely than their urban counterparts (11.22%) to be at risk of an AEP. In multiple logistic regression analyses, significant predictors of being in the ''at risk'' group for the urban women were (a) being 'white' as opposed to 'black/African', and being 'coloured' as opposed to 'black/African'; and (b) current smoking. For the rural women, significant risk factors were (a) current smoking and (b) early onset of alcohol use. The significant protective factors were (a) education; (b) knowledge about Fetal Alcohol Syndrome; (c) parity. Use of stricter alcohol use criteria (i.e., three or more drinks and five or more drinks per sitting) in the definition of risk of an AEP yielded slightly different patterns of significant predictors. The results revealed high levels of risk of an alcohol-exposed pregnancy, especially amongst the rural women, and a need for location-specific prevention programmes. The high burden of AEP in South Africa calls for the establishment of national AEP prevention strategies and programmes as a matter of urgency.

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Section: Discussionsupporting

confidence: 83%

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confidence: 99%

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confidence: 99%

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

Morojele

London

Olorunju

et al. 2010

Social Science & Medicine

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“…[42][43][44] Current alcohol consumption for the week preceding the interview was embedded into the nutrition questions 45 to aid accurate calibration of drinking quantity, frequency, and timing of alcohol use before and during the index pregnancies. 10,11,[23][24][25]33 Retrospective reports of alcohol use have been found to be superior to concurrent reports, but alcohol use has still been found to be frequently underreported in studies such as this. 33,[46][47][48] Maternal risk data were gathered for 153 women (Fig 2).…”

Section: Study Procedures: Screening In Tiers I and Iimentioning

confidence: 99%

“…8 More current estimates of the prevalence of FAS in the US general population range from 0.2 to 7 per 1000 children, 5 and 2% to 5% for the entire continuum of FASD. 5,9 One approach used successfully to determine the minimal prevalence of FASD in communities in South Africa, [10][11][12][13][14] Italy, 15,16 and Croatia 17,18 uses active case ascertainment in schools. Providing targeted physical examinations and cognitive/ behavioral testing to primary school children [19][20][21][22] and interviewing their mothers [23][24][25] can be effective for studying FASD prevalence and characteristics.…”

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Prevalence and Characteristics of Fetal Alcohol Spectrum Disorders

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Most studies of fetal alcohol syndrome and fetal alcohol spectrum disorders (FASD) prevalence in the general population of the United States have been carried out using passive methods (surveillance or clinicbased studies), which underestimate rates of FASD. WHAT THIS STUDY ADDS:Using active case ascertainment methods among children in a representative middle class community, rates of fetal alcohol syndrome and total FASD are found to be substantially higher than most often cited estimates for the general US population. abstract OBJECTIVES: To determine the prevalence and characteristics of fetal alcohol spectrum disorders (FASD) among first grade students (6-to 7-year-olds) in a representative Midwestern US community. METHODS:From a consented sample of 70.5% of all first graders enrolled in public and private schools, an oversample of small children (#25th percentile on height, weight, and head circumference) and randomly selected control candidates were examined for physical growth, development, dysmorphology, cognition, and behavior. The children's mothers were interviewed for maternal risk. RESULTS:Total dysmorphology scores differentiate significantly fetal alcohol syndrome (FAS) and partial FAS (PFAS) from one another and from unexposed controls. Alcohol-related neurodevelopmental disorder (ARND) is not as clearly differentiated from controls. Children who had FASD performed, on average, significantly worse on 7 cognitive and behavioral tests and measures. The most predictive maternal risk variables in this community are late recognition of pregnancy, quantity of alcoholic drinks consumed 3 months before pregnancy, and quantity of drinking reported for the index child's father. From the final multidisciplinary case findings, 3 techniques were used to estimate prevalence. FAS in this community likely ranges from 6 to 9 per 1000 children (midpoint, 7.5), PFAS from 11 to 17 per 1000 children (midpoint, 14), and the total rate of FASD is estimated at 24 to 48 per 1000 children, or 2.4% to 4.8% (midpoint, 3.6%). (Continued on last page) CONCLUSIONS:

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Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth

et al. 2017

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Prevalence estimates are essential to effectively prioritize, plan, and deliver health care to high-needs populations such as children and youth with fetal alcohol spectrum disorder (FASD). However, most countries do not have population-level prevalence data for FASD.OBJECTIVE To obtain prevalence estimates of FASD among children and youth in the general population by country, by World Health Organization (WHO) region, and globally.

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The epidemiology of fetal alcohol syndrome and partial FAS in a South African community

Abstract: A high rate of FAS and PFAS was again documented in this community, and it has increased. Given population similarities, we suspect that other communities in the Western Cape Province of South Africa also have high rates. Programs for prevention are needed.

Cited by 259 publications

References 44 publications

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

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

Prevalence and Characteristics of Fetal Alcohol Spectrum Disorders

Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth

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