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Louw JG, Broodryk M, White L, Acker D, Viljoen DL, Olivier L. A multi-year, multi-site study of the prevalence of fetal alcohol syndrome in South Africa. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:867-879. [PMID: 38548386 DOI: 10.1111/acer.15306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. METHODS The cross-sectional epidemiological study used an active case-ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered-screening recruitment and diagnostic process. RESULTS Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6-251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5-78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4-89.9). CONCLUSIONS As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address.
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Affiliation(s)
- Jacobus Gidion Louw
- Foundation for Alcohol Related Research, Cape Town, South Africa
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mandi Broodryk
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Liska White
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Debbie Acker
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | | | - Leana Olivier
- Foundation for Alcohol Related Research, Cape Town, South Africa
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Kuschick D, Kuck J, Pachanov A, Geene R. Health promotion for families with parental alcohol addiction: a systematic review. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Abstract
Aim
Alcohol-related illnesses represent a major burden and challenge to families and pose health risks for all involved. Therefore, health promotion attempts need to focus on these vulnerable families and identify effective interventions. A systematic review was conducted of approaches to health promotion and prevention and their effectiveness for families with addiction concerns. The review focused on parental alcohol dependency.
Subject and methods
A systematic search of relevant databases was conducted, followed by a multistep screening process and a narrative synthesis of results.
Results
A total of 20 studies were included that evaluated 14 intervention programmes. The main target group was children with any form of fetal alcohol spectrum disorders and their caregivers. The study sample was dominated by behavioural approaches. The evidence base was heterogeneous. There was limited evidence of the effectiveness of combined counselling and coaching interventions that aimed to strengthen psychosocial resources.
Conclusion
The robustness of the results is limited by the moderate methodological quality of the studies. Because of the search strategy, which focused on studies with outcomes for parents with alcohol dependence, and the systematic review methodology, almost all studies reviewed featured behavioural prevention interventions. Very few studies provided specific information on the effectiveness of interventions for alcohol-dependent parents with a focus on environmental changes. The selected approach provided a limited mapping of the field of interest. However, these review findings provide the foundation for an evidence-based approach to health promotion for families with parental alcohol dependence.
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Horan H, Mobley E, Lavender C, Thompson A, Bryant W, McDaniel J, Robertson E, McIntosh S, Albright DL. "I am busy enough…": Navigating challenges experienced by Medicaid providers serving pregnant people living with substance use disorders in Alabama. J Nurs Scholarsh 2023; 55:556-565. [PMID: 36642921 DOI: 10.1111/jnu.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Perinatal substance use is a clinical and public health concern. The purpose of the study was to understand the perspectives and experiences of perinatal healthcare providers serving pregnant people who receive Medicaid and are living with a substance use disorder. DESIGN AND METHODS We conducted a secondary data analysis of the responses from perinatal healthcare providers who completed a survey to assess the state of Alabama's capability to effectively identify and treat individuals with substance use disorder. We analyzed short answer responses using consensus coding. FINDINGS Nine-hundred and ninety-five Medicaid providers completed the survey, 36 of the respondents identified that they were employed in an obstetric practice. Health insurance limitations, a lack of time and resources, and limited treatment options were the primary barriers indicated in the participants' responses. CONCLUSIONS Structural and health system barriers negatively impact the capacity of perinatal healthcare providers in Alabama to serve pregnant people who receive Medicaid and are living with a substance use disorder. CLINICAL RELEVANCE Perinatal healthcare providers need educational opportunities, training, and up-to-date resources to provide supportive, comprehensive care programming for perinatal populations with substance use disorders.
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Affiliation(s)
- Holly Horan
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Emmily Mobley
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Alyssa Thompson
- Department of Anthropology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Wesley Bryant
- Department of Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
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Agiresaasi A, Nassanga G, Maina GW, Kiguli J, Nabiwemba E, Kiwanuka N, Mukose A, Tumwesigye NM. Effect of a communication intervention on alcohol use during pregnancy in post conflict Northern Uganda: a quasi experimental study. Subst Abuse Treat Prev Policy 2022; 17:80. [PMID: 36503676 PMCID: PMC9743753 DOI: 10.1186/s13011-022-00505-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Alcohol use during pregnancy is a preventable risk factor for Fetal Alcohol Spectrum disorders. Psycho-social and educational interventions have been reported to enable women reduce alcohol intake levels during pregnancy and help improve some health outcomes of unhealthy alcohol use. We set out to assess the effect of a communication intervention on alcohol use during pregnancy in post conflict northern Uganda. METHODS The study employed a quasi - experimental design to assess the effect of a community health worker led communication strategy on pregnant women's knowledge, attitudes and various patterns of alcohol use using Difference in Difference(DiD). 420 respondents were recruited at baseline as at endline. RESULTS The communication messages were significantly associated with reduced odds of binge drinking (P = 0.018; OR = 0.09; CI = 0.012-0.66). Also those who received the intervention were less likely to drink frequently (P = 0.80; OR = 0.75; 95%CI = 0.074-7.5) or be harmful alcohol users(P = 0.948). The intervention also positively influenced having fair (β =0.49;P = 0.217;RRR =1.63)or adequate knowledge(β = 0.89;P = 0.25;RRR = 2.44) and having positive(β = 0.37;RRR =1.44;P = 0.46) or fair attitude(β = 0.19;RRR = 1.21; P = 0.693) although not to a significant level. CONCLUSIONS The communication intervention affected some patterns of alcohol use among pregnant women and not others. Our results contribute to existing evidence that communication interventions are a promising approach in reduction of alcohol exposed pregnancies. Interventions aimed at promoting alcohol abstinence during pregnancy should be implemented alongside other strategies that address factors that influence pregnant women to drink to achieve maximum results.
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Affiliation(s)
- Apophia Agiresaasi
- grid.11194.3c0000 0004 0620 0548Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, P.0 Box, 7062 Kampala, Uganda
| | - Goretti Nassanga
- grid.11194.3c0000 0004 0620 0548Department of Journalism and Communication, School of Language, Literature and Communication, Makerere University College of Social Sciences and Humanities, P.0 Box, 7062 Kampala, Uganda
| | - Gakenia Wamuyu Maina
- grid.11194.3c0000 0004 0620 0548Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, P.0 Box, 7062 Kampala, Uganda
| | - Juliet Kiguli
- grid.11194.3c0000 0004 0620 0548Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, P.0 Box, 7062 Kampala, Uganda
| | - Elizabeth Nabiwemba
- grid.11194.3c0000 0004 0620 0548Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, P.0 Box, 7062 Kampala, Uganda
| | - Noah Kiwanuka
- grid.11194.3c0000 0004 0620 0548Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, P.0 Box, 7062 Kampala, Uganda
| | - Aggrey Mukose
- grid.11194.3c0000 0004 0620 0548Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, P.0 Box, 7062 Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- grid.11194.3c0000 0004 0620 0548Department of Epidemiology and Biostatistics School of Public Health, Makerere University College of Health Sciences, P.0 Box, 7062 Kampala, Uganda
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Agiresaasi A, Tumwesigye NM, Nabiwemba E, Kiguli J, Maina GW, Nassanga G. Alcohol use during pregnancy in post-conflict northern Uganda: pregnant women's experiences and provider perceptions. Subst Abuse Treat Prev Policy 2021; 16:84. [PMID: 34749776 PMCID: PMC8577008 DOI: 10.1186/s13011-021-00418-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Alcohol use during pregnancy has been associated with several birth defects and developmental disabilities generally known as Fetal Alcohol Spectrum Disorders (FASD). Contextual in-depth understanding on why women drink while pregnant is scarce. For this reason, we explored pregnant women's experiences, knowledge, attitudes as well as provider perceptions regarding prenatal alcohol consumption to inform interventions meant to address alcohol-exposed pregnancies in post-conflict settings. METHODS In the months of May and June 2019, 30 in-depth interviews were conducted with pregnant mothers who reported maternal alcohol use during pregnancy. In addition 30 Key informant interviews were carried out with health workers providing Antenatal Care services (ANC) in health facilities in Gulu, Kitgum and Pader districts in Northern Uganda. Data was recorded, transcribed and subjected to thematic content analysis. RESULTS Women reported diverse views regarding maternal alcohol use during pregnancy. Whereas some felt it was favourable, others had misgivings about it. There was marked variability in knowledge on dangers of drinking during pregnancy. In this study, women reported that they found themselves in alluring situations that predisposed them to drinking alcohol. These included brewing alcohol as a source of livelihood, pregnancy-induced craving for alcohol, and participation in cultural festivities that are characterised by eating and drinking alcohol. Nonetheless, women who consume alcohol during pregnancy were not held in high esteem in the Acholi communities. Various prevention interventions reportedly existed in communities to address alcohol use during pregnancy including ANC health education, public debates, radio talk shows, community health worker group and individual counselling, and local council by laws. CONCLUSIONS AND RECOMMENDATIONS Pregnant mothers in post-conflict northern Uganda regard alcohol as a remedy to some of the social, economic and health challenges they face. Hence they continue drinking even during pregnancy because of the existing socio-cultural norms that promote it. The findings of this study demonstrate a need for sensitising communities in which pregnant women live so they can provide a supportive environment for mothers to abstain from alcohol consumption during pregnancy. Health care providers should ensure pregnant women consistently receive accurate and honest messages on the dangers of drinking during pregnancy so they can make informed decisions.
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Affiliation(s)
- Apophia Agiresaasi
- College of Health Sciences Makerere University School of Public Health, Kampala, Uganda.
| | | | - Elizabeth Nabiwemba
- College of Health Sciences Makerere University School of Public Health, Kampala, Uganda
| | - Juliet Kiguli
- College of Health Sciences Makerere University School of Public Health, Kampala, Uganda
| | - Gakenia Wamuyu Maina
- College of Health Sciences Makerere University School of Public Health, Kampala, Uganda
| | - Goretti Nassanga
- College of Humanities and Social Sciences, Makerere University School of Languages Literature and Communication, Kampala, Uganda
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Adebiyi BO, Mukumbang FC. Perspectives of Policymakers and Service Providers on Why Fetal Alcohol Spectrum Disorders Remain Unabated in South Africa: a Qualitative Study. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Reynolds R, McCarthy R, Cook PA. We do things differently here: the Greater Manchester approach to preventing alcohol-exposed pregnancy. Perspect Public Health 2021; 141:252-254. [PMID: 34431392 DOI: 10.1177/1757913920985553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Róisín Reynolds
- Senior Advisor, Alcohol Exposed Pregnancies, Greater Manchester Health & Social Care Partnership, 3 Piccadilly Place, Manchester M1 3BN, UK
| | - Robyn McCarthy
- School of Health and Society, University of Salford, Salford, UK
| | - Penny A Cook
- School of Health and Society, University of Salford, Salford, UK
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Kang SY, Kim HW. [Comparison of Awareness about Alcohol Use during Pregnancy among Female College Students by Drinking Levels: Using the Theory of Planned Behavior]. J Korean Acad Nurs 2020; 49:690-700. [PMID: 31932564 DOI: 10.4040/jkan.2019.49.6.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/19/2019] [Accepted: 09/18/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to examine the awareness of alcohol use during pregnancy and factors influencing the intention to abstain from alcohol during pregnancy by drinking levels. METHODS Utilizing a comparative descriptive design, a total of 359 female college students were recruited. Measurements were Theory of Planned Behavior (TPB) variables related awareness of alcohol use during pregnancy, Korean Version of the Alcohol Use Disorders Identification Test, knowledge about alcohol use during pregnancy, and socio-demographic factors. Main variables were compared by drinking levels. The factors influencing the intention to abstain from alcohol during pregnancy were identified using hierarchical regression analysis. RESULTS Non-problematic alcohol behavior group (n=185) had higher the intention to abstain from alcohol during pregnancy than problematic alcohol behavior group (n=174) (t=3.13, p=.002). The significant TPB variables influencing the intention to abstain from alcohol during pregnancy were that attitudes (β =-.44, p<.001), subjective norms (β =.14, p=.026), and perceived behavior control (β =.19, p=.002) in non-problematic alcohol behavior group, whereas the corresponding variables in the problematic alcohol behavior group were attitudes (β =-.51, p<.001) and subjective norms (β =.21, p=.006). CONCLUSION It is necessary to increase the intention to abstain from alcohol during pregnancy for the female college students having problematic alcohol behavior. The following strategies are recommended for them; decreasing acceptable attitudes toward alcohol use during pregnancy and reinforcing the influence of social pressure toward to abstain from alcohol during pregnancy.
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Affiliation(s)
- Saem Yi Kang
- College of Nursing, Seoul National University, Seoul, Korea
| | - Hae Won Kim
- College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
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Adebiyi BO, Mukumbang FC, Beytell AM. A guideline for the prevention and management of Fetal Alcohol Spectrum Disorder in South Africa. BMC Health Serv Res 2019; 19:809. [PMID: 31694624 PMCID: PMC6836420 DOI: 10.1186/s12913-019-4677-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background Fetal Alcohol Spectrum Disorder (FASD) is a public health problem globally, with South Africa having the highest recorded prevalence of all countries. Government programmes to prevent and manage FASD remain limited because of the lack of a specific policy. Herein, we developed a guideline to inform policy on the prevention and management of FASD in South Africa. Methods We applied a modified version of the World Health Organization’s approach to guideline development in three phases. In the first phase, we designed the initial guideline prototype. To do this, we conducted an in-depth interview with policymakers and a focus group with relevant service providers on policy requirements for FASD, a document review of policies on FASD and a scoping review of various interventions for FASD. In phase 2, we refined the initially formulated guideline prototype through a discursive approach with seven local and international experts on FASD. Phase 3 involved refining the prototype using a modified Delphi approach. Forty-three and forty-one experts participated in rounds 1 and 2 of the Delphi approach, respectively. The acceptable consensus for each included policy statement was 85%. Results We identified three aspects of the proposed guideline, which are the approaches and guiding principles, the prevention measures and the management measures. The guideline proposes that a FASD policy should consider lifespan needs, be culturally diverse, collaborative, evidence-based, multi-sectoral and address social determinants of health contributing to FASD. The essential components of FASD prevention policy consist of awareness and education of the dangers of drinking alcohol, access to treatment for alcohol problems and training of service providers. The management components include capacity building related to diagnosis, educating parents regarding the needs and management, appropriate referral pathways, training of teachers regarding classroom management and support for parents and individuals with FASD. Conclusion FASD in South Africa deserves urgent attention. Developing a specific policy to guide programmes could enhance and coordinate the efforts towards preventing and managing FASD. The guideline has the potential to assist policymakers in the development of a comprehensive and multi-sectoral policy for prevention and management of FASD, considering the consensus obtained from the experts.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Cape Town, 8001, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Cape Town, 8001, South Africa
| | - Anna-Marie Beytell
- Department of Social Work, University of the Western Cape, Cape Town, South Africa
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Francis JM, Cook S, Morojele NK, Swahn MH. Rarity and limited geographical coverage of individual level alcohol interventions in sub Saharan Africa: findings from a scoping review. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1664662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Joel M. Francis
- Department of Family Medicine & Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sarah Cook
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Neo K. Morojele
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Monica H. Swahn
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GE, USA
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Adebiyi BO, Mukumbang FC, Erasmus C. The Distribution of Available Prevention and Management Interventions for Fetal Alcohol Spectrum Disorder (2007 to 2017): Implications for Collaborative Actions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122244. [PMID: 31242673 PMCID: PMC6617245 DOI: 10.3390/ijerph16122244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 11/16/2022]
Abstract
The global prevalence of Fetal Alcohol Spectrum Disorder (FASD) remains high despite the various preventive and management interventions that have been designed and implemented to tackle the issue in various settings. The aim of the scoping review is to identify and classify prevention and management interventions of FASD reported globally across the life span and to map the concentration of these interventions across the globe. We searched some selected databases with predefined terms. Framework and narrative approaches were used to synthesize and report on the findings. Thirty-two prevention intervention studies and 41 management interventions studies were identified. All the interventions were reported to be effective or showed promising outcomes for the prevention and management of FASD, except four. Although Europe and Africa have a relatively higher prevalence of FASD, the lowest number of interventions to address FASD were identified in these regions. Most of the interventions for FASD were reported in North America with comparatively lower FASD prevalence. The uneven distribution of interventions designed for FASD vis-à-vis the burden of FASD in the different regions calls for a concerted effort for knowledge and intervention sharing to enhance the design of contextually sensitive preventive and management policy in the different regions.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Charlene Erasmus
- Child and Family Studies, University of the Western Cape, Cape Town 8001, South Africa.
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Adebiyi BO, Mukumbang FC, Beytell AM. To what extent is Fetal Alcohol Spectrum Disorder considered in policy-related documents in South Africa? A document review. Health Res Policy Syst 2019; 17:46. [PMID: 31036004 PMCID: PMC6489263 DOI: 10.1186/s12961-019-0447-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/29/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND South Africa is considered to have the highest prevalence of fetal alcohol spectrum disorder (FASD) globally. Nevertheless, the extent to which the South African government has responded to the high FASD prevalence at the policy level is unclear. Herein, we aimed to identify targeted and generic clauses that could be attributed to the prevention and management of FASD in relevant South African policy documents. METHODS We conducted a search of two search engines (PubMed and Google) and the websites of South African national and provincial departments from January to April 2018. A total of 33 policy documents were included in this review. Using content analysis, we sought documents that mention the terms 'fetal alcohol syndrome' and 'fetal alcohol spectrum disorder'. The Framework method was also used to thematically identify specific and generic clauses attributed to the prevention and management of FASD in South Africa. RESULTS The content analysis indicated that 12 policy documents contained the searched terms. Findings from the thematic analysis showed that targeted and generic clauses for FASD exist in various policy documents. Some of the generic clauses focused on the regulation of liquor outlets, enforcement of liquor laws, and the general management of persons with mental and educational challenges. Specific clauses focused on creating platforms to improve the awareness, screening, identification and support for individuals with FASD. CONCLUSIONS There is a noticeable increase in the number of policy documents that considered elements of FASD enacted in the last decade. Although this study revealed the existence of targeted and generic clauses that could be attributed to the prevention and management of FASD, the sustained high prevalence of FASD in South Africa, as reported in the literature, calls for more holistic and comprehensive approaches to tackle the FASD problem in South Africa.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Anna-Marie Beytell
- Department of Social Work, University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa
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Adebiyi BO, Mukumbang FC, Cloete LG, Beytell AM. Policymakers' Perspectives Towards Developing a Guideline to Inform Policy on Fetal Alcohol Spectrum Disorder: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060945. [PMID: 30884766 PMCID: PMC6466131 DOI: 10.3390/ijerph16060945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 01/28/2023]
Abstract
Fetal alcohol spectrum disorder (FASD) has a high prevalence in South Africa, especially among the poor socioeconomic communities. However, there is no specific policy to address FASD. Using a qualitative study design, we explored the perspectives of policymakers on guidelines/policies for FASD, current practices and interventions, and what practices and interventions could be included in a policy for FASD. The data analysis was done using the Framework Method. Applying a working analytical framework to the data, we found that there is no specific policy for FASD in South Africa, however, clauses of FASD policy exist in other policy documents. Preventive services for women and screening, identification, assessment, and support for children are some of the current practices. Nevertheless, a multi-sectoral collaboration and streamlined program for the prevention and management of FASD are aspects that should be included in the policy. While there are generic clauses in existing relevant policy documents, which could be attributed to the prevention and management of FASD, these clauses have not been effective in preventing and managing the disorder. Therefore, a specific policy to foster a holistic and coordinated approach to prevent and manage FASD needs to be developed.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Lizahn G Cloete
- Division of Occupational Therapy, University of Stellenbosch, Stellenbosch 7602, South Africa.
| | - Anna-Marie Beytell
- Department of Social Work, University of the Western Cape, Cape Town 8001, South Africa.
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Louw KA. Substance use in pregnancy: The medical challenge. Obstet Med 2018; 11:54-66. [PMID: 29997687 PMCID: PMC6038015 DOI: 10.1177/1753495x17750299] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023] Open
Abstract
Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.
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Affiliation(s)
- Kerry-Ann Louw
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Brink Y, Cockcroft J, Seedat S, May P, Kalberg W, Louw Q. The postural stability of children with foetal alcohol spectrum disorders during one-leg stance: A feasibility study. Afr J Disabil 2018; 7:319. [PMID: 29707515 PMCID: PMC5913772 DOI: 10.4102/ajod.v7i0.319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/01/2017] [Indexed: 12/29/2022] Open
Abstract
Background Postural control may be impaired in children with foetal alcohol spectrum disorders (FASD). The study assessed the protocol feasibility in terms of (1) recruiting children with FASD in a rural, small town; (2) using the measurement instruments in a real-life setting; (3) the one-leg standing (OLS) task and (4) presenting preliminary results on postural stability of children with and without FASD. Methods Nine-year-old children diagnosed with and without FASD were invited to participate. Twenty-eight children performed OLS. Feasibility outcomes included recruitment, measurement instrument use and task instruction. Postural stability outcomes included standing duration, centre of pressure (COP) and body segment acceleration. Results Participants recruitment was feasible in terms of the (1) ability to sample a reasonable participant number in a rural town setting and the capacity to increase the sample size if more schools are included in the sampling frame and (2) use of assent and consent forms that were appropriate for this population. The measurement instruments were user-friendly, cost-effective and time-efficient. Instructions for the task require amendment to address foot placement of the non-weight–bearing leg. There was a significant difference between cases and controls on mean COP velocity (p = 0.001) and the pelvis segment acceleration in the mediolateral direction (p = 0.01) and the anteroposterior direction (p = 0.027). The control children took longer to achieve postural control. The girls demonstrated a significant difference for the COP anteroposterior displacement (p = 0.008) and velocity (p = 0.049). Conclusions The recruitment of children with and without FASD in a rural, small town and the administration of measurement instruments in a real-life, school-based setting was feasible. However, the verbal instructions for the task require revision. The male control group took longer to achieve postural control because the task was performed differently between the two groups. However, the case girls were slower to achieve postural control than control girls though performing the task similarly.
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Affiliation(s)
- Yolandi Brink
- Division of Physiotherapy, Stellenbosch University, South Africa
| | - John Cockcroft
- Division of Physiotherapy, Stellenbosch University, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, South Africa
| | - Philip May
- Department of Nutrition, University of North Carolina, United States.,Nutrition Research Institute, Kannapolis, United States
| | - Wendy Kalberg
- Center on Alcoholism, Substance Abuse, and Addictions, The University of New Mexico, Mexico
| | - Quinette Louw
- Division of Physiotherapy, Stellenbosch University, South Africa
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16
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Davies LA, Cockcroft K, Olinger L, Chersich M, Urban M, Chetty Makkan CM, Turnbull OH, Olivier L, Viljoen D. Alcohol exposure during pregnancy altered childhood developmental trajectories in a rural South African community. Acta Paediatr 2017; 106:1802-1810. [PMID: 28685855 DOI: 10.1111/apa.13978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/05/2017] [Accepted: 07/04/2017] [Indexed: 11/26/2022]
Abstract
AIM This study examined the effects of prenatal alcohol exposure on childhood development trajectories in a rural South African community between 2003 and 2008. METHODS We assessed 121 children at 7-12 months (year one) and 5-6 years (year five) using the Griffiths Mental Developmental Scales - Extended Revised, which measures sensorimotor, cognitive and social development, with lower scores indicating developmental delay. We also interviewed their mothers or caregivers. Three groups were identified: 29 with foetal alcohol syndrome (FAS) or partial FAS (pFAS), 57 more who had been exposed to alcohol and 35 controls who had not. RESULTS The scale's total score was higher in the controls than in the FAS/pFAS group at year one and year five and in the alcohol-exposed group at year five. Many groups' trajectories declined when compared with global norms, but the trajectories in the FAS/pFAS and the alcohol-exposed groups declined more than the controls for eye-hand and performance and total score. Earlier pregnancy recognition in the FAS/pFAS group correlated strongly (r = -0.77) with higher GQ in year five. CONCLUSION FAS/pFAS and prenatal alcohol exposure affected the Griffiths scores more than the control group. Efforts are needed to detect pregnancy early and reduce alcohol exposure.
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Affiliation(s)
- Leigh-Anne Davies
- Department of Psychology; School of Human and Community Development; University of Witwatersrand; Johannesburg South Africa
| | - Kate Cockcroft
- Department of Psychology; School of Human and Community Development; University of Witwatersrand; Johannesburg South Africa
| | - Lynda Olinger
- School of Health Systems & Public Health; Faculty of Health Sciences; University of Pretoria; Pretoria South Africa
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute; Faculty of Health Sciences; University of Witwatersrand; Johannesburg South Africa
| | - Michael Urban
- Division of Molecular Biology and Human Genetics; University of Stellenbosch; Western Cape South Africa
| | | | - Oliver H. Turnbull
- Department of Psychology; School of Human and Community Development; University of Witwatersrand; Johannesburg South Africa
| | - Leana Olivier
- Division of Molecular Biology and Human Genetics; University of Stellenbosch; Western Cape South Africa
- Foundation for Alcohol Related Research (FARR); Cape Town South Africa
| | - Denis Viljoen
- Division of Molecular Biology and Human Genetics; University of Stellenbosch; Western Cape South Africa
- Foundation for Alcohol Related Research (FARR); Cape Town South Africa
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17
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Lange S, Probst C, Gmel G, Rehm J, Burd L, Popova S. Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth: A Systematic Review and Meta-analysis. JAMA Pediatr 2017; 171:948-956. [PMID: 28828483 PMCID: PMC5710622 DOI: 10.1001/jamapediatrics.2017.1919] [Citation(s) in RCA: 341] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/10/2017] [Indexed: 11/14/2022]
Abstract
Importance 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. Data Sources MEDLINE, MEDLINE in process, EMBASE, Education Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, and Scopus were systematically searched for studies published from November 1, 1973, through June 30, 2015, without geographic or language restrictions. Study Selection Original quantitative studies that reported the prevalence of FASD among children and youth in the general population, used active case ascertainment or clinic-based methods, and specified the diagnostic guideline or case definition used were included. Data Extraction and Synthesis Individual study characteristics and prevalence of FASD were extracted. Country-specific random-effects meta-analyses were conducted. For countries with 1 or no empirical study on the prevalence of FASD, this indicator was estimated based on the proportion of women who consumed alcohol during pregnancy per 1 case of FASD. Finally, WHO regional and global mean prevalence of FASD weighted by the number of live births in each country was estimated. Main Outcomes and Measures Prevalence of FASD. Results A total of 24 unique studies including 1416 unique children and youth diagnosed with FASD (age range, 0-16.4 years) were retained for data extraction. The global prevalence of FASD among children and youth in the general population was estimated to be 7.7 per 1000 population (95% CI, 4.9-11.7 per 1000 population). The WHO European Region had the highest prevalence (19.8 per 1000 population; 95% CI, 14.1-28.0 per 1000 population), and the WHO Eastern Mediterranean Region had the lowest (0.1 per 1000 population; 95% CI, 0.1-0.5 per 1000 population). Of 187 countries, South Africa was estimated to have the highest prevalence of FASD at 111.1 per 1000 population (95% CI, 71.1-158.4 per 1000 population), followed by Croatia at 53.3 per 1000 population (95% CI, 30.9-81.2 per 1000 population) and Ireland at 47.5 per 1000 population (95% CI, 28.0-73.6 per 1000 population). Conclusions and Relevance Globally, FASD is a prevalent alcohol-related developmental disability that is largely preventable. The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol. Brief interventions should be provided, where appropriate.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Electrical Engineering and Telecommunications, Faculty of Engineering, University of New South Wales, Sydney, Australia
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Larry Burd
- Department of Pediatrics, University of North Dakota School of Medicine, Grand Forks
| | - Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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18
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Swahn MH, Culbreth RE, Staton CA, Self-Brown SR, Kasirye R. Alcohol-Related Physical Abuse of Children in the Slums of Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1124. [PMID: 28954410 PMCID: PMC5664625 DOI: 10.3390/ijerph14101124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 12/23/2022]
Abstract
This study examines the patterns of alcohol-related physical abuse and alcohol use and related behaviors among children living in the slums of Kampala, Uganda. The study is based on a cross-sectional survey, conducted in spring 2014, of service-seeking children ages 12 to 18 years (n = 1134) attending Uganda Youth Development Link drop-in centers for vulnerable children in the slums. Descriptive statistics, chi-squares, and bivariate and multivariable logistic regression analyses were conducted to determine patterns of children's alcohol-related behaviors, based on alcohol-related physical abuse and neglect. Nearly 34% of children (n = 380) reported experiencing physical abuse, and 12.4% (n = 140) reported experiencing alcohol-related physical abuse. Alcohol-related neglect was reported among 19.6% (n = 212) of the children. Past year alcohol use was significantly more prevalent among children who reported experiencing alcohol-related neglect ( χ 2 = 79.18, df = 1, p < 0.0001) and alcohol-related physical abuse ( χ 2 = 62.02, df = 1, p < 0.0001). Reporting physical abuse was also associated with parental alcohol use (OR: 1.85; 95% CI: 1.38, 2.48) and parental partner violence (OR: 5.51; 95% CI: 4.09, 7.43), after adjusting for other variables in the model. Given the high levels of alcohol-related abuse and neglect reported in this population, both primary and secondary prevention initiatives are needed to improve parenting strategies and to reduce alcohol-related harm. Similarly, strategies to reduce and delay alcohol use among these vulnerable children are also needed.
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Affiliation(s)
- Monica H Swahn
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - Rachel E Culbreth
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - Catherine A Staton
- Duke University Medical Center, Duke Global Health Institute and Department of Emergency Medicine, Duke University, Durham, NC 27703, USA.
| | - Shannon R Self-Brown
- School of Public Health, Georgia State University, P.O. Box 3984, Atlanta, GA 30302, USA.
| | - Rogers Kasirye
- Uganda Youth Development Link, Sir Appollo Kaggwa Rd, Box 12659, Kampala, Uganda.
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19
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Unrealistic optimism with regard to drinking during pregnancy among women of childbearing age in a South African community. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1177/0081246317717105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drinking alcohol during pregnancy is a risk factor in a range of adverse birth outcomes, including fetal alcohol spectrum disorders, and is a major health concern. For this behaviour to change one of the necessary conditions is for women to have an accurate perception of the risks drinking during pregnancy poses. A major obstacle to this is the presence of unrealistic optimism which leads to women believing they are less at risk than others. This study examined a sample of women ( N = 129) from a community in the Northern Cape Province in South Africa with a high prevalence of fetal alcohol spectrum disorder for signs of unrealistic optimism. A questionnaire about the perception of personal and general risk was administered during a one-on-one interview and responses compared. Neither a Student’s t-test ( t(115) = −1.720, p = .088, 95% confidence interval [−0.180, 0.013]) nor a Wilcoxon matched-pairs signed-rank test ( z = −1.72, p = .285) showed a significant difference. The perception of risk posed by drinking during pregnancy to others, knowledge of fetal alcohol spectrum disorder, and the perception of how easy it would be for the participant to quit drinking were significant predictors of the perception of personal risk. Only the perception of personal risk predicted the perception of general risk. There was no evidence that participants believed themselves to be less at risk than their peers when it came to the risks of drinking during pregnancy. Future directions for research into unrealistic optimism and drinking during pregnancy are discussed.
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20
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Hafekost K, Lawrence D, O'Leary C, Bower C, Semmens J, Zubrick SR. Maternal Alcohol Use Disorder and Risk of Child Contact with the Justice System in Western Australia: A Population Cohort Record Linkage Study. Alcohol Clin Exp Res 2017. [PMID: 28641361 PMCID: PMC5575459 DOI: 10.1111/acer.13426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early contact with the justice system is associated with a multitude of negative outcomes across the life course. This includes an increased risk of ongoing justice contact, social disadvantage and marginalization, and mental health and substance use issues. Children whose mothers have an alcohol use disorder may be at risk of early justice system contact, and we sought to quantify this relationship in a Western Australian cohort. METHODS This population cohort study made use of linked administrative data. Those in-scope for the study were women who had a birth recorded on the Midwives Notification System (1983 to 2007). The exposed cohort were mothers who had an alcohol-related diagnosis (ICD9/10), recorded on administrative data. This included mental and behavioral disorders which were alcohol related, diseases which could be entirely attributed to alcohol and other ICD alcohol codes. These women were considered to have an alcohol use disorder, which was a proxy for heavy drinking. The comparison cohort was frequency-matched sample with no alcohol-related diagnosis identified on administrative data sets. RESULTS After adjusting for potential confounders, children whose mothers had a maternal alcohol use disorder had a significantly increased odds of justice contact when compared to those whose mothers had no diagnosis (odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.60 to 1.99). Additional significant maternal factors associated with child justice contact included being Indigenous (OR = 5.14, 95% CI = 4.54 to 5.81), low maternal age, low socioeconomic status, being unmarried, and a history of a mental health problems. Significant child-level factors, which were associated with increased odds of justice contact, included being male, a mental health diagnosis, child protection contact, parity, and academic failure. CONCLUSIONS Children who were exposed to a maternal alcohol use disorder had significantly increased odds of contact with the justice system. Additional risk was associated with being Indigenous and with markers of social disadvantage. These results suggest that prevention and early intervention services should span across agencies in an effort to reduce risk.
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Affiliation(s)
- Katherine Hafekost
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Colleen O'Leary
- Office of the Chief Psychiatrist, Western Australian Department of Health, Perth, Western Australia, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - James Semmens
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Graduate School of Education, The University of Western Australia, Perth, Western Australia, Australia
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21
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Neuropsychological Aspects of Prevention and Intervention for FASD in South Africa. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2017. [DOI: 10.1007/s40817-017-0035-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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22
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Abstract
PURPOSE OF REVIEW This review aims to summarize data published in the scientific literature and available on official websites on fetal alcohol spectrum disorder (FASD) in Africa. RECENT FINDINGS There is a paucity of published literature and evidence-based information on prenatal exposure to alcohol in the African continent and the majority of the continent's literature on FASD emanates from South Africa. A small number of scientific publications document FASD and drinking in pregnancy in other Sub-Saharan African countries and these findings provide evidence that FASD occurs across the continent. Further evidence shows that the world's highest reported rates of FASD occur in South Africa and that this confers a significant public health and neurodevelopmental disability burden on the region. There is an established body of epidemiological, diagnostic, neurobehavioral and neuroscientific knowledge from studies in South Africa. Universal and indicated case method preventions are effective in reducing maternal alcohol consumption in high-risk areas. Throughout Africa, a policy and service implementation gap exists that impedes translation of generated knowledge into effective prevention and intervention strategies. SUMMARY FASD is likely a widely occurring and largely unrecognized neurodevelopmental disability in Africa. A key future direction for global agencies and research partnerships is to collaboratively address evidence gaps and knowledge translation through scalable approaches and strategies that aim to ameliorate the burden of FASD in African and other countries.
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23
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Urban MF, Olivier L, Louw JG, Lombard C, Viljoen DL, Scorgie F, Chersich MF. Changes in drinking patterns during and after pregnancy among mothers of children with fetal alcohol syndrome: A study in three districts of South Africa. Drug Alcohol Depend 2016; 168:13-21. [PMID: 27610936 DOI: 10.1016/j.drugalcdep.2016.08.629] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mixed ancestry populations in South Africa have amongst the highest rates of fetal alcohol syndrome (FAS) worldwide. Defining the drinking patterns of women with a FAS child guides FAS preventive interventions. METHODS Data were drawn from FAS prevalence surveys conducted in three districts: Witzenberg (Cape Winelands), Frances Baard (inland mining town) and Saldanha Bay (coastal towns). 156 mothers and 50 proxy informants of school-entry children diagnosed with FAS and partial-FAS were interviewed, and compared with 55 controls recruited in Saldanha Bay. RESULTS Study participants were of low socio-economic status (SES), and a majority of children were either in foster care (12%) or had been cared for by relatives for long periods (44%). Of cases, 123/160 (77%) reported current drinking, similar between sites. During pregnancy, only 35% (49/139) of cases had stopped drinking, varying between sites (from 21% to 54% in chronological order of surveys; p<0.001), while 6% (7/109) increased drinking. Though many women who stopped in pregnancy resumed postpartum, cessation in pregnancy was strongly associated with discontinuation in the long run (OR=3.3; 95%CI=1.2-8.9; p=0.005). At interview, 36% of cases (54/151) and 18% of controls (9/51) were at risk of an alcohol-exposed pregnancy (p=0.02). Median maternal mass of cases was 22kg lower than controls, with 20% being underweight and 14% microcephalic. CONCLUSIONS Increasing rates of drinking cessation during pregnancy over time suggest rising awareness of FAS. Cessation is associated with recidivism after pregnancy but also with reduced long-term drinking. Interventions should target alcohol abstinence in pregnancy, but extend into the puerperium.
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Affiliation(s)
- Michael F Urban
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602 Stellenbosch, South Africa; International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZ P114-9000 Ghent, Belgium.
| | - Leana Olivier
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Private Bag X1, Matieland, 7602 Stellenbosch, South Africa; Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa; Governor Kremer's Centre, Maastricht University Medical Centre, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, Netherlands
| | - Jacobus G Louw
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Chanelle Lombard
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Denis L Viljoen
- Foundation for Alcohol Related Research (FARR), P. O. Box 4373, Tygervalley, 7536 Cape Town, South Africa
| | - Fiona Scorgie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew F Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZ P114-9000 Ghent, Belgium
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Roozen S, Peters GJY, Kok G, Townend D, Nijhuis J, Curfs L. Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic Literature Review Including Meta-Analysis. Alcohol Clin Exp Res 2016; 40:18-32. [PMID: 26727519 DOI: 10.1111/acer.12939] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/14/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although fetal alcohol spectrum disorders (FASD) affect communities worldwide, little is known about its prevalence. The objective of this study was to provide an overview of the global FASD prevalence. METHODS We performed a search in multiple electronic bibliographic databases up to August 2015, supplemented with the ascendancy and descendancy approach. Studies were considered when published in English, included human participants, and reported empirical data on prevalence or incidence estimates of FASD. Raw prevalence estimates were transformed using the Freeman-Tukey double arcsine transformation so that the data followed an approximately normal distribution. Once the pooled prevalence estimates, 95% confidence intervals and prediction intervals were calculated based on multiple meta-analyses with transformed proportions using random effects models, these estimates were transformed back to regular prevalence rates. Heterogeneity was tested using Cochran's Q and described using the I(2) statistic. RESULTS Among studies that estimated prevalence in general population samples, considerable differences in prevalence rates between countries were found and therefore separate meta-analyses for country were conducted. Particularly high-prevalence rates were observed in South Africa for fetal alcohol syndrome (55.42 per 1,000), for alcohol-related neurodevelopmental disorder (20.25 per 1,000), and FASD (113.22 per 1,000), For partial fetal alcohol syndrome high rates were found in Croatia (43.01 per 1,000), Italy (36.89 per 1,000), and South Africa (28.29 per 1,000). In the case of alcohol-related birth defects, a prevalence of 10.82 per 1,000 was found in Australia. However, studies into FASD exhibited substantial heterogeneity, which could only partly be explained by moderators, most notably geography and descent, in meta-regressions. In addition, the moderators were confounded, making conclusions as to each moderator's relevance tentative at best. CONCLUSIONS The worldwide pooled prevalence estimates are higher than assumed so far, but this was largely explained by geography and descent. Furthermore, prevalence studies varied considerably in terms of used methodology and methodological quality. The pooled estimates must therefore be interpreted with caution and for future research it is highly recommended to report methodology in a more comprehensive way. Finally, clear guidelines on assessing FASD prevalence are urgently needed, and a first step toward these guidelines is presented.
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Affiliation(s)
- Sylvia Roozen
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Gjalt-Jorn Y Peters
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.,Faculty of Psychology and Education Science, Open University of the Netherlands, Heerlen, the Netherlands
| | - Gerjo Kok
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - David Townend
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Health, Ethics & Society, Maastricht University, Maastricht, the Netherlands
| | - Jan Nijhuis
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Obstretrics & Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Genetics, Maastricht University Medical Centre, Maastricht, the Netherlands
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25
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Bazzo S, Black D, Mitchell K, Marini F, Moino G, Riscica P, Fattori G. 'Too Young To Drink'. An international communication campaign to raise public awareness of fetal alcohol spectrum disorders. Public Health 2016; 142:111-115. [PMID: 27600792 DOI: 10.1016/j.puhe.2016.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 11/25/2022]
Affiliation(s)
- S Bazzo
- European FASD Alliance, Landskrona, Sweden.
| | - D Black
- European FASD Alliance, Landskrona, Sweden
| | - K Mitchell
- National Organization on Fetal Alcohol Syndrome, Washington, DC, USA
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26
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Bazzo S, Battistella G, Riscica P, Moino G, Marini F, Bottarel M, Dal Pozzo G, Padovan M. Evaluation of a Multilevel and Integrated Program to Raise Awareness of the Harmful Effects of Prenatal Alcohol Exposure in a Local Community. Alcohol Alcohol 2015; 50:708-15. [PMID: 26018219 DOI: 10.1093/alcalc/agv051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 05/05/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate a multilevel program to raise awareness of the risks of prenatal exposure to alcohol in the area of Treviso (Italy). The program started in 2008 and consists of an action-research experience involving health professionals of maternal-child services, and in the campaign 'Mamma Beve Bimbo Beve', targeted to the childbearing-aged population. METHODS A comparative study was carried out in 2013. Surveys using semi-structured self-report questionnaires were carried out among professionals and pregnant women in Treviso, and among control groups belonging to another local area of Italy (Verona). The questionnaires investigated awareness and opinions about alcohol and pregnancy, as well as sources and kind of information provided and received. RESULTS Health professionals in Treviso, who had been exposed both to the action-research experience and to the campaign, showed a more rational approach to alcohol than colleagues in the control group, and were more aware and sensitized about the risks of alcohol consumption during pregnancy. Physicians and midwives had a higher probability of having advised pregnant women to abstain from alcohol in Treviso. Pregnant women in Treviso, who had received information through the campaign and from professionals, had a higher probability of having received only correct advice about the issue of alcohol and pregnancy, but did not hold perceptions different to women in Verona. CONCLUSIONS The multilevel program carried out in the Treviso area was effective in increasing awareness and improving attitudes towards the risks of alcohol use during pregnancy among local healthcare professionals, compared with the control group.
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Affiliation(s)
| | - Giuseppe Battistella
- Epidemiologic Unit, Local Health Authority of Treviso, Treviso, Veneto Region, Italy
| | - Patrizia Riscica
- Addiction Department, Local Health Authority of Treviso, Treviso, Veneto Region, Italy
| | - Giuliana Moino
- Addiction Department, Local Health Authority of Treviso, Treviso, Veneto Region, Italy
| | - Francesco Marini
- Department of Innovation, Development and Planning, Local Health Authority of Treviso, Treviso, Veneto Region, Italy
| | - Mery Bottarel
- Ginaecology and Obstetrics Unit, Local Health Authority of Treviso, Treviso, Veneto Region, Italy
| | - Giuseppe Dal Pozzo
- Ginaecology and Obstetrics Unit, Local Health Authority of Treviso, Treviso, Veneto Region, Italy
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Urban MF, Olivier L, Viljoen D, Lombard C, Louw JG, Drotsky LM, Temmerman M, Chersich MF. Prevalence of fetal alcohol syndrome in a South African city with a predominantly Black African population. Alcohol Clin Exp Res 2015; 39:1016-26. [PMID: 25941030 DOI: 10.1111/acer.12726] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) and fetal alcohol syndrome (FAS) are common in some South African populations, notably those of mixed ancestry descent in rural areas and small towns. Little is known about FAS/FASD prevalence in the majority of South Africans: city dwellers of Black African ethnicity. This study describes the prevalence of FAS in a South African city, comparing 2 suburbs with predominantly mixed ancestry (Roodepan) and Black African (Galeshewe) populations that house over 60% of the city population. METHODS We conducted a tiered, active case ascertainment study for the prevalence of FAS and also detected some less clinically specific FASD cases. All first-grade learners in the 2 suburbs were eligible for anthropometric screening, and screen-positive learners were assessed for dysmorphic features of FAS. Those with suggestive clinical features received neurocognitive assessment, and maternal or collateral interview. Final diagnosis was made following a case conference. RESULTS Complete ascertainment of FAS status was made in 1,503 (94.7%) of 1,587 eligible learners (435 in Roodepan and 1,152 in Galeshewe). Overall, FAS was diagnosed in 83 (5.5%, 95% confidence interval [CI] = 4.4 to 6.8) learners and FASD in 96 (6.4%, 95% CI = 5.2 to 7.7). Levels of FAS were high in both areas: 26 (6.3%, 95% CI = 4.2 to 9.2) learners from Roodepan, compared to 57 (5.2%, 95% CI = 4.0 to 6.7) from Galeshewe (p = 0.39). No cases were previously diagnosed. The mortality rate for mothers of FASD children from Galeshewe was 19 of 65 (29%), compared to 3 of 31 (9.7%; p = 0.03) for Roodepan. Interviewed mothers in Galeshewe were older and had higher body mass index. CONCLUSIONS Prevalence of FAS is high in both Galeshewe and Roodepan, and the lack of prior diagnoses indicates that awareness remains low. The maternal mortality rate was especially high in Galeshewe. The unexpectedly high burden of FAS in an urban area with predominantly Black African population mandates extension of surveillance and intervention measures in southern Africa.
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Affiliation(s)
- Michael F Urban
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Leana Olivier
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Foundation for Alcohol Related Research (FARR), Cape Town, South Africa
| | - Denis Viljoen
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Foundation for Alcohol Related Research (FARR), Cape Town, South Africa
| | - Chanelle Lombard
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Foundation for Alcohol Related Research (FARR), Cape Town, South Africa
| | - Jacobus G Louw
- Foundation for Alcohol Related Research (FARR), Cape Town, South Africa
| | | | - Marleen Temmerman
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Ghent, Ghent, Belgium
| | - Matthew F Chersich
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Ghent, Ghent, Belgium.,Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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28
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Mertens JR, Ward CL, Bresick GF, Broder T, Weisner CM. Effectiveness of nurse-practitioner-delivered brief motivational intervention for young adult alcohol and drug use in primary care in South Africa: a randomized clinical trial. Alcohol Alcohol 2014; 49:430-8. [PMID: 24899076 DOI: 10.1093/alcalc/agu030] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS To assess the effectiveness of brief motivational intervention for alcohol and drug use in young adult primary care patients in a low-income population and country. METHODS A randomized controlled trial in a public-sector clinic in Delft, a township in the Western Cape, South Africa recruited 403 patients who were randomized to either single-session, nurse practitioner-delivered Brief Motivational Intervention plus referral list or usual care plus referral list, and followed up at 3 months. RESULTS Although rates of at-risk alcohol use and drug use did not differ by treatment arm at follow-up, patients assigned to the Brief Motivational Intervention had significantly reduced scores on ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) for alcohol-the most prevalent substance. CONCLUSION Brief Motivational Intervention may be effective at reducing at-risk alcohol use in the short term among low-income young adult primary care patients; additional research is needed to examine long-term outcomes.
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Affiliation(s)
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Graham F Bresick
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tina Broder
- National Viral Hepatitis Roundtable, San Francisco, CA, USA
| | - Constance M Weisner
- Langley Porter Psychiatric Institute, University of California San Francisco, San Francisco, CA, USA Division of Research, Kaiser Permanente, Oakland, CA, USA
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29
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Crawford-Williams F, Fielder A, Mikocka-Walus A, Esterman A. A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women. Drug Alcohol Rev 2014; 34:154-61. [PMID: 24840708 DOI: 10.1111/dar.12152] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/15/2014] [Indexed: 12/01/2022]
Abstract
ISSUES It is well established that alcohol can cross the placenta to the fetus and can affect both physical and psychological development of the infant; however, many women continue to drink during pregnancy. It is therefore important to determine whether interventions can be successful in reducing alcohol consumption among pregnant women. Past reviews have investigated the effectiveness of clinical interventions in reducing alcohol consumption in pregnancy; however, the aim of the current review was to focus on the effectiveness of public health interventions. APPROACH A critical literature review was conducted by searching several electronic databases using key words such as 'pregnancy', 'alcohol', 'interventions' and 'public health'. Studies were included if they utilised a public health intervention and included alcohol consumption or levels of knowledge as an outcome measure. KEY FINDINGS Seven studies were included in the review. Interventions included multimedia and educational interventions. Improvements in knowledge were reported in six studies, whereas one study found contradictory results. Four studies used alcohol consumption rates as an outcome measure, and although a reduction in consumption was reported, the results were non-significant. IMPLICATIONS The effectiveness of public health interventions that aim to increase awareness and reduce alcohol consumption among pregnant women cannot be assessed because of the paucity of studies. CONCLUSIONS The results of this critical review emphasise a lack of evidence and highlight the need for further evaluation research on this topic.
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30
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Wabiri N, Chersich M, Zuma K, Blaauw D, Goudge J, Dwane N. Equity in maternal health in South Africa: analysis of health service access and health status in a national household survey. PLoS One 2013; 8:e73864. [PMID: 24040097 PMCID: PMC3765324 DOI: 10.1371/journal.pone.0073864] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/25/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND South Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources. METHODS Analysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data. FINDINGS Poorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2-6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group. CONCLUSIONS Aside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.
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Affiliation(s)
- Njeri Wabiri
- Epidemiology and Strategic Information Unit, Human Sciences Research Council, Pretoria, South Africa
- * E-mail:
| | - Matthew Chersich
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Gent, Belgium
| | - Khangelani Zuma
- Epidemiology and Strategic Information Unit, Human Sciences Research Council, Pretoria, South Africa
| | - Duane Blaauw
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Ntabozuko Dwane
- Epidemiology and Strategic Information Unit, Human Sciences Research Council, Pretoria, South Africa
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31
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Rendall-Mkosi K, Morojele N, London L, Moodley S, Singh C, Girdler-Brown B. A randomized controlled trial of motivational interviewing to prevent risk for an alcohol-exposed pregnancy in the Western Cape, South Africa. Addiction 2013; 108:725-32. [PMID: 23216868 DOI: 10.1111/add.12081] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/26/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Abstract
AIM To test the effectiveness of motivational interviewing (MI) to reduce the risk of an alcohol exposed pregnancy (AEP) in a high-risk population. DESIGN Randomized controlled trial. SETTING Rural population in the Western Cape, South Africa. PARTICIPANTS A total of 165 women aged 18-44 years at risk of AEP. INTERVENTION Five-session MI intervention. MEASUREMENTS Structured questionnaires were administered pre-intervention and at 3 and 12 months follow-up. The primary outcome measure was AEP at 12 months. Secondary outcomes were AEP at 3 months, and alcohol use and effective contraception at 3 and 12 months. FINDINGS There was a significant difference in the decline in the proportion of women at risk for an AEP in the MI group at 3 months (50 versus 24.59%; P = 0.004), maintained at 12 months (50.82 versus 28.12%; P = 0.009). In an intention-to-treat analysis these differences were also significant (32.93 versus 18.07%; P = 0.029; and 37.80 versus 21.69%; P = 0.024, respectively). The odds ratio for no longer being at risk of an AEP (MI versus control) at 12 months was 2.64 [95% confidence interval (CI): 1.18-5.94]. In the intention-to-treat analysis this ratio was 2.19 (95% CI: 1.05-4.65). CONCLUSIONS A five-session motivational interviewing intervention was found to be effective with women at risk of an alcohol-exposed pregnancy, and could be implemented as part of routine primary care clinic services in similar populations. The message of 'no alcohol in pregnancy' should be adapted to include better family planning and early recognition of pregnancy.
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Affiliation(s)
- Kirstie Rendall-Mkosi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
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