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Chu JTW, McCormack J, Marsh S, Wells A, Wilson H, Bullen C. Impact of prenatal alcohol exposure on neurodevelopmental outcomes: a systematic review. Health Psychol Behav Med 2022; 10:973-1002. [PMID: 36238426 PMCID: PMC9553152 DOI: 10.1080/21642850.2022.2129653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022] Open
Abstract
Background Prenatal exposure to alcohol (PAE) represents a significant public health concern. Previous research linking PAE to neurodevelopmental outcomes has been mixed and often has limited focus on residual confounding or moderating factors. Methods A systematic review of prospective cohort studies (n = >1000) assessing the impact of PAE on neurodevelopmental outcomes was undertaken (neurophysiology, motor skills, cognition, language, academic achievement, memory, attention, executive function, affect regulation, and adaptive behaviour, social skills, or communication). Electronic searches of EMBASE, Medline, CINAHL, and Psychinfo were conducted in May 2021. A quality assessment was conducted using an adapted version of the Newcastle-Ottawa Scale (NOS). Results Thirty longitudinal cohort studies met the inclusion criteria. Evidence of the impact of PAE was mixed across domains. We found no evidence that PAE affects executive function, but there were impacts on motor skills, cognition, language, academic achievement, attention, affect regulation, and adaptive behaviour. The most consistent adverse effect was on affect regulation (nine out of thirteen studies, six of which found an association between heavy alcohol consumption or binge drinking during pregnancy). We found no protective factors. Few studies controlled for variables in the postnatal environment. Discussion This review was unable to conclude a safe level of alcohol consumption during pregnancy. Methodological improvements are needed to improve the quality and consistency in which PAE is studied. Further research into residual confounding variables is vital, including a greater focus on the postpartum environment.
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Affiliation(s)
- Joanna Ting Wai Chu
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jessica McCormack
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Samantha Marsh
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Alesha Wells
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Holly Wilson
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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Wechsberg WM, van der Drift I, Howard BN, Myers B, Browne FA, Bonner CP, Carney T, Ndirangu J, Washio Y. Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8661. [PMID: 35886515 PMCID: PMC9316816 DOI: 10.3390/ijerph19148661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022]
Abstract
Heavy alcohol consumption and other drug use are prominent across Africa and increase the risk of exposure to violence, HIV acquisition, and other life-threatening injuries. This review synthesizes evidence on alcohol and other drug (AOD) interventions in Africa; evaluates the differences between interventions that do and do not specifically target populations that use AODs; and highlights the impact of comprehensive vs. brief interventions and those that address syndemic issues from a gender and contextualized lens. Literature searches were conducted to identify research outcomes of randomized interventions published between January 2010 and May 2022 that address AOD use in Africa. Thirty-five full-text articles were included in this review. Most of the identified research studies were concentrated in a few countries. Most studies were conducted in South Africa. Many of the studies comprised brief interventions. However, the most comprehensive interventions were the most effective for AOD outcomes. Several studies indicated the importance of addressing AOD use alongside gender-based violence, mental health needs, gender roles, and other social determinants that affect health outcomes. Intervening on AOD use and addressing social determinants from a gender and contextually relevant perspective is essential to ensuring the long-term health and well-being of people in Africa.
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Affiliation(s)
- Wendee M. Wechsberg
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27708, USA
| | - Isa van der Drift
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Brittni N. Howard
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Bronwyn Myers
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7580, South Africa; (B.M.); (T.C.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth 6102, Australia
| | - Felicia A. Browne
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Courtney Peasant Bonner
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tara Carney
- Alcohol Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town 7580, South Africa; (B.M.); (T.C.)
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Jacqueline Ndirangu
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
| | - Yukiko Washio
- Substance Use, Gender and Applied Research Program, RTI International, Research Triangle Park, NC 27709, USA; (I.v.d.D.); (B.N.H.); (F.A.B.); (C.P.B.); (J.N.); (Y.W.)
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19122, USA
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Tesfaye G, Demlew D, G/tsadik M, Habte F, Molla G, Kifle Y, Gebreegziabher G. The prevalence and associated factors of alcohol use among pregnant women attending antenatal care at public hospitals Addis Ababa, Ethiopia, 2019. BMC Psychiatry 2020; 20:337. [PMID: 32600291 PMCID: PMC7325233 DOI: 10.1186/s12888-020-02747-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Alcohol use during pregnancy is a significant public health problem, ultimately affecting the neonatal offspring. Recent studies explore that no safe amount and safe time to drink alcohol during pregnancy. Even though drinking in pregnancy has a wide range of problems, a small number of scientific publications document on the magnitude of drinking alcohol during pregnancy in Sub-Saharan African countries including Ethiopia. The aim of this study was to assess prevalence and associated factors of alcohol use among pregnant women attending prenatal care at public hospitals, Addis Ababa, Ethiopia. METHODS Hospital based cross sectional study was employed from May 7 to June 6, 2019 at public hospitals, Addis Ababa. A total of 585 pregnant women participated in the study selected through systematic random sampling technique. Frequency of consumption was measured by using AUDIT. Frequency tables and graphs were used to describe the study variable. The association between variables analyzed with bi-variable and multivariable binary logistic regression. A statistical significance was declared at p value < 0.05 with 95% confidence interval. RESULT A total of 585 participants were included in the study with the response rate of 98.6%. The study showed that the prevalence of alcohol use among pregnant women were 37.1% with (95% CI, 33.2-41). Factors like no formal education [AOR = 3.22, 95%CI, 1.72, 6.02], pre-pregnancy alcohol use [AOR = 3.16, 95%CI, 2.03, 4.91], partner alcohol use [AOR = 3.43, 95%CI, 2.21, 5.32], and poor social support [AOR = 3.16, 95%CI, 1.88, 5.31] were statistically associated with alcohol use during pregnancy. CONCLUSION In this study the prevalence of alcohol use during pregnancy was high as compared to majority of other studies. This study observed that no formal education, pre-pregnancy alcohol use, partner alcohol use, and poor social support, were highly associated with alcohol use during pregnancy. Based on the findings of this study early management of alcohol use and problematic alcohol use is needed for pregnant women.
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Affiliation(s)
- Getaneh Tesfaye
- Department of Psychiatry, College of Health Sciences, Aksum University, Aksum, Ethiopia.
| | - Demeke Demlew
- grid.59547.3a0000 0000 8539 4635College of Medicine and Health, Department of Psychiatry, University of Gondar, Gondar, Ethiopia
| | | | | | - Gebeyaw Molla
- Department of Psychiatry, College of Health Sciences, Axum University, Aksum, Ethiopia
| | - Yohannes Kifle
- Department of Psychiatry, College of Health Sciences, Axum University, Aksum, Ethiopia
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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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Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder. Lancet Neurol 2019; 18:760-770. [PMID: 31160204 DOI: 10.1016/s1474-4422(19)30150-4] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/21/2022]
Abstract
Although prenatal alcohol exposure causes craniofacial anomalies, growth retardation, neurological abnormalities, cognitive impairment, and birth defects, fetal alcohol spectrum disorder is underdiagnosed. Global prevalence of fetal alcohol spectrum disorder is 0·77%, with a higher prevalence of 2-5% in Europe and North America, highlighting the need for increased diagnosis and treatment. However, diagnosis remains challenging because of the poor reliability of self-reported maternal drinking histories, an absence of sensitive biomarkers, and the infrequency of diagnostic dysmorphic facial features among individuals with fetal alcohol spectrum disorder. Different diagnostic systems and disagreements over criteria have slowed progress in the diagnosis and management of the disorder. Neuroimaging shows abnormalities in brain structure, cortical development, white matter microstructure, and functional connectivity in individuals with fetal alcohol spectrum disorder. These abnormalities modify developmental trajectories and are associated with deficits in cognition, executive function, memory, vision, hearing, motor skills, behaviour, and social adaptation. Promising trials of nutritional interventions and cognitive rehabilitation therapies are underway, with the aim of treating cognitive deficits in fetal alcohol spectrum disorders.
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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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Subramoney S, Eastman E, Adnams C, Stein DJ, Donald KA. The Early Developmental Outcomes of Prenatal Alcohol Exposure: A Review. Front Neurol 2018; 9:1108. [PMID: 30619064 PMCID: PMC6305542 DOI: 10.3389/fneur.2018.01108] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/04/2018] [Indexed: 02/05/2023] Open
Abstract
Aim: This paper systematically reviews the literature on the effects of prenatal alcohol exposure on early child development from birth to 5 years with the aim to synthesize the developmental outcomes associated with prenatal alcohol exposure, and inform further research to improve our knowledge of the manifestations of prenatal alcohol exposure. Methods: Electronic databases (MEDLINE, Psych INFO, and Psych ARTICLES) were searched to find papers on the developmental outcomes of prenatal alcohol exposure in neonates, infants and toddlers and pre-school aged children. Studies were selected based on participants self-reporting alcohol consumption during pregnancy (either prospectively or retrospectively) and/or children being diagnosed with FASD based on a standardized assessment that includes a dysmorphology examination. The search was limited to peer-reviewed, English language studies involving human subjects, up to 5.5 years old. Results: Out of the 1,684 titles screened, a total of 71 papers were identified as relevant and included in this review. The majority of studies were prospective longitudinal studies. A range of assessment modalities (or tools) was used to determine neurodevelopmental outcomes of prenatal exposure to alcohol in the age group under review, the most frequently described being the Bayley Scales of Infant and Toddler Development (BSID) (n = 19). Studies varied in terms of the dose, frequency, and timing of alcohol consumption during pregnancy and methodology used to assess alcohol consumption. Findings demonstrate extensive evidence for poor global developmental outcomes in children prenatally exposed to alcohol, particularly with moderate to severe levels of prenatal alcohol exposure. Conclusion: The outcomes related to lower levels of prenatal alcohol exposure as well as outcomes in specific developmental domains, are poorly understood. Further research should aim to clarify the more subtle or less easily measurable manifestations of prenatal alcohol exposure on early development when the potential for greatest impact of interventions is highest.
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Affiliation(s)
- Sivenesi Subramoney
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Emma Eastman
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Colleen Adnams
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Kirsten A. Donald
- Division of Developmental Pediatrics, Department of Pediatrics, and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Adebiyi BO, Mukumbang FC, Cloete LG, Beytell AM. Exploring service providers' perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: a qualitative study. BMC Public Health 2018; 18:1238. [PMID: 30400900 PMCID: PMC6220472 DOI: 10.1186/s12889-018-6126-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background Fetal alcohol spectrum disorder (FASD) is among the leading causes of developmental and intellectual disabilities in individuals. Although efforts are being made toward the prevention and management of FASD in South Africa, the prevalence remains high. The sustained high prevalence could be attributed to several factors, including the lack of policy for a coordinated effort to prevent, diagnose and manage FASD nationally. In this study, our aim was to explore the perspectives of service providers (health and allied professionals, teachers, social workers) on the prevention and management of FASD towards developing a guideline to inform policy. Method Guided by the exploratory qualitative research design, we purposively sampled relevant service providers in the field of FASD prevention and management for focus group discussions. Nine of these discussions were conducted with to eight participants per discussion session. The discussants were asked various questions on the current and required interventions and practices for the prevention and management of FASD. Following the Framework Method, data were transcribed verbatim and analysed using the thematic content analysis approach. Results Our findings show that aspects of the prevention and management of alcohol-related conditions are present in various policies. However, there is no clear focus on coordinated, multi-sectoral efforts for a more comprehensive approach to the prevention and management of FASD. The participants recognized the need for specific requirements on broad-based preventive awareness programs, training and support for parents and caregivers, inclusive education in mainstream schools and training of relevant professionals. Conclusion Comprehensive and coordinated prevention and management programs guided by a specific policy could improve the prevention and management of FASD. Policy formulation demonstrates commitment from the government, highlights the importance of the condition, and elaborates on context-specific prevention and management protocols. Electronic supplementary material The online version of this article (10.1186/s12889-018-6126-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535, South Africa
| | - Lizahn G Cloete
- Division of Occupational Therapy, University of Stellenbosch, Stellenbosch, South Africa
| | - Anna-Marie Beytell
- Department of Social Work, University of the Western Cape, Cape Town, South Africa
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Adebiyi BO, Mukumbang FC, Okop KJ, Beytell AM. A modified Delphi study towards developing a guideline to inform policy on fetal alcohol spectrum disorders in South Africa: a study protocol. BMJ Open 2018; 8:e019907. [PMID: 29703853 PMCID: PMC5922479 DOI: 10.1136/bmjopen-2017-019907] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Maternal alcohol consumption during pregnancy can result in mental and physical birth defects in individuals. These birth defects are usually described as fetal alcohol spectrum disorders (FASDs). With an estimated 183-259 per 1000 children born with FASDs, South Africa is identified to have the highest prevalence of FASDs in the world. Nevertheless, there is a lack of appropriate policies, guidelines and interventions addressing the issues around FASDs. This protocol outlines a proposed process for developing a guideline to inform policies on FASDs. METHODS AND ANALYSIS This process will have three phases. Phase I will be carried out in three steps; we plan to conduct a document review of available policies on the prevention and management of FASDs and update the existing systematic review on FASDs interventions. The aim of the two reviews is to explore the availability and content of existing policies and global interventions on FASDs. In addition, we will conduct two exploratory qualitative studies to obtain the perspectives of various stakeholders on the existing or possible guidelines and policies for the management of FASDs and available interventions and services. In phase II, we will aggregate the findings of the previous phase to develop a prototype guideline. In phase III, using the developed prototype, we will apply the Delphi approach with experts on FASDs, soliciting their opinions on the nature and content of the proposed guidelines for policies. The information gathered will be used to modify the prototype to formulate a policy guideline on FASDs. The data will be analysed using thematic analysis and narrative synthesis. ETHICS AND DISSEMINATION Ethical clearance has been obtained from the ethics committee of the university and governmental departments. The findings will be disseminated through publications and the guideline will be submitted to relevant departments.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | - Kufre J Okop
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Anna-Marie Beytell
- Department of Social Work, University of the Western Cape, Cape Town, South Africa
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Advances in developmental neuropsychiatry: autism spectrum disorder, Cornelia De Lange syndrome, self-injurious behavior, Down syndrome, fetal alcohol spectrum disorder, and borderline intellectual functioning. Curr Opin Psychiatry 2017; 30:65-68. [PMID: 28067728 DOI: 10.1097/yco.0000000000000318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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