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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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2
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Adebiyi BO, Mukumbang FC. A pooled prevalence of fetal alcohol spectrum disorders in South Africa: a systematic review and meta-analysis protocol. Arch Public Health 2021; 79:156. [PMID: 34461997 PMCID: PMC8404255 DOI: 10.1186/s13690-021-00679-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorder (FASD) remains a global public health problem. South Africa is estimated to have the highest recorded prevalence of FASD. However, no study has systematically evaluated the available prevalence studies to provide estimates that may facilitate effective planning and delivery of prevention and management services. Therefore, we propose to conduct a systematic review and meta-analysis to report a pooled estimate of the FASD prevalence among children, youth and adults in South Africa. METHODS We will include quantitative (cohort and cross-sectional) studies that reported on the prevalence of FASD in South Africa. We will search databases such as Academic Search Complete, Education Resource Information Center (ERIC), SocINDEX, Health Source: Nursing/Academic Edition, Cumulative Index of Nursing and Allied Health and PsycARTICLES), Scopus, Science Direct, Springer Link, JSTOR, SAGE journals, PubMed, Web of Science and Sabinet. The references of included studies will be searched for additional studies on the prevalence of FASD. The search will be from inception to October 2021. Screening of (titles, abstracts and full text of the potentially relevant articles) will be done by two independent authors using software. All disagreements will be resolved by discussion. A standardised data extraction form will be designed for the extraction. Two authors will independently extract the data from the selected articles and all disagreements will be resolved by discussion. We will use a tool developed by Munn and colleagues to critically appraise all the included studies. The primary outcome will be the proportion of individuals with FASD in South Africa. We will use the Freeman-Tukey double arcsine transformation to transform the raw prevalence estimates so that the data can follow an approximately normal distribution. We will use random-effects models to calculate 95% confidence intervals and prediction intervals based on multiple meta-analyses with transformed proportions. We will test heterogeneity using Cochran's Q and describe using the I2 statistic. DISCUSSION The pooled prevalence estimate will assist the government and other stakeholders (such as non-profit organisations and researchers) to plan and prioritise prevention and management interventions. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered with PROSPERO (registration number: CRD42020197979 ).
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Affiliation(s)
- Babatope O. Adebiyi
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535 South Africa
| | - Ferdinand C. Mukumbang
- Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, WA USA
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3
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Louw JG, van Heerden A, Olivier L, Lambrechts T, Broodryk M, Bunge L, Vosloo M, Tomlinson M. Executive Function After Prenatal Alcohol Exposure in Children in a South African Population: Cross-sectional Study. JMIR Form Res 2021; 5:e20658. [PMID: 34255647 PMCID: PMC8285745 DOI: 10.2196/20658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/27/2020] [Accepted: 03/16/2021] [Indexed: 01/04/2023] Open
Abstract
Background Alcohol is a teratogen; its consumption during pregnancy can lead to negative birth outcomes, collectively referred to as fetal alcohol spectrum disorders. Neurodevelopmental delays in higher-order cognitive functions that affect development of executive functions are a common feature. Studies on executive function in children have focused on children diagnosed with fetal alcohol spectrum disorder, and there is a lack of information on the impact on children not diagnosed with fetal alcohol spectrum disorder but who had been exposed to alcohol. Objective The aim of this study was to compare the development of executive function in children between 4 and 6 years of age with and without prenatal exposure to alcohol. Methods Children both exposed and not exposed to alcohol were recruited as part of a feasibility RCT evaluating a computer-based cognitive training program for improving executive function development. The study was conducted in a low–socioeconomic status community in South Africa with a high prevalence of fetal alcohol spectrum disorder. Neurodevelopment was assessed in participating children; NEPSY-II standardized scores for executive function domains were compared using a multivariate analysis of variance with group membership as the predictor variable. Results No significant differences in executive functions assessments (P=.39) were found between children in the alcohol-exposed group (n=76) and those in the nonexposed group (n=40). Both groups showed moderate to severe delays in domains. In all but one subtest, the average score for both groups was below the 25th percentile of expected norms. Conclusions We expected that alcohol exposure would have a measurable impact on executive function development. The lack of differences highlights the prevalence of developmental delays in low–socioeconomic status communities in South Africa and suggests that children are exposed to various threats to cognitive development. International Registered Report Identifier (IRRID) RR2-10.2196/14489
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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.,Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa.,Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand/Medical Research Council, Johannesburg, South Africa
| | - Leana Olivier
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Tersius Lambrechts
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mandi Broodryk
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Liska Bunge
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Martlé Vosloo
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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Schaidhauer FG, Caetano HA, da Silva GP, da Silva RS. Contributions of Zebrafish Studies on the Behavioural Consequences of Early Alcohol Exposure: A Systematic Review. Curr Neuropharmacol 2021; 20:579-593. [PMID: 33913405 DOI: 10.2174/1570159x19666210428114317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The consequences of mild to severe exposure to alcohol during brain development is still a matter of debate and scientific investigation. The long-term behavioural effects of ethanol exposure have been related to impaired social skills and cognition. Zebrafish have become a suitable animal model to investigate the effects of early ethanol exposure because it is very feasible to promote drug delivery during early development. OBJECTIVE The goal of the current report is to review existing behavioural studies addressing the impact of early alcohol exposure using zebrafish to determine whether these models resemble the behavioural effects of early alcohol exposure in humans. METHODS A comprehensive search of biomedical databases was performed using the operation order: "ZEBRAFISH AND BEHAV* AND (ETHANOL OR ALCOHOL)". The eligibility of studies was determined using the PICOS strategy, contemplating the population as zebrafish, intervention as exposure to ethanol, comparison with a non-exposed control animal, and outcomes as behavioural parameters. RESULTS The systematic search returned 29 scientific articles as eligible. The zebrafish is presented as a versatile animal model that is useful to study FASD short and long-term behaviour impairments, such as anxiety, impaired sociability, aggressiveness, learning problems, memory impairment, seizure susceptibility, sleep disorders, motivational problems, and addiction. CONCLUSION This systematic review serves to further promote the use of zebrafish as a model system to study the pathophysiological and behavioural consequences of early alcohol exposure.
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Affiliation(s)
- Flávia Gheller Schaidhauer
- Laboratório de Neuroquímica e Psicofarmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Higor Arruda Caetano
- Laboratório de Neuroquímica e Psicofarmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Guilherme Pietro da Silva
- Laboratório de Neuroquímica e Psicofarmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rosane Souza da Silva
- Laboratório de Neuroquímica e Psicofarmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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5
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May PA, Hasken JM, Stegall JM, Mastro HA, Kalberg WO, Buckley D, Brooks M, Hedrick DM, Ortega MA, Elliott AJ, Tabachnick BG, Abdul-Rahman O, Adam MP, Robinson LK, Manning MA, Jewett T, Hoyme HE. Fetal Alcohol Spectrum Disorders in a Southeastern County of the United States: Child Characteristics and Maternal Risk Traits. Alcohol Clin Exp Res 2020; 44:939-959. [PMID: 32293734 DOI: 10.1111/acer.14313] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To detail the characteristic traits of children with fetal alcohol spectrum disorders (FASDs) and maternal risk factors in a southeastern U.S. County. METHODS Independent samples were drawn from 2 different cohorts of first-grade students. All consented children (49.8%) were measured for height, weight, and head circumference, and those ≤ 25th centile entered the study along with a random sample drawn from all enrolled students. Study children were examined for physical growth, dysmorphology, and neurobehavior, and their mothers were interviewed. RESULTS Total dysmorphology scores discriminated well the physical traits of children across the FASD continuum: fetal alcohol syndrome (FAS) = 15.8, partial FAS (PFAS) = 10.8, alcohol-related neurobehavioral disorder (ARND) = 5.2, and typically developing controls = 4.4. Additionally, a neurobehavioral battery distinguished children with each FASD diagnosis from controls. Behavioral problems qualified more children for FASD diagnoses than cognitive traits. Significant proximal maternal risk variables were as follows: reports of prepregnancy drinking, drinking in any trimester, and comorbid use of other drugs in lifetime and during pregnancy, especially alcohol and marijuana (14.9% among mothers of children with FASD vs. 0.4% for controls). Distal maternal risks included reports of other health problems (e.g., depression), living unmarried with a partner during pregnancy, and a lower level of spirituality. Controlling for other drug use during pregnancy, having a child diagnosed with a FASD was 17.5 times greater for women who reported usual consumption of 3 drinks per drinking day prior to pregnancy than for nondrinking mothers (p < 0.001, 95% CI = 5.1 to 59.9). There was no significant difference in the prevalence of FASD by race, Hispanic ethnicity, or socioeconomic status. The prevalence of FASD was not lower than 17.3 per 1,000, and weighted estimated prevalence was 49.0 per 1,000 or 4.9%. CONCLUSION This site had the second lowest rate in the CoFASP study, yet children with FASD are prevalent.
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Affiliation(s)
- Philip A May
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.,Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Julie M Hasken
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Julie M Stegall
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Heather A Mastro
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Marita Brooks
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Dixie M Hedrick
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Marian A Ortega
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), The University of New Mexico, Albuquerque, New Mexico
| | - Amy J Elliott
- Avera Research, Sioux Falls, South Dakota.,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | | | | | | | - Luther K Robinson
- Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York
| | - Melanie A Manning
- Departments of Pathology and Pediatrics, Stanford University, Stanford, California
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - H Eugene Hoyme
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota.,Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.,Sanford Research, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota
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6
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May PA, Hasken JM, Baete A, Russo J, Elliott AJ, Kalberg WO, Buckley D, Brooks M, Ortega MA, Hedrick DM, Tabachnick BG, Abdul-Rahman O, Adam MP, Jewett T, Robinson LK, Manning MA, Hoyme HE. Fetal Alcohol Spectrum Disorders in a Midwestern City: Child Characteristics, Maternal Risk Traits, and Prevalence. Alcohol Clin Exp Res 2020; 44:919-938. [PMID: 32293735 DOI: 10.1111/acer.14314] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the characteristics of children with fetal alcohol spectrum disorders (FASD) and their mothers in a Midwestern city. METHODS Case-control samples were drawn from 2 separate first-grade cohorts (combined N = 4,047) in every city school using different methods. In Cohort Sample 1, all consented small children (≤25th centile on height, weight, and/or head circumference) entered the study along with a random sample from all enrolled students. Cohort Sample 2 was drawn totally at random. Child growth, dysmorphology, and neurobehavior were assessed using the Collaboration on FASD Prevalence (CoFASP) criteria, and mothers were interviewed. RESULTS For the samples combined, 891 children received dysmorphology examinations, and 692 were case-conferenced for final diagnosis. Forty-four children met criteria for FASD. Total dysmorphology scores differentiated diagnostic groups: fetal alcohol syndrome (FAS), 16.7; partial FAS, 11.8; alcohol-related neurodevelopmental disorder (ARND), 6.1; and typically developing controls, 4.2. Neurobehavioral tests distinguished children with FASD from controls, more for behavioral problems than cognitive delay. Children with ARND demonstrated the poorest neurobehavioral indicators. An adjusted regression model of usual prepregnancy drinking indicated that maternal reports of 3 drinks per drinking day (DDD) were significantly associated with a FASD diagnosis (p = 0.020, OR = 10.1, 95% CI = 1.44 to 70.54), as were 5 or more DDD (p < 0.001, OR = 26.47, 95% CI = 4.65 to 150.62). Other significant maternal risk factors included the following: self-reported drinking in any trimester; smoking and cocaine use during pregnancy; later pregnancy recognition and later and less prenatal care; lower maternal weight, body mass index (BMI), and head circumference; and unmarried status. There was no significant difference in FASD prevalence by race, Hispanic ethnicity, or socioeconomic status at this site, where the prevalence of FASD was 14.4 to 41.2 per 1,000 (1.4 to 4.1%). CONCLUSION This city displayed the lowest prevalence of FASD of the 4 CoFASP sites. Nevertheless, FASD were common, and affected children demonstrated a common, recognizable, and measurable array of traits.
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Affiliation(s)
- Philip A May
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina.,Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - Julie M Hasken
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Amy Baete
- Sanford Research, Sioux Falls, South Dakota
| | | | - Amy J Elliott
- Avera Research, Sioux Falls, South Dakota.,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - David Buckley
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - Marita Brooks
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - Marian A Ortega
- Center on Alcoholism, Substance Abuse and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico
| | - Dixie M Hedrick
- Department of Nutrition, Nutrition Research Institute, University of North Carolina, Chapel Hill, North Carolina
| | | | - Omar Abdul-Rahman
- Department of Pediatrics, University of Nebraska College of Medicine, Omaha, Nebraska
| | - Margaret P Adam
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Tamison Jewett
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Luther K Robinson
- Department of Pediatrics, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Melanie A Manning
- Departments of Pathology and Pediatrics, Stanford University School of Medicine, Stanford, California
| | - H Eugene Hoyme
- Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota.,Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.,Sanford Health, Sanford Children's Genomic Medicine Consortium, Sioux Falls, South Dakota
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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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Louw JG, Olivier L, Skeen S, van Heerden A, Tomlinson M. Evaluation of a Custom-Developed Computer Game to Improve Executive Functioning in 4- to 6-Year-Old Children Exposed to Alcohol in Utero: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14489. [PMID: 31596247 PMCID: PMC6806122 DOI: 10.2196/14489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/28/2022] Open
Abstract
Background Fetal alcohol spectrum disorder (FASD) is one of the most common causes of preventable intellectual disability, and the key associated deficits are in executive function (EF). Aspects of EF can be improved using cognitive training interventions. The highest prevalence of FASD globally (at a rate of 135.1 per 1000) has been found in a South African population in the Western Cape province. There is a shortage of specialized health service personnel, and there are limited remedial services. Computer-based cognitive training, if age and culturally appropriate, could be an effective way to provide the interventions with minimal need for skilled personnel and other resources. The Foundation for Alcohol Related Research has developed such a program for the South African context. Objective This protocol aimed to evaluate whether it is feasible to use computerized cognitive training in a resource-poor context to improve cognitive function in children exposed to alcohol in utero. Methods We are conducting a randomized controlled trial in the Saldanha Bay Municipal area, evaluating a custom-developed cognitive training program to improve the cognitive function of children aged between 4 and 6 years who were exposed to alcohol in the prenatal stage. Participants will be recruited from local Early Childhood Development centers. Community workers will interview biological mothers to identify alcohol-exposed pregnancies. Alcohol-exposed children will be randomized into an intervention or a control group of 40 participants each using block randomization. A group of 40 children not exposed to alcohol will be included in a normative group using individual randomization. The intervention group will play the game for 6 months (40 sessions). Normative and control groups will receive no intervention. Neurodevelopmental assessments will be done at baseline and upon completion of the study with all participants. Results The intervention has started, and all baseline assessments have been done at the time of submission. Conclusions This study will provide insight into whether computerized cognitive training is viable and effective in the South African context. It has the potential to provide a means of intervention globally and in other resource-poor context and expand the knowledge base regarding executive functioning and FASD. This paper presents the research protocol and intervention design of the study. Trial Registration ISRCTN Registry ISRCTN17244156; http://www.isrctn.com/ISRCTN17244156. International Registered Report Identifier (IRRID) DERR1-10.2196/14489
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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.,Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leana Olivier
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alastair van Heerden
- Human and Social Development, Human Sciences Research Council, Pietermaritzburg, South Africa.,MRC/WITS Developmental Pathways for Health Research Unit Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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"The Dop System of Alcohol Distribution is Dead, but It's Legacy Lives On….". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193701. [PMID: 31581441 PMCID: PMC6801681 DOI: 10.3390/ijerph16193701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 12/02/2022]
Abstract
Objective: Determine the prevalence of Dop, a system of labor payment via alcoholic beverages, in a South African province, and its influence on maternal drinking and fetal alcohol spectrum disorders (FASD). Methods: Data from studies of FASD epidemiology were analyzed. Results: Forty-two percent to 67% of mothers reported drinking. In 1999, 5% of women reported Dop allocations in their lifetime: 14% of mothers of FASD children and 1% of controls. In 2010, 1.1% of mothers reported lifetime Dop: 1.6% of FASD mothers and 0.7% of controls. Commercial alcohol sales have replaced the Dop system. Total FASD rates remained high in rural areas in 2010 and rose in urban settings. Urban rates of total FASD surpassed rural area rates in 2010. Correlation analysis did not reveal a strong or significant, direct relationship between Dop experience and heavy drinking (r = 0.123, p < 0.001, r2 = 0.015), or the diagnosis of FASD in children (OR = 0.003, p = 0.183). Conclusion: Dop, as a systematic practice, is dead and does not have a direct influence on alcohol availability, heavy maternal drinking, or the probability of an FASD diagnosis. Nevertheless, today’s problematic drinking patterns were heavily influenced (shaped) by Dop and have negatively impacted the prevalence and severity of FASD.
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Popova S, Lange S, Poznyak V, Chudley AE, Shield KD, Reynolds JN, Murray M, Rehm J. Population-based prevalence of fetal alcohol spectrum disorder in Canada. BMC Public Health 2019; 19:845. [PMID: 31253131 PMCID: PMC6599312 DOI: 10.1186/s12889-019-7213-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 06/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background Fetal alcohol spectrum disorder (FASD) is one of the most disabling potential outcomes of prenatal alcohol exposure. The population-based prevalence of FASD among the general population of Canada was unknown. The objective of this study was to determine the population-based prevalence of FASD among elementary school students, aged 7 to 9 years, in the Greater Toronto Area (GTA) in Ontario, Canada. Methods This screening study used a cross-sectional, observational design utilizing active case ascertainment, along with retrospective collection of prenatal alcohol exposure information. Data collection involved two phases. Phase I consisted of taking growth measurements, a dysmorphology examination, and obtaining a history of behavioral and/or learning problems. Phase II consisted of a neurodevelopmental assessment, maternal interview, and behavioral observations/ratings by parents/guardians. Final diagnostic screening conclusions were made by consensus by a team of experienced multidisciplinary experts during case conferences, using the 2005 Canadian guidelines for FASD diagnosis. The prevalence of FASD was estimated, taking into consideration the selection rate, which was used to account for students who dropped out or were lost to follow-up during each phase. Monte Carlo simulations were employed to derive the confidence interval (CI) for the point estimates. Results A total of 2555 students participated. A total of 21 cases of suspected FASD were identified. The prevalence of FASD was estimated to be 18.1 per 1000, or about 1.8%. Using a less conservative approach (sensitivity analysis), the prevalence of FASD was estimated to be 29.3 per 1000, or about 2.9%. Therefore, the population-based prevalence of FASD is likely to range between 2 and 3% among elementary school students in the GTA in Ontario, Canada. Conclusions This study provides the first population-based estimate of the prevalence of FASD in Canada. The estimate is approximately double or possibly even triple previous crude estimates. FASD prevalence exceeds that of other common birth defects such as Down’s syndrome, spina bifida, trisomy 18, as well as autism spectrum disorder in Canada. More effective prevention strategies targeting alcohol use during pregnancy, surveillance of FASD, and timely interventions and support to individuals with FASD and their families are urgently needed. Electronic supplementary material The online version of this article (10.1186/s12889-019-7213-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Svetlana Popova
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada. .,Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Shannon Lange
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Vladimir Poznyak
- Department of Mental Health and Substance Abuse, World Health Organization, 20 Avenue Appia, CH-1211, Geneva, Switzerland
| | - Albert E Chudley
- Department of Paediatrics and Child Health, University of Manitoba, 840 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Kevin D Shield
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - James N Reynolds
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, 18 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Margaret Murray
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
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11
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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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12
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Serum concentrations of IGF-I/IGF-II as biomarkers of alcohol damage during foetal development and diagnostic markers of Foetal Alcohol Syndrome. Sci Rep 2019; 9:1562. [PMID: 30733584 PMCID: PMC6367511 DOI: 10.1038/s41598-018-38041-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/30/2018] [Indexed: 12/23/2022] Open
Abstract
Foetal Alcohol Syndrome (FAS) is the most deleterious health effect derived from alcohol consumption during pregnancy and is placed at the end of the Foetal Alcohol Spectrum Disorders (FASD). Few studies have proposed potential molecular biomarkers of physical and neurological damage associated with prenatal alcohol exposure. We prospectively recruited 55 children from 8 to 12 years old, with a prenatal assessment for ethanol exposure using meconium analysis of fatty acid ethyl esters (FAEE). The control group was established for FAEE < 2 nmol/g (n = 31) and a Prenatal Ethanol Exposure (PEE) group for FAEEs > 2 nmol/g (n = 33). Moreover, 98 children adopted from Eastern European Countries (EEC) were also recruited to evaluate FASD diagnosis comprising 31 cases with complete FAS, 42 with partial FAS, 6 with ARBD and 5 with ARND. Serum values of IGF-I and IGF-II for all children recruited were determined by immunoassay. Anthropometric and neurocognitive evaluation showed severe impairments in FAS children, moderate effects in PEE and no harmful effects in the control group with no prenatal exposure to alcohol. Analysis of IGF-I and IGF-II serum concentrations revealed that FASD from EEC as well as PEE children showed significantly lower concentrations of both IGF-I and IFG-II than the control group and reference values. Moreover, Spearman correlations showed a significant effect of IGF-I on anthropometric measurements in girls, whereas IGF-II affected the neuropsychological variables in both genders. These findings validate the use of growth factors IGF-I and IGF-II as surrogate biomarkers of damage induced by prenatal exposure to ethanol and could be used in the diagnosis of foetal alcohol spectrum disorders.
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13
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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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14
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Terband H, Spruit M, Maassen B. Speech Impairment in Boys With Fetal Alcohol Spectrum Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1405-1425. [PMID: 30398563 DOI: 10.1044/2018_ajslp-17-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Fetal alcohol spectrum disorders (FASD) are a highly prevalent spectrum of patterns of congenital defects resulting from prenatal exposure to alcohol. Approximately 90% of the cases involve speech impairment. Yet, to date, no detailed symptom profiles nor dedicated treatment plans are available for this population. PURPOSE This study set out to chart the speech and speech motor characteristics in boys with FASD to profile the concomitant speech impairment and identify possible underlying mechanisms. METHOD Ten boys with FASD (4.5-10.3 years old) and 26 typically developing children (4.1-8.7 years old; 14 boys, 12 girls) participated in the study. Speech production and perception, and oral motor data were collected by standardized tests. RESULTS The boys with FASD showed reduced scores on all tasks as well as a deviant pattern of correlations between production and perception tasks and intelligibility compared with the typically developing children. Speech motor profiles showed specific problems with nonword repetition and tongue control. CONCLUSIONS Findings indicate that the speech impairment in boys with FASD results from a combination of deficits in multiple subsystems and should be approached as a disorder rather than a developmental delay. The results suggest that reduced speech motor planning/programming, auditory discrimination, and oral motor abilities should be considered in long-term, individually tailored treatment.
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Affiliation(s)
- Hayo Terband
- Utrecht Institute of Linguistics - OTS, Utrecht University, the Netherlands
| | - Manon Spruit
- Utrecht Institute of Linguistics - OTS, Utrecht University, the Netherlands
- Logopedie & Stottertherapie, Lingen, Germany
| | - Ben Maassen
- Centre for Language and Cognition & University Medical Centre, University of Groningen, the Netherlands
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15
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Viljoen D, Louw JG, Lombard C, Olivier L. Comparing diagnostic outcomes of children with fetal alcohol syndrome in South Africa with diagnostic outcomes when using the updated Institute of Medicine diagnostic guidelines. Birth Defects Res 2018; 110:1335-1342. [PMID: 30347134 DOI: 10.1002/bdr2.1399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/16/2018] [Accepted: 08/22/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION During fetal alcohol spectrum disorder (FASD) prevalence studies in South Africa, cases of fetal alcohol syndrome (FAS) were identified that presented differently from the 2016 Hoyme et al. modified Institute of Medicine (IOM) criteria. We compared diagnostic outcomes of children diagnosed with FAS using a combination of the 2005 Hoyme et al. criteria and the "gestalt method" in South Africa to the diagnosis they would have received using the latest Hoyme et al. criteria. The frequency with which dysmorphic features presented was compared to the frequency with which they were reported in the revised criteria which drew on a larger sample. METHODS Data were gathered from four South African FASD prevalence studies. Dysmorphology data, anthropometric data, and final diagnosis for participants (N = 917) were extracted. RESULTS Of the 390 participants with diagnoses of "full FAS," 175 would not have received a "full FAS" diagnosis using the 2016 criteria. Of these, 21 would have received a pFAS diagnosis, and 154 would have received a diagnosis of ARND or a "no-FASD" diagnosis. The frequency of all but five dysmorphic features differ significantly between this sample and the sample examined for the 2016 criteria. There is more variability in the features present in the current sample. DISCUSSION Differences regarding diagnostic outcomes and prevalence of dysmorphic features suggest that strict application of the diagnostic criteria may miss children who present with FAS. We recommend including gestalt-based screening in a research setting where the clinical experience is available to inform future guidelines.
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Affiliation(s)
- Denis Viljoen
- Foundation for Alcohol-Related Research (FARR), Cape Town, South Africa.,Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jacobus G Louw
- Foundation for Alcohol-Related Research (FARR), Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Chanelle Lombard
- Foundation for Alcohol-Related Research (FARR), Cape Town, South Africa
| | - Leana Olivier
- Foundation for Alcohol-Related Research (FARR), Cape Town, South Africa.,Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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16
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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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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: 350] [Impact Index Per Article: 50.0] [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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Lubbe M, van Walbeek C, Vellios N. The Prevalence of Fetal Alcohol Syndrome and Its Impact on a Child's Classroom Performance: A Case Study of a Rural South African School. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080896. [PMID: 28792446 PMCID: PMC5580600 DOI: 10.3390/ijerph14080896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/26/2017] [Accepted: 08/04/2017] [Indexed: 12/13/2022]
Abstract
Alcohol consumption is high among farm labourers in the Western and Northern Cape of South Africa. Excessive alcohol consumption during pregnancy is common, resulting in a high prevalence of Fetal Alcohol Syndrome (FAS) among children. FAS causes intellectual and behavioural problems, which create considerable obstacles to a child’s education. The aim of this study is to provide a prevalence estimate of FAS in a rural school and to examine the effects of FAS on learners’ educational outcomes. The study was conducted at a farm school near Clanwilliam in the Western Cape of South Africa. The sample comprises 166 learners from Grades 1 to 4. Educational outcomes include class scores (Afrikaans home language and mathematics), reading ability, and classroom behaviour. A physician diagnosed FAS using a three-stage process. We find FAS prevalence of 127 per 1000 (12.7%). Children with FAS score significantly lower (at the 10% level) for home language and behaviour than children who do not have FAS. Large-scale interventions in rural areas of the Western and Northern Cape that specifically target females of child-bearing age, as well as children with FAS, are necessary.
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Affiliation(s)
- Melissa Lubbe
- School of Economics, University of Cape Town, Cape Town 7700, South Africa.
| | - Corné van Walbeek
- School of Economics, University of Cape Town, Cape Town 7700, South Africa.
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7700, South Africa.
| | - Nicole Vellios
- Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7700, South Africa.
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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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Fitzpatrick JP, Latimer J, Olson HC, Carter M, Oscar J, Lucas BR, Doney R, Salter C, Try J, Hawkes G, Fitzpatrick E, Hand M, Watkins RE, Tsang TW, Bower C, Ferreira ML, Boulton J, Elliott EJ. Prevalence and profile of Neurodevelopment and Fetal Alcohol Spectrum Disorder (FASD) amongst Australian Aboriginal children living in remote communities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 65:114-126. [PMID: 28499185 DOI: 10.1016/j.ridd.2017.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/23/2017] [Accepted: 04/01/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Despite multiple risk factors for neurodevelopmental vulnerability, few studies have assessed neurodevelopmental performance of Australian Aboriginal children. An important risk factor for neurodevelopmental vulnerability is prenatal alcohol exposure (PAE), which places children at risk for Fetal Alcohol Spectrum Disorder (FASD). AIMS This study assesses neurodevelopment outcomes in a population of Australian Aboriginal children with and without PAE. METHODS AND PROCEDURES Children born in 2002/2003, and living in the Fitzroy Valley, Western Australia between April 2010 and November 2011, were eligible (N=134). Sociodemographic and antenatal data, including PAE, were collected by interview with 127/134 (95%) consenting parents/caregivers. Maternal/child medical records were reviewed. Neurodevelopment was assessed by clinicians blinded to PAE in 108/134 (81%) children and diagnoses on the FASD spectrum were assigned. OUTCOMES AND RESULTS Neurodevelopmental disorder was documented in 34/108 children (314.8 per 1000). Any diagnosis on the FASD spectrum was made in 21/108 (194.4 per 1000) children (95% CI=131.0-279.0). CONCLUSIONS AND IMPLICATIONS Neurodevelopmental impairment with or without PAE is highly prevalent among children in the Fitzroy Valley. Rates of diagnoses on the FASD spectrum are among the highest worldwide. Early intervention services are needed to support developmentally vulnerable children in remote communities.
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Affiliation(s)
- James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia.
| | - Heather Carmichael Olson
- The University of Washington School of Medicine, Seattle, Washington, USA; Seattle Children's Research Institute, Seattle, Washington, USA.
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia.
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia; University of Notre Dame, Broome, Australia.
| | - Barbara R Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia.
| | - Robyn Doney
- School of Public Health, Curtin University, Perth, Australia.
| | - Claire Salter
- Derby Allied Health Service, Western Australian Country Health Services, Derby, Australia.
| | - Julianne Try
- Department of Education and Early Childhood Development, Government of Victoria, Australia.
| | - Genevieve Hawkes
- Derby Allied Health Service, Western Australian Country Health Services, Derby, Australia.
| | - Emily Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia.
| | | | - Rochelle E Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia.
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Manuela L Ferreira
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia.
| | - John Boulton
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia.
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21
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Replication of High Fetal Alcohol Spectrum Disorders Prevalence Rates, Child Characteristics, and Maternal Risk Factors in a Second Sample of Rural Communities in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14050522. [PMID: 28498341 PMCID: PMC5451973 DOI: 10.3390/ijerph14050522] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/17/2022]
Abstract
Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 89–129 per 1000 children. Total FASD affect 196–276 per 1000 or 20–28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.
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22
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Howlett H, Abernethy S, Brown NW, Rankin J, Gray WK. How strong is the evidence for using blood biomarkers alone to screen for alcohol consumption during pregnancy? A systematic review. Eur J Obstet Gynecol Reprod Biol 2017; 213:45-52. [PMID: 28426943 DOI: 10.1016/j.ejogrb.2017.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 12/14/2022]
Abstract
Accurate and early identification of women at risk from alcohol consumption during pregnancy allows education and support programmes to be targeted at those most in need. We aimed to conduct a systematic review to compare the efficacy of blood analysis and maternal self-report in detecting at risk women during pregnancy. This review investigated diagnostic accuracy. We searched four databases (Medline, Embase, Psychinfo and CINAHL) for relevant articles and conducted hand searches of recent issues of key journals in the field. No restriction was placed on inclusion in terms of publication date or language. Studies were deemed eligible if they were original research and included a direct comparison of the results of blood biomarker analysis and self-reported alcohol use for the detection of alcohol consumption in pregnant women. Quality appraisal of included studies was conducted using the QUADAS II tool. Eight studies met the inclusion criteria. Gamma-glutamyltransferase (GGT) was investigated in five studies, mean corpuscular volume (MCV) and phosphatidylethanol (PEth) in three studies and carbohydrate deficient transferrin (CDT), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and whole blood associated acetaldehyde assay (WBAA) were each investigated in two studies. Although all of the studies were rated of good methodological quality, none of the biomarkers had both high sensitivity and specificity when compared to self-report. There was some evidence that a combination of biomarkers, or combining biomarkers with self-report, increases accuracy. In summary, the blood biomarkers examined were of limited use in screening for low and moderate alcohol consumption in pregnancy when compared to self-report. However, certain biomarkers, such and CDT and PEth may complement self-report and help improve the accuracy of diagnosis.
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Affiliation(s)
- Helen Howlett
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.
| | - Sarah Abernethy
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Nigel W Brown
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
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23
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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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24
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Amanuel H, Morojele N, London L. The Health and Social Impacts of Easy Access to Alcohol and Exposure to Alcohol Advertisements Among Women of Childbearing Age in Urban and Rural South Africa. J Stud Alcohol Drugs 2017; 79:302-308. [PMID: 29553360 DOI: 10.15288/jsad.2018.79.302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the impact of easy access to alcohol and exposure to alcohol advertisements on women's alcohol consumption, reproductive history, and health and social outcomes in an urban and rural site in South Africa. METHOD Trained fieldworkers conducted face-to-face interviews with 1,018 women of childbearing age in the Moot, Mamelodi, and Eesterus areas of the City of Tshwane (Gauteng province) and in the rural Cederberg, Bergrivier, and Swartland municipalities (Western Cape province), recruited through random sampling and stratified cluster random sampling, respectively. Multivariate logistic regression analyses were conducted, stratified according to the urban and rural sites and controlled for four demographic factors. RESULTS In Tshwane, complications in the last pregnancy (odds ratio [OR] = 7.84, 95% CI [1.77, 34.80]), interpartner binge drinking (OR = 6.50, 95% CI [3.85, 10.94]), and community drinking (OR = 7.92, 95% CI [4.59, 13.65]) were positively associated with alcohol accessibility. Interpartner violence (OR = 4.16, 95% CI [1.99, 8.70]) and community drinking (OR = 3.39, 95% CI [2.07, 5.53]) were positively associated with exposure to alcohol advertisements. In Western Cape, community drinking (OR = 10.26, 95% CI [4.02, 26.20]) was positively associated with alcohol accessibility, whereas ability to pay for health care (OR = 0.48, 95% CI [0.24, 0.96]) was inversely associated. Hazardous drinking on the Alcohol Use Disorders Identification Test (AUDIT; OR = 2.26, 95% CI [1.03, 4.95]) and CAGE (OR = 4.51, 95% CI [1.30, 15.61]), interpartner violence (OR = 1.69, 95% CI [1.04, 2.76]), and community drinking (OR = 3.39, 95% CI [2.07, 5.53]) were positively associated with exposure to alcohol advertisements. CONCLUSION Easy access to alcohol and exposure to alcohol advertisements are positively associated with adverse health and social outcomes. Although further studies are needed, these findings lend support to emphasizing upstream policy interventions to limit access to alcohol and advertisements.
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Affiliation(s)
- Hanna Amanuel
- African Studies Programme, Oxford University, Oxford, United Kingdom
| | - Neo 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
| | - Leslie London
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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25
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May PA, Marais AS, de Vries MM, Kalberg WO, Buckley D, Hasken JM, Adnams CM, Barnard R, Joubert B, Cloete M, Tabachnick B, Robinson LK, Manning MA, Jones KL, Bezuidenhout H, Seedat S, Parry CDH, Hoyme HE. The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample. Drug Alcohol Depend 2016; 168:274-286. [PMID: 27736681 PMCID: PMC5086258 DOI: 10.1016/j.drugalcdep.2016.09.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in a fifth sample in a South African community. METHODS An active case ascertainment approach was employed among all first grade learners in this community (n=862). Following individual examination by clinical geneticists/dysmorphologists, cognitive/behavioral testing, and maternal interviews, final diagnoses were made in multidisciplinary case conferences. RESULTS Physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories in a consistent, linear fashion, from severe to mild. Neurodevelopmental delays and behavioral problems were significantly worse for each of the FASD diagnostic categories, although not as consistently linear across diagnostic groups. Alcohol use was documented by direct report from the mother in 71% to 100% of cases in specific diagnostic groups. Significant distal maternal risk factors in this population are: advanced maternal age at pregnancy; low height, weight, and body mass index (BMI); small head circumference; low education; low income; and rural residence. Even when controlling for socioeconomic status, prenatal drinking correlates significantly with total dysmorphology score, head circumference, and five cognitive and behavioral measures. In this community, FAS occurs in 59-79 per 1,000 children, and total FASD in 170-233 per 1,000 children, or 17% to 23%. CONCLUSIONS Very high rates of FASD continue in this community where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development in a significant portion of the population.
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Affiliation(s)
- Philip A May
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States.
| | - Anna-Susan Marais
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marlene M de Vries
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Wendy O Kalberg
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - David Buckley
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | - Colleen M Adnams
- University of Cape Town, Department of Psychiatry and Mental Health, South Africa
| | - Ronel Barnard
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Belinda Joubert
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marise Cloete
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | | | - Luther K Robinson
- State University of New York, Buffalo, Department of Pediatrics, United States
| | - Melanie A Manning
- Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States
| | - Kenneth Lyons Jones
- University of California San Diego School of Medicine, Department of Pediatrics, United States
| | - Heidre Bezuidenhout
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Soraya Seedat
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; South African Medical Research Council, South Africa
| | - H Eugene Hoyme
- Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States; The University of Arizona College of Medicine, Department of Pediatrics and the Center for Applied Genetics and Genomic Medicine, United States
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26
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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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27
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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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28
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Lucas BR, Latimer J, Doney R, Watkins RE, Tsang TW, Hawkes G, Fitzpatrick JP, Oscar J, Carter M, Elliott EJ. Gross motor performance in children prenatally exposed to alcohol and living in remote Australia. J Paediatr Child Health 2016; 52:814-24. [PMID: 27439995 DOI: 10.1111/jpc.13240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to determine the gross motor (GM) performance of Aboriginal children living in remote Australia. The relationship between GM skills, prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders (FASD) was explored. METHODS A population-based observation study was conducted in 2011 to assess motor performance in children living in the Fitzroy Valley, Western Australia, using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). BOT-2 data were retrospectively analysed using recently developed software enabling separation of fine and GM outcomes. RESULTS A total of 108 children (98.1% Aboriginal; 53% male, mean age: 8.7 years) were assessed. Half (52.2%) were exposed to at least 'risky' levels of PAE, and 21 (19%) were diagnosed with an FASD. The mean GM composite score of the cohort (47.0 ± 8.4) approached the BOT-2 normative mean (50.0 ± 10) and was similar between children with and without PAE (P = 0.27). This mean score, however, was significantly lower in children with FASD than without (mean difference: -5.5 ± 20.6; P = 0.006). Compared with children without FASD, children with FASD had significant impairment in subtests for running speed and agility (mean difference ± standard deviation (SD): -2.4 ± 8.1; P = 0.003) and strength (mean difference ± SD:-2.8 ± 9.9; P = 0.004) and (ii) a higher proportion than expected had overall GM impairment (≤2 SD: 9.5%; ≤1 SD: 23.8%). In groups with PAE, no PAE and no FASD, GM function approached expected population norms. CONCLUSIONS A higher than expected proportion of children with FASD had GM scores that indicated impairment and need for therapy. Evaluation of GM performance should routinely be included in FASD assessment to determine strategies to optimise child development.
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Affiliation(s)
- Barbara R Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jane Latimer
- The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Doney
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Rochelle E Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Genevieve Hawkes
- Derby Allied Health Service, Western Australian Country Health Services, Perth, Western Australia, Australia
| | - James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Perth, Western Australia, Australia.,University of Notre Dame, Broome, Western Australia, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Kimberley, Western Australia, Australia
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,University of Notre Dame, Broome, Western Australia, Australia.,The Sydney Children's Hospital Networks (Westmead), Sydney, New South Wales, Australia
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29
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Lucas BR, Doney R, Latimer J, Watkins RE, Tsang TW, Hawkes G, Fitzpatrick JP, Oscar J, Carter M, Elliott EJ. Impairment of motor skills in children with fetal alcohol spectrum disorders in remote Australia: The Lililwan Project. Drug Alcohol Rev 2016; 35:719-727. [DOI: 10.1111/dar.12375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 11/15/2015] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Barbara R. Lucas
- Discipline of Paediatrics and Child Health; The University of Sydney, The Children's Hospital at Westmead, Clinical School; Sydney Australia
- The George Institute for Global Health, Sydney Medical School; The University of Sydney; Sydney Australia
- Poche Centre for Indigenous Health, Sydney Medical School; The University of Sydney; Sydney Australia
- Physiotherapy Department; Royal North Shore Hospital; Sydney Australia
| | - Robyn Doney
- School of Public Health; Curtin University; Perth Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School; The University of Sydney; Sydney Australia
| | - Rochelle E. Watkins
- Discipline of Paediatrics and Child Health; The University of Sydney, The Children's Hospital at Westmead, Clinical School; Sydney Australia
- Telethon Kids Institute, The University of Western Australia; Perth Australia
| | - Tracey W. Tsang
- Discipline of Paediatrics and Child Health; The University of Sydney, The Children's Hospital at Westmead, Clinical School; Sydney Australia
| | - Genevieve Hawkes
- Derby Allied Health Service; Western Australian Country Health Services; Derby Australia
| | - James P. Fitzpatrick
- Discipline of Paediatrics and Child Health; The University of Sydney, The Children's Hospital at Westmead, Clinical School; Sydney Australia
- The George Institute for Global Health, Sydney Medical School; The University of Sydney; Sydney Australia
- Telethon Kids Institute, The University of Western Australia; Perth Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre; Fitzroy Crossing Australia
- University of Notre Dame; Broome Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services; Fitzroy Crossing Australia
| | - Elizabeth J. Elliott
- Discipline of Paediatrics and Child Health; The University of Sydney, The Children's Hospital at Westmead, Clinical School; Sydney Australia
- The George Institute for Global Health, Sydney Medical School; The University of Sydney; Sydney Australia
- The Sydney Children's Hospital Networks (Westmead); Sydney Australia
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30
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May PA, de Vries MM, Marais AS, Kalberg WO, Adnams CM, Hasken JM, Tabachnick B, Robinson LK, Manning MA, Jones KL, Hoyme D, Seedat S, Parry CDH, Hoyme HE. The continuum of fetal alcohol spectrum disorders in four rural communities in South Africa: Prevalence and characteristics. Drug Alcohol Depend 2016; 159:207-18. [PMID: 26774945 PMCID: PMC4724497 DOI: 10.1016/j.drugalcdep.2015.12.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prevalence and characteristics of the continuum of diagnoses within fetal alcohol spectrum disorders (FASD) were researched in previously unstudied rural, agricultural, lower socioeconomic populations in South Africa (ZA). METHODS Using an active case ascertainment approach among first grade learners, 1354 (72.6%) were consented into the study via: height, weight, and/or head circumference ≤ 25th centile and/or random selection as normal control candidates. Final diagnoses were made following: examination by pediatric dysmorphologists/geneticists, cognitive/behavioral testing, and maternal risk factor interviews. RESULTS FASD children were significantly growth deficient and dysmorphic: physical measurements, cardinal facial features of FAS, and total dysmorphology scores clearly differentiated diagnostic categories from severe to mild to normal in a consistent, linear fashion. Neurodevelopmental delays were also significantly worse for each of the FASD diagnostic categories, although not as consistently linear across groups. Alcohol use is well documented as the proximal maternal risk factor for each diagnostic group. Significant distal maternal risk factors in this population are: low body weight, body mass, education, and income; and high gravidity, parity, and age at birth of the index child. In this low SES, highly rural region, FAS occurs in 93-128 per 1000 children, PFAS in 58-86, and, ARND in 32-46 per 1000. Total FASD affect 182-259 per 1000 children or 18-26%. CONCLUSIONS Very high rates of FASD exist in these rural areas and isolated towns where entrenched practices of regular binge drinking co-exist with challenging conditions for childbearing and child development.
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Affiliation(s)
- Philip A May
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
| | - Marlene M de Vries
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Anna-Susan Marais
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Wendy O Kalberg
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Colleen M Adnams
- University of Cape Town, Department of Psychiatry and Mental Health, South Africa
| | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | | | - Luther K Robinson
- State University of New York, Buffalo, Department of Pediatrics, United States
| | - Melanie A Manning
- Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States
| | - Kenneth Lyons Jones
- University of California San Diego School of Medicine, Department of Pediatrics, United States
| | - Derek Hoyme
- University of Iowa, Department of Pediatrics, United States
| | - Soraya Seedat
- South African Medical Research Council, United States
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; South African Medical Research Council, United States
| | - H Eugene Hoyme
- Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States
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