Purple Tod Consulting

“Fetal alcohol syndrome among Grade 1 schoolchildren in Northern Cape Province: Prevalence and risk factors” by Michael Urban, Matthew F Chersich, Leigh-Anne Fourie, Candice Chetty, Leana Olivier, Denis Viljoen

Whereas the average prevalence of FAS in high-income countries has been estimated at 0.97/1 000 rates reported from Wellington, Western Cape Province, have ranged between 40.5 and 54 per 1 000. The reasons for South Africa’s high FAS burden are incompletely understood, and relate to risky maternal alcohol consumption and other maternal personal, social and perhaps genetic factors that increase the risk of FAS. The answers are necessarily multifaceted. Regular binge-drinking (heavy episodic drinking of 5 or more units of alcohol per occasion) is the most risky drinking pattern for FAS. High rates of binge drinking were found among women attending antenatal clinics in the Western Cape. The dop system (alcohol forming part of labourers’ wages on wine farms) is believed to have played a role in entrenching binge-drinking. Maternal factors also linked to increased risk of having a child with FAS include: older age at pregnancy, smoking and low socio-economic status the latter may be a blanket term for numerous poorly defined factors including psychological depression, unintended pregnancies and poor nutrition that provoke, or interact with, alcohol consumption to exacerbate the effects of high-risk drinking patterns. We aimed to describe and investigate the prevalence of and risk factors for FAS and PFAS in Grade 1 children in De Aar and Upington, two large towns in Northern Cape Province.

Rates of FAS reported from South Africa are generally much higher than other countries, where rates of FAS seldom exceed 10/1 000, even in high-risk populations. These results broaden the evidence that FAS is of considerable public health importance in the Western and Northern Cape provinces, although information available for other provinces of South Africa is limited.

In South Africa, FAS is often linked to the historical legacy of the dop system in wine-farming areas, and stereotypical assumptions are made that FAS is peculiar to the coloured communities that comprised the local workforce. It is noteworthy that the FAS rate is higher in De Aar (a sheep- arming area) than Upington (a wine-farming area), and that there was no overall difference in FAS between black and coloured subjects. Therefore, FAS is limited neither to viticultural areas nor to a specific ethnic group. Maternal drinking during pregnancy was much more frequently reported in mothers of children with

Children with FAS performed poorly across a broad range of neuro developmental domains, with

significantly lower results than controls in all tests. Markedly lower intellectual functioning and attention deficits were noted during the assessment. Children with FAS particularly struggled with language skills – speaking, writing and basic understanding of words. There was a delay in speed and accuracy of problem solving and practically implementing tasks compared with expected developmental age. Neuro-cognitive deficits were global and not specific to ‘executive functioning’ as found by some authors.