Fetal alcohol syndrome epidemiology in a South African community: a second study of a very high prevalence area.
OBJECTIVE
The aim of the study was to determine the prevalence and characteristics of fetal alcohol syndrome (FAS) in a second primary school cohort in a community in South Africa.


METHODS
Active case ascertainment, two-tier screening, and Institute of Medicine assessment methodology were employed among 857 first grade pupils, most born in 1993. Characteristics of children with FAS were contrasted with characteristics of a randomly selected control group from the same classrooms. Physical growth and development, dysmorphology and psychological characteristics of the children and measures of maternal alcohol use and smoking were analyzed.


RESULTS
The rate of FAS found in this study is the highest yet reported in any overall community in the world, 65.2-74.2 per 1,000 children in the first grade population. These rates are 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000). Detailed documentation of physical features indicates that FAS children in South Africa have characteristics similar to those elsewhere: poor growth and development, facial and limb dysmorphology, and lower intellectual functioning. Frequent, severe episodic drinking of beer and wine is common among mothers and fathers of FAS children. Their lives are characterized by serious familial, social and economic challenges, compared with controls. Heavy episodic maternal drinking is significantly associated with negative outcomes of children in the area of nonverbal intelligence but even more so in verbal intelligence, behavior and overall dysmorphology (physical anomalies). Significantly more FAS exists among children of women who were rural residents (odds ratio: 7.36, 95% confidence interval: 3.31-16.52), usually among workers on local farms.


CONCLUSIONS
A high rate of FAS was documented in this community. Given social and economic similarities and racial admixture, we suspect that other communities in the Western Cape have rates that also are quite high.
Viljoen
Denis L
DL
Department of Human Genetics, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Services, South Africa.
Gossage
J Phillip
JP
Brooke
Lesley
L
Adnams
Colleen M
CM
Jones
Kenneth L
KL
Robinson
Luther K
LK
Hoyme
H Eugene
HE
Snell
Cudore
C
Khaole
Nathaniel C O
NC
Kodituwakku
Piyadasa
P
Asante
Kwadwo Ohene
KO
Findlay
Richard
R
Quinton
Barbara
B
Marais
Anna-Susan
AS
Kalberg
Wendy O
WO
May
Philip A
PA
D002648:Child; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007360:Intelligence / Q000187:drug effects; D008297:Male; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013019:South Africa