Universal prevention is associated with lower prevalence of fetal alcohol spectrum disorders in Northern Cape, South Africa: a multicentre before-after study.
OBJECTIVE
Prevalence of fetal alcohol spectrum disorders (FASDs) is remarkably high in several provinces of South Africa; yet population-level knowledge of the harms of maternal drinking remains low. In two heavily affected areas, we assessed effectiveness of interventions to heighten awareness of these harms and to alter social norms about drinking in pregnancy.


METHODS
FASD prevalence, maternal knowledge and drinking behaviours were investigated in two Northern Cape Province towns, before and after interventions which included highlighting FASD using local media and health promotion talks at health facilities. Independently, two dysmorphologists and a neuropsychometrist examined children at 9 and 18 months.


RESULTS
Pre-intervention maternal knowledge of alcohol harms was low and FASD prevalence 8.9% (72/809). Interventions reached high coverage and knowledge levels increased substantially. FASD prevalence was 5.7% post-intervention (43/751; P = 0.02); 0.73 lower odds, controlling for maternal age and ethnicity (95% confidence interval = 0.58-0.90). No change was detected in more severe FASD forms, but in the whole population, median dysmorphology scores reduced from 4 [inter-quartile range (IQR) = 2-7] to 3 (IQR = 1-6; P = 0.002).


CONCLUSIONS
This, the first prevention study using FASD outcomes, suggests that universal prevention might reduce FASD by ∼30% and have population-level effects. This supports intensifying universal interventions where knowledge of harms of maternal drinking is low. These efforts need to be accompanied by alcohol-dependence treatment to lower more severe FASD forms.
Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, South Africa. matthew.chersich@wits.ac.za
Matthew F
MF
Chersich
Michael
M
Urban
Leana
L
Olivier
Leigh-Anne
LA
Davies
Candice
C
Chetty
Denis
D
Viljoen
D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008425:Maternal Behavior / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult