title: Screening for fetal alcohol spectrum disorders by nonmedical community workers.
abstract: BACKGROUND
  South Africa has the highest prevalence of Fetal Alcohol Spectrum Disorders (FASD) in the world yet many women have no access to clinic care or to physicians in their communities. The shortage of physicians trained in the diagnosis of FASD is even more severe. Thus there is a need to train community workers to assist in the delivery of health care.
  
  
  OBJECTIVE
  This study reports on the effectiveness of training community workers to screen for a possible diagnosis of a FASD.
  
  
  METHODS
  Community workers in Cape Town, South Africa were trained to screen for FASD in 139, 18-month-old toddlers with prenatal alcohol exposure (PAE). Children were assessed according to the salient characteristics of individuals with PAE using height, weight, head circumference (OFC), philtrum, and lip measurements according to criteria set forth by the Institute of Medicine. Screen-positive children were referred for diagnostic assessment to a pediatrician reliably trained in the diagnosis of FASD.
  
  
  RESULTS
  Of the screen-positive children, 93% received an FASD diagnosis suggesting that the screening procedure was highly sensitive. Diagnoses included 15% with fetal alcohol syndrome (FAS), 23% with Partial FAS, and 62% with Alcohol Related Neurodevelopmental Disorder (ARND, provisional).
  
  
  CONCLUSIONS
  The use of community workers to screen for FASD represents a promising approach to effective diagnosis of children affected by PAE in areas lacking adequate medical resources.
authors: Mary J
authors: MJ
authors: O'Connor
authors: Mary Jane
authors: MJ
authors: Rotheram-Borus
authors: Mark
authors: M
authors: Tomlinson
authors: Claudine
authors: C
authors: Bill
authors: Ingrid M
authors: IM
authors: LeRoux
authors: Jackie
authors: J
authors: Stewart
mesh_terms: D000328:Adult; D000367:Age Factors; D000886:Anthropometry / Q000379:methods*; D002657:Child Development; D003153:Community Health Services; D003150:Community Health Workers / Q000193:education* / Q000600:supply & distribution; D003695:Delivery of Health Care; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007318:Inservice Training; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D015397:Program Evaluation; D013019:South Africa / Q000453:epidemiology; D000078329:Workforce; D055815:Young Adult