title: The continuum of fetal alcohol spectrum disorders in four rural communities in South Africa: Prevalence and characteristics.
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.
authors.affiliation: The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa. Electronic address: philip_may@unc.edu.
authors.forename: Philip A
authors.initials: PA
authors.lastname: May
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Marlene M
authors.initials: MM
authors.lastname: de Vries
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
authors.forename: Anna-Susan
authors.initials: AS
authors.lastname: Marais
authors.affiliation: The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States.
authors.forename: Wendy O
authors.initials: WO
authors.lastname: Kalberg
authors.affiliation: University of Cape Town, Department of Psychiatry and Mental Health, South Africa.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Adnams
authors.affiliation: The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Hasken
authors.affiliation: California State University, Northridge, United States.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tabachnick
authors.affiliation: State University of New York, Buffalo, Department of Pediatrics, United States.
authors.forename: Luther K
authors.initials: LK
authors.lastname: Robinson
authors.affiliation: Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Manning
authors.affiliation: University of California San Diego School of Medicine, Department of Pediatrics, United States.
authors.forename: Kenneth Lyons
authors.initials: KL
authors.lastname: Jones
authors.affiliation: University of Iowa, Department of Pediatrics, United States.
authors.forename: Derek
authors.initials: D
authors.lastname: Hoyme
authors.affiliation: South African Medical Research Council, United States.
authors.forename: Soraya
authors.initials: S
authors.lastname: Seedat
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; South African Medical Research Council, United States.
authors.forename: Charles D H
authors.initials: CD
authors.lastname: Parry
authors.affiliation: Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States.
authors.forename: H Eugene
authors.initials: HE
authors.lastname: Hoyme
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D002648:Child; D002657:Child Development; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D009035:Mothers / Q000523:psychology; D009483:Neuropsychological Tests; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology
keywords: Alcohol abuse; Children with FASD; Fetal alcohol spectrum disorders (FASD); Maternal risk for FASD; Prenatal alcohol use; Prevalence; South Africa