The 130th Annual Meeting of APHA

Abstract #51862

Patricia Craig and Denis Viljoen. Division of Human Genetics, NHLS and University of the Witwatersrand, PO Box 1038, Johannesburg, South Africa, 27114899243, pc@cormack.uct.ac.za

Fetal alcohol syndrome (FAS) in at-risk in communities in South Africa, is the single, most common birth defect and preventable cause of mental retardation. The economic and psychosocial costs to individuals, families, communities and healthcare systems are immense. Four at-risk communities in Gauteng were studied to ascertain alcohol consumption patterns during pregnancy and the prevalence of FAS amongst school-entry children in mainstream schools. Of 809 pregnant women interviewed at antenatal clinics, 128 (16%) admitted to a history of drinking before pregnancy, with a range of consumption from 679 ml AA to 8925ml AA per month. Slightly less women, 126 (15.6%) were drinking during pregnancy with only a quarter of them admitting to heavy drinking, sufficient to cause FAS in their babies. A further 15% were drinking moderate amounts, enough to put their babies at risk for FAS-related complications. Although 35% of women stated that alcohol consumption during pregnancy could harm the baby, there was a general underestimation of the harmful effects of alcohol use and abuse in pregnancy, and also of the personal risk for producing a child with FAS. Altogether 834 children were clinically appraised for FAS. Neurodevelopmental assessments of the children with a suspected clinical diagnosis, and maternal alcohol consumption questionnaires with the mothers or caregivers of these children were administered to ascertain whether there was sufficient evidence for a diagnosis of FAS. The frequency of FAS within the four communities varied between 0-37/1000 with a mean of 18/1000 school children. Although this is a little less than half the prevalence in similar communities in the Western Cape Province, the rate has appalling health implications: it is higher than worst case at-risk communities in developed nations by a factor of 3-4 fold. Gauteng FAS prevalences are more common than Down syndrome and neural tube defects by 10 to 20 fold. A community-based prevention programme is currently in progress.

Learning Objectives: At the conclusion of this session the participant will be able to

1.Describe and evaluate the methodology used in conducting a study on the epidemiology of fetal alcohol syndrome
• Understand the criteria used in the study for making a clinical diagnosis of FAS
• Understand some key constraints in conducting alcohol research with pregnant women in third world communities
• Appreciate the need for sensitivity while conducting alcohol-related interviews
• Appreciate the significance and impact of the findings of the study on socio-economically disadvantaged communities and the need for urgent prevention and intervention programmes
• Recognize the importance of community consent and participation in order to facilitate the sustainability of future intervention programmes
• Anticipate obstacles and evaluate possible solutions when planning a research project of this nature

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: CDC provided partial funding for the project, and analysis of some of the data
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Grant