Replication of High Fetal Alcohol Spectrum Disorders Prevalence Rates, Child Characteristics, and Maternal Risk Factors in a Second Sample of Rural Communities in South Africa

Philip A May; Marlene M De Vries; Anna-Susan Marais; Wendy O Kalberg; David Buckley; Colleen M Adnams; Julie M Hasken; Barbara Tabachnick; Luther K Robinson; Melanie A Manning; Heidre Bezuidenhout; Margaret P Adam; Kenneth L Jones; Soraya Seedat; Charles D H Parry; H Eugene Hoyme

doi:10.3390/ijerph14050522

Replication of High Fetal Alcohol Spectrum Disorders Prevalence Rates, Child Characteristics, and Maternal Risk Factors in a Second Sample of Rural Communities in South Africa

Int J Environ Res Public Health. 2017 May 12;14(5):522. doi: 10.3390/ijerph14050522.

Authors

Philip A May^{1

2

3}, Marlene M De Vries⁴, Anna-Susan Marais⁵, Wendy O Kalberg⁶, David Buckley⁷, Colleen M Adnams⁸, Julie M Hasken⁹, Barbara Tabachnick¹⁰, Luther K Robinson¹¹, Melanie A Manning¹², Heidre Bezuidenhout¹³, Margaret P Adam¹⁴, Kenneth L Jones¹⁵, Soraya Seedat¹⁶, Charles D H Parry^{17

18}, H Eugene Hoyme^{19

20

21}

Affiliations

¹ Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 28081, USA. philip_may@unc.edu.
² Department of Psychiatry, Stellenbosch University, Stellenbosch 7599, South Africa. philip_may@unc.edu.
³ Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM 87131, USA. philip_may@unc.edu.
⁴ Department of Psychiatry, Stellenbosch University, Stellenbosch 7599, South Africa. mmdevries@sun.ac.za.
⁵ Department of Psychiatry, Stellenbosch University, Stellenbosch 7599, South Africa. asmarais@sun.ac.za.
⁶ Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM 87131, USA. wkalberg@unm.edu.
⁷ Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM 87131, USA. dbuckley@unm.edu.
⁸ Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7700, South Africa. colleen.adnams@uct.ac.za.
⁹ Nutrition Research Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 28081, USA. julie_hasken@unc.edu.
¹⁰ Emerita of Psychology, California State University, Northridge, Los Angeles, CA 91330, USA. barbara.tabachnick@csun.edu.
¹¹ Department of Pediatrics, State University of New York, Buffalo, NY 14222, USA. lutherkrobinson@gmail.com.
¹² Departments of Pathology and Pediatrics, School of Medicine, Stanford University, Stanford, CA 94305, USA. mmanning@stanford.edu.
¹³ Department of Psychiatry, Stellenbosch University, Stellenbosch 7599, South Africa. heidreb@sun.ac.za.
¹⁴ Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98195, USA. Margaret.adam@seattlechildrens.org.
¹⁵ Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA. Klyons@ucsd.edu.
¹⁶ Department of Psychiatry, Stellenbosch University, Stellenbosch 7599, South Africa. sseedat@sun.ac.za.
¹⁷ Department of Psychiatry, Stellenbosch University, Stellenbosch 7599, South Africa. Charles.Parry@mrc.ac.za.
¹⁸ Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town 7501, South Africa. Charles.Parry@mrc.ac.za.
¹⁹ Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD 57105, USA. Gene.Hoyme@sanfordhealth.org.
²⁰ Sanford Research, Sioux Falls, SD 57104, USA. Gene.Hoyme@sanfordhealth.org.
²¹ Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ 85724, USA. Gene.Hoyme@sanfordhealth.org.

Abstract

Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference ≤25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 9-129 per 1000 children. Total FASD affect 196-276 per 1000 or 20-28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.

Keywords: South Africa; alcohol abuse; binge drinking; children with FASD; fetal alcohol spectrum disorders (FASD); maternal risk for FASD; microcephaly; prenatal alcohol use; prevalence.

MeSH terms

Adult
Alcohol Drinking / epidemiology
Alcohol Drinking / psychology
Child
Child Development
Female
Fetal Alcohol Spectrum Disorders / diagnosis
Fetal Alcohol Spectrum Disorders / epidemiology*
Humans
Maternal Exposure*
Mothers / psychology
Neuropsychological Tests
Pregnancy
Prevalence
Risk Factors
Rural Population / statistics & numerical data*
South Africa / epidemiology

Abstract

MeSH terms

Grants and funding