Research

Maternal alcohol use and children’s emotional and cognitive outcomes in rural South Africa

T J Rochat, B Houle, A Stein, J Mitchell, R M Bland

Abstract


Background. Alcohol use in South Africa (SA) is increasing. The World Health Organization (WHO) states that SA is the third-largest drinking population in Africa, with the highest rate of fetal alcohol syndrome in the world. Internationally, parental drinking during childhood is a risk factor for poor child mental health, behavioural problems and weaker educational outcomes in middle childhood. However, parental alcohol use in Africa is under-researched, and much of the literature on maternal alcohol consumption is restricted to clinical and pregnancy samples.

Objectives. To investigate alcohol use and hazardous drinking (HD) among mothers/primary caregivers of children aged 7 - 11 years in a rural SA cohort. We explored risk factors for drinking and the association between HD and child behaviour/cognition.

Methods. The primary outcome measure was the WHO Alcohol Use Disorder Identification Test (AUDIT) using the standardised cut-off for HD (≥8). Secondary measures were the Patient Health Questionnaire Depression Scale (PHQ-9), Patient Health Questionnaire General Anxiety Disorder Scale (GAD-7), Parenting Stress Index, short form (PSI-36), Child Behaviour Checklist (CBCL, parent reported), Kaufman Developmental Assessment Battery (KABC-II) for child cognition, and Neuropsychological Assessment Battery, 2nd edition, subtests (NEPSY-II) for executive function. We compared characteristics of those drinking/not drinking, using χ2 tests, and modelled outcomes on parenting stress, cognitive outcomes and CBCL scores for children using logistic regression analysis. We grouped mothers/caregivers engaged in HD to examine its effect on parent/child outcomes using t-tests to test for significant differences.

Results. Of 1 505 women (1 266 mothers and 239 caregivers) with 1 536 children, 12% reported consuming alcohol and 3% reported HD. Higher maternal/caregiver age (31 - 40 years, adjusted odds ratio (aOR) 0.57 (95% confidence interval (CI) 0.4 - 0.9); >41 years, aOR 0.30 (95% CI 0.2 - 0.5)), education (matriculation, aOR 0.49 (95% CI 0.3 - 0.9); post matriculation, aOR 0.30 (95% CI 0.1 - 0.6)), and a stable relationship with the father (aOR 0.6 (95% CI 0.4 - 1.0)) were associated with no alcohol use. Food insecurity increased the odds of alcohol use (aOR 1.52 (95% CI 1.1 - 2.1)), while parental mental health (parenting stress, anxiety) and child mental health problems were associated with approximately double the odds of consuming alcohol in univariate analysis. Children of HD mothers/caregivers had higher mean scores for psychological problems (CBCL total score: no HD (mean 45.0) v. HD (mean 48.9); p=0.029) and lower cognitive scores (KABC Learning Scale: no HD (mean 14.3) v. HD (mean 12.8); p=0.017).

Conclusions. While HD rates were low, maternal/caregiver alcohol use negatively impacted on parenting and children’s behavioural/cognitive outcomes. International evidence suggests that integrated approaches engaging parents and families may be more effective for parent-child outcomes than individual psychiatric or medical care for the parent on their own.

 


Authors' affiliations

T J Rochat, Africa Health Research Institute, Durban, South Africa; MRC/Wits Developmental Pathways to Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

B Houle, School of Demography, The Australian National University, Canberra, Australia; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colo., USA

A Stein, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Psychiatry, University of Oxford, UK

J Mitchell, Department of Psychology, Faculty of Humanities, University of Cape Town, South Africa

R M Bland, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Royal Hospital for Sick Children, Glasgow, Scotland, UK; Institute of Health and Wellbeing, University of Glasgow, UK

Full Text

PDF (281KB)

Keywords

Alcohol; HIV; Parenting; Child mental health; Child cognition; Cohort study

Cite this article

South African Medical Journal 2019;109(7):526-534. DOI:10.7196/SAMJ.2019.v109i7.13120

Article History

Date submitted: 2019-06-28
Date published: 2019-06-28

Article Views

Abstract views: 415
Full text views: 96

Comments on this article

*Read our policy for posting comments here