Fetal alcohol syndrome among grade-one children in the Northern Cape Province: prevalence and risk factors.

Abstract

Objective: To describe prevalence, characteristics and risk factors for fetal alcohol syndrome (FAS) and partial FAS among children attending grade one in the Northern Cape Province of South Africa.
Design: Cross-sectional study using a two-tiered method for active ascertainment of FAS/partial FAS cases. This comprised screening of growth parameters, and then diagnostic assessment for screen-positive children using clinical and neuro-cognitive assessments, and maternal history of drinking during pregnancy. Mothers or care-givers of children with FAS were interviewed, as well as matched controls.
Setting: Primary schools in De Aar (8) and Upington (15).
Subjects: Grade one pupils in 2001 (De Aar, n=536) and 2002 (Upington, n=1299).
Outcome measures: FAS or partial FAS.
Results: Prevalence of FAS/partial FAS was high: 64/536 (119.4/1000, 95% CI=93.2-149.9) in De Aar, and 97/1299 (74.7/1000, 95% CI=61.0-90.3) in Upington. Overall, 67.2 per 1000 children (95% CI=56.2-79.7) had full FAS features. Growth retardation was also common in this population: 66.6% (1181/1774) were underweight, 48.3% (858/1776) stunted and 15.1% had a head circumference <2S.D. for age. Interviews with cases and controls showed that mothers of children with FAS were less likely to have fulltime employment or have attended secondary school. These women also had lower body mass index and about 80% currently smoked. Over two-thirds of all pregnancies were unplanned.
Conclusions: Nearly one in ten pupils has FAS/partial FAS, with the rate in De Aar the highest yet described in South Africa. The epidemiological features described are important for designing preventive interventions.