Approaching the Prevalence of the Full Spectrum of Fetal Alcohol Spectrum Disorders in a South African Population-Based Study

BackgroundFetal alcohol spectrum disorders (FASD) are a global health concern. To further understand FASD in adulthood is a major public health interest.ObjectiveTo describe the clinical characteristics of young adults with FASD adopted from orphanages to a socially more favourable and stable rearing environment as children.DesignProspective observational cohort studySettingWestern SwedenParticipantsA population-based cohort of 37 adoptees diagnosed with FASD in childhood.Outcome measuresAssessment consisted of clinical evaluations of social, medical, psychiatric, neuropsychological, adaptive and ophthalmological status by a physician, ophthalmologist, orthoptist and psychologist.ResultsOut of 37 adoptees with FASD, 36 (15 females) were evaluated at a median age of 22 years (range 18–28) and a mean follow-up time of 15.5 years (range 13–17). Twenty (56%) were dependent on social support. Sexual victimisation was reported by nine (26%). In 21 individuals with fetal alcohol syndrome, growth restriction in height and head circumference of approximately −1.8 SD persisted into adulthood. Of 32 examined, 22 (69%) had gross motor coordination abnormalities. High blood pressure was measured in nine (28%). Ophthalmological abnormalities were found in 29 of 30 (97%). A median IQ of 86 in childhood had declined significantly to 71 by adulthood (mean difference: 15.5; 95% CI 9.5–21.4). Psychiatric disorders were diagnosed in 88%, most commonly attention deficit hyperactivity disorder (70%). Three or more disorders were diagnosed in 48%, and 21% had attempted suicide. The median Clinical Global Impression-Severity score was 6 = ‘severely ill’.ConclusionMajor cognitive impairments, psychiatric morbidity, facial dysmorphology, growth restriction and ophthalmological abnormalities accompanies FASD in adulthood. Recognition of FASD in childhood warrants habilitation across the lifespan.

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“The Dop System of Alcohol Distribution is Dead, but It’s Legacy Lives On….”

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16193701 ◽

2019 ◽

Vol 16 (19) ◽

pp. 3701

Author(s):

Philip May ◽

Anna-Susan Marais ◽

Marlene De Vries ◽

Julie Hasken ◽

Julie Stegall ◽

...

Keyword(s):

South African ◽

Rural Areas ◽

Fetal Alcohol Spectrum Disorders ◽

Heavy Drinking ◽

Alcoholic Beverages ◽

Drinking Patterns ◽

Fetal Alcohol ◽

Problematic Drinking ◽

Spectrum Disorders ◽

Fetal Alcohol Spectrum

Objective: Determine the prevalence of Dop, a system of labor payment via alcoholic beverages, in a South African province, and its influence on maternal drinking and fetal alcohol spectrum disorders (FASD). Methods: Data from studies of FASD epidemiology were analyzed. Results: Forty-two percent to 67% of mothers reported drinking. In 1999, 5% of women reported Dop allocations in their lifetime: 14% of mothers of FASD children and 1% of controls. In 2010, 1.1% of mothers reported lifetime Dop: 1.6% of FASD mothers and 0.7% of controls. Commercial alcohol sales have replaced the Dop system. Total FASD rates remained high in rural areas in 2010 and rose in urban settings. Urban rates of total FASD surpassed rural area rates in 2010. Correlation analysis did not reveal a strong or significant, direct relationship between Dop experience and heavy drinking (r = 0.123, p < 0.001, r2 = 0.015), or the diagnosis of FASD in children (OR = 0.003, p = 0.183). Conclusion: Dop, as a systematic practice, is dead and does not have a direct influence on alcohol availability, heavy maternal drinking, or the probability of an FASD diagnosis. Nevertheless, today’s problematic drinking patterns were heavily influenced (shaped) by Dop and have negatively impacted the prevalence and severity of FASD.

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