SA: sky-high foetal alcohol syndrome

Around 25 000 babies are born with Foetal Alcohol Syndrome (FAS) every year in South Africa, the highest incidence in the world, according to FASfacts, a nongovernmental organisation ) working with rural communities to combat FAS.

Foetal Alcohol Syndrome is a completely preventable disease, characterised by abnormalities in the foetus, caused by the consumption of alcohol in pregnant women. This leads to stunted mental and physical growth in babies, who may also have facial abnormalities and learning disabilities.

According to FASfacts, the rural areas of the Western Cape and towns in the Northern Cape towns like De Aar are the hardest hit, but FAS also affects babies born in urban areas from Soweto to Khayelitsha. De Aar has recorded 122 FAS babies for every 1 000 babies born alive. The prevalence of FAS among grade ones in the Boland area is 4,6% to 10,3%. This figure is dramatically higher than figures for first world countries like the US where the incidence in high risk rural areas is 8 FAS babies for every 1 000 live births.

FAS trends in SA
According to a statement released by the Western Cape Provincial government, the impact study commissioned by FASfacts has uncovered some worrying trends. While the “dop” system used on farms (where wages were paid in part by alcohol) may have come to an end, alcohol abuse remained a major concern.

"People are still abusing alcohol and obtain their liquor now from bottle stores in town or from shebeens," according to the study, reported by the Western Cape government.

Another issue highlighted in the FASfacts study was the new trend “amongst some labour brokers to provide alcohol to workers on the job. This is done under cover and in great secrecy.”

FAS in the United Statesbr> Despite the well-known damaging effects of alcohol intake during pregnancy, investigators at the US Centers for Disease Control and Prevention say alcohol use and binge drinking among pregnant women and women of childbearing age has changed little between 1991 and 2005.

Foetal alcohol syndrome, birth defects, and low birth weight are among the problems associated with alcohol consumption during pregnancy, Dr C H Denny and co-authors note in the CDC's Morbidity and Mortality Weekly Report.

Alcohol use by pregnant women hasn’t changed
To examine trends in alcohol use among women of childbearing age, US researchers analysed data from 533,506 women 18 to 44 years of age surveyed during 1991-2005; of these, 22,027 were pregnant at the time of the interview.

Any alcohol use was defined as having at least one drink in the past 30 days, and binge drinking as having five or more drinks on at least one occasion in the past 30 days. The report states that the prevalence of any alcohol use and binge drinking did not change substantially over time.

US findings
Among pregnant women, the average annual percentage of any alcohol use was 12.2%, while the average annual percentage for binge drinking was 1.9%. Corresponding rates among non-pregnant women were 53.7% and 12.1%.

Denny's team found that problem drinking among pregnant women was tied to older age, having a college degree, being employed, and being unmarried.

As to why these factors are associated with drinking in pregnancy, the authors of an editorial note suggest that "1) older women might be more likely to be alcohol dependent and have more difficulty abstaining from alcohol while pregnant; 2) more educated women and employed women might have more discretionary money for the purchase of alcohol; and 3) unmarried women might attend more social occasions where alcohol is served." – (Reuters Health, Updated by Thania Gopal, Health24, May 2009).

Morbidity and Mortality Weekly Report, May 22, 2009.
Statement issued by the Office of the Premier, Western Cape Provincial Government, March 25, 2009.

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