Objective: To describe the prevalence, characteristics and risk factors for fetal alcohol syndrome (FAS) and partial FAS among schoolgoing children in Grade 1 in Northern Cape Province, South Africa.
Design: A cross-sectional study using a two-tiered method for ascertainment of FAS/partial FAS cases, comprising: screening of growth parameters, diagnostic assessment for screen-positive children using clinical and neurocognitive assessments, and maternal history of drinking during pregnancy. Mothers or caregivers of FAS children and matched controls were interviewed.
Setting: Primary schools in De Aar (8) and Upington (15). Subjects. Grade 1 pupils in 2001 (De Aar, N=536) and 2002 (Upington, N=1299).
Outcome measures: FAS or partial FAS.
Results: The prevalence of FAS/partial FAS was high: 64/536 (119.4/1000, 95% CI 93.2-149.9) in De Aar, and 97/1299 (74.7/1 000, 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 <2 SD for age. Mothers of children with FAS were less likely to have full-time employment or have attended secondary school and had lower body mass index, and about 80% currently smoked. Over two-thirds of all pregnancies had been unplanned.
Conclusions: A very high proportion of pupils (nearly 1 in 10) had FAS/partial FAS, the rate in De Aar being the highest yet described in South Africa. FAS/partial FAS may contribute to the extremely high rate of growth retardation in South Africa as a whole and is a major cause of learning disability. These epidemiological features are important in designing preventive interventions.