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Fetal Alcohol Syndrome In Africa. Betty Wakou Childhood Nutrition NSCI 5373 November 7, 2002. Prenatal Exposure to Alcohol Fetal Alcohol Syndrome (FAS) . FAS –a set of birth defects Growth deficiency (delayed physical growth and devt)

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Fetal alcohol syndrome in africa l.jpg

Fetal Alcohol Syndrome In Africa

Betty Wakou

Childhood Nutrition

NSCI 5373

November 7, 2002


Prenatal exposure to alcohol fetal alcohol syndrome fas l.jpg
Prenatal Exposure to Alcohol Fetal Alcohol Syndrome (FAS)

  • FAS –a set of birth defects

    • Growth deficiency (delayed physical growth and devt)

    • A characteristic set of minor facial traits—normalize with growth

    • Mental and behavioral deficits (the effects of alcohol induced damage to the developing brain are life long-devastating to children and families)

    • Demonstrate difficulties with learning, memory, attention, and problem solving

    • Problems with mental health and social interaction

    • Most common nonhereditary, most preventable mental retardation


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Prevalence Estimates of FAS

  • Identified in France in 1968 and US in 1973

  • Between 0.5 – 3 per 1000 live births (Stratton et al., 1996)

  • US rates: 0.33 to 2.2 per 1000 (Abel & Sokol, 1991; 1987)

  • Developed countries: 0.97 per 1000 (Abel, 1995)

  • American Indians 10 per 1000 (May et al., 1991)

  • African Americans 2.29 (Abel, 1995)

  • S.Africa Western Cape Province 39.2 to 42.9 per 1000 (May et al., 2000)


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Mechanisms of Alcohol Induced Damage to the Fetus

  • Multiple actions at different sites

  • Developing brain- development and function, migration and survival of nerve cells

  • Embryonic cell layer that develops into the bones and cartilage of the head and face-premature cell death


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Diagnosis of FAS

  • Identifies a small proportion of children

  • Easy when facial features and growth retardation are present AND known maternal alcohol use in pregnancy

  • Children may lack the characteristic facial defects and growth deficiency but still have alcohol induced mental impairments just as serious or more serious that FAS - ARND (alcohol related neurodevelopment disorder) and ARBD of the skeleton and organ systems

  • A single measure cannot explain all the deleterious effects from alcohol exposure during pregnancy.


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Facial Features of FAS

Small head circumference

Skin folds at the corner of the eye

Small eye opening

Low nasal bridge

Small midface

Short nose

Thin upper lip

Indistinct groove between nose and upper lip


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Head circumference

Effects of alcohol exposure on growth

Birth weight

Length


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Head circumference

Effects of alcohol exposure on growth and aptitude

Mental summary score

Academic achievement summary score


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FAS

  • Reduced intellectual functioning and academic skills

  • Deficits in verbal learning, spatial memory and reasoning, reaction time, balance, and other cognitive and motor skills

  • Social functioning worsens during adolescence and adult hood with increased rates of mental health disorders.


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age >25 y

parity >3

separated, divorced or never married

high blood alcohol conc

binge drinking

long history of drinking

heavy drinking by male partner or by any family member

culture tolerant of heavy drinking

low socioeconomic status

work in a male dominated occupation,

unemployment,

social transience,

low self-esteem,

loss of children to other care,

sexual dysfunction,

use of multiple substances, cigarette smoking

Risk Factors Associated with FAS


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Alcohol Research In Africa

  • Alcohol research in Africa is still in its infancy

  • There are few reliable data on alcohol consumption and harm in general population

  • Drinking is on the increase in rural and urban areas

  • Drinking in the traditional setting is changing

  • New is drinking in bars and solitary drinking at home

  • Most literature is on surveys on alcohol use

  • Not many on drinking and its association with alcohol problems.


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Alcohol Drinking in S. Africa

  • The legal ‘dop’ system- practice of paying farm workers in part with alcohol

  • Institutionalized element for 300 years

  • Successive laws were in place

  • In 1961 an Act outlawed payment with alcohol as part of the wage

  • Dispensing of wine as a ‘gift’ was not addressed


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Alcohol Drinking in S. A. West. Cape Province

  • Alcohol consumption among farm workers is extraordinarily high

  • Western Cape - drinking is about twice that of urban areas

  • 50% of traumatic injuries are alcohol related and are 30% higher than in urban areas


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Research Support

  • National Institute on Alcohol Abuse and Alcoholism supported pilot studies in S. Africa

  • Patterns of FAS occurrence, maternal risk, FAS characteristics similar to those in North American communities BUT higher

  • May et al. (2000) measured 1st grade children


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Epidemiology of FAS in S. African Community in the Western Cape Province (May et al., 2000)

Objective: To determine the characteristics of FAS in S. African community

  • Methods: - Active case ascertainment

  • Passive case ascertainment

    • Birth records, registries, clinic-based systems, population-based initiatives

  • Subjects: - 992 first grade pupils


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Population Distribution Cape Province (May et al., 2000)


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Diagnosis of FAS-Institute of Medicine Cape Province (May et al., 2000)

  • Facial and other dysmorphology

  • Diminished structural growth for age

  • Developmental (intelligence and social skills) delay

  • Maternal alcohol consumption


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Results Cape Province (May et al., 2000)

  • 40.5 - 46.4 per 1000 age 5-9y in schools

  • 39.2-42.9 per 1000 age specific community rates

  • 18-141x > US rates

  • Early stages of economic development

  • Low SES

  • Increased access to alcohol

  • Loss of folk and traditional culture


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Factors Associated with Alcohol Consumption Cape Province (May et al., 2000)

  • Patterns of binge and heavy drinking that produce FAS are associated with

    • rapid community change

    • detribalization

    • rural-to-urban transitions

    • progressions from traditional to modern (secular) culture

  • These changing social and cultural contexts, adaptation, coping and recreation are replaced with alcohol


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FAS Risk Factors Cape Province (May et al., 2000)

  • Advancing maternal age

  • High gravidity and parity

  • Early onset of regular drinking career

  • Quantity, frequency, and timing of maternal drinking during pregnancy

  • Socioeconomic status

  • Rural residence residence on certain grape growing, wine producing farms


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Issues in Fetal Alcohol Syndrome Cape Province (May et al., 2000)

  • Maternal alcohol use is controllable BUT

  • Prevention needs to use existing theory and knowledge in the fields of health promotion and health education

  • Pay attention to the risk factors that affect the target population’s use of alcohol and behaviors


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Levels of Prevention Cape Province (May et al., 2000)

  • Primary - stop maternal drinking before it starts

  • Secondary- early detection and treatment of maternal drinking

  • Tertiary - to change behavior of high risk women

  • Universal – promote health and well-being of all people-use media, policy and environmental change

  • Selection – intervene in target populations at risk using trained health personnel

  • Indicated – intervene is women that drink


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