The prevalence of fetal alcohol spectrum disorder in South Africa: A study in a Free State Province community

Background. South Africa (SA) has the highest reported prevalence of fetal alcohol spectrum disorders (FASDs) globally, estimated at 111.1/1 000 (95% confidence interval (CI) 71.1 - 158.4) or 11.11%, but rates as high as 276.2/1 000 (95% CI 215.3 - 337.1; 27.62%) and 310/1 000 (95% CI 283.4 - 336.7; 31%) have been reported. There are still four provinces with no published prevalence for FASDs. At the time of the present study, only one study had been conducted in a Free State Province community. Objectives. To establish the prevalence of FASDs in a rural town in Kopanong Local Municipality in the Free State. Methods. This was a cross-sectional epidemiological study using active case ascertainment. A tiered recruitment and screening process was used for FASDs. Three schools were included in the study, and 122 children were invited to participate. Prevalence figures were calculated using two denominators, eligible participants and consented participants. Demographic data and anthropometric measurements were compared between FASD cases and controls. Maternal demographic, anthropometric and alcohol use data were also compared between FASD cases and controls. Results. In total, 119 participants consented to the study, with 106 given a primary healthcare and anthropometric screening. Of these, 80 received a paediatric and dysmorphology examination, of whom 64 were referred for maternal interviews and neurodevelopmental assessments. After a case conference, 22 were diagnosed with an FASD. Of 46 controls, 29 were unaffected and 17 were diagnosed with an FASD. Using all eligible participants as denominator, the prevalence was 180/1 000 (95% CI 117 - 260) or 18.0%, and using all consented participants, it was 185/1 000 (95% CI 120 - 266) or 18.5%. Of the 106 recruited participants, 48 were male and 58 female. The mean (standard deviation) age of participants was 7.55 (0.56) years, with diagnosed participants 7.75 (0.69) years old on average, and controls 7.52 (0.54) years old. Mothers of children diagnosed with an FASD differed significantly from mothers of controls on maternal weight (p=0.038, 95% CI –26.58 - –0.795 kg), household income (p=0.036, 95% CI –11 523.861 - –411.139 ZAR), standard drinks consumed on one occasion before pregnancy (p<0.001, 95% CI 2.718 - 6.546), and educational attainment (median Grade 8 v. Grade 12, p=0.001). Maternal age at the birth of the participants, body mass index and standard drinks per week were not significantly different. Conclusion. This study adds to existing research identifying SA as the country with the world’s highest reported prevalence of FASDs. It was the second study in the Free State and should highlight the need for expanded services, surveillance and research in this province.