Transcript Fetal Alcohol Syndrome In Africa

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)
– 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
Prevalence Estimates of FAS
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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)
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 facepremature cell death
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.
Facial Features of FAS
Small head circumference
Skin folds at the
corner of the eye
Low nasal bridge
Small eye opening
Small midface
Short nose
Indistinct groove between
nose and upper lip
Thin upper lip
Head circumference
Effects of alcohol
exposure on growth
Birth weight
Length
Head circumference
Effects of alcohol
exposure on growth
and aptitude
Mental summary
score
Academic achievement
summary score
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.
Risk Factors Associated with
FAS
• 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
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.
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
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
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
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
Population Distribution
Population Distribution in Western Cape Province
60
50
40
30
Population
20
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0
Coloured
Black
White
Other
Diagnosis of FAS-Institute of
Medicine
1. Facial and other dysmorphology
2. Diminished structural growth for age
3. Developmental (intelligence and social
skills) delay
4. Maternal alcohol consumption
Results
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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
Factors Associated with Alcohol
Consumption
• Patterns of binge and heavy drinking that
produce FAS are associated with
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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
FAS Risk Factors
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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
Issues in Fetal Alcohol Syndrome
• 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
Levels of Prevention
1. Primary - stop maternal drinking before it starts
2. Secondary- early detection and treatment of
maternal drinking
3. Tertiary - to change behavior of high risk women
1. Universal – promote health and well-being of all
people-use media, policy and environmental
change
2. Selection – intervene in target populations at risk
using trained health personnel
3. Indicated – intervene is women that drink