6 August 2001
The poorer areas of the Western Cape have been found to have among the highest incidence of Fetal Alcohol Syndrome (FAS) in the world, with over 7.5% of children in socio-economically disadvantaged areas being affected.
And early results from studies in the Northern Cape by Prof. Denis Viljoen, head of Human Genetics at the South African Institute for Medical Research (SAIMR) and Wits, show incidences of over 10%, reflecting the poverty of the area and the 'at risk' populations living there.
"This is devastating. We found in the Western Cape that the incidence had increased by 56% between 1997 and 1999, which is very worrying. These figures are representative of many of the smaller towns and villages in the Western Cape," said Prof. Viljoen, who is hosting a FAS Workshop today ahead of the National Department of Health's Birth Defects and Disabilities conference which starts tomorrow.
Studies in four 'at risk' areas in Gauteng of school-entry 7-year-old children found incidences of 2.2% (22/1000) in Soweto, 1.2 % (12/1000) in Lenasia South, and 3.7% (37/1000) in Westbury. The study was also conducted in Diepsloot where the incidence was 0/1000. "But this is a new informal settlement which was not in existence when the children under study were conceived; in five years time we predict a different picture," said Prof. Viljoen.
"Although this is a little less than half the prevalence in similar communities in the Western Cape, the rate has appalling health implications: it is higher than worst case at-risk communities in developed countries by up to four fold." FAS is the most common preventable cause of mental retardation worldwide.
The syndrome is caused by alcohol which, among other mechanisms, reduces blood-flow to the uterus, damaging the baby's growth and brain development. Children born with FAS are often smaller than their peers, and have low IQ's. As there is no blood test for the syndrome, doctors regularly identify FAS children from the age of three by clinical diagnosis of the typical FAS features. These children are behaviourally abnormal with short attention spans (mimicking Attention Deficit Disorder), very hyperactive, and aggressive.
"The jury is out regarding what are safe levels for drinking alcohol during pregnancy. I would recommend that women do not drink at all during pregnancy, as it has been shown that anyone drinking more than 2 drinks per day, or just one binge of more than 6 drinks during pregnancy, can have a child with FAS. Alcohol is very poisonous to the fetus," said Prof. Viljoen. …../2 He further advises women who are able to fall pregnant - those who are not on contraception and are sexually active - to be careful, particularly of binge drinking. It is during the first 8 weeks when a woman is often unaware of her pregnancy, that the embryo is at increased risk. An ultra-sound study may help to identify FAS babies in utero. Damage to the baby can be limited by reducing alcohol abuse during the pregnancy.
"The social impact of alcoholism on the incidence of FAS cannot be under-estimated. Most of these children are born to alcoholic parents, and while the mother is the one causing the damage to the fetus, there is in most cases an alcoholic partner and a heavy drinking home environment," said Prof. Viljoen.
"These children may enter the school system for a few years, fail each year because of their reduced IQ, and drop out of school and become street children. Here they become susceptible to gangs and peer-pressure, and may end up in prison. A lot of petty crime and gang-related incidents are probably related to FAS, where it is clear the environment is the issue, rather than a genetic defect.
"The solutions to FAS are multi-faceted. Among other things, we need to alleviate poverty generally, increase social work among alcoholic families, and inform individuals about the dangers of drinking during pregnancy. Health workers also need to be more adept at determining the real drinking levels of pregnant women," said Prof. Viljoen. Teachers also need to identify children with learning difficulties and refer them for appropriate educational interventions.
In line with the World Health Organisation's slogan "pregnancy is special, let's make it safe," the National Department of Health in its ongoing public awareness campaign on FAS encourages: women to attend antenatal clinics as early as possible during the pregnancy; men to give support to their partners, help their pregnant partner avoid alcohol and eat properly. Those who cannot stop drinking during pregnancy are encouraged to contact their nearest clinic or health facility for assistance.
The First International Conference in the Developing World on Birth Defects and Disabilities is being hosted by the National Department of Health, and takes place at the Sandton Convention Centre from 6 - 10 August.
Issued by Department of Health
Enquiries:
Prof. Denis Viljoen, Head: Human Genetics, SAIMR/Wits University
Tel: (011) 489-9239; Cell: 082-807-6844
Ms Pat Craig, SAIMR/Wits University Genetics Department
Tel: (011) 489-9243; Cell: 082-923-6774
Dr Busi Madolo, Head Human Genetics, National Department of Health
Tel: (012) 312-0203; Cell: 082-338-0824
Nombulelo Legalatladi, Department of Health Communications Directorate
Tel: (012) 312-0559 Cell: 082-444-9503
Greer van Zyl, World Health Organisation Health Information and Promotion
Tel: (012) 338-5204; Cell: 082-375-8551