A guideline for the prevention and management of Fetal Alcohol Spectrum Disorder in South Africa

Abstract

BackgroundFetal Alcohol Spectrum Disorder (FASD) is a public health problem globally, with South Africa having the highest recorded prevalence of all countries. Government programmes to prevent and manage FASD remain limited because of the lack of a specific policy. Herein, we developed a guideline to inform policy on the prevention and management of FASD in South Africa.MethodsWe applied a modified version of the World Health Organization’s approach to guideline development in three phases. In the first phase, we designed the initial guideline prototype. To do this, we conducted an in-depth interview with policymakers and a focus group with relevant service providers on policy requirements for FASD, a document review of policies on FASD and a scoping review of various interventions for FASD. In phase 2, we refined the initially formulated guideline prototype through a discursive approach with seven local and international experts on FASD. Phase 3 involved refining the prototype using a modified Delphi approach. Forty-three and forty-one experts participated in rounds 1 and 2 of the Delphi approach, respectively. The acceptable consensus for each included policy statement was 85%.ResultsWe identified three aspects of the proposed guideline, which are the approaches and guiding principles, the prevention measures and the management measures. The guideline proposes that a FASD policy should consider lifespan needs, be culturally diverse, collaborative, evidence-based, multi-sectoral and address social determinants of health contributing to FASD. The essential components of FASD prevention policy consist of awareness and education of the dangers of drinking alcohol, access to treatment for alcohol problems and training of service providers. The management components include capacity building related to diagnosis, educating parents regarding the needs and management, appropriate referral pathways, training of teachers regarding classroom management and support for parents and individuals with FASD.ConclusionFASD in South Africa deserves urgent attention. Developing a specific policy to guide programmes could enhance and coordinate the efforts towards preventing and managing FASD. The guideline has the potential to assist policymakers in the development of a comprehensive and multi-sectoral policy for prevention and management of FASD, considering the consensus obtained from the experts.

Policy Requirements for the Prevention and Management of Fetal Alcohol Spectrum Disorder in South Africa: A Policy Brief

“…In the Delphi study (20), the experts identified measures that could be included for the prevention and management of FASD in South Africa based on the refined prototype. Some of the guiding principles and approaches include collaboration, consider the family as a unit, human right-based, holistic, evidence-based, culturally diverse and sensitive, considering input from individuals with FASD and their families and addressed social determinant of health.…”

“…We adapted the WHO's approach to guideline development (18,19). The study was conducted in three phases (Figure 1) (20). In the first phase, two qualitative studies were conducted (indepth interviews with policymakers and focus group discussions with service providers).…”

Reported health, social support, stress and associations with choline intake in pregnant women in central South Africa: the NuEMI study 2018–2019

“…Alcohol and tobacco are well-known teratogens and can cause an array of poor health outcomes. South Africa has the highest rate of foetal alcohol spectrum disorder (FASD) in the world [ 23 ], and almost one in ten participants (9.0%) in the current study consumed alcohol during the current pregnancy. Ideally, pregnant women who consume alcohol should consume higher amounts of choline, because it has been shown that higher choline intake may protect against some of the adverse consequences of FASD [ 24 , 25 ].…”

Perspectives of Policymakers and Service Providers on Why Fetal Alcohol Spectrum Disorders Remain Unabated in South Africa: a Qualitative Study

“…This is because these clauses are generic and poorly implemented or translated into effective programs and interventions. Some policymakers associate the development of a separate policy to increase commitment to addressing the incessant rise in FASD prevalence (Adebiyi et al, 2021;Adebiyi et al, 2019d;.…”