Looking further upstream to prevent fetal alcohol spectrum disorder in Canada

Cloete

et al. 2019

IJERPH

Fetal alcohol spectrum disorder (FASD) has a high prevalence in South Africa, especially among the poor socioeconomic communities. However, there is no specific policy to address FASD. Using a qualitative study design, we explored the perspectives of policymakers on guidelines/policies for FASD, current practices and interventions, and what practices and interventions could be included in a policy for FASD. The data analysis was done using the Framework Method. Applying a working analytical framework to the data, we found that there is no specific policy for FASD in South Africa, however, clauses of FASD policy exist in other policy documents. Preventive services for women and screening, identification, assessment, and support for children are some of the current practices. Nevertheless, a multi-sectoral collaboration and streamlined program for the prevention and management of FASD are aspects that should be included in the policy. While there are generic clauses in existing relevant policy documents, which could be attributed to the prevention and management of FASD, these clauses have not been effective in preventing and managing the disorder. Therefore, a specific policy to foster a holistic and coordinated approach to prevent and manage FASD needs to be developed.

Section: Discussionmentioning

confidence: 99%

Policymakers’ Perspectives Towards Developing a Guideline to Inform Policy on Fetal Alcohol Spectrum Disorder: A Qualitative Study

Cloete

et al. 2019

IJERPH

“…An FASD policy should also address the social, structural and economic factors affecting health behaviour and examine the growing gap in health inequities [33]. Thus, the notion of having a policy which addresses upstream drivers (social determinants of health contributing to FASD) is in alignment with these arguments [40].…”

Section: Discussionmentioning

confidence: 99%

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

Beytell

2019

BMC Health Serv Res

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.

“…The drinking pattern in general and during pregnancy is facilitated by the presence of numerous illegal liquor stores "shebeens" (Bowers et al, 2014), making alcohol accessible to anyone with little or no restriction. In addition to the presence of illegal liquor stores, there are other socio-economic and socio-political realities such as high unemployment rates and poverty driving the demand for alcohol in this group (Lukasse et al, 2015;Sanders & Currie, 2014).…”

Section: Study Settingmentioning

confidence: 99%

“…Studies conducted in six European countries and Canada show that women who experience unintended pregnancy are more likely to drink alcohol during pregnancy (Lukasse et al, 2015;Sanders & Currie, 2014), which means the developing fetus might have been exposed before the pregnancy state is known. It has also been reported in studies conducted in SA that women use alcohol before and during pregnancy as a coping mechanism for the socio-economic and socio-political realities of their everyday lives (Cloete & Ramugondo, 2015;Fletcher et al, 2018).…”

mentioning

confidence: 99%

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

Int J Ment Health Addiction

2021

Fetal alcohol spectrum disorder (FASD) remains one of the leading sources of non-genetic intellectual and developmental disabilities globally. South Africa (SA) could be considered to bear the greatest burden of FASD globally with the recorded prevalence of FASD ranging from 29 to 290 per 1000 live births. Despite several efforts to reduce the incidence and prevalence of FASD in SA, its incidence and prevalence remain high. In this study, we examined the factors behind the sustained high incidence and prevalence of FASD in SA. Using an exploratory qualitative design, we explored the perspectives and experiences of 10 policymakers and 65 service providers on why FASD remains unabated despite various efforts to address the problem in SA. Ten in-depth interviews were conducted with policymakers and nine focus group discussions were conducted with the service providers in the Western Cape Province of SA. Data were analyzed inductively using the thematic analysis approach and emerging themes were deductively classified using the ecological model. Our findings revealed several reasons for the sustained high prevalence and increasing incidence of FASD in SA. At the individual level, late antenatal booking, alcohol consumption during pregnancy, and socio-economic conditions of individuals were identified as relevant factors driving the FASD prevalence in SA. Inadequate support groups for women were reported at the interpersonal level. The widespread availability of illegal liquor stores and inadequate specialized prevention programs were reported as community-level challenges. At the institutional level, the reasons included inadequate training of professionals and inadequate collaboration between government departments. At the policy level, the absence of a specific policy addressing FASD constitutes a significant barrier to the unabated FASD. The study findings suggest a cascade effect within the different levels of the ecological model highlighting the need for a holistic and systemic approach to preventing FASD in SA. The design and implementation of holistic, human rights-based, and interdepartment policies and programs addressing the social determinants of FASD should be considered.