Universal Prevention is Associated with Lower Prevalence of Fetal Alcohol Spectrum Disorders in Northern Cape, South Africa: A Multicentre Before–After Study

Chersich, Matthew; Urban, Michael; Olivier, Leana; Davies, L; Chetty, Candice; Viljoen, Denis

doi:10.1093/alcalc/agr145

Cited by 41 publications

(53 citation statements)

References 23 publications

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“…One study focused on exposure to multiple sources of public health messages, as well as government warnings on alcoholic beverage containers [33]. One study used a combination of mass media campaigns and health promotion events in order to reduce the prevalence of FAS as well as improving knowledge and reducing alcohol consumption among pregnant women [31]. One study used a 30 s television announcement with a message on alcohol and pregnancy [35].…”

Section: Resultsmentioning

confidence: 99%

A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women

Crawford‐Williams

Fielder

Mikocka‐Walus

et al. 2014

Drug and Alcohol Review

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Issues: It is well established that alcohol can cross the placenta to the foetus and can affect both physical and psychological development of the infant; however, many women continue to drink during pregnancy. It is therefore important to determine whether interventions can be successful in reducing alcohol consumption among pregnant women. Past reviews have investigated the effectiveness of clinical interventions in reducing alcohol consumption in pregnancy; however, the aim of the current review was to focus on the effectiveness of public health interventions. Approach: A critical literature review was conducted by searching several electronic databases using keywords such as; pregnancy, alcohol, interventions, and public health. Studies were included if they utilised a public health intervention, and included alcohol consumption or levels of knowledge as an outcome measure. Key Findings: Ten studies were included in the review. Interventions included multimedia and educational interventions. Improvements in knowledge were reported in six studies, whereas one study found contradictory results. Four studies used alcohol consumption rates as an outcome measure, and although a reduction in consumption was reported, the results were nonsignificant. Implications: The effectiveness of public health interventions that aim to increase awareness and reduce alcohol consumption among pregnant women cannot be assessed because of the paucity of studies. Conclusions: The results of this critical review emphasize a lack of evidence and highlight the need for further evaluation research on this topic.

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Section: Resultsmentioning

confidence: 99%

A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women

Crawford‐Williams

Fielder

Mikocka‐Walus

et al. 2014

Drug and Alcohol Review

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“…[17] As a local example of a successful intervention, we have reported a 30% reduction in FAS/PFAS rates associated with a community-level intervention comprising intensive 'universal prevention' measures. [8] Interventions within the health sector that should be implemented, upgraded or urgently investigated include: (i) strengthened family planning services; (ii) improved antenatal education regarding the risks of drinking; (iii) identification of risky drinking in pregnancy and implementation of brief interventions to reduce it; (iv) strategies aimed at early identification of FASD to allow early intervention in the child and prevention of recurrence in future children; and (v) national-level surveillance of risky drinking and FASD rates to improve data on the problem of FASD. Table 2 indicates that, although there is a high level of FAS in many parts of SA, the prevalence varies.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Drinking during pregnancy remains a problem despite considerable media attention, efforts by the national government to limit alcohol harm, [7] and isolated initiatives to increase universal and other prevention activities in these provinces. [8] Heavy drinking has been socially entrenched and 'normalised' through a history including, but not restricted to, the dop system. For many women, the underlying social determinants of heavy alcohol consumption remain unchanged, and include poor socio-economic conditions, singleparent families, low levels of maternal education, concomitant use of tobacco and other substances, low religiosity and lack of alternative recreational opportunities.…”

mentioning

confidence: 99%

Burden of fetal alcohol syndrome in a rural West Coast area of South Africa

Olivier¹,

Urban

Chersich

et al. 2013

S Afr Med J

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Background. Fetal alcohol syndrome (FAS) is common in parts of South Africa; rural residence is a frequently cited risk factor. We conducted a FAS school prevalence survey of an isolated rural community in a West Coast village of Western Cape Province, so obtaining the first directly measured rate, focusing specifically on a South African rural area, of FAS and partial FAS (PFAS). Methods. The study area (Aurora village), a community of about 2 500 people in a grain-producing region, has one primary school. All learners were eligible for study inclusion. Initial anthropometry screening was followed by a diagnostic stage entailing examination by a dysmorphologist for features of FAS, neurodevelopmental assessment, and an interview assessing maternal alcohol consumption. Results. Of 160 learners screened, 78 (49%) were screen-positive, of whom 63 (81%) were clinically assessed for FAS. The overall FAS/PFAS rate among the screened learners was 17.5% (95% confidence interval 12.0 -24.2%), with 16 (10.0%) children having FAS and 12 (7.5%) PFAS. High rates of stunting, underweight and microcephaly were noted in all learners, especially those with FAS or PFAS. Five (18%) mothers of affected children were deceased by the time of assessment. Conclusion. We describe very high rates of FAS/PFAS in an isolated rural part of the Western Cape that is not located in a viticultural region. Our study suggests that the prevalence of FAS may be very high in isolated communities, or in particular hot-spots. It adds to the growing evidence that FAS/PFAS is a significant, and underestimated, health problem in South Africa. Expanded screening and surveillance programmes, and preventive interventions, are urgently needed.

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“…Equally, with foetal alcohol spectrum disorders, there are tremendous benefits to early antenatal attendance with alcohol screening and interventions, as well as for repeat visits with reinforcement of the need for alcohol abstinence. Levels of this condition are extremely high in Western and Northern Cape, and more generally in rural areas and those of mixed ancestry [24], [25]. Targeted efforts to optimise early ANC utilisation are needed in areas heavily-affected by this condition.…”

Section: Discussionmentioning

confidence: 99%

Equity in Maternal Health in South Africa: Analysis of Health Service Access and Health Status in a National Household Survey

et al. 2013

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BackgroundSouth Africa is increasingly focused on reducing maternal mortality. Documenting variation in access to maternal health services across one of the most inequitable nations could assist in re-direction of resources.MethodsAnalysis draws on a population-based household survey that used multistage-stratified sampling. Women, who in the past two years were pregnant (1113) or had a child (1304), completed questionnaires and HIV testing. Distribution of access to maternal health services and health status across socio-economic, education and other population groups was assessed using weighted data.FindingsPoorest women had near universal antenatal care coverage (ANC), but only 39.6% attended before 20 weeks gestation; this figure was 2.7-fold higher in the wealthiest quartile (95%CI adjusted odds ratio = 1.2–6.1). Women in rural-formal areas had lowest ANC coverage (89.7%), percentage completing four ANC visits (79.7%) and only 84.0% were offered HIV testing. Testing levels were highest among the poorest quartile (90.1% in past two years), but 10% of women above 40 or with low education had never tested. Skilled birth attendant coverage (overall 95.3%) was lowest in the poorest quartile (91.4%) and rural formal areas (85.6%). Around two thirds of the wealthiest quartile, of white and of formally-employed women had a doctor at childbirth, 11-fold higher than the poorest quartile. Overall, only 44.4% of pregnancies were planned, 31.7% of HIV-infected women and 68.1% of the wealthiest quartile. Self-reported health status also declined considerably with each drop in quartile, education level or age group.ConclusionsAside from early ANC attendance and deficiencies in care in rural-formal areas, inequalities in utilisation of services were mostly small, with some measures even highest among the poorest. Considerably larger differences were noted in maternal health status across population groups. This may reflect differences between these groups in quality of care received, HIV infection and in social determinants of health.

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Universal Prevention is Associated with Lower Prevalence of Fetal Alcohol Spectrum Disorders in Northern Cape, South Africa: A Multicentre Before–After Study

Cited by 41 publications

References 23 publications

A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women

A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women

Burden of fetal alcohol syndrome in a rural West Coast area of South Africa

Equity in Maternal Health in South Africa: Analysis of Health Service Access and Health Status in a National Household Survey

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