Fetal alcohol syndrome among grade 1 schoolchildren in Northern Cape Province: prevalence and risk factors.

OBJECTIVE To describe the prevalence, characteristics and risk factors for fetal alcohol syndrome (FAS) and partial FAS among schoolgoing children in Grade 1 in Northern Cape Province, South Africa. DESIGN A cross-sectional study using a two-tiered method for ascertainment of FAS/partial FAS cases, comprising: screening of growth parameters, diagnostic assessment for screen-positive children using clinical and neurocognitive assessments, and maternal history of drinking during pregnancy. Mothers or caregivers of FAS children and matched controls were interviewed. SETTING Primary schools in De Aar (8) and Upington (15). Subjects. Grade 1 pupils in 2001 (De Aar, N=536) and 2002 (Upington, N=1299). OUTCOME MEASURES FAS or partial FAS. RESULTS The prevalence of FAS/partial FAS was high: 64/536 (119.4/1000, 95% CI 93.2-149.9) in De Aar, and 97/1299 (74.7/1 000, 95% CI 61.0-90.3) in Upington. Overall, 67.2 per 1000 children (95% CI 56.2-79.7) had full FAS features. Growth retardation was also common in this population: 66.6% (1181/1774) were underweight, 48.3% (858/1776) stunted, and 15.1% had a head circumference <2 SD for age. Mothers of children with FAS were less likely to have full-time employment or have attended secondary school and had lower body mass index, and about 80% currently smoked. Over two-thirds of all pregnancies had been unplanned. CONCLUSIONS A very high proportion of pupils (nearly 1 in 10) had FAS/partial FAS, the rate in De Aar being the highest yet described in South Africa. FAS/partial FAS may contribute to the extremely high rate of growth retardation in South Africa as a whole and is a major cause of learning disability. These epidemiological features are important in designing preventive interventions.