La distorsión de la realidad

The most widely used international summary prevalence estimate for FAS in the developed world is “1 to 1.5 cases per 1000 live births” (Klug & Burd 2003). Population estimates in the US are that “1% of newborns fall into the spectrum of

58 fetal alcohol disorders” (Rendall-Mkosi, et al. 2008). FAS rates have been “estimated to be 18 to 141 times greater than those for the various populations in the United States” (May, et al. 2000). For urban populations, “the prevalence of FAS/FASD commonly reported in the literature for urban populations is 0.5 to 3 cases per 1000 live births for FAS and approximately 9 cases per 1000 live births for a FAS

(Zadunayski, et al. 2006).

A national study to determine the prevalence of FAS/FASD in South Africa has not been conducted (May, et al. 2007; Olivier, et al. 2013; Urban, et al. 2015). However, prevalence studies have been conducted in 3 of the country’s 9 provinces - viz. Gauteng, the Western Cape and the Northern Cape – and mostly in “geographically and socio-economically localised” communities (Rendall-Mkosi, et al. 2008). According to Urban, et al. (2015:1017), research has “almost exclusively targeted populations with 2 demographic characteristics: (i) residents of rural areas or small towns, and (ii) areas with populations comprising predominantly the mixed ancestry minority group, designated officially as ‘Coloured’”.

Rates of FAS/FASD in South Africa are reportedly amongst the highest in the world (Rendall-Mkosi, et al. 2008). Available data suggests that the rate of FAS/FASD is worryingly high in areas where research has been conducted. Surveys involving screening of Grade 1 school children found the prevalence to be more than 40 cases per 1000 children in the Western Cape and Northern Cape and more than 20 cases per 1000 children in Gauteng (Rosenthal, Christianson & Cordero 2005).

A study conducted in Gauteng among first-graders from four schools estimates the median prevalence of FAS to range from 19/1000 to 26.5/1000 (Rendall-Mkosi, et al. 2008). In the Western Cape, three studies were conducted in 1997, 1999 and 2002, amongst three different cohorts of Grade 1 children in the wine-producing town of

59 Wellington. The first study reported a prevalence of FAS of between 40.5 and 46.4/1000, the second a higher rate of 65.2-74.2/1000 and the third a combined FAS and PFAS rate of 68.0-89.2/1000 (Rendall-Mkosi, et al. 2008).3 These results reflect an upward trend which can partly be explained by the influence of increased diagnostic accuracy over the years.

Results from a more recent survey conducted in the rural town of Aurora, describe equally high rates of FASD among Grade 0 to 7 learners (Olivier, et al. 2013). “Of the 160 learners screened” for FAS/PFAS, “78 (49%) were screen-positive, of whom 63 (81.5%) were clinically assessed for FAS. The overall FAS/PFAS rate among the screened learners was 17.5%, with 16 (10%) children having FAS and 12 (7.5%) PFAS” (Olivier, et al. 2013). “High rates of stunting4

; underweight and microcephaly were noted in all learners, especially those with FAS or PFAS” (Olivier, et al. 2013). “The median body mass index of children without” FAS/PFAS was 15.8 kg/m2, “

compared with a median 14.7 kg/m2 in children with FAS/PFAS” (Olivier, et al. 2013).

In studies conducted in the Northern Cape towns of De Aar and Upington among first graders in 2001 and 2002, , an overall prevalence rate of 67.2/1000 of FAS, and PFAS of 20.8/1000 was reported (Rendall-Mkosi, et al. 2008; Urban, et al. 2008). The town of De Aar had the highest yet reported prevalence of 119.4/1000 of FAS and PFAS combined. A recent study by Urban and colleagues (2015) that compared the prevalence of FAS/FASD among Grade 1 school children in “2 suburbs with predominantly mixed ancestry and Black African populations” (Urban, et al.

3 _{Rendall-Mkosi, et al. (2008) explains “that in the third study the prevalence of both FAS and PFAS}

was determined and reported together which in part explains the higher prevalence”.

4 _{Stunting can be defined as a failure to grow optimally (height-for-age below -2SD from the median of}

the growth standard) and is usually caused by chronic undernutrition and/or infections. It is associated with poor physical and cognitive development in childhood and higher risks of cardiovascular and metabolic diseases in adulthood (Said-Mohamed, et al. 2015).

60 2015:”1016) in the city of Kimberly found there to be no difference between the FAS and FASD prevalence in the two communities (Urban, et al. 2015:1018). “Stratified by school, ascertainment for FAS status was over 90% for 12 schools and over 85% for the remaining 2 schools” (Urban, et al. 2015:1018). A FASD diagnosis was made in “96 children (6.4%) including 83 (5.5%) with FAS, 6 (0.4%) with partial FAS, and 7 (0.5%) with ARND and none with ARBD” (Urban, et al. 2015:1024).

Prior to the study by Urban and colleagues (2015), only one study reportedly sought to determine the prevalence of FAS in the Black African population of South Africa (Urban, et al. 2015:1017). This study found a “1.9% prevalence of FAS among 830 first graders, with 1.7% prevalence in the subset of 414 learners from 2 predominantly Black African suburbs” in metropolitan Gauteng (Urban, et al. 2015:1017).

The findings from the various studies are particularly noteworthy because it shows that FASD is an issue in both rural and urban areas, as well as one in predominantly Black African communities, and suggests that the rates of FASD may underestimate the true magnitude of FASD for at least two reasons. Firstly, epidemiological studies to determine the rates of FASD have typically been conducted among Grade 1 school children, therefore excluding a large pool of people who are not in school or who are older and who may have a FASD (Clarren, et al. 2001; Little et al. 1990). Secondly, the difficulty and lack of uniformity in accurately diagnosing the range of FASD, means that some children may be misdiagnosed or not diagnosed. Given that the rates of FASD may be greater than research suggests, it is worth reflecting on the patterns and rates of drinking among pregnant women and alcohol and contraceptive use among women of reproductive age, in an effort to gain a more accurate picture of the magnitude and scope of FASD.

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