Introduction
Fetal Alcohol syndrome ( FAS ) refers to “ growing, mental and physical jobs that may happen in a babe when a female parent drinks intoxicant during gestation ” ( Medline 2010 ) . It is at the terrible terminal of the spectrum of Foetal Alcohol Spectrum Disorder ( FASD ) , at the other terminal of the spectrum is alcohol-related neurodevelopmental upset and intoxicant related birth defects ( CDC 2003 ) .FAS is one of the prima causes of preventable birth defects and developmental disablements ( CDC 2003 ) .
The US Institute of Medicine diagnostic standards for FAD is one ) form of facial anomalousnesss, ( as seen in figure below ) , two ) reduced growing for age three ) grounds of cardinal nervous anomalousnesss like developmental holds and four ) confirmed history of maternal intoxicant consumption ( Sampson, Streissguth, Bookstein et al. 1997 )
( Medline 2006 )
The overall estimated incidence of FAS is 0.97 per 1000 unrecorded births ( Godel G. 2002 ) . Audited account of birth records in Victoria, Australia from 1995-2001 where FAS is a notifiable disease gave an incidence of 0.014/1000 unrecorded births ( Allen, Riley and Halliday 2007 ) . Prevalence of FAS in the United States is estimated to be 0.5-2.0/1000 unrecorded births ( May and Gossage 2001 ) . A survey was conducted in Croatia by Petcovic and Barisic in 2009 in which active instance surveillance was conducted in grade 1-4 urban school kids. Prevalence of FAS was found to be 6.44/1000, PFAS 34.33/1000 and overall prevalence of FAS/PFAS 40.77/1000.Active instance ascertainment method in a primary school in Italy gave the prevalence of FAS as 3.7 – 7.4/1000children and FASD as 20.3-40.5 per 1000 ( May, Fiorentino, Gossage et Al. 2006 ) .
Method
Pubmed hunts were done utilizing the undermentioned cardinal words: fetal intoxicant syndrome, intoxicant related birth defects, incidence, prevalence, epidemiology fetal intoxicant defects and South Africa. Thirty one articles were identified. An extra hunt was conducted through web of cognition and MEDLINE but no new articles were obtained. Fifteen articles were considered reasonably relevant and effort was made to recover the full texts for closer examination, two could non be retrieved.
Inclusion and exclusion standards were made and used to contract done the hunt
Inclusion standards:
* Clearly diagnosed instances of Foetal intoxicant syndrome or Partial Foetal Alcohol Syndrome
* Studies conducted after 1973
* Studies done in South Africa
* Studies conducted on people
Exclusion standards:
* Surveies that did non clearly define FAS or PFAS
* Studies conducted before 1973
* Studies that utilizing secondary informations
* Reports that were columns
* Studies that full study could non be obtained
* Studies that elucidated intercession for FAS or PFAS
* Studies non done in South Africa
* Reports that were non in English
S. NO |
Search |
Consequence |
1. |
Fetal Alcohol Syndrome, Alcohol Related Birth Defects, Foetal Alcohol Defects |
3420 |
2. |
Number 1 + Epidemiology, prevalence, incidence |
568 |
3. |
Number 2 + South Africa |
31 |
Consequences
Seven instance control surveies were found. All but one of the surveies was based on South Africa, the latter compared informations between Plains Indian adult females and South African adult females with FAS diagnosed kids. Six surveies were conducted on a cohort of class 1 student in primary schools at the Cape Cod country. The method of informations analysis for these six surveies was active instance ascertainment. Two-tier showing was conducted by a squad of two: a dysmorphologist and a doctor. After that, diagnosing of non fetal intoxicant syndrome, deferred or fetal intoxicant syndrome was made. Three of the surveies involved the kids and their female parents and two surveies focused merely on the female parents. The last instance control survey was a clinic based survey that identified FAS affected kids and their female parents at everyday familial clinics.
Summary of surveies
S. No |
Survey |
Writers |
Sample size |
Study design |
Consequences |
1 |
Epidemiology of Fetal Alcohol Syndrome in a South African community in the Western Cape Province |
May, Brooke, Gossageet Al. ( 2000 ) |
992 |
Case control |
39.2 – 42.9 per 1000 |
2 |
FAS epidemiology in a South African ( S/A ) community: A 2nd survey of a really high prevalence are |
Viljoen, Gossage, Brooke et Al. ( 2005 ) |
857 |
Case control |
65.2-74.2 per 1000 |
3 |
Alcohol ingestion and other maternal hazard factors for foetal intoxicant syndrome among three distinguishable samples of adult females, before during and after gestation: The hazard is comparative |
May, Gossage, White-Country et Al. ( 2004 ) |
976 |
Case control |
FAS is related to biological and environmental factors |
4 |
Maternal hazard factors for FAS in the western ness state of S/A: a population based survey |
May, Gossage, Brooke et Al. ( 2005 ) |
169 |
Case control |
Hazard factors for FAS |
5 |
The epidemiology of FAS and partial FAS in a S/A community |
May, Gossage, Marais et Al. ( 2007 ) |
818 |
Case control |
68.0 – 89.2 per 1000 |
6 |
Maternal hazard factors for FAS and partial FAS in S/A: a 3rd survey |
May, Gossage, Marais et Al. ( 2008 ) |
206 |
Case control |
Hazard factors to FAS |
7 |
Alcohol dehydrogense-2*2 allelomorph is associated with reduced prevalence of FAS in the assorted lineage population of the Western ness state, S/A |
Viljoen, Carr, Foroud et Al. ( 2001 ) |
290 |
Case control |
ADH*2 allelomorph is protective against FAS |
Discussion
Three surveies May et Al. 2000, Viljoen et Al. 2005 and May et Al. 2007 gave the prevalence of FAS in class 1 kids at the old ages the surveies were conducted. A instance control survey was conducted from this cohort group ( nested instance control ) . These surveies had the undermentioned advantages: temporal relationship can be ascertained, the surveies are cheaper and less clip is spent on informations aggregation and analysis compared to a cohort survey ( Ernster 1994 ) . There was increasing prevalence noted with clip 39.2 – 42.9/1000, 65.2 – 74.2 /1000 and 68.0 – 89.2/ 1000. This might be due to improved diagnostic accomplishments with clip or the researches know the country better. The first survey ascertained the prevalence of FAS while the 2nd and 3rd ascertained both FAS and partial FAS. These surveies besides noted that kids with FAS were shorter, weighed less, had smaller occipital-frontal perimeter and higher dysmorphic tonss than the controls.
The three afore mentioned surveies, in add-on to two surveies, May et Al. 2005 and May et Al. 2008 gave the hazard factors for this status. In all five surveies, female parents of instances were more likely to be current drinkers who lived in rural countries and drank and smoked coffin nails during index gestation. The male parents of the kids with FAS were besides current drinkers. May et Al. 2008 and May et Al. 2005 reported that female parents of instances were individual, non regular church members, did non pray frequently and had high gravidness. There were besides more likely to be unemployed, or farm workers if employed.
Active surveillance was used for informations aggregation in the surveies discussed. The advantage of this method is that specializers sought out these kids to do the diagnosing, more instances will be discovered while traveling out to look for them in the community than by waiting for them to show in the wellness installations. This gives a more accurate method of gauging prevalence ( May and Gossage 2001 ) . The disadvantages of this method include it being expensive for specializers have to be trained. It is besides clip devouring and needs the cooperation of a batch of people in the community to be a success ( May and Gossage 2001 ) .
May 2004 et Al. Compared informations from obtained from Plains Indian adult females and from South African adult females. Data aggregation was by active surveillance and clinic based surveies. It was discovered that with lower degrees of hazard factors, South African adult females due to their lower organic structure mass index ( BMI ) and poorer nutritionary position had higher hazard of holding kids with FAS. Higher maternal age of instances compared to controls which was statistically important was besides noticed. The same consequence ( higher maternal age in instances ) was obtained in May et Al 2008. In May et Al 2008, though the age of female parents with FAS diagnosed kids was higher, it was non statistically important.
Other consequences obtained from May et Al. 2001 were in harmony with the other five antecedently discussed surveies. Mothers of FAS kids were binge drinkers of low socioeconomic position with high para, individual and populating with a spouse who drinks.
Viljoen et Al. 2001 carried out genotyping for kids with FAS, their female parents and controls and found out that ADH2*2 allelomorph was lower in the instances than controls. This suggests that the allelomorph is a protective factor against development of FAS. This determination is in understanding with a survey by Hard 2003.
Strengths of surveies
All the instances except Viljoen et Al. 2001 had defined choice methods for instances and controls. The US institute of Medicine diagnostic standards was used. In Viljoen et Al. 2001 it was non confirmed that the control group was free from the disease. Blood specimens that had been antecedently collected from givers were used. The doctors were blinded during the instance ascertainment to avoid observer prejudice. The exposure, maternal intoxicant consumption during gestation was ascertained in all instances. Cases and controls were obtained from the same population. The same inclusion and exclusion standards applied to both instances and controls. Matching of instances to controls was done in May et Al. 2002 to cut down the consequence of confusing. Questionnaires administered to female parents were adapted to South Africa and administered in Africaans. The showing consequences for the FAS were non known to the female parents before they filled the questionnaires. This was to avoid newsman prejudice. Information from female parents that could non be reached was obtained through collaterals. May et Al. 2005, May et Al. 2007 and May et Al. 2008 gave a 7 twenty-four hours imbibe log for the female parents to make full to avoid underreporting of current imbibing position. The survey design used allows for multiple exposures to be determined. By trying the full community, choice prejudice was eliminated. Bing instance control surveies, there was no job of loss to follow up.
Restrictions
Mothers were asked to remember events environing index gestation which occurred seven old ages antecedently so recall prejudice can non be ruled out. Some female parents refused to take portion in the surveies and did non give consent to their kids to make so which might take to trying prejudice.
Drinking normally occurs in groups and locally brewed intoxicant is typically consumed. It will hence be hard to quantify the exact sum of intoxicant consumed. The orgy imbibing practiced by these adult females can take to memory loss. Besides the low degree of instruction prevalent in the participant population might impact the manner they answer the questionnaires. All these can take to describing prejudice which will impact the cogency of the survey.
May et Al. 2005 conducted the survey with a sample size of 169, no power computation was reported. It will be impossible to state if the sample size is big plenty. A little sample size affects the preciseness of the survey. In May et Al. 2004 and May et Al. 2005 odds ratio was given but 95 % Confidence interval was non stated.
No multivariate analysis was done in any of the surveies to set for confounders. The consequences obtained hence may hold been as a consequence of confounders. Matching was merely done in one survey, May et Al 2002.
All these surveies were conducted by the same of people. Viljoen was in all the surveies and May in all but one of the surveies. This review is hence looking at information from the same people ‘s point of position which can take to bias.
Decision
The Western Cape Cod of South Africa is noted to hold the highest prevalence of FAS worldwide. These surveies critiqued outlined the same factors found in surveies conducted elsewhere. These hazard factors include low socioeconomic category, populating in rural countries, high para, non spiritual, individual female parents populating with a imbibing spouse. Mothers were current drinkers who drank all through gestation. The hapless nutritionary position and lower BMI of these adult females besides make them more predisposed to holding kids with this status. Alcohol dehydrogenese-2*2 allelomorph was found to be protective for FAS.
Though these surveies are non without defects, they decidedly add to our wealth of cognition about this preventable but irreversible status. The focal point should now be on educating these adult females to alter their imbibing wonts particularly whilst pregnant so as to hold healthy babes.
Mentions
1. Allen, K. , Riley, M. and Halliday, J. ( 2007 ) Estimating the prevalence of FAS in Victoria utilizing routinely collected information. Aust N Z J Public Health31 ( 1 ) : pp62-66
2. Center for Disease Control ( 2003 ) Fetal intoxicant syndrome — Alaska, Arizona, Colorado, and New York, 1995-1997.MMWR: morbidity and mortality hebdomadal study 51 ( 20 ) ; 433-5
3. Ernster, V. L. ( 1994 ) Nested instance control surveies. Preventive medical specialty 23: pp587-590
4. Godel, J. ( 2002 ) Foetal Alcohol Syndrome. Paediatr Child Health 7 ( 3 ) : pp161-174
5. Hard, L.M. ( 2003 ) Alcohol dehydrogenase genotype, maternal intoxicant usage, and infant result – where are we now? J FAS Int 1: e5
6. May, P. , Brooke, L. , Croxford, J. , Adnams, C. , Robinson, L and Viljoen, D. ( 2000 ) Epidemiology of foetal intoxicant syndrome in a South African community in the Western Cape Province. Am J Public Health 90 ( 12 ) : pp1905-1912.
7. May, P. , Gossage, J. , Brooke, Snell, C. , L. Marais, A. , Hendricks, L. , Croxford J. and Viljoen, D. ( 2005 ) Maternal Risk Factors for Fetal Alcohol Syndrome in the Western Cape Province of South Africa: A Population-Based Study. Am J Public Health 95 ( 7 ) : pp1190-1199.
8. May, P. , Gossage, J. , Marais, A. , Adnams, C. , Hoyme, H. , Jones, K. Robinson, L. Khaloe, N. , Snell, C. , Kalberg, W. , Hendricks, L. , Brooke, L. , Stellavato C. and Viljoen, D. ( 2007 ) The epidemiology of foetal intoxicant syndrome and partial FAS in a South African community. Drug and Alcohol Dependence, 2007. 88 ( 2-3 ) : pp 259-271.
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18. Urban, M. , Chersich, M. , Fourie, L. , Chetty, C. , Olivier, L. and Viljoen, D. ( 2008 ) Fetal alcohol syndrome among grade 1 schoolchildren in Northern Cape Province: prevalence and hazard factors. S Afr Med J. ( 11 ) : pp877-82.
19. Viljoen, D.L. , Carr, L.G. , Forood, T.M. , Brooke L. , Ramsay M. and Li, T.K. ( 2001 ) Alcohol Dehydrogenase-2*2 Allele is Associated With Decreased Prevalence of Fetal Alcohol Syndrome in the Mixed-Ancestry Population of the Western Cape Province, South Africa. Alcoholism: Clinical and Experimental Research, 2001. 25 ( 12 ) : p. 1719-1722.
20. Viljoen, D.L. , Gossage, J.P. , Brooke, L. , Adnams, C.M. , Jones, K.L. , Robinson, L.K. , Hoyme, H.E. , Snell, C. , Khaole, N.C. , Kodituwakku, P. , Asante, K.O. , Findlay, R. , Quinton, B. , Marais, A.S. , Kalberg, W.O. and May P.A ( 2005 ) Fetal Alcohol Syndrome Epidemiology in a South African Community: A Second Study of a Very High Prevalence Area. J Stud Alcohol 66 ( 5 ) : pp593-604.
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