However, the latest FAS statistics for De Aar (published in the scientific journal Alcohol and Alcoholism in October last year) tells a more hopeful story ‘€“ there has been a 30% drop in the FAS rate since the 2002-study thanks to an intervention programme by the Foundation for Alcohol Related Research (FARR).  Although this is a remarkable achievement since it is the highest ever reported decrease in a FAS community prevalence rate in the world, De Aar’€™s current rate of 8.5% is still among the highest reported.

Another first for FARR happened recently when its founder, Professor Denis Viljoen, received the Henry Rosett Award from the Research Society on Alcoholism, an international body of scientists studying alcoholism and related topics. Viljoen is the first non-American ever to receive this award in recognition of the contribution his extensive research has made to the field of FAS.

High rates of poverty

‘€œWhere there is poverty, you will find FAS,’€ said Viljoen who was the principle investigator of the 2002-study that revealed the shockingly high prevalence of FAS in De Aar. This stern, no-nonsense semi-retired professor has little time for the media who he believes have in the past portrayed the communities he works in, in a poor light instead of addressing the underlying issues that cause and drive the problem.

The unemployment rate in De Aar is soaring at a staggering 80% and unsurprisingly many people in the community live in poverty. This small, dusty town in the arid Northern Cape used to have a large railway repair and manufacturing yard and work opportunities attracted many people to De Aar. But as activity at the railway declined, so did the job opportunities.

‘€œJoblessness and poverty has created a general feeling of hopelessness in the community,’€ said the FARR area-coordinator, Lian-Marie Drotsky, who is stationed at the ‘€œpink house’€ in De Aar from where the foundation conducts research and operates FAS community prevention programmes in the area.

Due to the high rate of poverty many pregnant mothers are malnourished which also stunts the foetus’€™ development. ‘€œThere were women weighing just 40kg,’€ said Viljoen. ‘€œThey are like match sticks.’€

Because of their low body weight and poor general health, these women have a much lower alcohol tolerance than normal-weight women. For this reason, these women wouldn’€™t have to drink a lot of alcoholic products for their babies to be affected.

‘€˜Nothing to do but drink’€™

Viljoen believes that the lack of job opportunities and recreation drive people to alcohol. ‘€œIn the very poor communities, alcohol is the recreation.’€

The high number of shebeens aggravates the issue. De Aar has a population of 28  000 and at last count, more than 100 shebeens ‘€“ that is one shebeen for every 280 people in town.

‘€œAlcohol is available everywhere, and now they even have mobile shebeens,’€ said Viljoen. These are bakkies stocked with alcohol that travel to farms to sell alcohol in communities that are far from shebeens or bottle stores. Shebeens also sell alcohol on credit, therefore giving people access to alcohol even when they don’€™t have money to buy it.

‘€œThe ‘€˜dop’€™ system has been replaced by shebeens,’€ said Viljoen, who believes that the ‘€œdrinking culture’€ was first introduced into these communities with the ‘€œdop’€ system that allowed workers to be paid a part of their wages in alcohol.  

Intervention

‘€œIt is really difficult to go into a population anywhere and find a problem, and just withdraw and write about it,’€ said Viljoen. ‘€œI don’€™t think it is totally ethical if you are not prepared to make some effort to alleviate the bad findings.’€

After studying the population and finding the alarming 12.2% FAS rate, FARR decided to implement an intervention programme to try and lower the stats. In 2003 FARR launched a study where they implemented an intervention programme and compared the FAS rates in the community before and after. This study eventually recorded the 30% drop in the FAS rate.

For their research, they recruited pregnant women visiting the local antenatal clinics. They then determined each individual’€™s risk for having a FAS baby, and implemented an intervention strategy according to the women’€™s risk. Low-risk women were counselled on the dangers of drinking and smoking during pregnancy; medium-risk women were counselled and followed-up throughout their pregnancy; and women at high risk were sent for rehabilitation to try and manage their alcohol use, and also received counselling, and were followed-up throughout their pregnancies.

The babies born from these mothers were followed up at nine months of age, and only 8.5% were diagnosed with FAS compared to the previous 12.2%.

The intervention didn’€™t have a positive effect on the FAS rate only, it also improved the morale of the community. ‘€œThese women [that were enrolled in the study] were the poorest of the poor ‘€“ they were malnourished and often didn’€™t take very good care of themselves,’€ said Viljoen. But through the counselling they received from the FARR fieldworkers and ‘€œbecause of our bonding with them, they became, almost ‘€˜model citizens’€™,’€ said Viljoen.  ‘€œThey started dressing better, they groomed themselves better, their own nutrition improved ‘€“ they weren’€™t the same group of women we started off with initially.’€

Since that first intervention study, FARR has implemented a ‘€œHealthy Mother, Healthy Baby’€ programme, aimed at teaching mothers about the advantages of a healthy pregnancy, as well as a ‘€œFAStrap’€ programmed to teach community members and parents with FAS children to manage their child’€™s impairment. They also provide a daily meal for up to 90 needy children ‘€“ many of who have FAS ‘€“ and pregnant women, and have a programme teaching FAS children to play musical instruments. Furthermore they implemented a ‘€œDo you have three minutes?’€ project whereby nurses at the antenatal clinics can identify pregnant women at risk of having a FAS baby by asking just three simple questions ‘€“ that take only three minutes.

‘€œI think the actual rate of FAS will continue to drop according to the amount of effort you put in,’€ said Viljoen. ‘€œYou can’€™t just attack it from one side, you have to go as broad as possible.’€

But all these projects cost money, and funding for FAS projects are scarce. ‘€œWe actually nearly closed down the De Aar centre recently. We did everything we could to possibly do to raise funds ‘€“ it takes R1 million to keep the project running for the year. Then, at the very last minute, we were given rescue for a year.’€

So the intervention projects will continue for another year, hopefully saving another 50-odd children from developing FAS, and helping the De Aar community carry the burden of FAS for a while longer. But there are 60 other towns just in the Northern Cape that has exactly the same problem, reminds Viljoen, ‘€œbut they don’€™t have any FARR programme.’€

***ADDITIONAL ARTICLES***

Different levels of FAS

FAS develops when a mother consumes alcohol during pregnancy. Alcohol inhibits cell growth and if a foetus is exposed to it in the womb, it can impair the development of organs, most often affecting the brain. There is no cure for FAS and the child is impaired for life.

 How much the foetus is affected depends on various factors, such as the amount of alcohol the mother drinks, her bodyweight, and overall health.

The effects may range from mild mental impairment to severe disability and delayed physical development. The range of mental and physical disorders is known as foetal alcohol spectrum disorders (FASD), of which foetal alcohol syndrome (FAS) is the most severe form. It is characterised by physical symptoms such as specific facial features, a smaller head circumference, and lower weight than children of the same age. Neurological symptoms of FAS include impaired mental functioning that leads to learning and behavioural problems.

It is believed that of the 50 million South Africans, around 2 million suffer from FAS, while a 4 or 5 million have FASD.

Foetal alcohol exposure linked to crime

A 1997-study by Prof Ann Streissguth and colleagues from the University of Washington Medical School in Seattle, in the United States, found that people with foetal alcohol syndrome (FAS) or the milder foetal alcohol spectrum disorders (FASD), often have trouble with the law.

In the study they followed 415 individuals with FAS or FASD and found that 14% of subjects between the ages of 6 and 11, 61% of adolescents, and 58% of adults had run afoul of the law at least once. Overall, 60% of FAS/FASD subjects age 12 or over had been in trouble with the authorities, charged with a crime, or convicted of a crime.

Streissguth et al. also report that 60% of subjects age 12 or older had been suspended or expelled from school, or dropped out, and almost a third of subjects age 12 or older had abused drugs and/or alcohol.

Sources: Crime Times; Alcohol and Alcoholism; South African Medical Journal