Viljoen Denis L, Gossage J Phillip, Brooke Lesley, Adnams Colleen M, Jones Kenneth L, Robinson Luther K, Hoyme H Eugene, Snell Cudore, Khaole Nathaniel C O, Kodituwakku Piyadasa, Asante Kwadwo Ohene, Findlay Richard, Quinton Barbara, Marais Anna-Susan, Kalberg Wendy O, May Philip A
Department of Human Genetics, Faculty of Health Sciences, University of Witwatersrand, National Health Laboratory Services, South Africa.
J Stud Alcohol. 2005 Sep;66(5):593-604. doi: 10.15288/jsa.2005.66.593.
The aim of the study was to determine the prevalence and characteristics of fetal alcohol syndrome (FAS) in a second primary school cohort in a community in South Africa.
Active case ascertainment, two-tier screening, and Institute of Medicine assessment methodology were employed among 857 first grade pupils, most born in 1993. Characteristics of children with FAS were contrasted with characteristics of a randomly selected control group from the same classrooms. Physical growth and development, dysmorphology and psychological characteristics of the children and measures of maternal alcohol use and smoking were analyzed.
The rate of FAS found in this study is the highest yet reported in any overall community in the world, 65.2-74.2 per 1,000 children in the first grade population. These rates are 33-148 times greater than U.S. estimates and higher than in a previous cohort study in this same community (40.5-46.4 per 1,000). Detailed documentation of physical features indicates that FAS children in South Africa have characteristics similar to those elsewhere: poor growth and development, facial and limb dysmorphology, and lower intellectual functioning. Frequent, severe episodic drinking of beer and wine is common among mothers and fathers of FAS children. Their lives are characterized by serious familial, social and economic challenges, compared with controls. Heavy episodic maternal drinking is significantly associated with negative outcomes of children in the area of nonverbal intelligence but even more so in verbal intelligence, behavior and overall dysmorphology (physical anomalies). Significantly more FAS exists among children of women who were rural residents (odds ratio: 7.36, 95% confidence interval: 3.31-16.52), usually among workers on local farms.
A high rate of FAS was documented in this community. Given social and economic similarities and racial admixture, we suspect that other communities in the Western Cape have rates that also are quite high.
本研究旨在确定南非一个社区第二所小学队列中胎儿酒精综合征（FAS）的患病率及特征。
对857名一年级学生（大多出生于1993年）采用主动病例确诊、两级筛查及医学研究所评估方法。将FAS患儿的特征与从同一教室随机选取的对照组儿童的特征进行对比。分析了儿童的身体生长发育、畸形学特征及心理特征，以及母亲饮酒和吸烟情况。
本研究发现的FAS发生率是世界上任何总体社区中报告的最高值，一年级人群中每1000名儿童中有65.2 - 74.2例。这些发生率比美国的估计值高33 - 148倍，且高于该社区之前的队列研究（每1000名中有40.5 - 46.4例）。身体特征的详细记录表明，南非的FAS患儿具有与其他地方患儿相似的特征：生长发育不良、面部和肢体畸形以及智力功能较低。FAS患儿的父母中，频繁、大量饮用啤酒和葡萄酒的情况很常见。与对照组相比，他们的生活面临严重的家庭、社会和经济挑战。母亲大量饮酒与儿童在非语言智力方面的负面结果显著相关，但在语言智力、行为和整体畸形（身体异常）方面更是如此。农村居民女性的子女中FAS发生率显著更高（优势比：7.36，95%置信区间：3.31 - 16.52），通常是当地农场工人的子女。
该社区记录到FAS的高发生率。鉴于社会经济相似性和种族混合情况，我们怀疑西开普省的其他社区发生率也相当高。
