The town with the highest known rates of foetal alcohol syndrome in the world is De Aar, which is roughly in the centre of South Africa in the country’s largest and most sparsely populated province.
New research has confirmed that at least 12 out of every 100 children in the Northern Cape town have been damaged by alcohol while in their mother’s womb. About 80% of the 27 000 people living in the town are unemployed.
In 2000, researchers and local health authorities examined all children entering school, usually between the ages of six and eight.
Their ”horrendous” finding, says Denis Viljoen of the Foundation for Alcohol Related Research (Farr) is that 12% of children exhibited the syndrome. Although such high levels had been found in isolated and deprived groups elsewhere in the world, it was the first time such a high incidence had been found in an entire population of children entering schools.
About one million people in South Africa are affected by the mental retardation and physical effects of foetal alcohol syndrome.
Children and adults living with the syndrome face a life of certain poverty and social dysfunction, especially as many are born to parents who were themselves damaged by alcohol as infants.
Excessive alcohol during pregnancy retards division of cells in the foetal brain and stops the neural cells migrating to their correct positions. The result is a smaller brain and one that is wired incorrectly. The two factors together cause a decrease in intelligence as well as behavioural problems.
The effect on children includes problems at school because they have difficulty concentrating, processing and remembering facts. But children with the syndrome also have social problems and are more likely to get into trouble because they fail to pick up social cues.
As they age, they often get involved in petty crime. The social dysfunction can extend to sexual relationships, causing sexual offences.
People with the syndrome have certain facial characteristics. The diagnosis is clinical — there is no laboratory test. The Farr researchers worked in three stages: screening children to identify those they thought had the syndrome and a control group of children who did not; neuropsychometric evaluations of both groups; and in depth interviews with the mothers.
Foetal alcohol syndrome is a disease of poverty because the effects are most severe when the mother herself is small and malnourished.
Successive research projects in the Western Cape have found rising levels of the syndrome, from 4,5% in 1997 to 6,5% in 1999 and 7,8% in 2002. A study in four communities in Gauteng found 2,2% of the population had the syndrome.
Local politicians and community leaders were shocked at the figures and expressed anger. ”We were threatened we would be taken to court,” says Viljoen about the study in De Aar. Further studies in 2004, 2005 and now the latest data from 2006 and 2007 have found the same levels of the syndrome.
Other studies in 13 primary schools in another Northern Cape town found a slightly better result — 7,4% of children had the syndrome. To put this and the results from De Aar in context, ”normal” levels of the syndrome in developed countries are between 0,1% and 0,3% of children.
Small population groups considered to have critical levels of alcohol problems in the United States, for example some native American communities, have foetal alcohol syndrome in up to 2% of children.
Malnutrition is an exacerbating factor in causing the syndrome. The problem was lower among native American women studied, even though they drank almost twice as much as women in the Northern Cape.
A key factor is the size and health of the mother and the style of drinking. Women in the Northern Cape tend to be small, between 40kg and 45kg on average. They are binge drinkers. Payday is Friday and the weekend is spent drinking. This also happens after social grants are paid.
The levels of the syndrome are higher on the outskirts of towns, including farms.
Viljoen says there is a belief that alcohol consumed in these communities is home-made, or even methylated spirits, but usually it is commercially available. The notorious dop system, in which alcohol was part of a worker’s wages, might have created a culture of drinking within these communities.
Today enterprising shebeen owners and taxi drivers take bakkie-loads of alcohol to farms where workers buy it, often on credit.
”On top of malnutrition, TB [tuberculosis] and Aids, alcohol drives a nail into the heart of the community. We need to stop the spin of the wheel of misfortune in these communities,” says Viljoen.
Education and help for the mothers are key to prevention, says Viljoen. ”These women are in the poorest circumstances.”