Epidemiology of fetal alcohol syndrome in a South African community in theWestern Cape Province

Objectives. This study determined the characteristics of fetal alcohol synd rome in a South African community, and methodology was designed for the mul tidisciplinary study of fetal alcohol syndrome in developing societies. Methods. An active case ascertainment 2-tier methodology was used among 992 first-grade pupils. A case-control design, using measures of growth, devel opment, dysmorphology, and maternal risk, delineated characteristics of chi ldren with fetal alcohol syndrome. Results. A high rate of fetal alcohol syndrome was found in the schools-40. 5 to 46.4 per 1000 children aged 5 to 9 years-and age-specific community ra tes (ages 6-7) were 39.2 to 42.9. These rates are 18 to 141 times greater t han in the United States. Rural residents had significantly more fetal alco hol syndrome. After control for ethnic variation, children with fetal alcoh ol syndrome had traits similar to those elsewhere. poor growth and developm ent, congruent dysmorphology, and lower intellectual functioning. Conclusions. This study documented the highest fetal alcohol syndrome rate to date in an overall community population. Fetal alcohol syndrome initiati ves that incorporate innovative sampling and active case ascertainment meth ods can be used to obtain timely and accurate data among developing populat ions.