Perspectives of policymakers and service providers on why fetal alcohol spectrum disorders remain unabated in South Africa: A qualitative study

Fetal alcohol spectrum disorder (FASD) remains one of the leading sources of non-genetic intellectual and developmental disabilities globally. South Africa (SA) could be considered to bear the greatest burden of FASD globally with the recorded prevalence of FASD ranging from 29 to 290 per 1000 live births. Despite several efforts to reduce the incidence and prevalence of FASD in SA, its incidence and prevalence remain high. In this study, we examined the factors behind the sustained high incidence and prevalence of FASD in SA. Using an exploratory qualitative design, we explored the perspectives and experiences of 10 policymakers and 65 service providers on why FASD remains unabated despite various efforts to address the problem in SA. Ten in-depth interviews were conducted with policymakers and nine focus group discussions were conducted with the service providers in the Western Cape Province of SA. Data were analyzed inductively using the thematic analysis approach and emerging themes were deductively classified using the ecological model. Our findings revealed several reasons for the sustained high prevalence and increasing incidence of FASD in SA. At the individual level, late antenatal booking, alcohol consumption during pregnancy, and socio-economic conditions of individuals were identified as relevant factors driving the FASD prevalence in SA. Inadequate support groups for women were reported at the interpersonal level. The widespread availability of illegal liquor stores and inadequate specialized prevention programs were reported as community-level challenges. At the institutional level, the reasons included inadequate training of professionals and inadequate collaboration between government departments. At the policy level, the absence of a specific policy addressing FASD constitutes a significant barrier to the unabated FASD. The study findings suggest a cascade effect within the different levels of the ecological model highlighting the need for a holistic and systemic approach to preventing FASD in SA. The design and implementation of holistic, human rights-based, and inter-department policies and programs addressing the social determinants of FASD should be considered

Foetal alcohol spectrum disorder: The development of guidelines to inform policy

Philosophiae Doctor - PhDIntroduction: Maternal alcohol consumption during pregnancy can result to birth defects, which may be developmental, intellectual and physical. Fetal alcohol spectrum disorder (FASD) is a term used to describe an array of disorders related to alcohol consumption during pregnancy. FASD is a severe public health problem globally, with South Africa having the highest prevalence (29 to 290 per 1000 live births). What makes the FASD problem severe in the country is rife of maternal risk factors and widespread binge drinking during pregnancy. There is no policy specifically addressing FASD despite being pervasive in South Africa. Government programmes to prevent and manage FASD remain limited and fragmental across relevant departments. Herein, we aimed to conduct a multi-method study with a modified Delphi approach to developing a guideline to inform the development of a comprehensive and multi-sectoral policy for the prevention and management of FASD. Method and analysis: We used a modified version of the World Health Organization’s approach to guideline development in three phases. In phase 1, we conducted four different studies to design the initial guideline prototype. The studies include an in-depth interview with policymakers and a focus group with relevant service providers on policy requirements for FASD, a document review of policies on FASD and a scoping review of various interventions employed for the prevention and management of FASD. The second phase involved using the initially developed guideline prototype to engage with the local and international experts on FASD for improvement on the content. In the third phase, we refined the prototype using a modified Delphi approach. Framework method and content analysis were used to analyse the qualitative data while the Statistical Package for Social Science (SPSS) software was used to analyse the quantitative data

A guideline for the prevention and management of fetal alcohol spectrum disorder in South Africa

Fetal Alcohol Spectrum Disorder (FASD) is a public health problem globally, with South Africa having the highest recorded prevalence of all countries. Government programmes to prevent and manage FASD remain limited because of the lack of a specific policy. Herein, we developed a guideline to inform policy on the prevention and management of FASD in South Africa

Alcohol ban during the Covid-19 pandemic lockdown: Lessons for preventing foetal alcohol spectrum disorder in South Africa

During the two national lockdowns implemented in South Africa to curb the spread of the coronavirus disease 2019 (COVID-19) pandemic, the sale and consumption of alcoholic beverages were prohibited. There is observational evidence from the literature suggesting a drastic reduction in the emergency and trauma unit admissions in many South African hospitals and clinics with alcohol-related restrictions. This article explores the potential benefits of the restrictions placed on the sale and consumption of alcohol during the COVID-19 pandemic on preventing foetal alcohol spectrum disorder (FASD) in South Africa. Following the potential benefits of the alcohol bans, we recommended that the current South African national liquor policy and the 2012 South African government-drafted Bill for Control of Marketing of Alcoholic Beverages should be fully implemented and enforced. Furthermore, the ‘best buys’ by the World Health Organization (WHO) should be adapted (based on local evidence) and executed. Implementing the abovementioned policies can reduce alcohol abuse by limiting and regulating the manufacturing, distribution, advertising, sponsorship, promotion, physical availability and hours of sale of alcoholic beverages in South Africa

A pooled prevalence of fetal alcohol spectrum disorders in South Africa: a systematic review and meta-analysis protocol

Fetal Alcohol Spectrum Disorder (FASD) remains a global public health problem. South Africa is estimated to have the highest recorded prevalence of FASD. However, no study has systematically evaluated the available prevalence studies to provide estimates that may facilitate effective planning and delivery of prevention and management services. Therefore, we propose to conduct a systematic review and meta-analysis to report a pooled estimate of the FASD prevalence among children, youth and adults in South Africa.We will include quantitative (cohort and cross-sectional) studies that reported on the prevalence of FASD in South Africa. We will search databases such as Academic Search Complete, Education Resource Information Center (ERIC), SocINDEX, Health Source: Nursing/Academic Edition, Cumulative Index of Nursing and Allied Health and PsycARTICLES), Scopus, Science Direct, Springer Link, JSTOR, SAGE journals, PubMed, Web of Science and Sabinet. The references of included studies will be searched for additional studies on the prevalence of FASD. The search will be from inception to October 2021. Screening of (titles, abstracts and full text of the potentially relevant articles) will be done by two independent authors using software. All disagreements will be resolved by discussion. A standardised data extraction form will be designed for the extraction. Two authors will independently extract the data from the selected articles and all disagreements will be resolved by discussion. We will use a tool developed by Munn and colleagues to critically appraise all the included studies. The primary outcome will be the proportion of individuals with FASD in South Africa

Developing a logic model of change for the determinants of parental nurturance in the first 1000 days: A mixed-method study protocol

Parents play a key role in providing nurturance and nurturing care to their child during the first 1000 days which is important for optimal child development. Various factors have been found to influence parenting but the contribution of these factors toward parental nurturance within the first 1000 days is not yet known in the South African context. This paper describes a protocol for a project that aims to develop a logic model of change for the determinants of parental nurturance in the first 1000 days in the South African context

A comparison of the relationship between parental efficacy and social support systems of single teen mothers across different family forms in South African low socioeconomic communities

Teenage parenting is recognised as one of the greatest health and social problems in South Africa. Research in South Africa has shown that by the age of 18 years, more than 30% of teens have given birth at least once. Teen mothers may feel disempowered because they are ‘othered’ and consequently, may develop forms of resistance which in most cases may inhibit their ability to parent. Social support is therefore, an imperative intervention for successful teen parenting but this is not clearly understood in South Africa. This study aimed to compare the relationship between parental efficacy and social support systems of single teen mothers across different family forms

Covid-19 daily realities for families: A South African sample

The COVID-19 pandemic affected families globally. Empirical research has been explored to understand the impact of COVID-19 on families across countries, however, there are limited findings of how COVID-19 has affected the daily realities of families in South Africa. This study used an exploratory qualitative research approach to explore the experiences of COVID-19 for South African families. Findings suggest that the negative outcomes of COVID-19 experienced by South African families included a shift in the daily routines, restrictions on family events, lack of socialization and loss of connections, family conflicts, financial constraints as well as psychological impacts. On the contrary, the positive outcomes included increased family time and communication, cleanliness, and good health status, and improved financial management. Implications for future research should include research focused on the health impacts of COVID-19 on diverse family structures, family compositions, and family dynamics. In-depth research and findings can assist in developing policies and interventions for families

How South African families protected themselves during the COVID-19 pandemic: a qualitative study

The World Health Organization (WHO) reported a cluster of cases of ‘viral pneumonia’— ‘Coronavirus Disease 2019’ (COVID-19)—in Wuhan City, the People’s Republic of China on 31 December 2019. To curb the spread of the virus, various containment measures were introduced. However, no study has explored how families protected themselves during the pandemic. Therefore, this study explored how families protected themselves during the COVID-19 pandemic using a qualitative exploratory design. Thirty-one adult participants, representing families in the Western Cape province of South Africa, were virtually interviewed. The sampling approach was both convenient and snowball. The data were analysed using thematic analysis. The results show that families followed and adapted to the mainstream protection measures as implemented by the South African government but in addition believed that adherence to non-pharmaceutical interventions would protect them from contracting the virus. Therefore, the government and other stakeholders should support families in making it easier to protect themselves during the current and future pandemic(s)

Lessons learnt during covid-19 lockdown: A qualitative study of south african families

In a pandemic, such as COVID-19, with every single person struggling to deal with the unknown, it is often within the family that support is found but it is also within the family that circumstances, contexts and behaviours could further drive the pandemic and where they struggle to cope. This is novel research in the South African context with no known information regarding family life during and post the pandemic. This study, therefore, explores the lessons learnt during COVID-19 by South African families. A qualitative approach was employed to guide the gathering and analysis of the data. Data were collected from a sample of 31 family members above the age of 18 years from communities of the Western Cape Province and analysed through thematic analysis. According to the participants interviewed some of the significant lessons learnt from the lockdown include hygiene and health consciousness, appreciation for family, valuing life, self-introspection, less dependency, remote working, and financial savings. The realisation of such lessons even post-pandemic has the potential of strengthening families to be a resource of coping and resilience during very difficult times at the same time, contributing to greater physical, social, and economic functioning of families across South Africa