A randomized controlled trial of motivational interviewing to prevent risk for an alcohol-exposed pregnancy in the Western Cape, South Africa

Aim To test the effectiveness of motivational interviewing (MI) to reduce the risk of an alcohol exposed pregnancy (AEP) in a high-risk population. Design Randomized controlled trial. Setting Rural population in the Western Cape, South Africa. Participants A total of 165 women aged 18–44 years at risk of AEP. Intervention Five-session MI intervention. Measurements Structured questionnaires were administered pre-intervention and at 3 and 12 months follow-up. The primary outcome measure was AEP at 12 months. Secondary outcomes were AEP at 3 months, and alcohol use and effective contraception at 3 and 12 months. Findings There was a significant difference in the decline in the proportion of women at risk for an AEP in the MI group at 3 months (50 versus 24.59%; P = 0.004), maintained at 12 months (50.82 versus 28.12%; P = 0.009). In an intention-to-treat analysis these differences were also significant (32.93 versus 18.07%; P = 0.029; and 37.80 versus 21.69%; P = 0.024, respectively). The odds ratio for no longer being at risk of an AEP (MI versus control) at 12 months was 2.64 [95% confidence interval (CI): 1.18–5.94]. In the intention-to-treat analysis this ratio was 2.19 (95% CI: 1.05–4.65). Conclusions A five-session motivational interviewing intervention was found to be effective with women at risk of an alcohol-exposed pregnancy, and could be implemented as part of routine primary care clinic services in similar populations. The message of ‘no alcohol in pregnancy’ should be adapted to include better family planning and early recognition of pregnancy.Cooperative Agreement Number 1 U01 DD00044 from the Centers for Disease Control and Prevention (CDC).http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1360-0443hb2013ay201

Community health and GIS: using GPS and GIS for foetal alcohol syndrome education and outreach in the Bergriver Municipality in the Western Cape, South Africa

Poster presented at the Sixth PHASA Conference, East London. 29 November-1 Decembe

Community health and GIS: using GPS and GIS for fetal alcohol syndrome education and outreach in the Bergriver Municipality in the Western Cape, South Africa

Paper presented at the MapAfrica 2010 Conference, Cape Town, 23-25 Novembe

Liquor outlet density, deprivation and implications for foetal alcohol syndrome prevention in the Bergriver municipality in the Western Cape, South Africa

Foetal alcohol syndrome (FAS) is the most common preventable birth defect in the world, and some South African communities have amongst the highest reported rates. In August 2008, global positioning systems and geographic information systems (GIS) were used to collect data on legal and illegal alcohol outlets in the Bergriver municipality. A total of 112 outlets were recorded and towns with the densest distributions (outlet/km2) were Piketberg and Eendekuil. Spearman coefficients were used to estimate the relationship between alcohol outlet distributions within the study area and the South African Index of Multiple Deprivation. Although not statistically significant, the data are suggestive of an inverse relationship between legal alcohol outlets and deprivation less deprived areas had higher density of legal alcohol outlets while the opposite relationship applied for illegal alcohol outlets. GIS provides spatial documentation of determinants of FAS risks amenable to geographically based prevention strategies, as well as providing baseline data to evaluate the effectiveness of liquor legislation aimed at controlling access to alcohol. Results are being repurposed into health education materials that encourage community action to address the social determinants of health outcomes such as FAS.

Factors associated with female high-risk drinking in a rural and urban South African site

Objective. To assess and compare the extent of high-risk drinking and factors associated with high-risk drinking in the adult female population of a rural and an urban region in South Africa. Design. Cross-sectional household survey using multistage sampling methods. Setting. A rural wine farming area of the Western Cape and an urban site in Gauteng. Subjects. Women of reproductive age (18 - 44 years). Outcome measures. The extent of risky alcohol consumption measured using the Alcohol Use Disorders Identification Test (AUDIT) scale which categorises current drinkers into high- and low-risk drinkers. Results. Twenty-seven per cent (166/606) and 46% (188/412) of the women interviewed in Gauteng and the Western Cape respectively were current drinkers. In turn, 20% (33/166) of the Gauteng current drinkers and 68% (128/188) of the Western Cape current drinkers were classified as high-risk drinkers. Multivariate analysis indicated that employed people in Gauteng were less likely to be high-risk drinkers (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1 - 0.8). Living in a household that never/seldom went hungry was inversely associated with risky drinking for both sites (OR 0.3, 95% CI 0.1 - 0.9 for Gauteng and OR 0.2, 95% CI 0.3 - 1.2 for the Western Cape). Current smokers (Western Cape) (OR 7.6, 95% CI 3.1 - 18.9) and respondents with an alcohol problem in one or more family members (both sites) (OR 6.0, 95% CI 2.3 - 15.7 and OR 3.1, 95% CI 1.5 - 6.4) were more likely to be high-risk drinkers. Conclusions. High-risk drinking by women is a major problem, especially in the Western Cape. Targeted interventions are needed for women with alcohol problems in the family setting, lower socio-economic status, and concurrent substance abuse.

Predictors of risk of alcohol-exposed pregnancies among women in an urban and a rural area of South Africa

The study sought to determine the prevalence and predictors of being at risk of an alcohol-exposed pregnancy (AEP) among women of child-bearing age in an urban and rural location in South Africa. We conducted a cross-sectional household survey of 1018 women aged 18-44 years in one urban (n = 606) and one rural (n = 412) site. The women were interviewed using a structured questionnaire. We defined the primary dependent variable, being at risk of having an AEP, as current alcohol use, not being pregnant, being fertile, and no effective use of contraceptives. The independent variables included demographic, substance use, health perceptions, psycho-social, and partner characteristics. The rural women (21.84%) were more likely than their urban counterparts (11.22%) to be at risk of an AEP. In multiple logistic regression analyses, significant predictors of being in the "at risk" group for the urban women were (a) being 'white' as opposed to 'black/African', and being 'coloured' as opposed to 'black/African'; and (b) current smoking. For the rural women, significant risk factors were (a) current smoking and (b) early onset of alcohol use. The significant protective factors were (a) education; (b) knowledge about Fetal Alcohol Syndrome; (c) parity. Use of stricter alcohol use criteria (i.e., three or more drinks and five or more drinks per sitting) in the definition of risk of an AEP yielded slightly different patterns of significant predictors. The results revealed high levels of risk of an alcohol-exposed pregnancy, especially amongst the rural women, and a need for location-specific prevention programmes. The high burden of AEP in South Africa calls for the establishment of national AEP prevention strategies and programmes as a matter of urgency.South Africa Fetal Alcohol Syndrome Alcohol-exposed pregnancy Alcohol consumption Contraception Women

Predictors of risk of alcohol-exposed pregnancies among women in an urban and a rural area of South Africa

The study sought to determine the prevalence and predictors of being at risk of an alcohol-exposed pregnancy (AEP) among women of child-bearing age in an urban and rural location in South Africa. We conducted a cross-sectional household survey of 1018 women aged 18–44 years in one urban (n ¼ 606) and one rural (n ¼ 412) site. The women were interviewed using a structured questionnaire. We defined the primary dependent variable, being at risk of having an AEP, as current alcohol use, not being pregnant, being fertile, and no effective use of contraceptives. The independent variables included demographic, substance use, health perceptions, psycho-social, and partner characteristics. The rural women (21.84%) were more likely than their urban counterparts (11.22%) to be at risk of an AEP. In multiple logistic regression analyses, significant predictors of being in the ‘‘at risk’’ group for the urban women were (a) being ‘white’ as opposed to ‘black/African’, and being ‘coloured’ as opposed to ‘black/African’; and (b) current smoking. For the rural women, significant risk factors were (a) current smoking and (b) early onset of alcohol use. The significant protective factors were (a) education; (b) knowledge about Fetal Alcohol Syndrome; (c) parity. Use of stricter alcohol use criteria (i.e., three or more drinks and five or more drinks per sitting) in the definition of risk of an AEP yielded slightly different patterns of significant predictors. The results revealed high levels of risk of an alcohol-exposed pregnancy, especially amongst the rural women, and a need for location-specific prevention programmes. The high burden of AEP in South Africa calls for the establishment of national AEP prevention strategies and programmes as a matter of urgency

Establishing a health promotion and development foundation in South Africa

South Africa has a 'quadruple burden of disease'. One way to reduce this burden, and address the social determinants of health and social inequity, could be through health promotion interventions driven by an independent Health Promotion and Development Foundation (HPDF). This could provide a framework to integrate health promotion and social development into all government and civil society programmes. On priority issues, the HPDF would mobilise resources, allocate funding, develop capacity, and monitor and evaluate health promotion and development work. Emphasis would be on reducing the effects of poverty, inequity and unequal development on disease rates and wellbeing. The HPDF could also decrease the burden on the proposed National Health Insurance (NHI) system. We reflect on such foundations in other countries, and propose a structure for South Africa's HPDF and a dedicated funding stream to support its activities. In particular, an additional 2% levy on alcohol and tobacco products is proposed to be utilised to fund the HPDF.

Establishing a Health Promotion and Development Foundation in South Africa

South Africa has a ‘quadruple burden of disease’. One way to reduce this burden, and address the social determinants of health and social inequity, could be through health promotion interventions driven by an independent Health Promotion and Development Foundation (HPDF). This could provide a framework to integrate health promotion and social development into all government and civil society programmes. On priority issues, the HPDF would mobilise resources, allocate funding, develop capacity, and monitor and evaluate health promotion and development work. Emphasis would be on reducing the effects of poverty, inequity and unequal development on disease rates and wellbeing. The HPDF could also decrease the burden on the proposed National Health Insurance (NHI) system. We reflect on such foundations in other countries, and propose a structure for South Africa’s HPDF and a dedicated funding stream to support its activities. In particular, an additional 2% levy on alcohol and tobacco products is proposed to be utilised to fund the HPDF.DHE