Fetal Alcohol Syndrome in the Western Cape, South Africa: Multiple exposures in a particularly vulnerable population, and what to do about it? EH Seminar Nov. 8th

in Fellowships
November 7th, 2013

November 8:  noon-1pm  L210

Title: “Fetal Alcohol Syndrome in the Western Cape, South Africa: Multiple exposures in a particularly vulnerable population, and what to do about it?”

Speaker: Leslie London, MD

Professor, School of Public Health and Family Medicine, University of Cape Town and Associate Director of the Centre for Occupational and Environmental Health Research,



Rural farming communities in the Western Cape province of South Africa are a vulnerable community who experience a diversity of hazardous exposures. One particular phenomenon that captures this conundrum is that of Foetal Alcohol Syndrome (FAS). FAS has been reported in 5 to 10% of school-going children in the province, which are rates that are the highest in the world, much higher than even so-called high-risk populations in North America. The direct antecedent of FAS, alcohol consumption in pregnancy, is itself a product of multiple behavioural, social and historical factors related to alcohol consumption by workers in agriculture in the region. However, consumption of alcohol during pregnancy may not be sufficient to explain these tremendously high rates, since the alcohol consumption of Western Cape mothers with FAS children is not as high as in other high-risk populations. There may thus be other factors common in this population which contribute individually, or synergistically, to increased risk of intra-uterine damage. Candidate exposures include pesticides, smoking and toxic contaminants within cheap wine drunk in the Western Cape, and genetic and nutritional deficits may also interact in the genesis of a public health calamity of this scale. Understanding the aetiology of the FAS epidemic in its fullest dimensions in the Western Cape, using the full range of exposure science characterization, is critical to successful interventions to reduce the burden of disease due to FAS in the region, particularly given that community-based interventions and upstream public health policies are likely to be the mainstay of FAS prevention.


1.            London L, Mazok H, Adams H, Parry C. If the alcohol doesn’t get you, then the toxins will:

The health impacts of bulk wine provision in the Western Cape province of South Africa. Poster presented to the American Public Health Association conference, Nov 2006.

[Source document is Henn C, Adam H, London L. (2005). The impact of bulk wine on Western Cape communities. Report to the Department of Economic Development and Tourism. DOPSTOP, Stellenbosch – available on request.]

Other background reading:

1.            Morojele NK, London L, Olorunju SA, Matjila J, Davids AS, Rendall-Mkosi KM. Predictors of Risk of Alcohol-Exposed Pregnancies among Women in an Urban and a Rural Area of South Africa.  SocSci Med 2010;70: 534-42.

2.            May PA, Gossage JP, Marais AS, et al.The epidemiology of fetal alcohol syndrome and partial FAS in a South African community. Drug Alcohol Depend. 2007 May 11;88(2-3):259-71.

Optional Reading

1.            Rendall-Mkosi K, London L, Adnams C, Morojele N, McLoughlin J, Goldstone C. Fetal Alcohol Spectrum Disorder in South Africa: Situational and Gap Analysis. Unicef, Pretoria, March 2008. http://www.unicef.org/southafrica/SAF_resources_fetalalcohol.pdf

2.            London L. Alcohol consumption amongst South African farm workers: a post-apartheid challenge. Drug and Alcohol Dependence 2000 ; 59 : 199-206.Topic:  Differentiating the Impacts of Alcohol and Alcohol Contaminant Exposures in Promoting Fetal Alcohol Syndrome