{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:10:43Z","timestamp":1775041843800,"version":"3.50.1"},"reference-count":31,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2017,8,9]],"date-time":"2017-08-09T00:00:00Z","timestamp":1502236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Alcohol consumption is high among farm labourers in the Western and Northern Cape of South Africa. Excessive alcohol consumption during pregnancy is common, resulting in a high prevalence of Fetal Alcohol Syndrome (FAS) among children. FAS causes intellectual and behavioural problems, which create considerable obstacles to a child\u2019s education. The aim of this study is to provide a prevalence estimate of FAS in a rural school and to examine the effects of FAS on learners\u2019 educational outcomes. The study was conducted at a farm school near Clanwilliam in theWestern Cape of South Africa. The sample comprises 166 learners from Grades 1 to 4. Educational outcomes include class scores (Afrikaans home language and mathematics), reading ability, and classroom behaviour. A physician diagnosed FAS using a three-stage process. We find FAS prevalence of 127 per 1000 (12.7%). Children with FAS score significantly lower (at the 10% level) for home language and behaviour than children who do not have FAS. Large-scale interventions in rural areas of the Western and Northern Cape that specifically target females of child-bearing age, as well as children with FAS, are necessary<\/jats:p>","DOI":"10.3390\/ijerph14080896","type":"journal-article","created":{"date-parts":[[2017,8,10]],"date-time":"2017-08-10T02:33:58Z","timestamp":1502332438000},"page":"896","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Prevalence of Fetal Alcohol Syndrome and Its Impact on a Child\u2019s Classroom Performance: A Case Study of a Rural South African School"],"prefix":"10.3390","volume":"14","author":[{"given":"Melissa","family":"Lubbe","sequence":"first","affiliation":[{"name":"School of Economics, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corn\u00e9","family":"Van Walbeek","sequence":"additional","affiliation":[{"name":"School of Economics, University of Cape Town, Cape Town 7700, South Africa"},{"name":"Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Vellios","sequence":"additional","affiliation":[{"name":"Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20154256","DOI":"10.1542\/peds.2015-4256","article-title":"Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders","volume":"138","author":"Hoyme","year":"2016","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/00004703-200408000-00002","article-title":"Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects","volume":"25","author":"Streissguth","year":"2004","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_3","first-page":"664","article-title":"The South African Comprehensive Risk Assessment Collaboration Group. Estimating the burden of disease attributable to alcohol use in South Africa in 2000","volume":"97","author":"Scheinder","year":"2007","journal-title":"S. Afr. Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.2105\/AJPH.2004.056366","article-title":"Using the past to step forward: Fetal alcohol syndrome in the Western Cape Province of South Africa","volume":"95","author":"McKinstry","year":"2005","journal-title":"Am. J. Public Health"},{"key":"ref_5","first-page":"59","article-title":"Human rights, environmental justice, and the health of farm workers in South Africa","volume":"9","author":"London","year":"2003","journal-title":"Int. J. Occup. Environ. Med."},{"key":"ref_6","unstructured":"Crush, J., and Ambler, C. (1992). Liquor and labour in the Western Cape 1870\u20131900. Liquor and Labor in Southern Africa, Ohio University Press."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1016\/S0277-9536(98)00445-6","article-title":"The \u2018dop\u2019 system, alcohol abuse and social control amongst farm workers in South Africa: A public health challenge","volume":"48","author":"London","year":"1999","journal-title":"Soc. Sci. Med."},{"key":"ref_8","unstructured":"(2017, July 26). Government Gazette, Available online: https:\/\/www.saps.gov.za\/resource_centre\/acts\/downloads\/liquor_act3.pdf."},{"key":"ref_9","first-page":"962","article-title":"Alcohol consumption by pregnant women in the Western Cape","volume":"89","author":"Croxford","year":"1999","journal-title":"S. Afr. Med. J."},{"key":"ref_10","unstructured":"Integrated Development Plan (2017, July 26). Cederberg Municipality Final IDP Review 2016\/17, Available online: http:\/\/www.cederbergmun.gov.za\/download_document\/819."},{"key":"ref_11","unstructured":"Rooibos Ltd. (2017, May 25). About Us: Company History. Available online: http:\/\/www.rooibosltd.co.za\/rooibos-company-profile.php."},{"key":"ref_12","unstructured":"Noshpitz, J.D. (1997). Substance abuse, fetal alcohol syndrome, and related neonatal disorders. Handbook of Child and Adolescent Psychiatry Volume 1: Infants and Preschoolers: Development and Syndromes, John Wiley & Sons, Inc."},{"key":"ref_13","unstructured":"Streissguth, A., and Kanter, J. (1999). Neurobehavioral and neuroantomical effects of heavy prenatal exposure to alcohol. The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities, University of Washington Press."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e290","DOI":"10.1016\/S2214-109X(17)30021-9","article-title":"Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: A systematic review and meta-analysis","volume":"5","author":"Popova","year":"2017","journal-title":"Lancet Glob. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1080\/02796015.2005.12088009","article-title":"Observing students in classroom settings: A review of seven coding schemes","volume":"34","author":"Volpe","year":"2005","journal-title":"School Psychol. Rev."},{"key":"ref_16","unstructured":"Canadian Academy of Child and Adolescent Psychiatry (2003). Diagnosis of fetal alcohol syndrome (FAS). Can. Child Adolesc. Psychiatr. Rev., 12, 81\u201386."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.drugalcdep.2016.09.025","article-title":"The continuum of fetal alcohol spectrum disorders in a community in South Africa: Prevalence and characteristics in a fifth sample","volume":"168","author":"May","year":"2016","journal-title":"Drug Alcohol Depend."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"May, P., De Vries, M., Marais, A.-S., Kalberg, W., Buckley, D., Adnams, C., Hasken, J., Tabachnick, B., Robinson, L., and Manning, M. (2017). Replication of high fetal alcohol spectrum disorders prevalence rates, child characteristics, and maternal risk factors in a second sample of rural communities in South Africa. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14050522"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/acer.12939","article-title":"Worldwide prevalence of fetal alcohol spectrum disorders: A systematic literature review including meta-analysis","volume":"40","author":"Roozen","year":"2016","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1111\/j.1530-0277.1995.tb01025.x","article-title":"A fetal alcohol syndrome screening tool","volume":"19","author":"Astley","year":"1995","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1542\/peds.2009-0712","article-title":"Prenatal alcohol exposure and neurodevelopmental disorders in children adopted from eastern Europe","volume":"125","author":"Landgren","year":"2010","journal-title":"Pediatrics"},{"key":"ref_22","first-page":"660","article-title":"Fetal alcohol syndrome\u2014South Africa 2001","volume":"52","author":"Viljoen","year":"2003","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_23","first-page":"877","article-title":"Fetal alcohol syndrome among Grade 1 schoolchildren in Northern Cape Province: Prevalence and risk factors","volume":"98","author":"Urban","year":"2008","journal-title":"S. Afr. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"402","DOI":"10.7196\/SAMJ.6249","article-title":"Burden of fetal alcohol syndrome in a rural West Coast area of South Africa","volume":"103","author":"Olivier","year":"2013","journal-title":"S. Afr. Med. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1111\/acer.12726","article-title":"Prevalence of fetal alcohol syndrome in a South African city with a predominantly Black African population","volume":"39","author":"Urban","year":"2015","journal-title":"Alcohol Clin. Exp. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.2105\/AJPH.90.12.1905","article-title":"Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province","volume":"90","author":"May","year":"2000","journal-title":"Am. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"593","DOI":"10.15288\/jsa.2005.66.593","article-title":"Fetal alcohol syndrome epidemiology in a South African community: A second study of a very high prevalence area","volume":"66","author":"Viljoen","year":"2005","journal-title":"J. Stud. Alcohol"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.drugalcdep.2006.11.007","article-title":"The epidemiology of fetal alcohol syndrome and partial FAS in a South African community","volume":"88","author":"May","year":"2007","journal-title":"Drug Alcohol Depend."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1111\/acer.12033","article-title":"Approaching the prevalence of the full spectrum of fetal alcohol spectrum disorders in a South African population-based study","volume":"37","author":"May","year":"2013","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1177\/1524838014537908","article-title":"Childhood maltreatment and educational outcomes","volume":"16","author":"Romano","year":"2015","journal-title":"Trauma Violence Abus."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"De Vries, M., Joubert, B., Cloete, M., Roux, S., Baca, B., Hasken, J., Barnard, R., Buckley, D., Kalberg, W., and Snell, C. (2016). Indicated prevention of fetal alcohol spectrum disorders in South Africa: Effectiveness of case management. Int. J. Environ. Res. Public Health, 13.","DOI":"10.3390\/ijerph13010076"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/8\/896\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:41:54Z","timestamp":1760208114000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/8\/896"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,9]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2017,8]]}},"alternative-id":["ijerph14080896"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14080896","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8,9]]}}}