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Background: South Africa has the highest rate of fetal alcohol spectrum disorders (FASD) globally. As with alcohol use during pregnancy, alcohol consumption while breastfeeding adversely impacts infant development. We pilot tested an incentive‐based text‐messaging intervention to reduce alcohol use during pregnancy and lactation in South Africa. Methods: A single‐arm pilot trial was conducted over 3 months in healthcare facilities in Cape Town, South Africa. Pregnant and breastfeeding participants tested positive for recent alcohol use by urinalysis. The three‐month intervention had two components, contingency management of alcohol abstinence confirmed by urinalysis twice weekly and weekly health‐related text messaging from an evidence‐based brief intervention. We collected twice weekly urine samples for measurement of ethyl glucuronide (EtG), an alcohol biomarker, and measures of self‐reported alcohol and drug use, violence exposure, and mental health at six weeks and three months post‐enrollment. Results: Sixty participants were enrolled, of whom 31 were pregnant and 29 lactating. The number of days with four or more drinks in the past month decreased from 9 days at baseline, on average, to 1–3 days (p‐value range: 0.144–0.010) at follow‐up timepoints. There were statistically significant increases in the proportions of participants with alcohol‐negative urine tests (p < 0.001). The percentages of participants breastfeeding while using alcohol decreased from baseline to the end of 3 months in the overall sample and among those enrolled postpartum, though these were not significant (p‐value range: 0.255–0.147). Maternal depression scores also decreased among participants enrolled postpartum (p = 0.054). Emotional abuse by the main partner, but neither physical nor sexual abuse, significantly decreased at both follow‐ups in the overall sample (p = 0.032) and among participants enrolled while pregnant (p = 0.015). Conclusions: This study is among the first to pilot test an incentive‐based text‐messaging intervention for maternal alcohol use and other outcomes such as depression and violence exposure. Further testing is warranted in a well‐powered, randomized controlled trial. [ABSTRACT FROM AUTHOR]

South Africa has one of the highest prevalence rates globally for fetal alcohol spectrum disorders. Despite this, few interventions are routinely available for countering the adverse effects of perinatal drinking. The current study used the ADAPT-ITT framework to guide the development of a behavioral intervention with remote alcohol use monitoring and provision of financial incentives contingent on alcohol abstinence for people who are pregnant and postpartum. The study aims to maximize the intervention’s relevance, acceptance, and effectiveness in reducing alcohol use during pregnancy and lactation, ultimately improving maternal and infant health outcomes in South Africa. Thirty-two in-depth interviews with people who were pregnant and 16 key-informant interviews with clinic and community members were conducted to help inform the intervention. The adapted intervention was pretested with 20 people who were pregnant or breastfeeding, and additional feedback was obtained from the community collaborative board. While there was widespread support for the intervention elements, some concerns were raised, including perceived high street value of a monitoring device, access to mobile phones to use such a device, frequency of monitoring, cheating when using a remote monitoring device, devices being lost or stolen, and the sustainability of long-term monitoring. The adapted intervention combines alcohol monitoring-based contingency management with text-based health promotion and information on where to access services tailored to maternal populations ready for testing in feasibility and efficacy trials. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Alcohol use is among the leading risk factors for premature death and morbidity in South Africa. This study sought to identify factors associated with drinking behaviour in on‐ and off‐licensed premises (typical occasion quantity and frequency) among adults in the City of Tshwane, South Africa. Design and Methods: A household survey was conducted in 2014, using a multi‐stage stratified cluster random sampling design. Participants comprised 982 adults (65% males) aged 18–65 years. Factors explored included socio‐demographic variables and situational variables at on‐ and off‐licensed premises. Multiple logistic regression analysis was performed to predict drinking behaviour at on‐ and off‐licensed premises. Results: The majority of the participants consumed alcohol in off‐licensed premises (64% vs. 36%). However, participants who consumed alcohol at on‐licensed premises were more likely to drink more alcohol and more frequently (weekly). Additionally, participants who consumed alcohol in above‐average sized containers were more likely to consume six or more drinks and drink weekly. Being of high socio‐economic status was associated with drinking weekly at off‐licensed premises, while being less educated was associated with a significantly higher frequency of drinking at on‐licensed premises. Discussion and Conclusions: Interventions to reduce alcohol use should target specific drinking behaviour at on‐ and off‐licensed premises, for example, regulating the availability of alcohol in big‐sized containers and the need for cutting down on quantity of alcohol and frequency of drinking for South African males who drink at on‐ and off‐licensed premises. [ABSTRACT FROM AUTHOR]

In one study on the impact of cannabis use during lactation, cannabis exposure via the mother's breast milk during the first month postpartum appeared to be associated with a decrease in infant motor development at 1 year of age ([4]). This effect was only observed with daily or near daily consumption, and occasional maternal cannabis use during breastfeeding did not demonstrate any significant effects on infant development, similar to findings from another study ([23]). South Africa lacks clear guidelines on how to respond, educate, and counsel lactating women about the risks of cannabis use on infant development and other health outcomes other than to simply advise pregnant and breastfeeding women against any substance use. [Extracted from the article]

Introduction: Little is known about the nature and extent of substance use among pregnant women in Cape Town (South Africa) despite the very high levels of substance use and related consequences such as FASD in this part of the country. The aim of the study was to determine predictors of alcohol use among pregnant women. Methods: A cross-sectional survey was conducted among pregnant women attending 11 Midwife Obstetric Units (MOUs) in greater Cape Town. A two-stage cluster survey design was used. In total, 5231 pregnant women were screened to assess self-reported prevalence estimates. Of these, 684 (13.1%) were intentionally sub-sampled and completed an interviewer-administered questionnaire and provided a urine sample for biological screening. Univariate and multivariate statistical procedures were used to determine factors predictive of alcohol use. Results: Findings highlight various demographic, social and partner substance use predictors for both self-reported and biologically verified alcohol use in two different models. Being Coloured, having a marital status other than being married, experiencing violence or aggression in the past 12 months compared to more than 12 months ago, having a partner who drinks, and partner drug use are all independently associated with higher odds of self-reported alcohol use. In contrast, only partner tobacco use is independently associated with higher odds of biologically verified alcohol use. Conclusion: Knowing the risk factors for alcohol use in pregnancy is important so that intervention efforts can accurately target those women in need of services. Intervention programs addressing risk factors of high-risk pregnant women are needed. [ABSTRACT FROM AUTHOR]

Aims: There is limited literature on the challenges encountered during household surveys on alcohol consumption in low- and middle-income countries. This paper aims to describe the problems encountered during data collection for the IAC study in South Africa and put forward recommendations for addressing identified challenges.Methods: Data on methodological and other challenges emerged from feedback sessions held with fieldworkers, supervisors, observations made of and follow up meetings with project investigators, based on the pilot and main study of 2844 adults and adolescents in Tshwane (South Africa).Results: Challenges identified included the following: delays in software development which resulted in postponement of data collection with subsequent budgetary implications; difficulties in identifying the full range of alcohol beverages during the adaptation of the questionnaire as manufacturers sometimes changed quantities and packaging to enhance sales; a resultant lengthy questionnaire which negatively impacted on participation; potential participants sometime being afraid to allow fieldworkers onto premises due to high crime rates in many participating areas and religious beliefs concerning alcohol consumption that prevented some parents from consenting to their adolescent children’s participation.Conclusion: When planning community surveys on alcohol use, it is important to anticipate and prepare for these and other challenging conditions that arise in the preparation for, and execution of fieldwork. [ABSTRACT FROM PUBLISHER]

Background: The burden of alcohol use among patients with trauma and the relative injury risks is not routinely measured in South Africa. Given the prominent burden of alcohol on hospital trauma departments, South Africa needs practical, cost-effective, and accurate alcohol diagnostic tools for testing, surveillance, and clinical management of patients with trauma., Objective: This study aims to validate alcohol diagnostics for injury-related trauma and assess its use for improving national health practice and policy., Methods: The Alcohol Diagnostic Validation for Injury-Related Trauma study will use mixed methods across 3 work packages. Five web-based focus group discussions will be conducted with 6 to 8 key stakeholders, each across 4 areas of expertise (clinical, academic, policy, and operational) to determine the type of alcohol information that will be useful for different stakeholders in the injury prevention and health care sectors. We will then conduct a small pilot study followed by a validation study of alcohol diagnostic tools (clinical assessment, breath analysis, and fingerprick blood) against enzyme immunoassay blood concentration analysis in a tertiary hospital trauma setting with 1000 patients. Finally, selected alcohol diagnostic tools will be tested in a district hospital setting with a further 1000 patients alongside community-based participatory research on the use of the selected tools., Results: Pilot data are being collected, and the protocol will be modified based on the results., Conclusions: Through this project, we hope to identify and validate the most appropriate methods of diagnosing alcohol-related injury and violence in a clinical setting. The findings from this study are likely to be highly relevant and could influence our primary beneficiaries-policy makers and senior health clinicians-to adopt new practices and policies around alcohol testing in injured patients. The findings will be disseminated to relevant national and provincial government departments, policy experts, and clinicians. Additionally, we will engage in media advocacy and with our stakeholders, including community representatives, work through several nonprofit partners to reach civil society organizations and share findings. In addition, we will publish findings in scientific journals., International Registered Report Identifier (irrid): DERR1-10.2196/52949., (©Petal Petersen Williams, Megan Prinsloo, Margaret M Peden, Ian Neethling, Shibe Mhlongo, Sithombo Maqungo, Charles Parry, Richard Matzopoulos. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.03.2024.)