Preliminary study of the prevalence of hypotrophy and fetal alcohol syndrome in Antananarivo, Madagascar

ABSTRACT

Background: Hypotrophy is a major contributor to neonatal mortality and morbidity in underdeveloped countries. In Madagascar, efforts have been made to improve this situation, particularly with regard to prevention and early treatment. This prevention is mainly focused on the search for determining factors. Fetal Alcohol Syndrome (FAS) is not yet mentioned in Madagascar although more than 9% of Tananarivian women drink alcohol. A study was conducted in our department to determine the relationship between maternal alcohol intake and hypotrophy.Methods: The prospective study was carried out in the pediatrics department of the Joseph Raseta Befelatanana University Hospital Centre, on hospitalized hypotrophic newborns (below the 10th percentile) over a period of 3 months from December 1, 2018 to February 31, 2019. In the newborn, authors studied facial features, neurological abnormalities and associated malformations. For the mother, alcohol consumption, pregnancy information was analyzed. The character of FAS could thus be classified.Results: Author counted 21 hypotrophs among the 128 newborns hospitalized during this period. The facial abnormalities observed were upper lip thickness abnormality (9.5%) and retrognathism (4.7%). Neurological signs described were difficulty sucking (76.1%), hypotonia (66.6%), restlessness (9.5%), hyper-responsiveness (9.5%), hypertonia (9.5%) and tremor (4.7%). Two organ malformations (9.5%) were seen cardiac and biliary tract malformations. Only one mother (4.7%) admitted having taken alcohol during pregnancy. Seven cases of familial alcoholism were reported. At the end of this study, we were able to identify only one case of doubtful FAS (4.7%), 2 cases of suspected FAS (9.5%) and 1 case of confirmed FAS (4.7%).Conclusions: This syndrome remains under-diagnosed in Madagascar due to the lack of staff training on FAS and the non-systematization of the search for its signs during systematic visits.