Cape Town Research Articles

Psychosocial Experiences of LGBTQIA+ Youth Experiencing Homelessness in Cape Town, South Africa

Social science literature demonstrates consistent trends of socioeconomic disadvantage and complex psychosocial problems for lesbian, gay, bisexual, transgender, queer, intersex, plus (LGBTQIA+) people globally. This is particularly salient in the area of homelessness among LGBTQIA+ youth in the literature from the Global North. This study sought to document and analyse the psychosocial experiences of LGBTQIA+ youth (aged 18 to 34) in Cape Town, South Africa. Through a mixed methods approach, using the theoretical frameworks of intersectionality, minority stress theory, and minority strengths theory, researchers examined semi-structured interview and survey data from 12 residents at an emergency shelter service organisation for LGBTQIA+ individuals experiencing homelessness in Cape Town. Findings indicate that residents in the shelter reported heightened levels of depression and experiences of discrimination. Several major themes emerged from interview transcript analysis, such as the role of culture, toxic masculinity, religion, substance use, and mental health concerns. Recommendations are that social workers continue to follow-up with residents once they have left the shelter to ensure that the interventions are successful and that programmes designed for the population should incorporate an understanding of these psychosocial aspects of LGBTQIA+ homelessness in South Africa.

Forensic taphonomic experimental design matters: a study assessing clothing and carrion biomass load on scavenging in Cape Town, South Africa.

The identification of unknown human remains is a significant and ongoing challenge in South Africa, worsened by the country's high murder rate. The rate of decomposition in South Africa is significantly influenced by vertebrate scavenging, which, if not considered, can impede the accurate estimation of the post-mortem interval. Scavenging patterns vary greatly depending on the environment and ecological region, and there is limited data for the Western Cape province. To address this gap, two clothed and uncaged pig carcasses weighing 60kg each were placed in the field in July 2021 and January 2022, respectively. Motion-activated infrared-capable trail cameras were used to observe decomposition, scavenger species, and their activities. Additionally, a comparative sample of 16 unclothed carcasses deployed between 2014 and 2016 in the same habitat were analyzed to assess the impact of clothing and biomass load. The study found three main results: (1) Regardless of habitat or biomass load, it took significantly less time to reach decomposition milestones (25%, 50%, and 75%) during the summer season; (2) the presence of mongoose scavengers had a greater impact on the time required to reach milestones during winter compared to summer; and (3) single carcass deployments reached the milestones faster than multi-carcass deployments in both seasons. This research highlights the potential inaccuracy of current methods for estimating the post-mortem interval when scavenging activity is not considered or documented in the underlying experimental data, particularly for environments or ecological biomes where scavengers actively impact decomposition rates.

“So that’s why I found PrEP to be safest way to protect yourself”: exploring IPV experiences and impact on HIV prevention among pregnant and postpartum women in Cape Town, South Africa

Intimate partner violence (IPV) occurs at alarmingly high rates towards pregnant women in South Africa. Experiences of emotional, physical, and sexual IPV in pregnancy can adversely impact the health and safety of mother and fetus. Furthermore, IPV is associated with increased risk of HIV, exacerbating the public health impact of violence among pregnant women in this HIV endemic setting. In-depth understanding of cultural and contextual drivers of experiences of IPV is a critical precursor to development of interventions effectively addressing this issue among pregnant women in South Africa. The present study examines factors contributing to IPV among pregnant women to identify potential points of intervention. We conducted twenty in-depth interviews with postpartum women who used oral pre-exposure prophylaxis (PrEP) in pregnancy and reported recent experiences of IPV and/or ongoing alcohol use in a township near Cape Town, South Africa that experiences a heavy burden of both HIV and IPV. Interpretive thematic analysis was used. Several patterns of IPV during pregnancy were identified and violence was frequently described as co-occurring with male partner alcohol use. A majority of women referenced oral PrEP as their preferred method for HIV prevention, highlighting the agency and discretion it provided as beneficial attributes for women experiencing IPV. Fear of judgement from peers for remaining with an abusive partner and a lack of clear community messaging around IPV were identified as barriers to disclosure and support-seeking. Addressing the lack of social support received by women experiencing IPV during pregnancy in South Africa is essential to comprehensive IPV programming.

The impact of school closures on learners’ mental health in the context of COVID-19 in the City of Cape Town

This paper explores the negative impact of the shutdown of contact-based learning on learners’ mental health as a result of COVID-19 and provides recommendations to promote learners’ mental health during and post COVID-19. A qualitative research method was used to guide the collection and analysis of the data. Data was collected from a sample of 20 learners from Cape Town and analysed through thematic analysis. The study findings revealed that with the shutdown of contact-based learning as one of the COVID-19 containment measures by the government learners experienced social anxiety disorder and sleeping disorder. Youth policymakers need to design interventions that promote mental health in after-school programmes implemented by qualified youth workers and social workers. Youth workers should take the courses of action in a non-formal education to promote youth mental health.

The burden and outcomes of firearm injuries at two district-level emergency centres in Cape Town, South Africa: A descriptive analysis

Background. In South Africa (SA), injuries are the second leading cause of years of healthy life lost, and interpersonal violence dominates the SA injury profile. Half of all injury-related deaths in SA are intentional, and firearms contribute to a quarter of these deaths. Injury surveillance systems are essential to develop, implement and monitor strategies that reduce preventable trauma. Objectives. To describe the burden of patients with firearm injuries and their outcomes at district-level emergency centres in the Western Cape. Methods. This study was a retrospective analysis of a prospectively collected database. All patients who presented to two district-level emergency centres with a firearm injury over a 12-month period (1 January 2019 - 31 December 2019) were eligible for inclusion. Results. Firearm injuries represented 5.7% of the trauma burden at the two district emergency centres. Of the 776 patients with firearm injuries who were included, the median age was 27 years, and 91% were male. A total of 520 (67%) patients self-presented, and there were 18 (2.3%) deaths in the emergency centre and a further 23 (3%) as inpatients. Of the total where wound location was determined (n=595), 30.4% sustained more than one firearm injury, and 112 out of the 167 admitted to Mitchells Plain Hospital required at least one visit to theatre. This accounted for 413 theatre hours and 1 376 inpatient bed days at Mitchells Plain Hospital. A significant proportion of patients (n=219, 29%) were transferred from the emergency centres to a tertiary service for further care. Conclusion. Firearm injuries represent a substantial proportion of the trauma burden at district emergency centres in the Western Cape Province. Managing patients with firearm injuries is resource intensive, as evident by their high acuity, the need for operative care, the long length of stay, the high burden on emergency medical services with interfacility transfers and the high demand for tertiary care. Data from this study aid our understanding of the prevalence and burden of firearm injuries at district level emergency centres, and multisectoral action, supported by evidence-based primary and secondary preventive strategies, is required to reduce the burden of firearm injuries, and mitigate their effects.

The salience of structural barriers and behavioral health problems to ART adherence in people receiving HIV primary care in South Africa

ABSTRACT Multilevel factors (individual and structural) influence adherence to antiretroviral therapy, particularly in high HIV prevalence areas such as South Africa. The present study examined the relative importance of structural barriers to HIV care and behavioral health factors, depression and alcohol use, in Khayelitsha, Cape Town, South Africa. People receiving HIV care in six primary care clinics in Khayelitsha (N = 194) completed the Center for Epidemiologic Studies Depression Scale, the Alcohol Use Disorders Identification Test, the Structural Barriers to Medication Taking questionnaire, and a qualitative rating of past-two-week adherence. Correlations were employed to examine associations among these variables, and hierarchical regression analysis was used to examine the unique effects of structural barriers over and above depression and alcohol use as predictors of adherence. Participants were primarily Black South African (99%) women (83%), and 41 years old on average. All four variables were significantly correlated. The hierarchical regression analysis showed that among behavioral health predictors, alcohol use alone significantly predicted ART adherence (b = -.032, p = .002). When structural barriers was added to the model, it was the only significant unique predictor of ART adherence (b = −1.58, p < .001). Findings highlight the need to consider structural vulnerabilities in HIV care in South Africa when developing behavioral health interventions.

The timing of antenatal care access for adolescent pregnancies in Cape Town, South Africa.

Late antenatal care (ANC)-seeking among pregnant adolescents threatens their health outcomes, and the health outcomes of their new-borns. South Africa has experienced a rapid increase in adolescent pregnancies during the COVID-19 pandemic, adding to the existing concerns around adolescent pregnancy care-seeking behaviour. The main aim of this study was to investigate the causes and covariates of late ANC access among adolescents in the Cape Town Metropole, South Africa. Three public healthcare facilities in the Cape Town Metropole, 2018-2019. A retrospective, cross-sectional study on ANC seeking behaviour was conducted, surveying 202 adolescents. Late attendance was defined as attending ≥ 3 months. For this study, adolescents were defined as women aged 16-18 years. The sample was restricted to adolescents who used public healthcare facilities or who did not attend at all. Data were analysed using univariate, bivariate and multivariate methods. A total of 50.8% (n= 99/195) of the pregnant adolescents in the sample had their first ANC visit 3 months. 14.9% (n= 29/195) did not attend at all. Major contributors to delayed care-seeking include poor pregnancy identification (n= 45/99, 45.5%), and a lack of information about ANC. Age, education, and alcohol consumption were significant predictors of delayed care-seeking. Delayed ANC attendance contributes to negative long-term health outcomes for pregnant adolescents and their new-borns. Improving access to pregnancy tests in the public sector could benefit adolescents with earlier pregnancy identification. Adolescents need to be made aware of their care seeking options.Contribution:There is evidence of long-term health impacts of late ANC attendance by pregnant adolescents, but there is an absence of evidence on the timing and barriers of late care-seeking behaviour. In this study, late ANC attendance among adolescents was associated with late pregnancy identification and poor knowledge of care options.

Clinical paediatric tuberculosis research: field experiences from Cape Town, South Africa

Implementing research in low‐ and middle‐income countries (LMICs) involves multiple operational and socioeconomic challenges. In order to make global health research equitable, it is essential to overcome these challenges and implement research where the burden lies. We describe cultural, socioeconomic, recruitment and retention challenges experienced in our paediatric research in South Africa. We found that additional strategies and resources were required to address the specific cultural and socioeconomic aspects in order to conduct high‐ quality research in our facility.

What about the widows? Widowhood and households in Cape Town 1938/1939

ABSTRACT At any given time, 16% of the world’s female population is made up of widowed women, though this figure varies by region. The loss of a spouse usually means the loss of economic and social support for the surviving partner. Understanding the experience of widowhood is essential to understanding society; the lives of widows offer insights into how societies are organised and what responses there are to those in need. This paper investigates the survival strategies of widows in Cape Town in 1938/9 using a household survey in order to understand whether their experiences differed by race in the city just before World War II and a decade before the formalisation of apartheid. The survey provides the opportunity to understand how widows in the city lived and worked, whether they cared for others or were given care from others. The paper considers the structures of households and the incomes of widows. Who did widows live with? Or did they live alone? Were they more likely to work than other women in the city? Was it common for widows to live with non-family members? One finding is that although coloured and white households seemed similar in size and nature, widowhood brought differences between them to the fore.

Inclusionary Housing Policy in Cities of the South: Navigating a Path Between Continuity and Disruption

Inclusionary housing policy (IHP) encourages developers to provide affordable housing in well-located areas. This can add to their costs and risks, so the process of policy adoption is complicated and contested. This paper provides a synthesis of the literature and then analyzes the efforts to implement IHP of two South African cities, Johannesburg and Cape Town. The core proposition is that making residential development more inclusive requires at least three ingredients to ensure meaningful change. First, the case for reform needs popular support and an active civil society to secure the backing of political leaders and officials facing resistance from entrenched real estate interests. Second, the policy needs to be feasible in an economic sense and calibrated in an incremental way that will not jeopardize private investment. Third, a robust legal framework is required to institutionalize the changes and to limit disputes and disruption.

Fit satisfaction and experiences of plus-size females with active-wear in Cape Town, South Africa

The increased level of health awareness globally has resulted in growing numbers of consumers participating in sports activities to achieve a healthier lifestyle. However, a significant number of active plus-size females face challenges in finding attire or active-wear that fits properly and is engineered to ensure predefined performance requirements. The aim of this research was to investigate plus-size women’s experiences regarding fit satisfaction levels, and their perceptions about active-wear to improve fit, functionality, and clothing aesthetics. The study sought to establish plus-size female experiences regarding fit satisfaction levels, clothing choices and alternatives, including perceptions around aesthetics and purchasing behavior pertaining to active-wear offered by local clothing retailers in Cape Town. A mixed qualitative method was employed with 38 participants aged between 18-46 years, who self-identified as plus-size. The findings from the data revealed that the needs of plus-size women are not understood nor recognised regarding active-wear. The research indicated that plus-size females feel excluded by the clothing industry; they often resort to purchasing unsuitable exercise gear because of limited choices that suit their body shape needs. The finding results were used to develop practical improvements of active-wear for plus-size females, where innovative ideas were developed to address the technical issues of problems identified in the survey.

Tackling climate change at the city level: insights from Lighthouse Cities' climate mitigation efforts.

The link between lifestyles and Greenhouse Gas (GHG) emissions has prioritized climate mitigation strategies of cities worldwide. As cities have increasingly generated GHG emissions by their industrial and transportation activities, their role in climate mitigation has gained prominence. Cities' climate mitigation policies to reduce the GHG intensity of their residents' daily lives are one of their significant efforts to tackle climate change. Lighthouse Cities (LCs), in particular, have emerged as remarkable actors in promoting lifestyle changes for their residents. This study examines climate mitigation strategies of LCs of Climate CAMPAIGNers project, including Baku, Vilnius, Lahti, Izmir, Trujillo, Athens, Linz, Milan, Cape Town, Dublin, and Skopelos, addressing lifestyle changes by conducting an expert survey in 11 LCs involving 89 respondents. The findings of the expert survey are comparatively analyzed across 11 LCs. The results show that experts form Lighthouse Cities identify increasing awareness and information provision as a significant component of climate mitigation policies. Concerning lifestyle changes, strategies toward energy efficiency and sustainable mobility are highlighted as the primary areas to be prioritized. This study enhances the understanding of cities' capacity to reduce their residents' GHG emissions. The findings can be utilized to identify and tailor policies for supporting the Lighthouse Cities in their climate change mitigation efforts and provide pointers for selecting the lifestyle changes that can be promoted and prioritized in Lighthouse Cities.

Identification of Illegal Dumping and Community Views in Informal Settlements, Cape Town: South Africa

Municipalities face the greatest difficulty in implementing an efficient and effective waste collection system, especially in informal settlements with limited spatial planning. Illegal dumping is exacerbated by the proliferation of informal settlements and the lack of adequate waste management services provided by municipalities. A geographic information system (GIS) provides decision makers with a framework for analyzing and simulating a wide variety of spatial problems, including waste management issues. The purpose of this study is to map areas susceptible to illegal dumping and to determine why the community dumps there. The data were collected qualitatively via a questionnaire using a purposeful sampling technique, and SPSS 28.0 was used to analyze the data. The accessibility of streets and the availability of vacant land affected the location and concentration of illegal dumping in the test area. The lands within a buffer zone of 250 to 500 m of populated areas are the most vulnerable. The majority of residents have individual garbage receptacles, while a minority of 43.18% do not. A total of 52 dumpsites were identified inside the red zone of the model, suggesting a strong likelihood of illegal dumping activities. Hence, the community continues to have difficulties in effectively managing garbage disposal, compelling them to resort to alternative methods of waste disposal.

Systems Perspectives on Business and Peace: The Contingent Nature of Business-Related Action with Respect to Peace Positive Impacts

AbstractWe examine three business-related initiatives designed to achieve peace positive impacts in the Cape Town township of Langa. Each was seemingly straightforward in its purpose, logic, and implementation. However, their positive intent was frustrated and their impacts ultimately harmful to their articulated goals. Understanding why this is so can be difficult in violent, turbulent, and information-poor environments such as Langa, confounding progress even by actors with ethical intentions. To aid in sense making and to provide insight for more positive future action, we develop from 125 interviews conducted for this study causal loop models for these initiatives within their conflict subsystems. These explain the perverse impacts of these initiatives by illuminating their (lack of) salience to key conflict factors, their (in)sufficiency to effect positive change in light of competing systems dynamics, and their (in)attentiveness to interdependencies with the intentions and actions of others. We thus contribute to understanding of the factors required to achieve positive social outcomes in more extreme contexts. More generally, we demonstrate the value of systems analysis both for scholarship related to business and peace and for reducing blind spots that can inhibit sound planning for ethical business action amidst complexity.

The role of oxytocin receptor gene variants in appetitive aggression: A study in a South African male sample

AbstractChronic exposure to trauma and violence can promote aggressive behavior. Oxytocin and variants in the oxytocin receptor (OXTR) gene may play a role in the etiology of proactive, that is, goal‐oriented instrumental aggression, or reactive aggression, which typically occurs in response to emotionally triggering situations. The current study builds on previous findings that experienced and witnessed trauma in childhood predicts higher levels of appetitive aggression, a form of proactive aggression characterized by the enjoyment of participating in violent behavior. The current study explores the role of OXTR rs2254298 and rs53576 variants in appetitive and reactive aggression. Adult males living in Cape Town, South Africa, and at risk for violent behavior completed the Appetitive Aggression Scale (AAS) and Buss–Perry Aggression Questionnaire (BPAQ). OXTR rs2254298 and rs53576 were successfully genotyped via restriction fragment length polymorphism (RFLP) analysis in 238 and 239 participants, respectively. Regression analysis showed that rs2254298 G/G and A/G genotypes and the rs53576 A/G genotype were significantly associated with lower AAS scores (p &lt; .001) compared to the A/A genotype. Additionally, genotype interaction analyses conducted in 232 participants, found that the combination of rs2254298 A/G and rs53576 G/G genotypes produced opposite effects on appetitive and reactive aggression. Specifically, this combination was associated with a 0.29‐point increase in AAS scores (p = .032) and a 0.13‐point decrease in BPAQ scores (p = .037) when compared to A‐allele homozygosity for both variants. These results suggest that genetic variation in a signaling system involved in influencing environmental and social salience may contribute to appetitive aggression.

Assessing the influence of technological innovations and community-based facilities management on the safety and security of universities. A case study of an open campus

PurposeSafety and security (S&S) are critical concerns in South Africa, especially in Cape Town, one of the country’s most crime-ridden cities. The University of Cape Town (UCT), situated on a large, open campus, has experienced increased malefaction. Facilities management (FM) services at universities bear the primary responsibility for providing S&S to their communities. To comprehensively understand and address the community’s demands regarding S&S, the current study was conducted to investigate the challenges specific to open universities. This study aims to determine whether implementing community-based FM (CbFM) principles and using technological innovations could offer a more effective and sustainable solution.Design/methodology/approachThe study adopted interpretivist overarching case study methodology, which is ontologically based. A mixed-method approach was used to incorporate the strengths and limitations of the weaknesses of both methods. The data collection took the form of an online survey of the university community and semi-structured interviews with university executive management to obtain data from the single case study of UCT. Descriptive statistics were used to analyze the quantitative data, and thematic analysis was used to identify emergent themes from the qualitative data.FindingsThe study presents an overall view of the provision of S&S at UCT, the unique challenges faced by management and the main S&S issues affecting the community. Moreover, the study reveals that UCT has implemented community participation processes in the past with limited success. This is because the strategies implemented constitute a narrow perspective of community participation. Therefore, a much smarter and more inclusive perspective using technological innovation is required for successful community participation to occur and to be successfully used in providing S&S toward achieving future-proofing facilities.Originality/valueThis research has demonstrated the influence of CbFM and innovative technologies on the S&S of the open campus. Hence, future-proof facilities can be achieved when FM actively engages university communities in managing campuses through technological innovation.

Out of Sight, Out of Catalogue: The Neglected Grey Collection Medical MS G.4.c.14, Its Problematic Provenance, and Its Colonial Context

Cape Town National Library of South Africa’s Grey Collection MS G.4.c.14 is a fifteenth-century paper manuscript that contains three medical works and a series of recipes. This article briefly explores MS G.4.c.14’s contents before examining the story of the manuscript itself. Containing commentaries on Book IV, fen 4 of Avicenna’s Canon of Medicine by well-known instructor of surgery Leonardo di Bertipaglia (d. 1448), and by the more obscure Maffeus di Laudi (fl. 1392–1417), and a summary of Benevenutus de Grassus’s De oculis (ca. 11–13th c.), MS G.4.c.14 has the potential to add greatly to our understanding of medieval medicine. However, medieval manuscripts also have histories outside the texts they contain. An exploration of the provenance and history of MS G.4.c.14 brought to light how it moved from Rome to Cape Town, through the antics of an infamous book thief, Guglielmo Libri (1802–69), and its purchase by Sir George Grey, colonial governor of the Cape Colony in South Africa between 1854 and 1861. Although neither British in origin nor explicitly Christian in content, like many other European manuscripts, MS G.4.c.14 played an important role in informal processes of colonialism and cultural imperialism. We examine why MS G.4.c.14 had been ignored in research and catalogues of medieval medical and ophthalmological works for decades, despite being digitized and available at the Hill Museum and Manuscript Library in 1990 and being included in a modern catalogue of the Grey Collection since 2002. We suggest that looking outside Europe to find manuscripts like MS G.4.c.14 requires scholars to confront the colonialist history in the disciplines of medieval and manuscript studies. This has become even more important as technologies of digitization have made it possible to examine a manuscript without any recognition of its history or provenance.

Charting a Course: Navigating Rigor and Meaning in Global Health Research.

In the rapidly evolving landscape of global health research, the tension between scientific rigor and contextual meaning presents a critical challenge. Drawing on our work with the Global Diet and Physical Activity Network, this commentary explores the complexities of conducting environmental audits for physical activity and diet in 4 rapidly urbanizing African cities: Yaoundé, Lagos, Cape Town, and Soweto. We illustrate the competing demands and tensions that researchers face in balancing rigor and meaning. We discuss the adaptation of internationally validated audit tools to local contexts and the importance of area-level deprivation in interpreting data. We also examine the feasibility of virtual assessment tools, emphasizing the value of local expertise. We argue for a balanced approach that marries research rigor with contextual meaning, advocating for transparency, humility, and meaningful community engagement.

The Acceptability, Feasibility, and Preliminary Effectiveness of a Courier HIV-Treatment Delivery and SMS Support Intervention for Young People Living With HIV in South Africa.

Young people living with HIV (YPLWH) experience poorer rates of virological suppression compared with adults. Differentiated service delivery models for YPLWH are urgently needed to address this disparity. Participants were recruited from an HIV treatment clinic near Cape Town, South Africa. We conducted a longitudinal pilot study to examine the acceptability, feasibility, and preliminary effectiveness of a courier ART delivery and SMS support intervention to retain YPLWH (13-24 years) in care during COVID-19. YPLWH had the option to enroll in the courier service and were randomized 1:1 to receive adherence support via a weekly SMS. Modified Poisson regression was used to estimate the preliminary effectiveness of the courier intervention on viral suppression (HIV-1 RNA <200 copies/mL) at months 3 and 6. Among 215 participants, 82% elected to enroll in the courier ART service at baseline, 41% reported receiving a delivery in the past 3 months at month 3, and 49% reported receiving a delivery in the past 3 months at month 6. Among those who received a delivery, most (91%-100%) rated the intervention as acceptable. Participants who reported receiving a delivery in the past 3 months at month 3 were 1.26 (95% CI: 1.05, 1.54) times as likely to have a suppressed viral load at month 3 and 1.21 (0.99, 1.48) times as likely at month 6, controlling for potential confounders. Findings reveal high uptake and acceptability of a courier ART delivery intervention among YPLWH and promising evidence for its effectiveness in increasing the probability of viral suppression. A fully powered trial is warranted.

Prenatal alcohol exposure is associated with changes in placental gene co-expression networks

Alcohol consumption during pregnancy can result in a range of adverse postnatal outcomes among exposed children. However, identifying at-risk children is challenging given the difficulty to confirm prenatal alcohol exposure and the lack of early diagnostic tools. Placental surveys present an important opportunity to uncover early biomarkers to identify those at risk. Here, we report the first transcriptome-wide evaluation to comprehensively evaluate human placental pathways altered by fetal alcohol exposure. In a prospective longitudinal birth cohort in Cape Town, South Africa, we performed bulk tissue RNAseq in placenta samples from 32 women reporting heavy drinking during pregnancy and 30 abstainers/light drinkers. Weighted gene co-expression network analysis (WGCNA) and differential gene expression analysis were performed to assess associations between fetal alcohol exposure and placental gene expression patterns at a network-wide and single gene level, respectively. The results revealed altered expression in genes related to erythropoiesis and angiogenesis, which are implicated in established postnatal phenotypes related to alcohol exposure, including disruptions in iron homeostasis, growth, and neurodevelopment. The reported findings provide insights into the molecular pathways affected by prenatal alcohol exposure and highlight the potential of placental biomarkers for detecting and understanding the effects of alcohol on fetal development.