Even several months into pregnancy, Johannesburg resident Martha regularly drank until she passed out. She never worried about the effect until her son was born with a hole in his heart. “I would have stopped if I knew that it would harm my baby like this,” said Martha, who declined to give her family name.

Her son, now 12 years old, was diagnosed with fetal alcohol syndrome, an incurable birth defect that has left him with the brain and body of a four-year old.

South Africa has the highest reported number of children with such birth defects: about 122 out of every 1,000 are born with the syndrome, compared with about 8 per 1,000 in the United States, according to South Africa’s Foundation for Alcohol Related Research.

But experts say many Africans, like Martha, don’t get proper education about the dangers of alcohol, especially in rural areas where access to hospitals and clinics is limited.

Alcohol also heightens the danger on a continent where driving is already perilous. Kenya’s Kenyatta National Hospital treats up to 40 victims of road accidents, mostly caused by drunk drivers and pedestrians, on some Saturday nights.

But with little to do beyond drinking for entertainment in many parts of rural Africa, health officials face a tough battle.