PRESENTATION AND PREDISPOSING FACTORS OF NUTRITIONAL RICKETS IN CHILDREN OF HAZARA DIVISION
Abstract
Background: There is no local data about rickets available in Hazara Division, while clinicalexperience suggests that problem exists in this area with abundant sunlight. We carried out thisstudy with an objective to determine presence, presentation and predisposing factors of rickets inpediatrics population of Hazara Division. Methods: This study was conducted in Department ofPediatrics, Ayub Teaching Hospital Abbottabad over a twelve months period from July 2003 toJuly 2004. Children from newborns to fifteen years of age presenting with signs and symptoms ofrickets were included and information regarding signs, symptoms, predisposing factors (crowdedhousing, isolated housing with deficient sun exposure, abundant sun but lack of awareness,malnutrition and antenatal factors) and investigations was recorded on a proforma. Diagnosis wasbased on clinical signs, radiological changes on x-ray wrist joint and biochemical disturbances inserum levels of alkaline phosphatase, calcium, and inorganic phosphorus. Results: Sixty Childrenwith rickets reported during the study period. The main clinical presentation was in the form ofdelayed motor milestones in 20 (33.33%) children, recurrent lower respiratory infections in 11(18.33%) children, recurrent diarrhea in 12 (20%) children, and fits in 3 (5%) children. Skeletalchanges on clinical examination were present in 40 (66.6%) children. Radiological signs of ricketswere present in 51 (85%) children. Symptoms and signs reverted to normal in all cases aftervitamin D supplementation. The apparent risk factors were lack of awareness, malnourishment andantenatal factors. Conclusion: Rickets is common in Hazara Division presenting with variablesigns and symptoms, predisposing the childhood population to different illnesses and skeletaldeformities. In the presence of abundant sunshine lack of awareness of exposure to sun,malnutrition and antenatal factors may be the important predisposing factors for development ofnutritional rickets.Key words: Rickets, vitamin D deficiency, and malnutrition.References
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