CONTRIBUTING FACTORS OF RICKETS AMONG CHILDREN AT HYDERABAD

OBJECTIVE: To determine the factors contributing to nutritional rickets among the children presenting at Isra University Hospital Hyderabad, Sindh - Pakistan. DESIGN: A case control study. SETTING: The Pediatrics Department of Isra University Hospital Hyderabad from August 2004 to August 2005. METHODS: Children less than 5 years of age of both sexes were included in study. Sixty children with rickets and 60 control children matched for age and social characteristics over study period were studied. Diagnosis was made on clinical, radiological and biochemical parameters. A specially designed questionnaire was administered, for patients and mothers of control subjects to assess the role of social, nutritional and other related factors in the pathogenesis of nutritional rickets. Biochemical investigations included estimation of serum calcium, serum phosphorus and alkaline phosphates. RESULTS: At the time of diagnosis, mean bodyweights of the patients and controls were 9.30 and 10.17kg respectively. Mean heights at the time of diagnosis were 60.08 and 62.38 cm for the patients and the controls respectively. Mean serum calcium and serum phosphate were significantly lower in the patients compared with the controls. Alkaline phosphates were higher among the patients. The weaning diet was started at the age of 6 months only in 30% of cases of rickets, compared with 52% of controls who started at the 6 months of age. Only 41% of mothers of children with rickets had normal nutritional status and 75% of control mothers had normal nutritional status. Most of the children with rickets (75%) were completely wrap during infancy compared to controls; only 20% wrapped. CONCLUSION: There are a lot of contributing factors for nutritional rickets. However, several factors seem to make more important contribution. Among these, lack of exposure to sunlight, prolonged breast-feeding without supplementation and inadequate complementary feeding practices are important. Maternal health and education is important as it can influence all of the above factors.