Nutritional rickets among children admitted with severe pneumonia at Mulago hospital, Uganda: a cross-sectional study
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
BMC pediatrics
Abstract
There’s abundant sunshine in the tropics but severe rickets is still observed. Nutritional rickets is
associated with an increased risk of acute lower respiratory infections. Pneumonia is the leading cause of death in
the under 5 -year old children with the highest burden in developing countries. Both Pneumonia and rickets are
common in the developing countries and may affect clinical presentation and outcome. This study aimed to
determine the prevalence and associated factors of nutritional rickets in children admitted with severe pneumonia.
Methods: This was a cross-sectional study of children aged 2–59 months presenting with severe pneumonia at an
emergency unit. We enrolled 221 children between February and June 2012 after consent. A pre-coded questionnaire
was used to collect data on socio-demographic, nutritional and past medical history. Physical exam was done for signs
of rickets and anthropometric measurements. Serum calcium, phosphorus, and alkaline phosphatase (ALP) were
assessed. Children with any physical signs of rickets or biochemical rickets (ALP > 400 IU); had a wrist x-ray done.
Nutritional rickets was defined as the presence of radiological changes of cupping or fraying and/ or metaphyseal
thickening. Severe pneumonia was defined using the WHO criteria.
Statistical analysis was performed using the Stata 10 statistical package. P- value < 0.05 was significant.
Results: The prevalence of nutritional rickets among children with severe pneumonia is 9.5%. However, 14.5%
had raised ALP (biochemical rickets). The factors independently associated with rickets was an elevated alkaline
phosphatase; p-value < 0.001, or 32.95 95% CI (10.54–102.93). Other factors like breastfeeding, big family size,
birth order were not significantly associated with rickets. Low serum calcium was detected in 22 (9.9%) of the
221 participants. Overall few children with rickets had typical clinical features of rickets on physical examination.
Conclusion: Rickets is a common problem in our setting despite ample sunshine.
Clinicians should actively assess children for rickets in this setting and screen for rickets in those children at high
risk even without clinical features.
Description
Keywords
Rickets, Pneumonia, Children
Citation
Piloya, T., Odongkara, B., Were, E. M., Ameda, F., Mworozi, E., & Laigong, P. (2018). Nutritional rickets among children admitted with severe pneumonia at Mulago hospital, Uganda: a cross-sectional study. BMC pediatrics, 18(1), 1-7. https://doi.org/10.1186/s12887-018-1310-9