Delay in skeletal maturity in Malawian children

Area of Science:

• Orthopedics
• Pediatrics
• Anthropology

Background:

• The Greulich and Pyle atlas is a standard tool for assessing skeletal maturity and planning orthopedic surgery.
• The atlas was developed using data from institutionalized American children in the 1950s.
• Its applicability to diverse populations, particularly in sub-Saharan Africa, remains unverified.

Purpose of the Study:

• To evaluate the accuracy of the Greulich and Pyle atlas for assessing skeletal age in Malawian children.
• To compare skeletal age with chronological age in a Malawian cohort.
• To investigate potential contributing factors to discrepancies in skeletal age assessment.

Main Methods:

• Skeletal age was assessed using the Greulich and Pyle atlas for 139 Malawian children and young adults.
• Chronological age, height, weight, and body mass index (BMI) were recorded for all participants.
• Statistical analysis, including t-tests, was used to compare skeletal and chronological ages.

Main Results:

• 85.6% of participants (119 out of 139) exhibited a skeletal age lower than their chronological age.
• The mean difference between skeletal and chronological age was 20.0 months, with a maximum difference of 100 months.
• A significant portion of participants (131) had a BMI below the normal range (20-25 kg/m²).

Conclusions:

• The Greulich and Pyle atlas is inaccurate for assessing skeletal age in Malawian children.
• Factors such as poor nutrition and endemic diseases (malaria, diarrhea) are likely contributors to delayed skeletal maturation.
• No correlation was found between reduced BMI and the degree of skeletal age retardation in this cohort.