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Preventable but neglected: rickets in an informal settlement, Nairobi, Kenya
J K Edwards1, A Thiongó1, R Van den Bergh2
1Médecins Sans Frontières, Nairobi, Kenya.
Insights
Rickets is common in Kibera
Area of Science:
- Pediatrics
- Public Health
- Nutritional Science
Background:
- Rickets is a significant health concern in developing regions.
- Informal settlements present unique challenges for child health.
- Limited sunlight exposure and malnutrition are suspected contributors.
Purpose of the Study:
- To characterize children diagnosed with rickets in Kibera, Kenya.
- To identify demographic and clinical factors associated with rickets.
- To evaluate treatment outcomes and loss to follow-up.
Main Methods:
- Retrospective case review of 82 children diagnosed with rickets.
- Analysis of routine program data on diagnosis and treatment.
- Data collected from Médecins Sans Frontières primary care clinics.
Main Results:
- Rickets affected 57% males, median age 12-14 months.
- 71% had limited sunlight exposure (<=3 hours/week).
- 39% experienced malnutrition; 44% had developmental delays; 40% lost to follow-up.
Conclusions:
- Rickets is prevalent in Kibera's informal settlement.
- Environmental factors likely contribute to rickets.
- Routine vitamin D supplementation is recommended for African well-child care.
Setting:
The primary care clinics of Médecins Sans Frontières within the informal settlement of Kibera, Nairobi, Kenya.
Objective:
To describe the demographic and clinical characteristics of children clinically diagnosed with rickets from September 2012 to October 2013.
Design:
Descriptive retrospective case review of diagnosis and treatment course with vitamin D and calcium using routine programme data.
Results:
Of the 82 children who met the clinical diagnosis of rickets, 57% were male, with a median age of 12 months and 14 months for females. Children with rickets were found to have ⩽3 hours/week sunlight exposure for 71% of the children and malnutrition in 39%. Clinical findings on presentation revealed gross motor developmental delays in 44%. The loss to follow-up rate during treatment was 40%.
Conclusions:
This study found that rickets is a common clinical presentation among children living in the informal settlement of Kibera and that there are likely multiple factors within that environment contributing to this condition. As rickets is a simply and inexpensively preventable non-communicable disease, we suggest that routine vitamin D supplementation be formally recommended by the World Health Organization for well-child care in Africa, especially in the contexts of informal settlements.
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