Clinical Rickets in Rural Kenyan Preschoolers

Abstract

Clinical rickets is reemerging in industrialized and developing countries. Clinical rickets among preschoolers, associated risk factors, intervention, and outcomes in a rural Kenyan study is reported. Baseline evaluation of 1–4 year‐old preschool children (n=324) prior to a nutrition intervention study was conducted. Usual food intake was assessed by 24‐hr recall. Anthropometric measures were obtained. Health history and physical examinations, including signs of nutritional deficiency, were conducted. No biochemical analyses for vitamin D and calcium were performed. Of the 324 children examined, 28 (6.6%), including 3 sets of twins, were diagnosed with clinical rickets. Developmental delays of sitting, walking, and teething were found. Bone deformities such as frontal and parietal bossing of the skull, chest deformities and rachitic rosaries, widening of wrists and ankles, and bowing of the extremities were observed. Risk factors were weaning under 1y, use of cereal‐based, unfortified foods, negligible cow or goat milk consumption, and being kept indoors when mothers were working in the fields. Treatment included of whole milk daily, 500mg of vitamin D‐3 tablets daily, advice to mothers about daily exposure of children to sunshine and inclusion of milk and other animal foods in the daily diet. Most features of rickets disappeared after 3–6 months. Deficient intake of calcium, limited to exposure to sunshine (Vitamin D), and poor quality weaning diets appear to be major factors. USAID Global Livestock CRSP DAN‐1328‐G‐00‐0046‐00