Abstract
The effects of rickets on children recovery from severe acute malnutrition (SAM) are unknown. Rickets may affect both growth and susceptibility to infectious diseases. We investigated the associations of clinically diagnosed rickets with life‐threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated SAM. This was a secondary analysis of clinical trial data among non‐human immunodeficiency virus‐infected Kenyan children with complicated SAM (2–59 months) followed for 1 year posthospital discharge (ClinicalTrials.gov ID NCT00934492). The outcomes were mortality, hospital readmissions, and growth during 12 months. The main exposure was clinically diagnosed rickets at baseline. Of 1,778 children recruited, 230 (12.9%, 95% CI [11.4, 14 .6]) had clinical signs of rickets at baseline. Enrolment at an urban site, height‐for‐age and head circumference‐for‐age z scores were associated with rickets. Rickets at study enrolment was associated with increased mortality (adjusted Hazard Ratio [aHR] 1.61, 95% CI [1.14, 2.27]), any readmission (aHR 1.37, 95% CI [1.09, 1.72]), readmission for severe pneumonia (aHR 1.37, 95% CI [1.05, 1.79]), but not readmission with diarrhoea (aHR 1.05, 95% CI [0.73, 1.51]). Rickets was associated with increased height gain (centimetres), adjusted regression coefficient 0.19 (95% CI [0.10, 0.28]), but not changes in head circumference, mid‐upper arm circumference, or weight. Rickets was common among children with SAM at urban sites and associated with increased risks of severe pneumonia and death. Increased height gain may have resulted from vitamin D and calcium treatment. Future work should explore possibility of other concurrent micronutrient deficiencies and optimal treatment of rickets in this high‐risk population.
Highlights
Rickets in children is a disease characterized by inadequate or defective bone mineralization and disruption of growth plates caused by deficiency of vitamin D or calcium or impaired metabolism of phosphate (Munns et al, 2016; Razali, Hwu, & Thilakavathy, 2015)
We investigated the associations of clinically diagnosed rickets with life‐threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated severe acute malnutrition (SAM)
The parent trial investigated the efficacy of daily co‐trimoxazole prophylaxis in reducing 1 year postdischarge mortality among severely malnourished children without human immunodeficiency virus (HIV) infection admitted to four hospitals in Kenya (ClinicalTrials.gov ID NCT00934492), as detailed elsewhere (Berkley et al, 2016)
Summary
Rickets in children is a disease characterized by inadequate or defective bone mineralization and disruption of growth plates caused by deficiency of vitamin D or calcium or impaired metabolism of phosphate (Munns et al, 2016; Razali, Hwu, & Thilakavathy, 2015). It manifests as skeletal abnormalities, including bowed legs, widening wrist, craniotabes (abnormal softening of skull), rachitic rosary (enlarged costochondral junctions of ribs resembling rosary beads), and frontal bossing (prominent forehead; Fukumoto et al, 2015). If rickets was unresolved or there was minimal improvement after 3 months, the doses were repeated
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