Using data from a multi-hospital clinical network to explore prevalence of pediatric rickets in Kenya.

Stella W Karuri,Mike English,Maureen K Murithi,Clinical Information Network Authors ,Grace Irimu

doi:10.12688/wellcomeopenres.12038.2

Stella W Karuri, Mike English + Show 3 more

Open Access

https://doi.org/10.12688/wellcomeopenres.12038.2

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Abstract

Background: Nutritional rickets is a public health concern in developing countries despite tropical climates and a re-emerging issue in developed countries. In this study, we reviewed pediatric admission data from the Clinical Information Network (CIN) to help determine hospital and region based prevalence of rickets in three regions of Kenya (Central Kenya, Western Kenya and Nairobi County). We also examine the association of rickets with other diagnosis, such as malnutrition and pneumonia, and study the effect of rickets on regional hospital stays. Methods: We analyzed discharge records for children aged 1 month to 5 years from county (formerly district) hospitals in the CIN, with admissions from February 1 st 2014 to February 28 th 2015. The strength of the association between rickets and key demographic factors, as well as with malnutrition and pneumonia, was assessed using odds ratios. The Fisher exact test was used to test the significance of the estimated odd ratios. Kaplan-Meier curves were used to analyze length of hospital stays. Results: There was a marked difference in prevalence across the three regions, with Nairobi having the highest number of cases of rickets at a proportion of 4.01%, followed by Central Region at 0.92%. Out of 9756 admissions in the Western Region, there was only one diagnosis of rickets. Malnutrition was associated with rickets; this association varied regionally. Pneumonia was found to be associated with rickets in Central Kenya. Children diagnosed with rickets had longer hospital stays, even when cases of malnutrition and pneumonia were excluded in the analysis. Conclusion: There was marked regional variation in hospital based prevalence of rickets, but in some regions it is a common clinical diagnosis suggesting the need for targeted public health interventions. Factors such as maternal and child nutrition, urbanization and cultural practices might explain these differences.

Highlights

Prolonged vitamin D deficiency causes rickets, the softening and weakening of bones due to inadequate mineralization, and which leads to bone deformities
We explore the association of rickets with co-morbidities, such as pneumonia and malnutrition, before discussing possible factors that could explain the regional variation of pediatric rickets
Our study reveals marked variation in the prevalence of rickets in different regions in Kenya. It is strongly associated with a clinical diagnosis of severe malnutrition and shows some association with a diagnosis of pneumonia in one region; the strength of these associations exhibits regional variation

Summary

Introduction

Prolonged vitamin D deficiency causes rickets, the softening and weakening of bones due to inadequate mineralization, and which leads to bone deformities. We reviewed pediatric admission data from the Clinical Information Network (CIN) to help determine hospital and region based prevalence of rickets in three regions of Kenya (Central Kenya, Western Kenya and Nairobi County). Children diagnosed with rickets had longer hospital stays, even when cases of malnutrition and pneumonia were excluded in the analysis. Conclusion: There was marked regional variation in hospital based prevalence of rickets, but in some regions it is a common clinical diagnosis suggesting the need for targeted public health interventions. Factors such as maternal and child nutrition, urbanization and cultural practices might explain these differences

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Results

Conclusion