Calcium deficiency and causation of rickets in Ethiopian children.

OBJECTIVE

To assess the role of calcium in the development of clinical rickets among Ethiopian children coming to Jimma Specialised Hospital outpatient, department.

DESIGN

Case control study.

SETTINGS

Jimma Specialised Teaching Hospital and surrounding urban and rural community in the catchment area.

SUBJECTS

One hundred and thirty five under five year old children (30 cases of rickets and 104 non-rachitic cases) who came for paediatric service in Jimma hospital.

RESULTS

The mean (+/- SD) level of calcium intake for cases and controls was 664.5 (+/- 102.7) mg and 645.8(+/- 144.4) mg, respectively. There was no statistically significance difference between the two groups in the mean level of calcium intake (t = 0.659, P > 0.05). Generally, in both cases and controls the majority of the study participants were taking calcium below the recommended daily calcium requirement of 800 mg for age group according to Food and Nutrition Board of the National Research Council. When adjusted for different co-variates including age, sex, breast feeding history, history of diarrhoea lasting longer than 14 days and 24 hours calcium intake children and religion, occupation, educational status and residence the mothers/care givers using logistic regression model, frequency of exposure to sunlight ( OR = 1.55, 95%CI: 1.2, 2.0), being from rural areas (OR = 5.0, 95% CI: 1.1, 23.3) and age 12-23 months (OR= 4.5, 95% CI: 1.2, 16.5) were significantly associated with rickets (P < 0.05).

CONCLUSION

It was found that Ethiopian children with rickets and without had a low calcium intake as compared to the recommended daily allowance. The fact that there was no difference in the dietary calcium intake between cases and controls and the significant difference observed between case and controls in terms of frequency of exposure to sunlight per week reflects that vitamin D deficiency emanating from poor exposure to radiant energy is the main cause of rickets in Ethiopian children. This study also documented the fact that rural children are at a higher risk of developing rickets as compared to their urban counterparts which could be mainly due to the traditional beliefs and practices more prevalent in the rural areas. Enhancing behaviour change communication about the benefits of exposing children to sunlight is very important in preventing the prevalence of rickets.