NUTRITIONAL RICKETS IN YOUNG NIGERIAN CHJLDREN IN THE SAHEL SAVANNA

Objectives: To determine the prevalence of clinical and biochemical rickets in an under-fiveout-patient population, relate the prevalence of biochemical ricliets (BR) to the socioculturalcharacteristics of families and determine the response af nutritional rickets tovitamin D therapy.Design: Prospective cross-sectional and retrospective case-series SI lrveys.Setting: Paediatric general out-patient and consultant clinics.Subjects: One hundred and ninety eight out-patients and twenty two patients aged >1 to 60months treated for nutritional rickets.Interventions: Clinical examination, interview with mothersand dete~ mination of biochemicalabnormalities of under-fives and management of patients with riclrets using stosstherapy.Main outcome measures: Prevalence of BR and response to stosstherapy.Results: Eight (4%) patients in the survey had clinical and biocbernic al rickets while 33 (17%)had biochemical rickets only; 92 (47%) other patients had isolate11 hypocalcaemia and/orhypophosphataemia. The prevalence of BR was higher in males (p d).05), and increased withage (p <0.001). The prevalence was lower in families who were indigel lous to the area (p <0.05),children of Moslem families (p <0.05) and children whose mothers w ere full-time housewives,unskilled or traders (p <0.01), and who lacked any formal western ed~ lcation (p = 0.157). Threeof the seven evaluable patients who received stosstherapy responde 3 late.Conclusion: The results support the hypothesis that deficiency 01. reduced availability ofdietary calcium may be of at least equal importance with vitamin D d eficiency in the aetiologyof nutritional rickets in the Sahel savanna