Are environmental conditions predisposing to calcium-deficiency rickets in developing countries? : A community-based case study from rural Kaduna, northern Nigeria

Calcium-deficiency rickets (CDR) is a metabolic bone disease in children that is characterized by impaired mineralization and severe bone deformities. As CDR is often an endemic phenomenon that is almost exclusively restricted to tropical areas, environmental conditions are currently considered to be a possible predisposing factor for the CDR. Apart from a lack of macronutrients and micronutrients, an oversupply of potentially toxic elements (PTEs) in the soil-plant pathway of the CDR areas is thought to be involved in the aetiology of CDR. This study is the first to comprehensively analyze the impact of the environment on Ca deficiency and the resulting CDR. To analyze the impact of the environment on CDR in developing countries, a rural region near Kaduna City, northern Nigeria, was chosen as a study area. From this area, cases of CDR have been reported since the early 2000s with a prevalence rate of 5%. Within this study area, 11 study sites, including areas with a high CDR prevalence (HR), a low CDR prevalence (LR) and no CDR prevalence (NR), were visited. In these HR, LR and NR study sites, the bedrock was investigated and the types of parent materials were identified. Local farmers were interviewed to determine the type and intensity of the land use. The soil types were determined along toposequences. The soil textures as well as the clay mineral fractions were determined. The pH values were measured, and the contents of organic carbon (OC) were determined. The potential cation-exchange capacity (CECpot) and the base saturation (BS) were analyzed. Furthermore, the total and plant-available macronutrient, micronutrient and PTE concentrations were measured in the soils. The drinking water was analyzed for pH values and the concentrations of Ca, Se and F were measured. The maize was analyzed for the Ca, Mg, K and P, Se and phytic acid (PA) contents. The field and laboratory analyses on the bedrock showed that the HR, LR and NR study sites near Kaduna City, northern Nigeria, were underlain by Older Granites. A direct link between the distribution of the bedrock, the parent materials and the prevalence of CDR was not found. Interviews with the local farmers showed that the land use in the Kaduna study area is dominated by the cultivation of cash crops and food crops. Field analyzes on the soil types in the Kaduna study area showed that the distribution of the soil types is highly dependent on the topography and the distribution of the parent materials. In near vicinity to the inselbergs, Lixisols had developed on grus slope deposits. In the lower pediment and plain positions, Acrisols had developed on grus slope deposits and pisolite slope deposits. In the upper plains, Plinthosols had developed on pisolite slope deposits and in the river valleys, Fluvisols had developed on river deposits. Such soil types and soil type distributions are typical for granite-underlain areas in the northern guinea savanna of West Africa. Similarly, the physical soil conditions were representative for the soils of the northern guinea savanna: sandy topsoils, clayey subsoils and relatively high contents of kaolinite clay minerals in the clay fractions. With regard to the geochemical composition, no significant difference was found between the soils of the Kaduna study area and the soils of other granite-underlain areas in West Africa. Only the concentrations of P were considerably low in the soils of the Kaduna study area. However, P deficiency is a typical phenomenon in West African savanna soils and is not restricted to CDR areas. The micronutrient concentrations in the soils were low, but not critically low. Laboratory analyses on the amounts of PTEs showed that compared to worldwide background levels and international critical limits the PTE concentrations were very low in the soils of the Kaduna study area. In the drinking water, neither a significant lack of macronutrients and micronutrients, nor a noticeable oversupply of PTEs was found. The maize in the HR, LR and NR study sites contained normal contents of Mg, K and P, low contents of Ca and Se as well as slightly elevated concentrations of PA compared to West African food composition tables. Comparisons between the mineral contents of traditional and modern maize cultivars showed that the traditional maize cultivars contained significantly higher contents of Ca and noticeably lower concentrations of PA than the modern maize cultivars. A direct link between the environmental conditions and the CDR in the Kaduna study area was considered unlikely, as neither a statistically significant lack of macronutrients and micronutrients, nor a statistically significant oversupply of PTEs was found in the environment of this area. Instead, the results indicated that the nutrition rather than the environmental conditions that impacts the prevalence of CDR