Vitamin D deficiency rickets: socio-demographic and clinical risk factors in children seen at a referral hospital in Addis Ababa
Objective: To test the association between vitamin D deficiency rickets and protein energy malnutrition in Ethiopian children.
Setting: Ethio-Swedish Children's Hospital, a tertiary health facility catering for children coming from Addis Ababa and the surrounding districts.
Design: A case-control study.
Subjects: One hundred and fifty seven children under three years of age who had vitamin D deficiency rickets constituted the cases. Controls were the same number of children matched with cases for sex and age within one month and were seen within a week of case recruitment.
Results: Cases and controls were similar (p<0.5) in terms of maternal education, paternal age, paternal education and family size. Factors strongly and independently associated with rickets were underweight, nutritional status [OR=12.7 (95% CI 4.47-11.08)], marasmus [OR=6.3 (95% CI 2.81-19.66)], lack of exposure to sunshine [OR=3.5 (95% CI 1.33-5.84)] and non-married maternal marital status [OR=5.1 (95% CI 2.90-10.62)].
Conclusion: Protein-energy-malnutrition is strongly associated with vitamin D deficiency rickets. Intervention strategies targeting vitamin D deficiency rickets should give emphasis to children with protein energy malnutrition. Further work will be required to detine the causal links between rickets and the risk factors identified in the present study.