Nutritional Rickets in Ethiopia: Perspectives on Epidemiological Patterns and Management

Abstract

It is well established that nutritional rickets, though prevalent among infants and young children in resource-limited settings, is a worldwide public health challenge. In Ethiopia, despite ‘13 months’ of sunshine, the disorder has continued to occur unabated in infants and young children. However, its epidemiological pattern, clinical spectrum, and management approaches are not fully understood. In this review, we have examined it based on reports from Ethiopia and other developing settings, as well as from developed countries. Available evidence shows that nutritional rickets has been with us since antiquity, and that, in Ethiopia, despite ‘13 months’ of sunshine, it has remained a major public health concern. The disorder is primarily caused by vitamin D deficiency and, less commonly, a low calcium intake, leading to decreased intestinal calcium absorption, secondary hyperparathyroidism, hypophosphatemia, and defective mineralization of growth plate cartilage and osteoid (bone matrix). Prevalence varies across regions and countries based on the risk factors. It carries grave consequences when combined with protein-energy malnutrition and infectious diseases. Lack of exposure to sunlight and other risk factors contribute to its occurrence. Diagnosis is based on clinical features, biochemical testing, radiography, along with low levels of 25-hydroxycolecalciferol. Age at onset, disease duration, underlying pathophysiology, and comorbidities define its skeletal and extraskeletal manifestations. Management of the disorder needs to balance the provision of vitamin D to correct the deficiency and guard against administering ‘too much’ of the vitamin. Prevention and eradication require                adequate sunlight exposure  for  infants, effective  implementation  of  vitamin  D and/or  calcium supplementation, and food fortification programs. Well-designed epidemiological studies are needed to fill existing gaps in our knowledge about the true prevalence, sociocultural, and psychological determinants of risk behaviors, screening biochemical markers, and effective community-based interventions.