OBJECTIVE: To determine the factors contributing to nutritional rickets among the children presenting
at Isra University Hospital Hyderabad, Sindh - Pakistan.
DESIGN: A case control study.
SETTING: The Pediatrics Department of Isra University Hospital Hyderabad from August 2004 to
METHODS: Children less than 5 years of age of both sexes were included in study. Sixty children
with rickets and 60 control children matched for age and social characteristics over study
period were studied. Diagnosis was made on clinical, radiological and biochemical parameters.
A specially designed questionnaire was administered, for patients and mothers of control subjects
to assess the role of social, nutritional and other related factors in the pathogenesis of nutritional
rickets. Biochemical investigations included estimation of serum calcium, serum phosphorus
and alkaline phosphates.
RESULTS: At the time of diagnosis, mean bodyweights of the patients and controls were 9.30
and 10.17kg respectively. Mean heights at the time of diagnosis were 60.08 and 62.38 cm for the
patients and the controls respectively. Mean serum calcium and serum phosphate were significantly
lower in the patients compared with the controls. Alkaline phosphates were higher
among the patients. The weaning diet was started at the age of 6 months only in 30% of cases
of rickets, compared with 52% of controls who started at the 6 months of age. Only 41% of
mothers of children with rickets had normal nutritional status and 75% of control mothers had
normal nutritional status. Most of the children with rickets (75%) were completely wrap during
infancy compared to controls; only 20% wrapped.
CONCLUSION: There are a lot of contributing factors for nutritional rickets. However, several
factors seem to make more important contribution. Among these, lack of exposure to sunlight,
prolonged breast-feeding without supplementation and inadequate complementary feeding
practices are important. Maternal health and education is important as it can influence all of the
Nutritional Rickets. Risk Factors. Breast Feeding. Feeding Practices.