NUTRITIONAL RICKETS IN ARAR CITY, NORTHERN SAUDI ARABIA; PREVALENCE, - PDF document

European Journal of Research in Medical Sciences Vol. 5 No. 1, 2017 ISSN 2056-600X NUTRITIONAL RICKETS IN ARAR CITY, NORTHERN SAUDI ARABIA; PREVALENCE, PRESENTATION AND ASSOCIATED FACTORS: A CROSS SECTIONAL STUDY Mahmoud Mohammed Alsharif 2 , Nagah Mohammed Abo El-fetoh1 , Shahad Ahmed Alsharif 2 , Nour Homoud Alanazi 2 , Naif Gharbi Alenazi 2 , Abdulmajeed Ahmed Alenazi 2 , Nasser Ghadeer Alshamari 2 , Omar Ayed Alanazi 2 , Yasser Hamoud Alanazi 2 , Zainab Muhammed Ibrahim Ory 3 1 Family and Community Medicine Department faculty of Medicine NBU, Arar, KSA 2 Faculty of Medicine, Northern Border University 3 Pediatric Department, College Of Medicine, Khartoum University ABSTRACT Nutritional Rickets is a common disease among our children and numbers of individuals suffering from it arising every year. Up to our knowledge no previous community based studies have been conducted in northern border of Kingdom of Saudi Arabia (KSA) addressing this issue could be traced. This study was carried out to estimate the prevalence, risk factors, presenting features and the previous treatment trials of nutritional rickets in northern Saudi Arabia, KSA. Methods : A cross-sectional study carried out on all children aged 6 months – 3 years attending the pediatrics outpatient clinic or the inpatient pediatrics department of the intended hospitals. Data were collected by means of personal interview with the children's mothers using pre designed questionnaire which include questions designed to fulfill the study objectives. Results: The overall prevalence of rickets among the studied children was 9%. There is no significant effect of child sex, age, arrangement between siblings, mother's age, mother's educational level, mother's work, father's age, father's educational level, father's work, parents consanguinity, skin color, exposure to sunlight, child feeding, Vitamin D supplementation, egg eating or diary milk consumption in the occurrence of rickets (P>0.05) but there is significant effect to presence of chronic diseases and family history of rickets (P<0.05). Conclusion : This study revealed that nutritional rickets is highly prevalent among children in Saudi Arabia. However, several factors seem to make important contributions. Appropriate preventive measures should include strategies such as health education, stressing the importance of exposure to sunlight, good quality weaning food and the right starting age for weaning. Mothers should be supplemented during pregnancy through food containing with vitamin D and infants may be supplemented after birth. Keywords: Nutritional rickets; Children; Vitamin D deficiency; Arar; Kingdom of Saudi Arabia. INTRODUCTION Rickets is emerging as a major public health problem worldwide. ] 1,9 [ It has been estimated that more than one billion people suffer from vitamin D deficiency. Nutritional rickets (NR) is a disease that affect children during times of rapid growth. It's characterized by defective mineralization and disorganization of the epiphyseal growth plates [2]. Vitamin D deficiency and/or nutritional rickets remain prevalent in developing regions of the world and rank among the 5 most common diseases in children [3,4]. Vitamin D deficiency causes rickets in children and will precipitate and exacerbate osteopenia, Progressive Academic Publishing, UK Page 43 www.idpublications.org

European Journal of Research in Medical Sciences Vol. 5 No. 1, 2017 ISSN 2056-600X osteoporosis, and fractures in adults [1]. Prevalence of nutritional rickets in developed countries appears to be rising [3,4,5,6,7,8]. There are also concerns for vitamin D deficiency in older children and adolescents. Because there are limited natural dietary sources of vitamin D and adequate sunshine exposure for the cutaneous synthesis of vitamin D is not easily determined for a given individual [4]. Suggested reasons in the literature for its reemergence include complacency in fortifying food, changing lifestyles where children spend most of their time indoors on various forms of technology and globalization which has resulted in immigration of different peoples to different geographic locations [4,10,11]. NR is distinct from other types of rickets in that it is merely caused by a simple deficiency in vitamins and nutrition and thus can be easily corrected if detected early [10]. Those particularly affected live in certain latitudes as is evident from numerous studies about immigrants to other nations [11,12,13]; winter season, atmospheric pollution and geographical latitude are also known to impair vitamin D absorption [14] and finally children spending prolonged hours inside on TV/computers rather than in the sun [15]. The second category of at risk individuals are those with an insufficient dietary intake of vitamin D: infants whose mothers are vitamin D deficient, as an infant's vitamin D concentration corresponds to that of its mother and especially breastfed infants (without vitamin D supplementation) as breast milk is very low in vitamin D [16]. In Almadinah Almunawwarah, Saudi Arabia, a study was conducted to show the presenting features of rachitic children, it is reported that The presenting features of the 136 cases of rickets seen were diarrhea and vomiting or cough and fever in 48, convulsions in 11 infants (8.1% of the total and 33.3% of those aged less than 1 year), bow legs in 78, delayed dentition in 33, delayed standing in 38, hypotonia in 25, abnormal gait in 54 and sweating in 33. ] 17 [ Despite its high prevalence, no previous studies that have been conducted in northern area of Kingdom of Saudi Arabia (KSA), addressing this issue could be traced. This study will describe magnitude and characteristics of vitamin D deficiency rickets, its presenting features and associated risk factors among children in northern Saudi Arabia, a very sun rich area. A study was conducted in Canada showed that The mean age at diagnosis was 1.4 years (standard deviation [SD] 0.9, min – max 2 weeks – 6.3 years). Sixty-eight children (65%) had lived in urban areas most of their lives, and 57 (55%) of the cases were identified in Ontario. Ninety-two (89%) of the children had intermediate or darker skin. Ninety-eight (94%) had been breast-fed, and 3 children (2.9%) had been fed standard infant formula [11]. Aims & Objective To estimate the prevalence, risk factors, presenting features and the previous treatment trials of nutritional rickets in northern Saudi Arabia. PARTICIPANTS AND METHODS Study design and setting A cross-sectional study carried out in Children and Maternity Hospital in Arar city. Progressive Academic Publishing, UK Page 44 www.idpublications.org