The clinical and demographic presentation of vitamin D deficiency rickets in Johannesburg, South Africa

Beretta, Marisa
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Overview: Over the past two decades a significant amount of research has been dedicated to vitamin D in an attempt to explore a contradictory reappearance of rickets despite a more extensive understanding of the predisposing factors and underlying pathophysiology of vitamin D deficiency, in addition to recommendations of vitamin D supplementation. Aim: To describe the demographical and the clinical presentation of vitamin D deficiency rickets in children presenting to the Metabolic Bone Clinics at Charlotte Maxeke Johannesburg Academic hospital (CMJAH) and Chris Hani Baragwanath Academic hospital (CHBAH). Results: A total number of 71 hospital files of children with vitamin D deficiency rickets were reviewed of which 35 (49.3%) were from CMJAH and 36 (50.7%) were from CHBAH. The majority of patients were black (97.2%). The mean age of presentation was 22.37 months (SD 12.51) and mean HAZ was -2.83 (1.64), WAZ was -1.33 (1.69) and BAZ was 0.62 (1.64). The most common presenting features were widened wrists (81.7%), rachitic rosary (80.3%) and genu varum deformities (65%). Comparisons between CMJAH and CHBAH showed that there was a greater number of patients residing in flats (91.2% vs 36.1%; p< 0.05) and in inner city areas ( 91.4% vs 30.5%; p< 0.05) attending the CMJAH. Nearly two-thirds of parents reported that their children had no sun-exposure and just over three-quarter of the children were breastfed; and there were no differences in these predisposing factors between the CMJAH and CHBAH patients. Conclusion: Despite adequate sunlight exposure in Johannesburg, vitamin D deficiency rickets was noted in more than ninety percent of children from CMJAH who reside in crowded flats in the inner city compared to the non-urban patients at CHBAH. Preventative strategies such as education and public health awareness in urban areas may be introduced to limit the incidence of this disease that could easily be prevented in the South African environment by encouraging sun-exposure
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Paediatrics Johannesburg, 2017