The Demographic And Clinical Characteristics Of Children Diagnosed With Rickets Who Presented To Msf Clinics From Informal Settlement Of Kibera, Nairobi, Kenya.
Edwards, Jeffrey K
Kosgei, Rose J
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Objectives: In primary health care clinics run by Médecins Sans Frontières in the informal settlement of Kibera, Nairobi, we describe the demographic and clinical characteristics of children with rickets from September 2012 to June 2013. Methods: In September 2012 a diagnostic and treatment protocol for identification and management of rickets in children was implemented. Demographic and clinical data were routinely collected on each child diagnosed with rickets. Children were started on vitamin D and calcium supplementation, unless provided in nutritional supplements given for concurrent malnutrition. Results: Between September 2012 and April 2013, 51 children were diagnosed with rickets. There were 29 males and 22 females with a mean age of enrollment of 14.5 months. The mean weight at intake for males and females was 8.1 kg and 7.7 kg, respectively. The frequency of continued breast feeding at intake was 66.7%, the frequency of supplemental feeding (with water, tea or porridge) was 49.0% and the average age of supplement feeding beginning was 5.6 months. Sun light exposure was less than or equal to 1-3 hours per week in 50% of reporting cases, while 21.6% used local daycare. There were 25.5% of children with a weight-height z-score less than -2. On clinical exam 70% of children were found with wrist swelling, 68.6% with frontal skull bossing and 56.9% with rachitic changes of the ribs. Conclusions: A subset of children living in Kibera are at increased risk to develop rickets with the characteristics of prolonged breast feeding, low sun light exposure and early supplemental feeding with low vitamin D source foods.