Why rickets are hitting hardest on Nairobi children

By Gatonye Gathura

Lack of sunlight, dark baby care centres and poor diets have left Nairobi with the highest number of children with rickets, says the Ministry of Health.

A recent survey of children with rickets in Central, Western and Nairobi regions, showed increasing cases of the disease with highest rates in the city.

The Clinical Information Network (CIN) analysed hospital admission of 20,528, children aged between one month and five years in the three regions and reports what the ministry says are new worrying trends on rickets.

CIN is a collaborative initiative of the Kenya Pediatric Association, Ministry of Health and the KEMRI-Wellcome Trust Research Programme

Nairobi, the findings show had the highest number of cases of rickets at four per cent followed by central region at 0.92 per cent.

In some hospitals in Nairobi the incidence of rickets in children was as high as six per cent.

“Significantly out of 9,756 admissions in the western Kenya, there was only one child diagnosed with rickets,” says the study.

Less urbanization, good diets, little wrap up of children are some of the things western Kenya was found to be doing right to keep rickets away.

For example the study published in August in the journal Wellcome Open Research says while in central and Nairobi children are likely to be weaned early on cereal porridge in western the practice is different.

Communities in western Kenya have both vegetable and fish based diets, including the leaves and grains of the amaranth or mchicha which are widely consumed.

The fish dagaa or omena, which is high in calcium and vitamin D, is widely used in weaning foods.

Rickets is a disease which causes bone deformities after prolonged vitamin D deficiency.

Vitamin D deficiency occurs in diets low in calcium, vitamin D or phosphates but it is also processed when the human skin is exposed to sunlight.

Lack of exposure to enough sunlight, which the researchers blame on rapid urbanization, was mainly the cause of increasing rickets in Nairobi.

“That six per cent of children in a region with abundant sunlight have rickets is quite extraordinary,” says Dr KelseyJones of  KEMRI‐Wellcome Trust Research Programme,  in a review of the study.

In his study of children with rickets in Mathare Nairobi last year Dr Jones raised questions why Nairobi, nostalgically called the City in the Sun, with abundant sunshine should have its children developed rickets.

He however cites evidence showing up to 71 per cent of children with rickets in Kibera slums for example have less than three hours’ sunlight exposure per week.

Dr Jones cites the mushrooming poorly constructed and ventilated baby care centres all over the poor residential areas in Nairobi where new mothers leave their infants as they go in search of work.

Most of the houses in poor estates, Dr Jones says lack windows or open spaces all which limit sunlight exposure leading to the current rise in rickets.

However in the much more colder central region compared to Nairobi and western the practice of swaddling or over clothing children was found to contribute to rickets.

Compared to Nyeri or Nyahururu, the authors say children in Kisumu or Kakamega, will certainly be less dressed hence more exposure to sunlight. The authors also reported a link between rickets and pneumonia in central Kenya.

Most children with rickets in this study were diagnosed with wrist widening and enlargement of the rib bones called rachitic rosary as opposed to bowed legs.

The authors suggest the Ministry of Health consider providing pregnant and breast feeding women with calcium or vitamin D supplements as well as fortified food for infant.

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