RICKETS IN BLACK-CHILDREN BEYOND INFANCY IN NATAL

Objective. To determine the clinical spectrum of rickets among black c hildren admitted to King Edward VIII Hospital, Durban. Design. Prospec tive study of black children with rickets beyond infancy. Setting, Hos pital-based population; King Edward VIII Hospital, Durban, Participant s. A total of 37 patients, aged 1 - 12 years, were recruited over a 3- year period, None had been on vitamin D or calcium supplementation pri or to investigation. Outcome measures, Pickets was diagnosed clinicall y, radiologically and biochemically (by a raised alkaline phosphatase value of > 350 IU), Gastro-intestinal, hepatic and renal glomerular ca uses were excluded in all patients using standard clinical and laborat ory criteria, Results, Twenty-three patients were diagnosed as having privational rickets, Nine had 25-hydroxyvitamin D (25-OHD) levels of < 10 ng/ml while 14 had levels within the normal range and were suspect ed of having dietary calcium deficiency, Ten had a phosphopenic variet y of rickets; the remaining 4 had healing or healed rickets on the bas is of radiological assessment and normal biochemical values, Pain toge ther with difficulty in walking and bowing of the lower limbs were the main reasons for presentation, The main clinical findings were thicke ned wrists and ankles and rickety rosary (100%), stunting (85%), anter ior bowing of lower limbs (70%) and genu valgum (65%). The calcium and vitamin D deficiency group showed a much better clinical, biochemical and radiological response to therapy than the phosphopenic group on f ollow-up (18 patients). Conclusion. This is the first substantial repo rt on rickets in the older child in Natal, which extends the findings from Transvaal, thereby establishing a recognisable pattern of rickets beyond infancy in South Africa, It draws attention to the common clin ical presentations which may alert health professionals to the presenc e of this problem, This report demonstrates that the two commonest typ es are privational rickets (due to calcium and/or vitamin D deficiency ) and phosphopenic rickets.