Rickets in Bangladesh: An Emerging Public-health Nutrition Crisis

Authors: S.K. Roy (skroy@icddrb.org), Rubhana Rakib, Nurul Alam, Mohammad Iqbal, Abbas Bhuiya, Mansura Khanam, Afroza Begum, Md. Fahim Hasan Ibne-e-Khair, Anik Podder, Shahidul Haque, H.K. Das, Mohosin Ali, Josephine Ippe, Tahmina Talukder, M. Chowdhury, and T.M. Alamgir Azad ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh, SARPV, 3/8, Block F, Lalmatia, Dhaka 1207, Bangladesh, CARE Bangladesh, Pragati RPR Centre (Level 12), 20-21 Kawran Bazar, Dhaka 1215, Bangladesh, UNICEF, BSL Office Complex, 1 Minto Road, Dhaka 1000, Bangladesh, 5National Nutrition Programme, Dhanmondi, Dhaka, Bangladesh,BRAC, Mohakhali, Dhaka 1212, Bangladesh, and PLANBangladesh, House CWN (B) 14, Road 35, Gulshan 2, Dhaka, Bangladesh

Background: Rickets, first reported in Europe in the mid-1600s, was recognized as an important health problem in Bangladesh in 1991. Dozens of countries have reported rickets in the past 3 decades; however, in Bangladesh, it received the first attention by Social Assistance and Rehabilitation of the Physically Vulnerable (SARPV), visiting the Chakaria region of southeastern Bangladesh after a devastating cyclone in 1991. Helen Keller International reported 0.26% prevalence of rickets among 21,571 children in 2000 and 0.12% among 10,005 children in 2004.

Objective: Determine the national prevalence of rickets among Bangladeshi children aged 1-15 year(s) and examine its association with their nutritional status.

Methodology: In total, 16,000 rural and 4,000 urban children from all socioeconomic groups were randomly selected from 6 divisions of Bangladesh and examined for features of rickets, and their parents/guardians were interviewed to understand the current and past feeding practices of the respective children. In clinically-suspected cases, anthropometric measurements [weight, height,and mid-upper arm circumference (MUAC) and radiological examination] were done for identifying radiological signs of active rickets, and 5 mL of venous blood was taken for biochemical tests.

Results: The national survey showed that the prevalence rate of rachitic children was 0.99%. The mean age of rachitic children was 5.6 years, and the mean weight was 13.89 kg. Radiologically, 24% had active rickets, 34% were in the growing phase of rickets, and 42% were not evident. The prevalence of severe stunting was 53%, severe underweight 40%, and severe wasting 1.4%

Conclusion: The results suggest that rickets is an emerging public-health problem in Bangladesh. The Government needs to develop policies and
programmes to prevent and cure rachitic disability in Bangladesh and terminate the social and humanitarian crisis.

Acknowledgements: The financial support of CARE Bangladesh, UNICEF, and NNP (MoHFW) is acknowledged.