Rickets was discovered in Bangladesh in 1991 after the cyclone when SARPV was there to provide service to the severely injured and disabled people. At the beginning of the relief work by my organization, the Social Assistance and Rehabilitation of the Physically Vulnerable (SARPV), in SE Bangladesh (Chakaria), I found everyday one or two children would come with their parents whose legs and hands had deformities. I was wondering what it was since as a result of these deformities, children might have to live their lives with physical disabilities.
Realizing the threats of disability, I shared this with Dr. John E. Bullock of Malumghat Christian Hospital (MCH), and he told me that name of this deformity was rickets but happens due to lack of vitamin D. Why it was happening it was unknown. I then consulted with Julian Franics who advised me to do a survey in one village to see the prevalence of this disease in the children. SARPV then did a survey in one village named Baraitali with support of one social worker name Maruf at that time we found about 1% children with these deformities in that time.
At that time SARPV sent 25 children to MCH hospital consulting with Dr. John E for operation as per advice of Dr. John E Bullock whether it is curable by operating or not to see and we found that 99% of them has got back their straight leg. That was the first time operation of Rickets children in Bangladesh .
In 1993 I got an opportunity to share about rickets with an organization named AEM of France, and then they came with a group of multi-disciplined professionals to come and practically see in late 1994 through one doctor named Jean Paul Cimma.
Rapid assessment of the Rickets in 1995 to 1997
In 1995 Dr. Cimma with other colleagues did a rapid assessment from Chittagong to Mhoheskhali where rickets was found near about 4.5% of the children. Then we informed UNICEF, DFID, Medical Association, and WHO. Brigadier M.A. Hafiz issued a letter from WHO to all medical concern to take care of this issue and to see what it was, but there was no response at all at that time.
In 1997 one day Dr. Craig Meisner and Dr. Jerry Combs came to SARPV and asked me about rickets. They had been contacted UNICEF local office about this disease and were further interested.
Chronology Efforts Into Rickets Situation in Bangladesh
- 1991 SARPV identified the abnormal incidence of rickets in Chakaria
- 1991-1993 SARPV raised campaigns through Newspapers, Dialogue forum, Letter correspondences, Annual reports and Workshops
- 1993-1994 Rapid prevalence-assessing surveys done by, SARPV Nutritional survey done by AEM Rachitic children clinically and pathologically examined by AEM
- 1995 Supplementation trial using different Calcium & Vitamin-D doses by AEM
- 1997 Rickets Consortium formed in Chakaria (ICDDRB, BRAC, Cornell University , CIMMYT UNICEF, SARPV, AEM, MCH, ICMH)
- 1998 A Survey on Food-habit of the inhabitant of the Cox’s Bazaar and Dianjpur conducted by Cornell University Rickets children clinically and pathologically examined by Cornell University , SARPV, MCH and Dhaka UniversitySupplementation trial of Calcium on 2 to 5 years old children done by Cornell University , CIMMYT, and SARPV
- 1999 -Prodipaloy (an integrated school) was set up to supervise control children under rickets’ research by AEM- France and AMD, KDM with SARPV
- 1999- 2000 -Rapid assessment on Rickets done by BRAC, HKI Under Rickets Consortium in
- 2000- 2001- Physiotherapy training started for community level physiotherapists by KDM- France for early intervention and check rickets by physiotherapy service along with other support.
- 2001-2002- To change the quality of food cooking utensils were changed in 100 families instead of cheap aluminum they were provided stainless steel utensils to cook their food to see the quality of food in one village in Cox’s Bazaar.
- 2002-2005- Using live and video dramas, a community awareness program was conducted by SARPV and CIMMYT which attempted to provide information to communities about rickets, its prevention by better Ca-rich food production and consumption.
- 2003- Surgical Program was taken to operate the rickets children for the curative purpose
- 2003-2005- At the same time Nutritional program was taken under 200 children who are till now under the close supervision of this program to observe their development through nutritional advice and also with the support of physiotherapy how far it can check and prevent this disease. Then another need developed to have a assistive device center.
- 2003-2005 An assistive device center has been developed now there it produce the brace, crutch, walker and other necessary equipments what is needed for the disabled children beside of rickets so that need of the other disabled children can also meet has been set-up by AMD- France
Current ApprehensionsRickets is not a problem of coastal belt only as the entire Bangladesh is at risk.
The most affected area of rickets are in the following divisions. This has been identified with the support of one our consortium member name HKI.that in all 6 Divisions Rickets has bee found but what is the prevalence of this it is not known to us till today.
1. Chittagong , 2.Syllhet, 3.Dhaka, 4.Rajshahi, 5.Khulna, 6. Barisal
These are the divisions where rickets has been found gradually increasing and from this picture in no way it can be said that it is the problem of only in the coastal belt. This is the problem of whole Bangladesh and it is an alarming factor for the overall development of the nation. Still we don’t know for sure the causes of rickets and probable prevention strategies Rickets is a Problem of ,Environment,People’s Food-habit ,Nutrition- child and parents, Health, and Disability. Rickets is a multi-dimensional social problem with grave aspects of concerns. I strongly disagree with this statement.We DEFINITELY now know that it is lack of Ca in The diet. We know that supplemental Ca in the diet alone can prevent and cure! Don’t reinvent the wheel here.
Rapid Assessment of Tribal Communities
A quick rapid assessment survey was conducted on 35 households in the ethnic groups and 35-house hold in the plain land to see the prevalence of Rickets in the tribal community as already we have found rickets children in the plain land household in previous studies. This 35 household of the tribe has been selected randomly from two district and 7 villages and rest 35 household of the plain land has been selected nearest plain land community of the tribal community what was in our sample. Out of total 13 tribes, 7 tribes were sampled randomly from Banderban District and Cox’s Bazaar District. After the recruitment of necessary staff, a training of 3 days was conducted in the local SARPV office at Chakaria about the purpose and procedure of the study. To identify and collect the children, the workers took the help of an identification slip to a particular place used Geographical Reconnaissance Sheets. Interview of the parents were taken and the children were examined for evidences of rickets and wherever it has been necessary a medical doctor has been taken to justify the rickets cases. In this study we have followed our methodology and talked to the parents and also we have seen the children of the sample households and referral house holds too. In addition we met the community leaders and elder persons of the community, Social Worker of each community. We tried to know the food habit of each house hold both in tribal and plain land household (in the previous study it is found that rickets is more common in low-socioeconomic group where dry fish is commonly used. Dry fish is preserved with some chemicals. So there might me some correlation with these two). Out of 35 tribal households we did not get any Rickets Children on the other hand and of 35 plain land houses hold we have got in the sample households 17% of rickets children and referral 11% of Rickets Children. Major difference in the food among the tribal and plain land household it has been found that tribal people takes maximum vegetables than the Plain land household (47%). Dry fish is also less among the tribal people (26%). The tribal people in comparison to the plain land household take less chilies and spices (36%). Finally their cooking time is less than the plain land people. Mostly tribal people eat most of the wild animal and all types sea fish, snail, snake, shark etc 100%. Another observation is that tribal people use less dress than the plain land people, it means more exposed to sunlight. Birth spacing in tribal is more, as result children get maximum time to have the breast milk (%). It is also has been observed that tribal People spent only 6% in education, 68% to the food and to the health17% sector from their income. On the other hand Plain land people spent 57% for the food, 16% for education and for health 17%.
SARPV strongly feel that there is a need to again have a national survey to see the current prevalence of rickets in Bangladesh and root cause of this lack of calcium in food what has been identified now.
Second also to see the difference of food behave of the tribal people and cooking pattern and Environmental difference what has been push the people in to threat for he future generation to be affected by rickets and to turn their life as physically disabled. SARPV also feel that Nutritional Program can be redesigned to prevent the rickets disease from Bangladesh .
SARPV also feel that there is a real need to set up Rickets Research Institute so that in near future we can take proper action. We do feel we need a solution permanently to free this country from any further rickets’ epidemics and to save our future generations.
Shahidul Haque/ SARPV
26 January, 2006