The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study

Moses M Ngari, Johnstone Thitiri, Laura Mwalekwa, Molline Timbwa, Per Ole Iversen, Greg W Fegan, James A Berkley, Moses M Ngari, Johnstone Thitiri, Laura Mwalekwa, Molline Timbwa, Per Ole Iversen, Greg W Fegan, James A Berkley

Abstract

The effects of rickets on children recovery from severe acute malnutrition (SAM) are unknown. Rickets may affect both growth and susceptibility to infectious diseases. We investigated the associations of clinically diagnosed rickets with life-threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated SAM. This was a secondary analysis of clinical trial data among non-human immunodeficiency virus-infected Kenyan children with complicated SAM (2-59 months) followed for 1 year posthospital discharge (ClinicalTrials.gov ID NCT00934492). The outcomes were mortality, hospital readmissions, and growth during 12 months. The main exposure was clinically diagnosed rickets at baseline. Of 1,778 children recruited, 230 (12.9%, 95% CI [11.4, 14 .6]) had clinical signs of rickets at baseline. Enrolment at an urban site, height-for-age and head circumference-for-age z scores were associated with rickets. Rickets at study enrolment was associated with increased mortality (adjusted Hazard Ratio [aHR] 1.61, 95% CI [1.14, 2.27]), any readmission (aHR 1.37, 95% CI [1.09, 1.72]), readmission for severe pneumonia (aHR 1.37, 95% CI [1.05, 1.79]), but not readmission with diarrhoea (aHR 1.05, 95% CI [0.73, 1.51]). Rickets was associated with increased height gain (centimetres), adjusted regression coefficient 0.19 (95% CI [0.10, 0.28]), but not changes in head circumference, mid-upper arm circumference, or weight. Rickets was common among children with SAM at urban sites and associated with increased risks of severe pneumonia and death. Increased height gain may have resulted from vitamin D and calcium treatment. Future work should explore possibility of other concurrent micronutrient deficiencies and optimal treatment of rickets in this high-risk population.

Keywords: children; mortality; rickets; severe acute malnutrition; severe pneumonia.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2017 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for risk of (a) mortality, (b) all readmissions, (c) readmission for severe pneumonia, and (d) readmission for diarrhoea stratified by rickets status at baseline. Blue dashed line = no rickets; red line = rickets

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Source: PubMed

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