Rickets is an illness that is caused by a deficiency of calcium in the skeletal structure. This brings about a softness in the bone, thus resulting in the bending of the bone when continuous pressure is put upon it. It is usually seen in the legs because of the weight that has been exerted on the leg bones when a person is standing, walking, carrying loads, etc.
Rickets is endemic in southern Kaduna State. HVCF first came across cases as far back as 1995 when children from a community close to the clinic came for assistance. Since that time, the incidence of rickets has become much higher, and is seen in various parts of the Kaduna State. In 2005 HVCF began an intensive project to address rickets, a project consisting of care of children with rickets through administration of high dosage of calcium; surgery when needed for correction of deformities; and research into the cause. The field research was carried out by medical students from abroad, and full investigation was done in labs in Germany, England and the U.S. To date, while it is known that the immediate cause is the deficiency of calcium, the remote cause of the high incidence in the Kaduna State area has not been determined.
Rickets is a condition experienced by many children in Kaduna State. Children who experience the deformity often live with pain, pain which sometimes prevents them from going to school and taking part in the ordinary life of the family. With a daily supplement of calcium, the pain is lessened, if not stopped, and at times the calcium causes the deformity to be corrected. At other times the deformity is too severe, and surgery is required. After a period of recuperation, the children are proud to show off their new look, a confidence exhibited even in a new look in apparel. It is a time of joy for parents and friends, but none are so happy as the children themselves.
The rickets programme includes prevention as well as treatment.
To make some effort toward prevention, women in communities are taught how to use calcium-rich foods in preparing a variety of nutritious meals for their families. Another preventive measure is the distribution of calcium to pregnant women and nursing mothers in some of the communities with higher incidence of rickets among the children.
To date, close to 2000 children have been registered over the past eleven years. More than 400 bone surgeries have been carried out. Of the 2000 registered, some of those earlier seen with deformities have been able to have the deformities corrected through calcium supplement alone, and they are living full, active lives. There are others who have had surgeries, and due to the correction effected, have been able to move into their society confidently and without pain, completing formal education and planning for future careers and lifestyles once deemed impossible for them.
I thought that rickets was caused by a deficiency of Vitamin D but you say it is a calcium deficiency. Am I wrong?
No, you are not wrong. When rickets was prevalent in the far northern hemisphere where long winters resulted in little sunlight, people did not reap the benefits of Vitamin D that comes from the sun. And it is Vitamin D that is one of the essential elements that causes calcium to be absorbed by the bone, thus making it strong. This in the past resulted in rickets until people were able to make adjustments to get more Vitamin D. However, in Nigeria, sunshine is abundant, and laboratory tests show that the children here do not lack Vitamin D. Yet, they do have a calcium deficiency in their bones which causes the bones to be soft and thus bend abnormally.
Is there a genetic cause of this illness?
There has been no definite determination of a genetic cause. However, from observation, it is clear that some undetermined factor is in play because in a single family, perhaps only one child is affected whereas in another, the majority of children are affected, yet all in a family eat the same food.
Is this condition evident when children are born?
No, it is not. An infant is carried about, and no weight is put upon the bone structure. It is only when that infant begins to walk and the body begins putting weight on the legs or spine that the condition becomes apparent. Especially in families where several children are affected, parents await their infants’ initial steps with some trepidation.
Is rickets a disease of the legs? We have seen bow-legged people and knock-kneed people.
Rickets is a disease of the bones therefore it affects the whole skeletal structure, depending on the severity of the disease. In the rickets program of HVCF we see children with bowed legs and with knock knees but we also have what is known as wind swept rickets where both legs go out to one side. We also see children with other types of deformity of the legs. But rickets can also be seen in severe bending of the spinal column, in a very prominent forehead, in large ankle and wrist bones, even in lack of teeth and various other manifestations.
Do children with rickets go to school?
Yes, generally they do, if the school is sufficiently close to their home and if the level of deformity does not cause too much pain when they walk. They also take part in other family and social activities.
Some of their legs are very deformed. Are such children accepted by their peers?
This is a difficult question to answer. Because rickets is common, the children are seen in school, in the community, in the market, and so it is not like there is an outright rejection. However, as can be the case with children, at times they make comments about the children, the shape of their legs, their inability to run or walk as others, etc., that cause the children with rickets to feel ashamed and isolated. This is one reason for the joy of children who have surgery and begin to feel like they are just as other children.
Is this problem of rickets everywhere in Kaduna State? Does it involve children of more than one ethnic group?
The problem mainly exists in areas south of the city of Kaduna. Initially it was thought to be chiefly in an area immediately south and east of the city; however, it is now known to be widespread throughout some of the southern areas of the state. HVCF began a more intensive involvement with children with rickets in the Jaba Chiefdom in Southern Kaduna State two years ago. So yes, it does involve many different ethnic groups, but some more than others.
Is rickets seen only in Kaduna State?
No, rickets is a disease seen in children all over the country. However, to our knowledge, the high incidence of rickets is seen only in Kaduna State.