Nutritional Rickets During the COVID-19 Pandemic in Rivers State, Nigeria: A Case Series Highlighting Challenges in Management in A Resource-Constrained Setting

Abstract

Background: Nutritional rickets (NR) is a global preventable disease of public health significance which negatively affects the growth and development of infants, children and adolescents. NR results from insufficient sunlight exposure, Vitamin D and/or calcium deficiencies. Diagnosis is based on a combination of clinical, biochemical and radiological abnormalities. Treatment with Vitamin D and/ or calcium supplementation, and food fortification is efficacious in managing the metabolic disorder. Treatment challenges in resource-limited settings include financial constraints, high costs of diagnostic workup, lack of readily available diagnostic laboratories and high rate of loss to follow-up. Recently, an increasing prevalence has been attributed to the impact of the COVID-19 pandemic due to prolonged movement restrictions and indoor confinement, particularly in young infants and adolescents. Methods: This is a retrospective review of three Nigerian children who presented to the Endocrinology clinic of the Rivers State University Teaching Hospital with clinical, biochemical and radiological features suggestive of NR. Two of the cases were 42-month-old males while the third case was a 30-month-old female. All received vitamin D and calcium supplementation, however, response to treatment was mostly inadequately monitored due to lost to follow up. Conclusion: Nutritional rickets among children in Rivers State is on the increase and perhaps is a consequence of COVID-19 pandemic restrictions and worsening nutritional status due to rising inflation in the country. Paediatricians and healthcare workers are hereby alerted to have a heightened index of suspicion to screen and treat nutritional rickets among children with features of nutritional deficiencies with or without overt bony deformities. Key words: Nutritional Rickets, Vitamin D Deficiency, COVID-19 Pandemic, Inflation