Nutritional rickets and its associated factors among under-five children in Assela referral and teaching hospital, Ethiopia: a hospital based cross-sectional study design

Abstract

Background

Nutritional rickets is a preventable skeletal disorder caused by deficiencies in vitamin D, calcium, or phosphate, leading to softening and weakening of bones. While it was once nearly eliminated in high-income countries, the resurgence of rickets in various parts of the world—particularly in low- and middle-income countries (LMICs)—reflects the ongoing challenges of malnutrition, inadequate healthcare, and socioeconomic factors. This study aimed to determine the prevalence and associated factors of nutritional rickets in the study area.

Methods

A hospital-based cross-sectional study was conducted from June 15 to July 30, 2022, involving 442 children under the age of five who visited the pediatric ward, pediatric OPD, EPI, and pediatric emergency departments of referral and teaching hospitals in Assala, Ethiopia. Data were collected using a pre-tested, structured questionnaire administered through face-to-face interviews. A checklist was used for chart reviews. Data were entered into Epidata version 3.1 and analyzed using STATA version 18. Predictors of nutritional rickets were assessed using multivariate logistic regression analysis, with results presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value of < 0.05 was considered statistically significant.

Results

The study found that the prevalence of nutritional rickets in the study area was 3.8% (95% CI: 1.90–5.70). Factors significantly associated with nutritional rickets included being male (AOR = 1.59, 95% CI: 1.10–16.57), lack of information about rickets (AOR = 7.16, 95% CI: 4.22–12.68), and exposure to sunlight while fully dressed (AOR = 3.27, 95% CI: 1.05–5.28).

Conclusions

This study indicates that nearly one in every twenty-five children in the study area is affected by nutritional rickets. Factors such as male sex, lack of information about rickets, and inadequate sun exposure due to full clothing were identified as significant risk factors. To prevent this condition, coordinated efforts from all relevant bodies are required. Additionally, raising awareness among mothers and caregivers, particularly through maternal education, is essential. Educated mothers are more likely to adopt improved childcare practices, which can reduce the incidence of nutritional rickets.