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Bone. 2015 Aug;77:1-5. doi: 10.1016/j.bone.2015.04.011. Epub 2015 Apr 12.

Prevalence of rickets-like bone deformities in rural Gambian children.

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MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK; MRC Keneba, The Gambia.
MRC Keneba, The Gambia.
MRC Keneba, The Gambia; Northumbria Healthcare NHS Foundation Trust, UK.
MRC Keneba, The Gambia; MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK; MRC Keneba, The Gambia. Electronic address:


The aim of this study was to estimate the burden of childhood rickets-like bone deformity in a rural region of West Africa where rickets has been reported in association with a low calcium intake. A population-based survey of children aged 0.5-17.9 years living in the province of West Kiang, The Gambia was conducted in 2007. 6221 children, 92% of those recorded in a recent census, were screened for physical signs of rickets by a trained survey team with clinical referral of suspected cases. Several objective measures were tested as potential screening tools. The prevalence of bone deformity in children <18.0 years was 3.3%. The prevalence was greater in males (M = 4.3%, F = 2.3%, p < 0.001) and in children <5.0 years (5.7%, M = 8.3%, F = 2.9%). Knock-knee was more common (58%) than bow-leg (31%) or windswept deformity (9%). Of the 196 examined clinically, 36 were confirmed to have a deformity outside normal variation (47% knock-knee, 53% bow-leg), resulting in more conservative prevalence estimates of bone deformity: 0.6% for children <18.0 years (M = 0.9%, F = 0.2%), 1.5% for children < 5.0 years (M = 2.3%, F = 0.6%). Three of these children (9% of those with clinically-confirmed deformity, 0.05% of those screened) had active rickets on X-ray at the time of medical examination. This emphasises the difficulties in comparing prevalence estimates of rickets-like bone deformities from population surveys and clinic-based studies. Interpopliteal distance showed promise as an objective screening measure for bow-leg deformity. In conclusion, this population survey in a rural region of West Africa with a low calcium diet has demonstrated a significant burden of rickets-like bone deformity, whether based on physical signs under survey conditions or after clinical examination, especially in boys < 5.0 years.


Africa; Calcium; Deformity; Rickets

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