Dear Colleagues,
Greetings from Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV). It is nice to see an article on disability issues regarding their rights. This issue has been discussed for the last two decades but till now it is far from the reality. One of the major reasons is those who are talking or raising this issue might not be in the planning or decision-making process as a result is always being seen on the paper and discussion, not in the structural design and planning process.
Today I have taken an interest to raise another issue regarding the Prevention of childhood disability from Rickets. If we give a little attention I think it is very much possible to execute this. Here I am placing an idea of SARPV on this issue as follows you might help me to take this issue further.
Rickets: An Emerging and Neglected Public Health Problem Due to Micronutrient Deficiency in Bangladesh
Background
Rickets is a condition affecting children associated with bony deformity followed by disability due to inadequate mineralization of growing bones. Rickets is classically caused by a deficiency of vitamin D, but in Bangladesh, calcium deficiency is established to be an additional etiologic factor. Rickets, first reported in Europe in the mid-1600s, has been recognized as an important health problem in Bangladesh in 1991. Dozens of countries in different parts of the world have reported rickets in the past three decades. In Bangladesh rickets were first brought to broad attention by the workers of Social Assistance and Rehabilitation of the Physically Vulnerable (SARPV) while working in the Chakaria region of Southeastern Bangladesh after a devastating cyclone in 1991. The Helen Keller International (HKI) conducted surveys in 28 Upazilas of Bangladesh in 2000 and 2004. “Rickets” was identified as visible varus and/or valgus deformities in children aged 1-15 years. Nationally, rachitic deformities were observed in 0.26% of 21,571 children surveyed in 2000 and in 0.12% of 10,005 children surveyed in 2004. Rickets was identified in over half of the sub-districts with the highest prevalence in Sylhet (North East) and Chittagong (South East) divisions.
The highest prevalence (1.4% in children aged 1-15 years with visible rachitic deformities) was noted in the Cox’s Bazaar sub-district. BRAC conducted a survey among all inhabitants of Chittagong in 2003 and identified rachitic deformities in 0.9%. Institute of Child and Mother Health (ICMH) conducted a more detailed survey in the Chittagong Division in 1998 and observed at least one clinical feature indicative of rickets in 8.7% of children surveyed: 4% had lower limb deformities, 0.9% had radiological evidence of active rickets, and 2.2% had elevated levels of serum alkaline phosphatase. Dietary calcium and vitamin D deficiency represent two ends of the spectrum in the pathogenesis of nutritional rickets, with their combination occupying the middle. In Bangladesh, earlier studies had suggested that vitamin D deficiency was not a major causal factor for rickets, and calcium deficiency was assumed to be the primary etiologic factor.
A national survey conducted in 2008 by ICDDRB and supported by NNP, UNICEF and CARE showed the prevalence rate of rachitic children as 0.99%. In the southern parts of the Chittagong division; the Chittagong and Coxes Bazaar districts had the highest prevalence.
The national survey concluded that the high prevalence of rickets in this national survey is very important to bring to the attention of the policymakers for taking preventive approaches and intensity of their activities according to the density of the incidence. The significant number of cases estimated (1% of 1-15 yrs old children) in the country needs adequate treatment with nutritional, medical and surgical interventions.
Intervention:
Few small-scale intervention programs prove that dietary improvements through intake of calcium-rich foods and supplementation can effectively prevent Rickets.
Recommendation:
Rickets should be focused with due importance in the next health sector plan/HNPSP as an emerging public health problem due to micronutrient deficiency. It should be an integral part of nutrition interventions including nutrition education and prevention and control of micronutrient deficiency disorders.
Rickets intervention should be mainstreamed into the current essential service packages under DGHS and DFGP. It should be incorporated into the operational plans of the National Nutrition Program (NNP) and Institute of Public Health Nutrition (IPHN) with adequate resource allocation.
Wish your cooperation in this regards
Shahidul Haque (Ashoka Fellow)
Founder Chief Executive
SARPV
Address: House No: 274/4, 3rd Floor.
South Monipur, (60 Feet Road) .
Mirpur. Dhaka-1216
Telephone no: +88-02-226622022, 02-226622023 and 02-226622024
Email: shahidul@sarpv.org shahidul.sarpv@gmail.com, sarpv.1989@gmail.com,
Web: www.sarpv.org
"Please do not treat the human being with their impairment treat with their ability"
HIFA profile: Md. Shahidul Haque is Chief Executive of Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV) in Bangladesh. Professional interests: As we are working since 1992 to reduce childhood disability at an early stage and in some cases trying to prevent children with disabilities from Nutritional Rickets Disease. Email address: Shahidul.sarpv AT gmail.com
