Nutritional rickets in young Nigerian children in the Sahel savanna.

OBJECTIVES: To determine the prevalence of clinical and biochemical rickets in an under-five out-patient population, relate the prevalence of biochemical rickets (BR) to the sociocultural characteristics of families and determine the response of nutritional rickets to vitamin D therapy. DESIGN: Prospective cross-sectional and retrospective case-series surveys. SETTING: Paediatric general out-patient and consultant clinics. SUBJECTS: One hundred and ninety eight out-patients and twenty two patients aged >1 to 60 months treated for nutritional rickets. INTERVENTIONS: Clinical examination, interview with mothers and determination of biochemical abnormalities of under-fives and management of patients with rickets using stosstherapy. MAIN OUTCOME MEASURES: Prevalence of BR and response to stosstherapy. RESULTS: Eight (4%) patients in the survey had clinical and biochemical rickets while 33 (17%) had biochemical rickets only; 92 (47%) other patients had isolated hypocalcaemia and/or hypophosphataemia. The prevalence of BR was higher in males (p <0.05), and increased with age (p <0.001). The prevalence was lower in families who were indigenous to the area (p <0.05), children of Moslem families (p <0.05) and children whose mothers were full-time housewives, unskilled or traders (p <0.01), and who lacked any formal western education (p = 0.157). Three of the seven evaluable patients who received stosstherapy responded late. CONCLUSION: The results support the hypothesis that deficiency or reduced availability of dietary calcium may be of at least equal importance with vitamin D deficiency in the aetiology of nutritional rickets in the Sahel savanna.

The role of ions in goitre prevalence in two local government areas of Plateau State, Nigeria.

This study tried to show the contributory role of ions (cations and anions) to great contrast in the goitre prevalence between Bassa and Jos Local Government Areas, both of Plateau State, Nigeria. In pursuance of this, the concentration of cations (Ca++, Fe++, K+, Mg++, Na+, & Zn++) and anions (C1-, F, I-, & NO-3) in soil and drinking water in the two LGAs were determined and their results compared and correlated with the goitre prevalence of these areas. It was observed that both Bassa and Jos LGAs have very low but similar amounts of iodide ions in their soils. Besides, Bassa LGA contained more ions in both soil and drinking water than Jos LGA. In conclusion, the results appear to suggest that the higher ion contents of both soil and drinking water in Bassa LGA exacerbated the coexisting low iodide condition of the LGA, thus resulting in the higher goitre prevalence found in the LGA.

Endemic goiter in the Jos Plateau region of northern Nigeria.

This study is an endemic goiter survey of 3476 school children in 13 Local Government Councils (LGCs) and 1004 subjects in a whole community of one LGC, Plateau State, Northern Nigeria, to determine the prevalence of goiter as well as to identify some of the etiological agents involved. Results of the survey showed that the disease is highly endemic in the area with prevalence varying in places from 1 to 23% of these subjects. Females showed a markedly higher prevalence of goiter. Analysis of 729 urine samples indicated that iodine excretion ranged from 3.5 to 1.3 microgram/dl (32-154 microgram/g creatinine) and was similar to that in iodine deficient areas in the world, but no relation was observed between the prevalence of goiter and urinary iodine. Urinary thiocyanate levels were less than 0.5 mg/dl, suggesting that the role of the thiocyanate as a goitrogen is not important in the region. Thyroid hormone parameters in village subjects with goiter were similar to those in goiter endemia except serum thyroxine (T4). An interesting result found in village subjects was very high serum thyroxine binding globulin, which leads to an increase in serum T4. This study indicated that Northern Nigeria is an area of endemic goiter. Although some areas in Plateau State are iodine deficient zones, we could not conclude that the etiology of endemic goiter in this area is associated with iodine deficiency. There may be an interplay of multiple factors of etiological importance.

Cations and anions in drinking water as putative contributory factors to endemic goitre in Plateau State, Nigeria.

The prevalence of endemic goitre in Plateau State, Nigeria was established and an attempt was made to identify some of the possible environmental goitrogenic agents in the region to establish their likely relationship with the goitre endemicity. Iodine deficiency appears to be a major aetiological factor for the disease as indicated by low iodine levels observed in portable drinking water and in daily urinary excretion. The carbonate (CO3-) content of drinking water supply was found to bear a significant positive correlation with the goitre rate for the entire state (p less than 0.005). The calcium (Ca++) and magnesium (Mg++) levels of the drinking water also exhibited relatively good linear direct correlations with the percentage goitre distribution in a region, nearly 2/3 of the state. It is concluded that there is possibly an interplay of several factors and in particular the carbonate content of drinking water which, in association with a state of iodine deficiency, may be regarded as responsible for the goitre endemic seen in this part of the Continental Africa.