1. Description of Children Diagnosed with Rickets Attending Occupation Health Clinic at Kayole 1 Health Centre 2012-2014 Makena Muriithi Level V MbChB, UON

2. Rickets Disease of growing bone Several aetiological pathways identified all involving reduction in calcium and/or phosphorus Most common cause in developing countries is vitamin D deficiency Vitamin D is essential for intestinal absorption of calcium

3. Complications of Rickets Sequelae: Delayed developmental milestones Pain Crippling deformities Fractures Pneumonia (Muhe, Lulu et al Lancet 1997)

4. Burden of Rickets Several studies on causes and associations Prevalence and incidence largely based on rumuor log No international or local protocol on prevention and management of rickets

5. Study Objectives 1.To determine the proportion of children below 5 years of age with rickets in Kayole 2.To characterize children below 5 years of age undergoing occupational therapy at Kayole 1 Health Centre due to rickets

6. Study Methods (1) Study site: Kayole 1 Health Centre Study design: Retrospective records review Study population: Children less than 5 years attending O.H.C at Kayole 1 Health centre Sample: All children attending attending O.H.C at Kayole 1 Health Centre

7. Case Definition Any child less than 5 completed years (60 completed months) of age diagnosed with rickets confirmed by biochemical tests and enrolled into the occupational therapy clinic at Kayole 1 health Centre between 1 st January 2012 and 30 th November 2014.

8. Study Methods (2) Data sources: DHIS and attendance register Variables: Age; Sex; Residence; Clinical presentation; Medical therapy Data management: Microsoft Office Excel 2007 worksheets Data cleaning Analysis Calculated means and proportions

9. Results 468 new patients 281 (60%) new rickets patients 143 (50.9%) female 164 records identified for review 187 (40%) enrolled due to other causes

10. Proportion of Rickets Patients Enrolled to Occupational Health Clinic at Kayole 1 Health Centre 2012-2014

11. Distribution of Rickets Cases by Age Group, 2013-2014

12. Distribution of Rickets Cases by Sex 2013-2014 20132014 MALE34 (45.3%)34 (38.2%) FEMALE36 (48%)55 (61.8%) NOT SPECIFIED5 (6.7%)

13. Area of Residence of Rickets Cases at O.H.C at Kayole 1 Health Centre Area of residence2013 (n=75)2014 (n=89) Kayole49 (65.3%)79 (82.4%) Not indicated17 (22.7%)1 (1.1%) Mihango5 (6.7%)7 (8%) Umoja1 (1.3%)1(1.1%) Ruai1(1.3%)1(1.1%) Saika1(1.3%)1(1.1%) Njiru02 (2.3%) Pipeline01 (1.1%)

14. Clinical Presentation of New Rickets Patients at O.H.C at Kayole 1 Health Centre 2013-2014 Sign/Symptom20132014 Delayed developmental milestones 2075 Hypotonia1540 Hyporeflexia516 Bilateral lower limb bowing19 Bilateral foot eversion33 Confirmed medical therapy15 (20%)66 (74.1%)

15. Limitations Missing records Incomplete documentation of patient information Poor storage of medical records

16. Conclusion Rickets accounts for majority of new admissions into O.H.C at Kayole 1 health centre The 6-11 months age group is most affected by rickets Most of the rickets patients at the clinic are residents of Kayole Division A majority of these patients present with delayed developmental milestones

17. Recommendations Improvement of tools used for client documentation at the clinic to ensure data quality There is need for proper data keeping at the facility Integration of medical records Analytical studies to determine risk factors for rickets

18. Acknowledgements 1.School of Public Health, The University of Nairobi 2.Field Epidemiology and Laboratory Training Program, Ministry of Health 3.Ministry of Health 4.Nairobi County Health Department