Diagnosis of rickets and reassessment of prevalence among rural children in northern China

Authors

  • MARK A. STRAND,

    Corresponding author
    1. 1Medical Programs Department, Shanxi Evergreen Service, Taiyuan, 2Yuci Women and Children’s Health Center, Yuci, 3Shanxi Women and Children’s Hospital, Taiyuan, 4Shanxi Medical University, Taiyuan, Shanxi, China, 5Program in Health and Behavioral Science, University of Colorado, Denver, Colorado, and 6Mayo Clinic, Rochester, Minnesota, USA
      Mark A. Strand, Xinji Huayuan, Erqu, 2-408, Jinzhong, Shanxi Province, 030600, China. Email: markstrand3@aol.com
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  • 1 JUDITH PERRY,

    1. 1Medical Programs Department, Shanxi Evergreen Service, Taiyuan, 2Yuci Women and Children’s Health Center, Yuci, 3Shanxi Women and Children’s Hospital, Taiyuan, 4Shanxi Medical University, Taiyuan, Shanxi, China, 5Program in Health and Behavioral Science, University of Colorado, Denver, Colorado, and 6Mayo Clinic, Rochester, Minnesota, USA
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  • 1 MEIMEI JIN,

    1. 1Medical Programs Department, Shanxi Evergreen Service, Taiyuan, 2Yuci Women and Children’s Health Center, Yuci, 3Shanxi Women and Children’s Hospital, Taiyuan, 4Shanxi Medical University, Taiyuan, Shanxi, China, 5Program in Health and Behavioral Science, University of Colorado, Denver, Colorado, and 6Mayo Clinic, Rochester, Minnesota, USA
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  • 2 DAVID P. TRACER,

    1. 1Medical Programs Department, Shanxi Evergreen Service, Taiyuan, 2Yuci Women and Children’s Health Center, Yuci, 3Shanxi Women and Children’s Hospital, Taiyuan, 4Shanxi Medical University, Taiyuan, Shanxi, China, 5Program in Health and Behavioral Science, University of Colorado, Denver, Colorado, and 6Mayo Clinic, Rochester, Minnesota, USA
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  • 5 PHILIP R. FISCHER,

    1. 1Medical Programs Department, Shanxi Evergreen Service, Taiyuan, 2Yuci Women and Children’s Health Center, Yuci, 3Shanxi Women and Children’s Hospital, Taiyuan, 4Shanxi Medical University, Taiyuan, Shanxi, China, 5Program in Health and Behavioral Science, University of Colorado, Denver, Colorado, and 6Mayo Clinic, Rochester, Minnesota, USA
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  • 6 PEIYING ZHANG,

    1. 1Medical Programs Department, Shanxi Evergreen Service, Taiyuan, 2Yuci Women and Children’s Health Center, Yuci, 3Shanxi Women and Children’s Hospital, Taiyuan, 4Shanxi Medical University, Taiyuan, Shanxi, China, 5Program in Health and Behavioral Science, University of Colorado, Denver, Colorado, and 6Mayo Clinic, Rochester, Minnesota, USA
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  • 3 WEIPING XI,

    1. 1Medical Programs Department, Shanxi Evergreen Service, Taiyuan, 2Yuci Women and Children’s Health Center, Yuci, 3Shanxi Women and Children’s Hospital, Taiyuan, 4Shanxi Medical University, Taiyuan, Shanxi, China, 5Program in Health and Behavioral Science, University of Colorado, Denver, Colorado, and 6Mayo Clinic, Rochester, Minnesota, USA
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  • and 3 SIHAN LI 4

    1. 1Medical Programs Department, Shanxi Evergreen Service, Taiyuan, 2Yuci Women and Children’s Health Center, Yuci, 3Shanxi Women and Children’s Hospital, Taiyuan, 4Shanxi Medical University, Taiyuan, Shanxi, China, 5Program in Health and Behavioral Science, University of Colorado, Denver, Colorado, and 6Mayo Clinic, Rochester, Minnesota, USA
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Mark A. Strand, Xinji Huayuan, Erqu, 2-408, Jinzhong, Shanxi Province, 030600, China. Email: markstrand3@aol.com

Abstract

Background: Rates of rickets from 15.9 to 26.7% have been reported in China.

Methods: Combining the methods of epidemiology and the behavioral sciences, this study investigated the prevalence of rickets in children in rural Shanxi Province, China. A total of 250 children age 12–24 months were examined physically for the presence of rickets, blood was drawn for laboratory analysis, and X-rays were taken of each child’s wrists.

Results: Vitamin D deficiency in the spring was found among 65.3% of children. Rickets diagnosis relying on clinical signs alone determined a rickets prevalence of 41.6%, declining to 17.0% in the fall after a summer of sun exposure (χ2 = 8.356, P = 0.004). But an integrated diagnostic method exploiting clinical signs, X-ray and alkaline phosphatase levels found the prevalence of active rickets to be 3.7%. Furthermore, it was demonstrated that only five clinical signs reflect active rickets – wide wrists, frontal bossing, rachitic rosary, Harrison’s sulcus, and bowed legs.

Conclusions: The prevalence of active rickets in young children in northern China is lower than previously reported. Even in poor countries, simple tests such as X-rays and alkaline phosphatase can be added to physical examination to more accurately diagnose active rickets.

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