Tonye Princewill

May 11, 2012

Let’s eradicate rickets

By Tonye Princewill

A DOCTOR I know once opined that persons who grow into adulthood with excessively bowed legs ought to sue their parents.

Naturally I was shocked—until he explained the cause of this very common deformity and how easy it is to correct or prevent it.

I still don’t believe offspring should sue their parents. But the more I learn about rickets—the scientific name for this affliction—the more I understand why my doctor-friend feels so strongly.

Not only is rickets curable and preventable, but in most cases, the recommended treatment is nothing more than regular exposure to sunlight and a diet rich in calcium and phosphorus—the main materials in bones, which makes them hard and strong.

Yet there is hardly any day you will move about Port Harcourt, or other cities, towns and villages in Nigeria, and won’t see a child hobbling about on bent legs—often following behind an indifferent and unashamed adult. I travel the world and I don’t see it anywhere.

The implications are indicting and depressing. Scientifically, rickets is due mainly to vitamin D deficiency, arising either from malnutrition or not enough sunlight. But in Nigeria, it is a socially imposed disorder—a deformity which ignorant, callous and irresponsible parents inflict on their own offspring.

It is a sad reality indeed that many parents do not even bother to consult a physician, to find out why the legs of their child are severely crooked. The answer an inquiry often draws is: “That’s the way God intended for it to be”.

As an engineer, I possess only a layman’s knowledge of rickets. But insight from my medical friend, combined with what I have read, suggests that such a rationalisation is a crass perversion of religion—a lame excuse that borders on blasphemy.

Referred to colloquially as “bow legs” or “K-legs,” as was famously used by Obasanjo during Amaechi’s nomination debacle, rickets is the softening of bone in children (and occasionally adults), usually due to poor mineralization. In the absence of vitamin D, the calcium and phosphorus ingested in food cannot move from the intestines to the bones. explains that: “Vitamin D is a fat-soluble vitamin that is essential for the normal formation of bones and teeth and necessary for the appropriate absorption of calcium and phosphorus from the bowels”.

It is thus the job of vitamin D to carry calcium and other minerals to the site of bone formation. If these building materials come up short in early childhood, bone development is impaired.

This causes the long leg bones (femurs) to bend under the child’s weight—creating the characteristic deformity (“marked genu varum,” in medical jargon) we know as “bow legs”.

Health scientists list four major types of rickets, plus two sub-types. An infant is born with the congenital form, when its pregnant mother is vitamin D deficient. Vitamin D dependent rickets, types “I” and “II,” are transmitted genetically, while the vitamin D resistant variety also has a genetic component.

Another name for nutritional rickets, NR, is osteomalacia, meaning “soft bone”. It is the form that afflicts adults and is dietary in origin. Developing largely due to insufficient intake of calcium or phosphorus or both, NR occurs when these minerals are not replenished in mature bones.

“Regardless of the type of rickets, the cause is always either due to a deficiency of vitamin D, calcium, or phosphate”. These nutrients are easily obtainable from local foods: Phosphorus from fruits, nuts and green vegetables and calcium from egg, meat and fish.

Vitamin D comes in two forms. Ergocalciferol (vitamin D-2) is found in fungi and certain fish oils. But the most effective anti-rachitic (rickets medicine) is cholecalciferol (D-3). It is produced in oily saltwater fish, such as salmon, herring and tuna as well as in butter, egg, margarine, fish liver oils and milk.

The problem is, vitamin D-3 can only be obtained from these sources in very small amounts—too small to metabolize enough calcium and phosphorus to sustain rapid bone-growth in children. This is especially true of those six to 24 months old: Which makes them more vulnerable than others to rickets.

Ordinary sunlight is both abundant and a highly effective anti-rachitic. It consists of about four percent ultraviolet radiation, which your skin uses to synthesize vitamin D-3. Ultraviolet-B, in particular, emitted when the sun is directly overhead, is the best source of energy for powering cellular reactions.

Health specialists advise though, that dark-skinned children need longer exposure, to reap the same benefits. The melanin in their cells absorbs much ultraviolet radiation, leaving fewer photons available to synthesize vitamin D.

Says Wikipedia: “A sufficient amount of ultraviolet B… each day and adequate supplies of calcium and phosphorus in the diet can prevent rickets. Darker-skinned babies need to be exposed longer… The replacement of vitamin D has been proven to correct rickets using these methods…”.

Rickets, therefore, can, and should, be eradicated. It is a social rather than a biological affliction—a condition which indifferent parents, together with public apathy, have imposed on many of our children.

It’s time to make amends. Schools, religious bodies, affected government agencies and civil society groups, such as the Parent Teachers Association, PTA, need to organise a Rickets Awareness Campaign.

Bow-legged adults don’t have to sue their parents. But government certainly must take a lead and act. I have always been an advocate of school meals. The word quality in Free Quality Education has meaning to me. The sooner it starts to have meaning to those that matter, the better for our children. In the meantime, for God’s sake, let’s eradicate rickets.