title: Preventable but neglected: rickets in an informal settlement, Nairobi, Kenya.
abstract: METHODS
  The primary care clinics of Médecins Sans Frontières within the informal settlement of Kibera, Nairobi, Kenya.
  
  
  OBJECTIVE
  To describe the demographic and clinical characteristics of children clinically diagnosed with rickets from September 2012 to October 2013.
  
  
  METHODS
  Descriptive retrospective case review of diagnosis and treatment course with vitamin D and calcium using routine programme data.
  
  
  RESULTS
  Of the 82 children who met the clinical diagnosis of rickets, 57% were male, with a median age of 12 months and 14 months for females. Children with rickets were found to have ⩽3 hours/week sunlight exposure for 71% of the children and malnutrition in 39%. Clinical findings on presentation revealed gross motor developmental delays in 44%. The loss to follow-up rate during treatment was 40%.
  
  
  CONCLUSIONS
  This study found that rickets is a common clinical presentation among children living in the informal settlement of Kibera and that there are likely multiple factors within that environment contributing to this condition. As rickets is a simply and inexpensively preventable non-communicable disease, we suggest that routine vitamin D supplementation be formally recommended by the World Health Organization for well-child care in Africa, especially in the contexts of informal settlements.
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: J K
authors.initials: JK
authors.lastname: Edwards
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: A
authors.initials: A
authors.lastname: Thiongó
authors.affiliation: Medical Department, Luxembourg Operational Research Unit (LuxOR), Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: W
authors.initials: W
authors.lastname: Kizito
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: R J
authors.initials: RJ
authors.lastname: Kosgei
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: A
authors.initials: A
authors.lastname: Sobry
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: A
authors.initials: A
authors.lastname: Vandenbulcke
authors.affiliation: Medical Department, Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Zuniga
authors.affiliation: Medical Department, Luxembourg Operational Research Unit (LuxOR), Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
authors.forename: A J
authors.initials: AJ
authors.lastname: Reid
keywords: World Health Organization; operational research; pediatric; vitamin D deficiency