The proportional magnitude of rickets and diagnostic utility of radiography in children with cerebral palsy attending neurology clinic at tertiary hospital in a low resource setting: a cross-sectional study.

backgroundCerebral palsy (CP) remains a significant public health challenge in Africa, compounded by economic burdens and limited healthcare resources. The co-occurrence of rickets in children with CP is poorly understood, particularly in low-resource settings, where its etiology and radiographic features remain unclear. Children with cerebral palsy often stay indoors, have poor nutrition, and low vitamin D due to limited sun exposure. Vitamin D deficiency plays a key role in the development of rickets. It is therefore crucial to investigate the magnitude of rickets in CP, its radiographic features, and associated factors to improve treatment strategies and management protocols for affected populations. METHODOLOGY: This was a hospital-based cross-sectional study of 200 children with CP who were clinically suspected of having rickets. Each participant underwent clinical examination, plain hand X-rays, and blood sampling for laboratory investigations. Data analysis was performed using SPSS V.16, with summary statistics for univariate analysis and chi-square tests for bivariate comparisons. A p-value of less than 0.05 was considered statistically significant.

resultsThe study included 200 participants, 72% of whom were male. The mean age was 5.13 (± 3.43) years. The least represented age groups were 6 months to 1 year (2%) and 13 to 15 years (5%), while the majority (39%) were aged 1 to 3 years. Rickets was diagnosed in 49 participants (24.5%). 95% experienced bone soreness or stiffness, and all cases presented with muscle weakness or cramping. Other notable clinical findings included joint thickening (55.06%), skull abnormalities (55.10%), and dental abnormalities (42.86%). Radiographically, 80% of children with rickets exhibited coarse trabeculation, 65.30% showed reduced bone density, and 57.14% had frayed metaphyses. Biochemical analysis showed that 38% of patients had vitamin D deficiency. Among children with radiographic signs of rickets, 64% were vitamin D deficient and had lower serum calcium (p < 0.001). Serum phosphate levels remained unchanged (p = 0.44), while alkaline phosphatase (ALP) was significantly higher in the rickets group (p = 0.018).

conclusionThis study found that a significant proportion of children with cerebral palsy (CP) exhibited radiographic features of rickets, which were strongly linked to low serum calcium and vitamin D levels. These findings underscore the importance of routinely assessing calcium and vitamin D levels in children with CP at risk for rickets, and of conducting comprehensive radiographic evaluations to confirm its presence.