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. 2025 Apr 17;25(1):306.
doi: 10.1186/s12887-025-05665-x.

Nutritional rickets and its associated factors among under-five children in Assela referral and teaching hospital, Ethiopia: a hospital based cross-sectional study design

Helen Abebe  1 , Berhe Gebremichael  2 , Assefa Desalew  3 , Melat B Maruta  4 , Addis Eyeberu  3 , Jemal Ahmed Nure  3 , Adera Debella  3 , Lemma Demissie Regassa  2 , Ibsa Mussa  5
Affiliations

Nutritional rickets and its associated factors among under-five children in Assela referral and teaching hospital, Ethiopia: a hospital based cross-sectional study design

Helen Abebe et al. BMC Pediatr. .

Abstract

Background: Nutritional rickets is a preventable skeletal disorder caused by deficiencies in vitamin D, calcium, or phosphate, leading to softening and weakening of bones. While it was once nearly eliminated in high-income countries, the resurgence of rickets in various parts of the world-particularly in low- and middle-income countries (LMICs)-reflects the ongoing challenges of malnutrition, inadequate healthcare, and socioeconomic factors. This study aimed to determine the prevalence and associated factors of nutritional rickets in the study area.

Methods: A hospital-based cross-sectional study was conducted from June 15 to July 30, 2022, involving 442 children under the age of five who visited the pediatric ward, pediatric OPD, EPI, and pediatric emergency departments of referral and teaching hospitals in Assala, Ethiopia. Data were collected using a pre-tested, structured questionnaire administered through face-to-face interviews. A checklist was used for chart reviews. Data were entered into Epidata version 3.1 and analyzed using STATA version 18. Predictors of nutritional rickets were assessed using multivariate logistic regression analysis, with results presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value of < 0.05 was considered statistically significant.

Results: The study found that the prevalence of nutritional rickets in the study area was 3.8% (95% CI: 1.90-5.70). Factors significantly associated with nutritional rickets included being male (AOR = 1.59, 95% CI: 1.10-16.57), lack of information about rickets (AOR = 7.16, 95% CI: 4.22-12.68), and exposure to sunlight while fully dressed (AOR = 3.27, 95% CI: 1.05-5.28).

Conclusions: This study indicates that nearly one in every twenty-five children in the study area is affected by nutritional rickets. Factors such as male sex, lack of information about rickets, and inadequate sun exposure due to full clothing were identified as significant risk factors. To prevent this condition, coordinated efforts from all relevant bodies are required. Additionally, raising awareness among mothers and caregivers, particularly through maternal education, is essential. Educated mothers are more likely to adopt improved childcare practices, which can reduce the incidence of nutritional rickets.

Keywords: Associated factors; Ethiopia; Nutritional rickets; Under-five children.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University, College of Health Sciences. Support letters from the College of Health Sciences were submitted to the selected kebeles where the study was conducted. After getting all permission letters from the responsible body and being informed, voluntarily, written informed consent was signed by study participants. Confidentiality was maintained by using codes instead of the participant’s name. Participants were also informed that they had the full right to refuse participation or withdraw at any time from the research. All methods were performed following relevant guidelines and regulations in the Declaration of Helsinki. Consent for publication: Consent for publication for this study are available from the corresponding author upon reasonable request. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Sampling technique or procedures of mothers having under five children attending Assela Referral and Teaching Hospital, 2022
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