Rickets is an often-neglected, painful, and disabling childhood condition of impaired bone mineralization. In this case series we describe a cluster of 29 children with severe, painful bone deformities who live in the very remote region of Nagaland in northwest Myanmar. Children were found to have low 25-hydroxyvitamin D, elevated parathyroid hormone, and elevated alkaline phosphatase levels, consistent with nutritional rickets secondary to vitamin D deficiency, calcium deficiency, or a combination of the two. After treatment with vitamin D3 and calcium carbonate, significant improvement was seen in symptoms, biochemistry, and radiography. This is the first report of nutritional rickets in Myanmar in more than 120 years. Vitamin D and calcium supplementation, and food fortification for pregnant women and young children may be required to prevent this potentially devastating disease.
Address correspondence to Frank M. Smithuis, 32a1 Kokkine Swimming Club Lane, Bahan 11201, Yangon, Myanmar. E-mail: email@example.com
Financial support: This project was supported by the Planet Wheeler Foundation, the DAK Foundation, the Ripple Foundation, and Shindy Skaar. T. L. is supported by a Hamish Ogston Foundation fellowship. This research was funded, in part, by the Wellcome Trust grant number: 220211. For the purpose of Open Access, the author has applied a CCBY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Authors’ addresses: Hein Aung, Medical Action Myanmar, Yangon, Myanmar, E-mail: firstname.lastname@example.org. Kyaw Soe and Thomas Lamb, Myanmar Oxford Clinical Research Unit, Yangon, Myanmar, E-mails: email@example.com and firstname.lastname@example.org. Frank F. Smithuis, Department of Radiology, Amsterdam UMC Imaging Center, Amsterdam, The Netherlands, E-mail: email@example.com. Moe Wint Aung, Department of Endocrinology, Yangon General Hospital, Yangon, Myanmar, E-mail: firstname.lastname@example.org. Frank M. Smithuis, Medical Action Myanmar, Yangon, Myanmar, and Myanmar Oxford Clinical Research Unit, Yangon, Myanmar, E-mail: email@example.com.