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Abstract Rickets is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, PO4 or Ca, potentially leading to fractures and deformity. Rickets is among the most frequent childhood diseases in many developing countries. Aim of the study: The aim of the present research was to study the role of the family physician in management of rickets among under five children in all family health units and centers in Alexandria governorate by: 1. By assessing the available resources for prevention & management of nutritional rickets among under five children (x-ray, lab diagnosis, training manual, drugs, health education materials….etc) 2. By assessing the knowledge, attitude, and practices of the family physicians concerning risk assessment, screening, management, and prevention of rickets. 3. By assessing the knowledge of the parents of under five children attending family health units and centers about risk factors and prevention of rickets. To conduct the present study, the following techniques were used: 1. A checklist was designed according to the Egyptian Family Physician Guidelines and the American Academy of Pediatrics new guidelines to assess the resources available for management of nutritional rickets among under five children. 2. A self-administered KAP questionnaire was prepared for family physicians to assess their knowledge, attitude, and practice concerning risk assessment, screening, diagnosis, prevention, management and referral of rickets. 3. A pre-designed interview questionnaire was prepared for parents of under five children attending the study facilities to assess their knowledge regarding rickets management and prevention. The results of the present study could be summarized as follows: 1. The highest percentage of health care facilities was present in Alamria health district (22%). The lowest percentage of facilities was in Wasat health district (7%). 2. The total population size was highest in Almontaza health district (1,277,357) and lowest in Alborg health districts (113,168). The catchment area was identified and the map was present in all health care facilities. 3. Only the family health centers had radiology room. 4. All family physicians who were working in family health facilities were trained in family medicine principles and standards. 5. Regarding to nutritional training, some of the staff were trained in prevention of nutritional diseases through breast feeding programs supported by MOH. No training sessions had been done related to rickets or orthopedic diseases. 6. The PHC facilities were not equipped for diagnosis of rickets (investigation and plain x- rays). 7. Continuity of drug supply of vitamin D and Ca supplementations were fluctuating mainly in family health units. Vitamin D supplementations were available as oral form. Ca supplementations were available as an oral form only. 8. Most of family health facilities had daily registration records with complete medical data. There was no specific record for rickets. Also there were no practice guidelines for family physician about rickets. 9. Health education sessions about nutritional diseases were done in some of the family health centers but there were no health education sessions especially about rickets. Responsible persons for health education sessions differed from one health facility to another. 10. Health education materials regarding nutrition were sometime present but mainly in health care centers rather than the health care units. 11. Most of the suspected cases were referred for confirmation of diagnosis and choice for treatment plan. 12. About ¾ of physicians had good knowledge level (74.03%), while ¼ of physicians had fair knowledge level (25.97%). 13. Physicians with 10-15 years of medical experience constituted the highest percentage of physicians with good knowledge (39.55%) while Physicians with more than 20 years of medical experience constituted the highest percentage of physicians with fair knowledge (31.91%). The differences were statistically highly significant (P < 0.01). 14. Physicians with postgraduate education in pediatrics constituted the highest percentage with good (8.2%) and fair knowledge level (23.4%). The differences were statistically significant (P < 0.05). 15. Physicians who had attended training related to early detection of nutritional diseases constituted more than 4/5 of physicians with good knowledge (86.6%) and the majority of physicians with fair knowledge (97.9%). The differences were statistically significant (P < 0.05). 16. More than 4/5 of physicians had indifferent attitude level (84.5%), while less than 1/5 of physicians had positive attitude level (15.5%). 17. Physicians with more than 20 years of medical experience constituted the highest percentage of physicians with positive attitude (32.14%) while Physicians with 5-10 years of medical experience constituted the highest percentage of physicians with indifferent attitude (37.91%). The differences were statistically significant (P < 0.05). 18. Physicians with postgraduate diploma constituted highest percentage with positive attitude (53.6%) and indifferent attitude (13.7%) among physicians with post graduate degree. The differences were statistically highly significant (P < 0.01). 19. Physicians with postgraduate education in pediatric constituted the highest percentage in both positive (32.14%) and indifferent attitude level (8.5%). The differences were statistically highly significant (P < 0.01). 20. The physicians who had attended training related to management of rickets and orthopedic diseases constituted more than 1/2 of physicians with positive attitude (67.86%) and less than 1/4 of physicians with indifferent attitude level (13.07%). The differences were statistically highly significant (P < 0.01). 21. More than 1/2 of physicians had partial practice level (61.3%), while more than 1/3 of physicians had good practice level (38.7%).Regarding rickets disease, most of family physicians have good knowledge and indifferent attitude and partial practice towards management of rickets. 22. Physicians with 5-10 years of medical experience constituted the highest percentage of physicians with good practice (48.6%) while Physicians with10-15 years and more than 20 years of medical experience constituted the highest percentage of physicians with partial practice (29.7%). The differences were statistically highly significant (P < 0.01). 23. Most of the parents had poor knowledge about risk factors and prevention of rickets disease. Accordingly the following can be recommended: 1. A widespread and concerted effort is needed to ensure daily supplementation of breastfed and other infants at high risk with vitamin D 400 IU from birth and pregnant women in high risk communities with at least 600 IU; awareness needs to be developed among the public and medical practitioners of the urgent need to improve the vitamin D status of pregnant and lactating mothers and their infants. 2. Operational research studies also need to be conducted to understand the best methods of implementing supplementation programs and the factors that are likely to impede their success. 3. Government should allocate more money in health sector for integrated health packages and should ensure proper functioning of health programs and health workers. 4. Mass communication should be properly utilized for preventive programs of rickets. 5. Increase awareness among healthcare providers of such rare but significant complications associated with anticonvulsants; anticonvulsant-induced rickets 6. The PHC units and centers should organize training courses on nutritional diseases frequently and attendance of health care team should be made mandatory. 7. Mothers attending the Immunization Clinic, antenatal and postnatal visits should be informed about benefits of vitamin D supplementation and best time of sun exposure. More health education should be given to parents about the benefits of sunlight. |