الفهرس 
MATERIALS AND METHODSOnly 14 pages are availabe for public view
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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.