الفهرس 
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Abstract
Vitamin D deficiency rickets is still one of the most nutritional disorders in Egypt which causes considerable disability among children. Infants who are breast-fed without receiving vitamin D supplementation are at higher risk. Factors such as intake of a special –often vegetarian-diet, avoidance of sunlight, low socioeconomic level and increasing urbanisation are recognizable factors in pathogenesis of rickets. Children with vitamin D deficiency rickets are susceptible to many complications such as infection, many cases die of inter current infections as pneumonia, tuberculosis or enteritis. Deformities of the spine, pelvis and legs result in reduction in stature, rachitic dwarfism. Serum calcium may be reduced and tetany may develop. Iron deficiency anemia often develops in severe rickets. There is a significant association between vitamin D deficiency and iron deficiency not a mere overlap. Iron deficiency anemia may impair fat absorption including vitamin D, which is a fat soluble and hence decrease vitamin D concentration in the plasma. Also zinc deficiency presents commonly with anemia, because blood zinc is concentrated mainly in the RBCs. Also vitamin D increases the absorption of zinc from the intestinal tract of the children and vitamin D promotes absorption of many cationic elements in additions to calcium. In view of the association of poor iron, zinc and vitamin D states combined prophylaxis is desirable. Vitamin D deficiency rickets which is associated with considerable morbidity and possible mortality is entirely preventable through identification of the possible risk factors which contribute to the development of vitamin D deficiency rickets so we can avoid them. • So the present work was planned to study the possible risk factors which contribute to the development of vitamin D deficiency rickets and to study the relation between vitamin D deficiency rickets and plasma levels of iron and zinc. • The present study is a case-control study which comprised a total number of 100 infants and children aged 6-28 months (50 patients with vitamin D deficiency rickets and 50 healthy control group matched by age and sex). • Rachitic infants and children were selected randomly from those admitted to El-Shatby Pediatric Hospital while the control group were selected randomly from those attending the pediatric out-patient clinic at El-Shatby Hospital. • A predesigned questionnaire sheet was prepared for cases and controls and their mothers were interviewed for obtaining detailed history of their infants as regarding name, age, sex, residence, socioeconomic conditions, nutritional history including type of feeding whether breast, formula or cow’s milk, diet, age of weaning, duration of breast-feeding history of sun exposure, family history of rickets and if or not the child was taking vitamin D supplement. • Also history of infection and presence of complications. • Complete clinical examination of cases and controls was done with particular stress on growth and development -through anthropometric measurement- and signs of vitamin D deficiency rickets. • Plain radiographs for the wrist was done for cases and controls to verify the presence or absence of rickets and its degree of activity. • Laboratory investigation including: 1- Estimation of serum calcium. 2- Estimation of serum phosphorus. 3- Estimation of serum alkaline phosphatase. 4- Complete blood picture including: haemoglobin level, RBCs count, WBCs count. 5- Estimation of plasma iron. 6- Estimation of plasma zinc. Analysis of the data collected revealed that: • Vitamin D deficiency rickets increased significantly among infants and children with low and very low socioeconomic class as their families have lower per capita monthly income and houses with higher crowding index. Also the parent’s educational level of most of them was of low level (illiterate or read and write). • Vitamin D deficiency rickets occurred more in children living in rural areas. • Vitamin D deficiency rickets occurred more in children who are exclusively breast-fed with no vitamin D supplementation and increased significantly among those who were cow’s milk-fed, while significantly decreased in infants and children who had formula or combination of breast-feeding and formula. • Vitamin D deficiency rickets increased significantly among infants and children who eat more cereals at age more than 6 months and do not eat food rich in calcium. • Also it was found that the disease increased significantly among infants and children who had no exposure to sunlight and no vitamin D supplements together with positive family history of rickets. • The mean level of serum Ca, P and Ca ? P index was significantly lower in rachitic cases when compared to controls and the mean level of serum alkaline phosphatase was significantly higher in rachitic cases when compared to controls. • The mean level of haemoglobin and red cells count was significantly lower in rachitic cases when compared to controls and the mean level of WBCs count was lower in rachitic cases than controls. • The mean plasma level of zinc and iron was significantly lower in rachitic cases when compared to controls. We concluded that: 1- There are multiple risk factors which contribute to vitamin D deficiency rickets including: • Type of feeding either exclusive breast-feeding with no vitamin D supplementation or unfortified cow’s milk. • Intake of cereals which contain high phytate. • Lack of exposure to sunlight. • Low socioeconomic class with low level of education of families, low family income and high crowding index. • Positive family history of vitamin D deficiency rickets.