After Medical Action Myanmar (MAM) / Myanmar-Oxford Clinical Research Unit (MOCRU) health teams had earlier found a number of children with characteristics of rickets in remote communities in north-west of Myanmar's Naga region on the Indian border, active screening in other villages in the region led to 182 children being identified with severe rickets.
As can be seen from the photo and the x-ray, the children, and some adults, have great difficulties walking, with some unable to walk at all. It seems that none had been diagnosed or treated earlier, possibly because their communities are extremely remote, only accessible after many hours walking.
Lab results indicated that the rickets was caused by vitamin D deficiency. Treatment with vitamin D and calcium was started immediately and follow up laboratory and X-ray investigations showed improved bone growth and bone remodelling.
After being informed of the findings, Minister of Health Dr Myint Htwe invited MAM and MOCRU to discuss the findings and local needs. On 31 May, at a follow up meeting organised by the Minister with national and regional health officials, and UN and NGO representatives, MOCRU Director Frank Smithuis presented the findings of clinical screening, patient investigations, treatment results and a plan to do a large survey in several villages in the region to investigate vitamin D deficiency prevalence and its underlying causes. The survey would include:
The epidemiology and aetiology of rickets among children and pregnant women in Naga and other regions;
- Local behaviours related to vitamin D deficiency and nutritional rickets; and
- Potential and affordable resources of vitamin D and calcium in local communities to prevent rickets.
In addition, in cooperation with Myanmar health authorities, MOCRU/MAM proposed to:
- Continue to screen children in Naga region and surrounding areas for rickets;
- Treat and regularly follow up all children identified with rickets;
- Perform blood exams and X-rays of a small patient subgroup to monitor treatment success;
- Do community engagement to explore behaviours and raise awareness;
- Give preventive treatment in high incidence villages for high-risk children and pregnant women.
With thanks to Frank Smithuis for text and images