Prevalence and Factors associated with Vitamin D deficiency among Children aged 2-59 months with severe Pneumonia in Mulago Hospital.

Abstract

Background: Vitamin D is an immune modulator that regulates production of antimicrobial peptides cathelicidin and Beta-defensins-2 that are important in immune response (innate and adaptive). In Uganda, 80% of healthy community children in a survey were found to be vitamin D insufficient. According to Uganda demographic health survey (2016), pneumonia is the 2nd most common cause of mortality and the 3rd common cause of morbidity among children under 5 years. Despite significant strides towards prevention, protection and treatment of pneumonia, we still have children presenting with complications and longer hospital stay. Vitamin D deficiency is thought to be associated with severity and complications in children with pneumonia. The aim of this study was to determine the prevalence of vitamin D deficiency and factors associated among children aged 2-59 months with severe pneumonia admitted to Mulago Hospital in Kampala, Uganda. Objectives: To determine the prevalence and describe the factors associated with VDD among children aged 2-59 months with severe pneumonia admitted to Mulago Hospital. Methodology: This was a cross-sectional study among children aged 2-59 months who presented with severe pneumonia at Mulago Hospital. All children 2-59 months were screened and those that met the inclusion criteria were enrolled into the study after stabilization. Data was collected using a well-structured questionnaire. Socio-demographic information of the child and caregiver was obtained to determine the factors associated with VDD. Physical examination was done by a clinician to assess the severity of severe pneumonia at presentation. Blood samples were drawn for complete blood count, serum calcium, phosphate, alkaline phosphate levels and serum vitamin D concentration. Serum Vitamin D concentration was analyzed using electro-chemilumniscense immunoassay. Data analyzed using STATA 14.0. Continuous variables were summarized in means and standard deviations or medians and interquartile ranges while categorical variables were summarized in frequencies and percentages. Logistic regression was used to determine factors significantly associated with vitamin D deficiency. Results: Two hundred and thirteen (56.9%) children had low levels of vitamin D (<30ng/ml), of these 97 (25.9%) [(CI: 21.5-31.4)] were vitamin D deficient (<20ng/ml). Median age of vitamin D deficiency was 10 months (IQR:4-19). Factors significantly associated with VDD were caregiver’s level of education [AOR:0.54(CI: 0.31-0.96)]. Children whose caregivers had only attained primary education or no formal education) were less likely to be vitamin D deficient. Clinical signs and laboratory factors that were significantly associated with vitamin D deficiency in this study were presence of rachitic rosary and high alkaline phosphate above 350U/L [OR, 95% CI: 4.30(1.93-9.44), p<0.001)] and [OR,95% CI: 4.83(2.56-9.06), p<0.001)] respectively. Conclusion: More than 50% of children aged 2-59 months admitted with severe pneumonia had low levels of vitamin D. The prevalence of VDD was 25.9% in this population with 1 in every 4 being affected. Children with VDD presented with rachitic rosary and elevated alkaline phosphate levels of >350U/L. Those children whose caretakers had attained only primary education or no formal education were less likely to be vitamin D deficient.