Vitamin D Deficiency among Children Aged 2-59 Months with Severe Pneumonia attending a Ugandan Tertiary Hospital: a cross-sectional study

Abstract

<title>Abstract</title> Background Vitamin D is an immune modulator that regulates the production of antimicrobial peptides cathelicidin and Beta-defensins-2 which are important in the immune response. Global estimates of the deficiency are about 50% of the population. In Uganda, pneumonia is the 2nd leading cause of mortality and 3rd cause of morbidity in the under 5. The magnitude of Vitamin D deficiency among children with severe pneumonia in Uganda is unknown. The study was aimed at determining the prevalence and factors associated with vitamin D deficiency among children aged 2–59 months with severe pneumonia admitted to Mulago National Hospital. Methods A cross-sectional study done from January to December 2018. Patients were screened and consecutively enrolled. A pre-tested questionnaire was administered, detailed physical examination done, blood samples drawn for complete blood count, alkaline phosphate, calcium, and serum Vitamin D concentration 25(OHD)D was determined using an electrochemiluminescence assay. Data was analyzed using STATA version 14 software. Results One thousand one hundred and ninety-six patients were screened. Four hundred and four (404) met the inclusion criteria and were consecutively enrolled, three hundred and seventy-four (374) had completed information and their blood samples analyzed. Two hundred and thirteen (57%) had low vitamin D levels. Of these, 97 (25.9%) were vitamin D deficient (25OHD &lt; 20ng/ml) CI: 21.68–30.56. The median age was 10 months (IQR: 4–19) with more than 60% being between the age of 2-12months. Factors statistically significantly associated with VDD was the caregiver's low level of education [AOR: 0.54(CI: 0.31–0.96)], WHZ &lt;-3SD, high alkaline phosphate levels [AOR: 5.79(CI: 3.41–9.85)], presence of rachitic rosary [AOR: 4.42(CI: 2.04–9.55)] and widened wrist [AOR: 0.03(CI: 0.00-0.20)]. Conclusion The prevalence of VDD was found to be high among children with severe pneumonia and this reduces with increasing age. One in every 4 children with severe pneumonia is vitamin D deficient. Children whose caretakers had post primary education were more likely to be vitamin D deficient. Interventional studies are recommended to explore more on the factors associated with Vitamin D deficiency may be necessary.