Prevalence of hypocalcemia in infants aged 1 month to 6 months and its association to maternal serum calcium at Kenyatta national hospital

Abstract

BACKGROUND Hypocalcemia occurs as a manifestation of nutritional deficiency of calcium and vitamin D. Deficiency of calcium in the diet has been identified as a leading cause of nutritional rickets in studies from Bangladesh, Nigeria and South Africa. Infants less than 6 months are reliant on mothers for their daily calcium requirements. As such maternal deficiency of calcium may lead to hypocalcemia in the breastfeeding infant. OBJECTIVES The primary aim of the study was to establish the prevalence of hypocalcemia in infants aged 1-6 months. The secondary aims were to establish the prevalence of hypocalcemia in the mothers of the infants and to establish if there was an association between the infant and maternal serum calcium. METHODOLOGY This was a hospital based descriptive cross-sectional study carried out in the well baby and paediatric outpatient clinics at Kenyatta National Hospital. It was carried out over a period of 3 months. Infants aged 1-6 months and their mothers who fit the defined criteria were recruited for the study. Consecutive sampling was employed till the desired sample size was achieved. A standard questionnaire was administered and venous blood samples collected from the mother- infant pairs. The samples were analyzed for calcium and albumin and corrected calcium levels calculated. Continuous variables were presented as means with standard deviations. Categorical data was presented as percentages. Association between maternal and infant calcium was done using pearson Chi square test. RESULTS A total of 120 mother- infant pairs were screened. 94 (78.3%) of these gave samples which were analyzed. The mean age of the infants sampled was 3.5 months with a standard deviation of 1.8 months. The mean age of the mothers was 27.2 years with a standard deviation of 5.8 years. 78 (83%) infants were born at term and 16 infants (17%) were born preterm. 58 of 93 infants (62.4%) were exclusively breastfeeding whereas 35 of 93 infants (37.6%) were breastfeeding but not exclusive. Prevalence of hypocalcemia was 34% in the infants with 95% CI of 29.4-45%. Prevalence of hypocalcemia in the mothers of the infants was 39.4% with a 95% CI of 29.8-50.5%. There was no statistically significant association between hypocalcemia in the mother and infants. OR 1.4 (95% CI 0.6-3.4) and P= 0.447. CONCLUSION There is a high prevalence of hypocalcemia in breastfeeding infants as well as in lactating women. However there is no significant association between maternal and infant hypocalcemia RECCOMMENDATIONS Advice to mothers to increase dietary intake of Vitamin D and Calcium and to spend more time in the sun. To also ensure their infants spend adequate time in the sun