The problem of rickets and osteomalacia among the immigrant community living in Britain was first highlighted in 1962.1 More recent studies suggest that this problem persists.
Lawson and Thomas found suboptimal vitamin D levels in 20–34% of toddlers of Asian origin.2 Shaw and Pal found that 85% of patients of Asian origin attending Birmingham antenatal clinics were vitamin D deficient in winter months3 and Datta et al found that 50% of non-white patients attending antenatal clinics in South Wales had low vitamin D levels.4
Although supplementation of infants from racial groups is recommended, a previous study found that this occurred in less than 5% of infants.5 The problem is complicated by recent NICE guidelines, which do not recommend vitamin D supplements for pregnant women.6
We undertook a postal and face-to-face questionnaire among practices in the Thames Valley area and Lambeth (this London area was chosen as their PCT has a policy of encouraging vitamin D supplementation of infants with dark skin).
Practices were asked whether they prescribed vitamin D supplements to pregnant women of Asian or African–Caribbean extraction and their infants. They were also asked to state if the approximate percentage of Asian or African–Caribbean patients was above or below 8%.
There was a 71.2% response to the 73 questionnaires sent out. In addition, 11 practices were asked face to face. Thirty-eight (67.9%) practices stated that their population was above 8% Asian or African–Caribbean (two practices did not specify).
Only two (3.4%) of the practices stated that they supplemented and this was for infants and not the mothers. Both of these practices were in Lambeth.
We were surprised at the low level of supplementation. It may be that in addition the health visitors in these practices are also prescribing vitamin D.
The recent CMO update has reiterated the need for vitamin D supplementation.7
We would recommend that a publicity campaign be started to encourage vitamin D supplementation.
- © British Journal of General Practice, 2005.