Renal failure in tetanus.

Between 1968 and 1978 the probability of an Asian schoolchild being admitted to Glasgow hospitals with rickets was one in 29. A survey of one general practice in 1979 indicated that one Asian child in 12 (8%h) had been treated for rickets at city hospitals. One in seven (14%/') schoolchildren in the survey unprotected by vitamin D supplementation showed radiological evidence of active rickets and two out of five (400) biochemical evidence, while 44% had serum 25-OHD concentrations of less than 12-5 nmol/l (5 ng/ml). These results are similar to those found in our previous surveys in Glasgow in 19611 and 19712 and Bradford in 1973.3 The above facts provided clear evidence of the failure of previous prophylactic measures and the need for a more effective campaign. The basis for such a campaign was provided by our three dose-response studies relating vitamin D intake to serum 25-OHD concentrations, which showed that supplements equivalent to 10 tg vitamin D daily would provide effective prophylaxis. Successful prevention depends on making the supplements widely available and easily accessible. The pattern of serum 25-OHD concentrations in the children who were the subject of the small-scale campaign that preceded the Board's official campaign indicates that supplement taking in many children is at best intermittent. This study showed, however, that even intermittent consumption of supplements will reduce the prevalence and severity of Asian rickets, although being inferior to adequate food fortification as a prophylactic measure. The key administrative decision in devising more effective preventive measures was the formation of a small multidisciplinary working group able to make clear recommendations to the Health Board. Health education officers and community dietitians who are often charged with responsibility for preventing problems such as Asian rickets may not be powerful enough or near enough to the decision-making process to implement effective policies by themselves. Asian community leaders, although willing to help, lack the expertise to implement preventive policies, which are the province of the community health services. The ultimate success of the Glasgow rickets campaign remains to be evaluated, and the working group remains in being to monitor progress. In the interim, for an annual expenditure of about £12 000 at 1979 prices, the campaign seems likely to reduce the prevalence of rickets in Asian children in Glasgow. Other health authorities faced with similar problems may find the Glasgow experience useful in planning their own preventive measures.