High burden of hypovitaminosis D among the children and adolescents in South Asia: A systematic review and meta-analysis

Abstract

Background: Vitamin D is vital for the growth and development of children. While deficiency and/or insufficiency of vitamin D among South Asian children are frequently reported in the literature, the lack of a meta-analysis has left its true extent poorly characterized. In this study, we aimed to conduct a systematic review and perform meta-analyses of the prevalence of hypovitaminosis D among the children of the South Asian countries.Methods: Two major electronic search engines (PubMed and Scopus) and one database (Google scholar) were used; original studies, conducted among South Asian children and adolescents and published between 1st January 2001 and 31st December 2019. A random-effect meta-analysis was also performed to calculate the pooled prevalence of hypovitaminosis D followed by subgroup analyses for countries and age-groups.Results: After applying inclusion and exclusion criteria, a total of 41 studies with a total population size of 18,233 were finally selected. The overall prevalence of hypovitaminosis D was 61% [95% CI: 46% to 71%] with highly significant heterogeneity (I2 = 99.72%; p = 0.00). The average level of serum vitamin D ranged from 5 ng/mL to 34 ng/mL, with a weighted mean of 19.15 ng/mL (weighted standard deviation 11.59 ng/mL). Country-wise analysis showed that hypovitaminosis D in Afghanistan was the highest [96.2%; 95% CI: 91% to 99%], followed by Pakistan [94%; 95% CI: 90% to 96%], India [64%; 95% CI: 46% to 79%], Bangladesh [35.48%; 95% CI: 32% to 39%], Nepal [35%; 95% CI: 1% to 83%.]and Sri Lanka [25%; 95% CI: 16% to 36%]. Age-group analyses revealed that hypovitaminosis D was most prevalent among neonates [85%; 95% CI: 76% to 91%], followed by school-going children [57%; 95% CI: 33% to 80%], and pre-school children [55%; 95% CI: 35% to 75%].Conclusion: This study generates quantitative evidence and specific extent of hypovitaminosis D in the South Asian countries as a public health concern. Being the first systematic review for this region, results from this study will create awareness and will facilitate adopting mitigation strategies by the policymakers and the governments to address this problem.

Vitamin D deficiency is a public health emergency among Indonesian children and adolescents: a systematic review and meta-analysis of prevalence

“…Therefore, any interpretations should be observational, at best (59) . Our results are higher than the pooled serum vitamin D levels in South Asian children and adolescents (19.15 ng/mL) (16) but lower than in African children (28.88 ng/mL) (52) . Numerous factors affect the serum vitamin D levels besides the factors mentioned previously, such as dietary and vitamin D supplement intake (10) , body mass index, physical activity (60) , genetic influences (61,62) , and infection status (63) .…”

“…children and adolescents have low serum vitamin D (50) . Other studies have also confirmed this phenomenon (16,54) . One possible explanation for this is that Southeast Asian females practice traditional heavy clothing such as hijab or shari), concealing their skin from possible sources of ultraviolet (UV) light (55) .…”

“…According to the National Statistics Bureau, there were 88,385 children and adolescents aged 0-19 in 2021 (50) . Thus, this means that 29,167 children are currently suffering from hypovitaminosis D. This rate is higher compared to adolescent girls in India (25.7%) (51) , African children (10.55%) (52), and European children (4-7%) (9) but lower compared to Afghanistan (96.2%) and Pakistan (94%) (16) . The most recent systematic review that looks at the prevalence of vitamin D deficiency among five Southeast Asian countries (Thailand, Indonesia, Vietnam, Malaysia, and Cambodia) finds that the prevalence ranges from 0.9% to 96.4% (53) .…”

“…The best epidemiological data in Indonesia is a decade old, which may not reflect Indonesia's current vitamin D status (15) . Interestingly, reviews done to analyze vitamin D deficiency in Asia did not include Indonesian studies (16,17) . The lack of sound data is alarming because epidemiological data are needed for the government to identify the issues, find the causes and prepare the necessary policies to tackle this issue (18) .…”

Under‐five children's acute respiratory infection dropped significantly in Bangladesh: An evidence from Bangladesh demographic and health survey, 1996–2018

“…In Bangladesh, the child mortality rate was much higher at the decade of independence in 1971 24 . The cause behind this was various infectious diseases 25,26 . Since then, Bangladesh government had been started an extensive immunisation programme (EPI) across the country in order to protect the child from these diseases 27–30 .…”