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Modern living: same old problems

In 1965, a group of Swedish and Ethiopian researchers from the Tikur Anbessa Hospital published reports of their study in the Ethiopian Medical Journal. It showed that two in five children younger than three years of age in Ethiopia suffered from Rickets – a brittle bone disorder that infants who were not exposed to sunlight suffer from.

This nutritional disorder continues to plague child healthcare till present times, with current estimates suggesting four – 10.5 percent of infants and children presenting to hospitals diagnosed to be affected. Herein lies the great paradox – Ethiopia sits at just nine degrees north latitude from the Equator and receives abundant sunshine all through the year (Quote Ethiopian Tourism Commission: Thirteen months of sunshine). As little as half an hour daily of direct morning sunlight shining on your infant’s skin can provide enough daily doses of vitamin D. It has been known for decades, that adequate levels of vitamin D in your body relate to proper development of bones and improved immunity to help fight off infections better.

The incidence of respiratory infections and other infectious diseases also is reduced by disinfecting the air by ultraviolet radiation. Despite Ethiopia’s natural advantage, crowded living conditions in slums and taboos relating to avoidance of sunlight for newborns make it one of the most affected countries by Rickets.

Our population receives better access for health education (through formal and informal channels) than before and is rapidly urbanizing. The Central Statistics Agency estimates that the urban population in Ethiopia will triple to 42.3 million (about a third of total population) by 2037. Though residents in Addis and other metropolis are aware of the health benefits of sunlight for newborns, they are facing a dilemma on how to tailor it to their housing conditions. This is especially true for those living in condominium homes.

As of 2016, there are more than 176,000 condominium homes in Addis Ababa. There are thousands more in major cities around the nation. In Addis alone, there were close to 800,000 residents waiting their turn to own a condominium apartment in 2016. As our populace gets to grip of handling the transition from slum housings to living in communal buildings, that age-old problem of getting adequate sunshine for children keeps surfacing.

Pediatricians increasingly observe that parents (mothers more often than not) comment on a lack of space within the compound of these shared buildings which are free of dirt and bad odor and suitable to settle their infants for a morning sun exposure. Our society has always held a great fear of the “ብርድ or Birid”: the cold breezes which are attributed to bring with them a bad omen and a range of illnesses. The fact that most residential units are sky-borne thus limit access and will to expose infants for sunlight. Altogether the aforementioned factors are leading to stunted children unable to fight repeated infections.

So, what do we do about it?

The United Nations includes adequate lighting as an essential part to define a habitable house. Worldwide, countries have been successful in implementing building codes for shared buildings with the target of making enough green space and clean parks available. At the same time, it is essential to ensure adequate direct natural light to maintain our health – individual balconies for homes, appropriately sized windows, arrangements so that buildings face the open sky etc. Congested buildings obstruct natural light to themselves and to neighboring buildings. Sunlight shining through ordinary window glasses won’t do. It has a different angle of reflection and absorbs most ultraviolet radiation with wavelengths shorter than 320 MU. Thus it cannot compare in health benefit with direct sunlight. Nor does artificial lighting.

Further on, it is high time we include oral vitamin D supplements into our list of essential drugs in Ethiopia. While current urban life cannot guarantee enough sunshine exposure for synthesis of vitamin D by the skin, importers should be encouraged to introduce vitamin D oral drops into the market. Most regulated products meet the minimum daily intake of 400 IU of vitamin D recommended for infants beginning soon after birth.

Florence Nightingale summarized it best when she said: “It is the unqualified result of all my experience with the sick that, second only to their need of fresh air, is their need of light; that, after a close room, what hurts them most is a dark room and that it is not only light but direct sunlight they want”.

Ed.’s Note: Tinsae Alemayehu (MD) is a Pediatrician and Infectious Diseases’ Sub-Specialist and works at the American medical center in Addis Ababa. The views expressed in this article do not necessarily reflect the views of The Reporter. The writer can be reached at [email protected]

Contributed by  Tinsae Alemayehu (MD)