{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T05:46:14Z","timestamp":1740980774276,"version":"3.38.0"},"reference-count":13,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2005,1,1]],"date-time":"2005-01-01T00:00:00Z","timestamp":1104537600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Trop Doct"],"published-print":{"date-parts":[[2005,1]]},"abstract":"<jats:p> Osteomalacia is most commonly seen in the remoter northern regions (Kohistan District) of Hazara District, Pakistan. Low serum calcium is common, as is tetany, but not universal. A 2% prevalence was found retrospectively in all obstetric patients from 1978-1985. Overall, there was a 12% caesarean section rate (61\/annum), of which 37% (22) exhibited cranio-pelvic disproportion, nearly half of which (n=83, 46%) were thought clinically to be due to osteomalacia. Osteomalacia was found prospectively in 3.6% of all female outpatients (3600\/100,000). Purdah did not appear to influence the incidence of osteomalacia, although sunlight exposure varied significantly due to place of abode (0.05 &gt;P &gt; 0.025); those living in the deeper, darker valleys suffered more from osteomalacia and its side effects, such as cranio-pelvic disproportion and the resulting need for caesarean sections. Diet is an important factor, showing little variety in the affected region; it lacks animal protein and is low in calories. The estimated intake of vitamin D is ~1 \u03bcg per day, seriously short of the daily requirement of 2.5 \u03bcg. The other main factor is higher parity in the women with osteomalacia (15\/18 affected women had more than three pregnancies compared with 9\/18 controls; odds ratio 13, 0.05 &gt; P &gt; 0.025). These all indicate that in a marginal situation added metabolic stress can precipitate the condition. While supplementation of the diet is essential in such communities it will be difficult to initiate and maintain. We therefore also recommend that strategies for prevention be focused on the men to encourage them to help improve the diet and lifestyle of their womenfolk. <\/jats:p>","DOI":"10.1258\/0049475053001787","type":"journal-article","created":{"date-parts":[[2005,2,2]],"date-time":"2005-02-02T01:43:03Z","timestamp":1107308583000},"page":"8-10","source":"Crossref","is-referenced-by-count":16,"title":["Osteomalacia in Hazara District, Pakistan"],"prefix":"10.1177","volume":"35","author":[{"given":"F B","family":"Herm","sequence":"first","affiliation":[{"name":"Institut f\u00fcr Soziale Medizin, Arbeitsgruppe Epidemiologie, Freien Universit\u00e4t, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Killguss","sequence":"additional","affiliation":[{"name":"KOMAP, Pattan, District Kohistan, North West Frontier Province, Pakistan"},{"name":"Bach Christian Hospital, Qalandarabad, Hazara, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A G","family":"Stewart","sequence":"additional","affiliation":[{"name":"Aman Clinic, Khaplu, District Ghangche, Northern Areas, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2005,1,1]]},"reference":[{"key":"bibr1-0049475053001787","first-page":"951","volume":"18","author":"Wilson DC","year":"1932","journal-title":"Ind J Med Res"},{"key":"bibr2-0049475053001787","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(76)91141-7"},{"volume-title":"Measurements of Levels of Health - Example 8: Definition of Hospital Catchment Area Population as Denominator for Morbidity Indicators Derived from Hospital Data in Developing Countries","year":"1979","author":"Diesfield HJ","key":"bibr3-0049475053001787"},{"key":"bibr4-0049475053001787","unstructured":"Dambacher A. Praktische Osteologie. Stuttgart: Thieme Verlag, 1982: 92\u2013106"},{"key":"bibr5-0049475053001787","unstructured":"Nordin BEC. Metabolic Bone and Stone Disease. Edinburgh: Churchill Livingstone, 1984: 71\u201392"},{"volume-title":"Human Nutrition and Dietetics","year":"1979","author":"Davidson S","key":"bibr6-0049475053001787"},{"key":"bibr7-0049475053001787","unstructured":"Pschyrembel W. Praktische Geurtshilfe. Berlin: Walter De Gruyter Verlag, 1956: 23\u20138"},{"key":"bibr8-0049475053001787","first-page":"139","volume":"16","author":"Rajeswari J","year":"2003","journal-title":"Nat Med J India"},{"key":"bibr9-0049475053001787","doi-asserted-by":"publisher","DOI":"10.1055\/s-0028-1129268"},{"key":"bibr10-0049475053001787","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/j.1600-0412.1981.tb00024.x","volume":"59","author":"Chaim W","year":"1981","journal-title":"Acta Obstet Gyn Scand"},{"key":"bibr11-0049475053001787","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.6048.1351"},{"key":"bibr12-0049475053001787","first-page":"2","volume":"41","author":"Hassan TJ","year":"1991","journal-title":"J Pak Med Assoc"},{"key":"bibr13-0049475053001787","doi-asserted-by":"publisher","DOI":"10.1080\/j.1600-0412.1998.770309.x"}],"container-title":["Tropical Doctor"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1258\/0049475053001787","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1258\/0049475053001787","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T04:28:51Z","timestamp":1740976131000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1258\/0049475053001787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,1]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2005,1]]}},"alternative-id":["10.1258\/0049475053001787"],"URL":"https:\/\/doi.org\/10.1258\/0049475053001787","relation":{},"ISSN":["0049-4755","1758-1133"],"issn-type":[{"type":"print","value":"0049-4755"},{"type":"electronic","value":"1758-1133"}],"subject":[],"published":{"date-parts":[[2005,1]]}}}