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A survey of healthcare professionals' awareness of vitamin D supplementation in pregnancy, infancy and childhood- midwives, gps and health visitors have their say
  1. V Jain,
  2. R Raychaudhuri,
  3. W Barry
  1. Paediatrics, Queen Mary's Hospital, Sidcup, London, UK

Abstract

Aims Reported cases of childhood vitamin D deficient rickets in the UK are rising. The Department of Health (DoH) and the National Institute of Clinical Excellence have recognised this and devised guidelines on vitamin D supplementation during pregnancy, breastfeeding and childhood. ‘Healthy Start’, a recent Government initiative, allows access to free vitamin D for women and children from low-income families. Despite these measures, evidence suggests that supplementation rates remain poor. The aim of our study is to assess the awareness of vitamin D supplementation among different key groups of healthcare professionals.

Methods Questionnaires were distributed to health visitors, general practitioners (GPs), and midwives within a South London borough from June to July 2010.

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Which healthcare professionals routinely advise Vitamin D supplementation?

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For those who do not advise routine vitamin D supplementation, which high-risk groups are identified?

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How many health professionals knew more than one risk factor for vitamin D supplementation?

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Which GPs and health visitors knew of an occasion (s) when to supplement non breast fed infants/children?

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Which groups of healthcare professionals are aware of “Healthy Start” scheme?

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How many GPs, health visitors and midwives requested further clarity on vitamin D supplementation guidelines?

Results A total of 77/116 healthcare professionals responded. Pregnant women were routinely advised about supplementation by 8/34 (24%) midwives and 2/21 (10%) GPs. Supplementation advice for breastfeeding women and breast-fed babies was given by 10/22 (45%) health visitors and 3/21 (14%) GPs. Of those who do not routinely advise supplementation, 8/12 (67%) health visitors and 17/26 (65%) midwives targeted one or more high-risk groups, compared to 2/19 (11%) GPs. One or more occasions when formula fed children would need supplementation was recognised by 13% of GPs and 68% of health visitors. Knowledge of vitamin D deficient rickets was evident in 96% of health visitors and fewer midwives (53%). No GPs, 65% of midwives and 95% of health visitors were aware of ‘Healthy Start’. All groups requested further clarity on vitamin D supplementation (95% of GPs, 74% of midwives and 50% of health visitors).

Conclusions Less than half of the health visitors and fewer midwives routinely advised vitamin D supplementation to their patient groups. Interestingly, the vast majority of GPs were unaware of the various aspects of supplementation. General uncertainty exists among these groups, regarding which high-risk patients to target. Unless healthcare professionals have sufficient education and clarity on vitamin D supplementation, cases of preventable rickets will continue to rise. Educational programmes should particularly target GPs, who have the opportunity to intervene at all stages of pregnancy and childhood, and antenatal care providers, who are instrumental in early prevention.

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