Assessment of the prevalence and associated factors of vitamin D deficiency among patients age greater than or equal to 18 years presented with musculoskeletal pain in selected public hospitals under Addis Ababa city administration health Bureau, Addis Ababa, Ethiopia

International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 299 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 Assessment of the prevalence and associated factors of vitamin D deficiency among patients age greater than or equal to 18 years presented with musculoskeletal pain in selected public hospitals under Addis Ababa city administration health Bureau, Addis Ababa, Ethiopia  Libsework Nigussie (MD, MPH) (Primary Author) Contributors:  Abduletif Umer Ali, (MD)  Dagmawi Awoke Mulu (MD)  Teshome Ayalew Feleke (MD, MPH)  Eyerusalem Besufekad Mekonnen (MD)  Blen Tesfaye Demissie (MD)  Yordanos Damenu Hailu, (MD)  Gelila Zeleke Terefe, (MD)  Mulualem Dawit Bekele (MD)  Mulat G/Hiwot Teklu  Hailu Atikilt Ejigu(MD)  Adugna Tasewu Tebabal(MD)  Cherkos Kebede(Gyneobs)  Leyu Tamerat Estefanos (MD)  Engidayehu Girma Tessema(MD) Advisor: Marema Jebessa (PHD candidate) Addis Ababa, Ethiopia International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 300 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 ABSTRACT Introduction: Vitamin D deficiency is a significant global public health concern, crucial for healthy bones, immunity, and general well-being. Affecting an estimated one billion people worldwide, Vitamin D deficiency can lead to severe bone disorders, increased fracture risk, and chronic diseases. Often underdiagnosed and undertreated, it necessitates targeted public health interventions. Objective: This study aimed to assess the prevalence and associated factors of Vitamin D deficiency among adult patients (≥18 years) presenting with musculoskeletal pain in public hospitals in Addis Ababa, Ethiopia, in 2025. Methods: An institutional-based cross-sectional study was conducted in three randomly selected Addis Ababa public hospitals. A total of 385 proportionally allocated participants were chosen via systematic random sampling. Descriptive statistics and multivariable regression analyses (95% CI, p<0.05) were employed. Results: The overall prevalence of Vitamin D deficiency among adult respondents with musculoskeletal pain was 68.1% (95% CI: 63.1%–72.7%). Multivariable analysis identified age, urban residency, and marital status (single/widowed versus divorced) as significant factors. Respondents aged over sixty years were four times more likely to have Vitamin D deficiency than those aged 18–40 years (AOR = 4.412). Urban residents were three and half times more likely to be deficient than rural residents (AOR = 3.580). Conclusion and Recommendations: Vitamin D deficiency is prevalent among adult patients with musculoskeletal pain in Addis Ababa. These findings underscore the critical need for increased awareness, routine screening, and targeted interventions, particularly for older adults and urban dwellers, to improve musculoskeletal health and overall well-being. International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 301 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 Keywords: Vitamin D, Musculoskeletal, Public Hospital, prevalence, Addis Ababa, crosssectional study. 1. INTRODUCTION According to a 2020 systematic review in the USA, vitamin D, a fat-soluble vitamin, facilitates calcium and phosphorus absorption in the gut, supporting bone mineralization, growth, remodeling, and maintaining serum calcium and phosphate levels (1). Beyond bone health, vitamin D regulates many cellular functions as most nucleated cells express the vitamin D receptor (VDR). About 10–20% of requirements come from diet, mainly fatty fish, egg yolk, and fortified foods (2). Vitamin D exists as D2 (ergocalciferol, from molds) and D3 (cholecalciferol, synthesized in skin upon sunlight exposure) (3). Serum 25(OH)D below 30 nmol/L, the best marker of vitamin D status, indicates insufficiency (4). Multiple risk factors affect vitamin D levels, including age, sex, obesity, socioeconomic status, chronic illness, fractures, diet, clothing, skin color, ethnicity, latitude, culture, limited outdoor activity, and season (5). Globally, about 15.7% of adults are deficient (25(OH)D <30 nmol/L) (6). A 2019 systematic review in Africa showed prevalence ranging from 30–80%, with pooled prevalence at 17.3%. Causes include urbanization, cultural practices, and poor diet (7). In Ethiopia, deficiency is also a major concern: a 2022 study in Addis Ababa found 50–70% prevalence, higher in urban populations due to reduced sunlight exposure and indoor work (8). Vitamin D deficiency contributes to proximal muscle weakness, bone pain, and osteomalacia, often underdiagnosed in clinical practice (9). Raising awareness, early screening, and prevention can improve musculoskeletal health and reduce burden (10). However, most Ethiopian studies focus on children, with limited research among adults with musculoskeletal pain (8, 11–13). Thus, this study aims to assess prevalence and associated factors of vitamin D deficiency among adults with musculoskeletal pain in Addis Ababa. International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 302 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 1.1. Statement of problem Vitamin D deficiency is a major public health problem causing rickets in children and osteomalacia, osteoporosis, fractures, infections, autoimmune diseases, cardiovascular disorders, depression, cognitive decline, and certain cancers in adults (14–16). Prevention through sunlight, fortified foods, and supplementation is possible, yet awareness remains low. In Ethiopia, 56% of mothers had good knowledge and 55.6% practiced proper sunlight exposure, with regional variations—54.4% in Amhara vs. 58.3% in Sidama— due to education, cultural, and informational differences (17,18). Despite interventions, deficiency affects 50–70% of adults, especially in urban areas with less sun exposure (8). Musculoskeletal pain is a common presentation, with supplementation crucial for management. One study reported deficiency in 41.9% of adults with back pain, fatigue, or generalized pain (8). Most research in Ethiopia centers on children (8,11–13). Therefore, this study aims to assess the prevalence and associated factors of vitamin D deficiency among adults with musculoskeletal pain in Addis Ababa public hospitals. 1.2. Objective 1.2.1 General objective  To assess the prevalence and associated factors of vitamin D deficiency among adult patients presented with musculoskeletal pain in public hospitals under Addis Ababa city administration health bureau in Addis Ababa, Ethiopia, 2025. 1.2.2 Specific objective  To determine the prevalence of vitamin D deficiency among adult patients presented with musculoskeletal pain in public hospitals under Addis Ababa city administration health bureau in Addis Ababa, Ethiopia, 2025.  To identify factors of vitamin D deficiency among adult patients presented with musculoskeletal pain in public hospitals under Addis Ababa city administration health bureau in Addis Ababa, Ethiopia, 2025. International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 303 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 1.3. Significance of study The findings indicate that severe deficiency of vitamin D is significantly associated with the presence of chronic widespread pain, but it does not play a major independent triple rolehighlight in predicting regional musculoskeletal pain. This highlights the importance of further research in this area and suggests that people with low vitamin D levels are more likely to experience widespread pain via musculoskeletal system which can impact negatively on their quality of life. (17) The recognition that vitamin D deficiency is prevalent in the general population and may contribute to chronic pain supports public health recommendations including education and awareness-raising, dietary intake promotion, safe sun exposure as well as food fortification on occasion or recommendation for supplementation aimed at raising levels of 25(OH)D within populations. This is even more critical in regions with limited sunlight due to the higher deficiency rate.(8) Even if there are a lot of adult patients visiting public hospitals under Addis Ababa city administration health bureau, limited studies are done to assess the prevalence and associated factors of vitamin D deficiency in adult patients presented with musculoskeletal pain.(13, 16) As a result, this study is aimed to assess the prevalence and associated factors of vitamin D deficiency among adult patients presented with musculoskeletal pain in selected public hospitals under Addis Ababa city administration health bureau in Addis Ababa, Ethiopia. 2. Literature Review 2.1. Vitamin d deficiency and its prevalence International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 304 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 Vitamin D deficiency is recognized as a widespread global health concern, affecting populations across diverse regions. A cross-sectional study in Yemen highlighted its prevalence worldwide, particularly in South Asia, the Middle East, North Africa, Europe, and the United States, where it is largely underdiagnosed due to cultural, environmental, and lifestyle factors (19). Similarly, a meta-analysis in the Middle East, China, Mongolia, and India confirmed that high-risk groups such as children, pregnant women, older adults, and non-Western immigrants are disproportionately affected (20). A systematic review conducted by Cui et al. revealed that between 2000 and 2022, 15.7% of people had serum 25-hydroxyvitamin D levels below 30 nmol/L, indicating that many individuals face health risks associated with low vitamin D (6). In Africa, the problem is equally concerning. A South African study found that 28.5% of health workers were vitamin D deficient, particularly black Africans and those older than 42 years, with strong associations to obesity, diabetes, and metabolic syndrome (9). In Cameroon, prevalence was 10.2% (21), while in Uganda, 40.2% of pregnant women had serum vitamin D levels below 20 ng/mL (22). Evidence from Ethiopia shows a particularly high burden despite abundant sunshine. A retrospective cross-sectional study found widespread deficiency in patients with nonspecific neuromuscular pain and fatigue (3). In Sodo town, 39% of pregnant women were affected (23), while a case-control study in northwest Ethiopia reported 46.2% prevalence overall and 61.5% among tuberculosis patients (24). In Addis Ababa, vitamin D deficiency was found in 96% of patients with multiple sclerosis, with mean serum levels of only 14.8 ng/mL (11), and another study confirmed almost universal deficiency among patients with neuromuscular pain (3). International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 305 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 Several risk factors contribute to this high prevalence. Age and gender play important roles, with studies in Yemen and Thailand showing higher odds among women and younger adults who spend more time indoors (19,25). Other determinants include unemployment, low fish consumption, and infrequent sun exposure as reported in Egypt (26). Additional factors identified in a systematic review include poor diet, malabsorption disorders, liver and pancreatic disease, bariatric surgery, and obesity, which reduces vitamin D bioavailability (27). Urban residence and higher education have also been linked to deficiency due to indoor work patterns and lifestyle differences compared to rural populations (4). The clinical implications of vitamin D deficiency are wide-ranging. Low levels compromise brain function, leading to memory loss, dementia, depression, and poor recovery after injury (28). They are also associated with chronic inflammation and cardiovascular diseases (29), increased adiposity and low muscle mass in women (30), and worsened bone density loss, fractures, and osteoporosis in the elderly (31). An important area of research is the relationship between vitamin D deficiency and musculoskeletal pain. Several studies have found that lower vitamin D levels are correlated with greater pain intensity, chronic widespread pain, and worse outcomes in osteoarthritis, particularly in weight-bearing joints (32–34). The prevalence of deficiency among adults with musculoskeletal pain is typically between 30% and 53% when using a threshold of <20 ng/mL, though estimates vary across populations and settings (35). International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 306 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 2.5. Theoretical and conceptual framework FIGURE 1 PROPOSED CONCEPTUAL FRAMEWORK SHOWING THE FACTORS ASSOCIATED WITH VITAMIN D DEFICIENCY AMONG PATIENTS PRESENTED WITH MUSCULOSKELETAL PAIN IN PUBLIC HOSPITALS UNDER ADDIS ABABA CITY ADMINSTRATION HEALTH BUREAU IN ADDIS ABABA,ETHIOPIA,2024; ADAPTED FROM REVIEW OF LITERATURES. (36–42) Environmental factors •sunlight exposure •Geographical location Sociodemo graphic factors Age Sex Income Occupation Education Marital status  Place Residence Personal factors •Co-morbidities like GI disorder(malabso rption)  liver diseases & Bariatric surgery Obesity & DM CKD •Medication like HAART Anticonvulsants PPIs • Pregnancy and lactation •Alcohol •smoking Life style factors Nutritional deficiency Physical inactivity Unemployment Vitamin D deficiency International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 307 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 3. METHOD 3.1. Study area and period Addis Ababa, which serves as the political capital and the key commercial and cultural hub of Ethiopia, is situated geographically in the center of the country at a latitude of 9°2'N and a longitude of 38°45'E. The city has an average elevation of 2,400 meters above sea level, while the highest point, Entoto Hill, located to the north, reaches an elevation of 3,200 meters. It is divided into 11 subcities called kifle ketema and 116 woredas which are the lowest administrative units. According to the 2007 Census carried out by the Central Statistical Agency of Ethiopia (CSA), the population of Addis Ababa city is 3,384,569. The city is situated at an elevation of 7,546 feet (2,300 meters). The city has surface area of about 530.14 km2. Languages spoken include Amharic (71.0%), Afaan Oromo (10.7%), Gurage (8.37%), Tigrigna (3.60%), Silt'e (1.82%) and Gamo (1.03%).(43) Projected Population Size of Addis Ababa in 2022 is 3,859,638).(44) According to 2012 (EFY) Health and Health Related Indicators published by MoH, There are 49 hospitals,13 are public of which 6 are owned by Addis Ababa City administration health bureau, 5 NGOs, and 32 private,27 public health centers, and 130 public health stations,700 different levels of private clinics are found in Addis Ababa city administrative region.(45) The research was conducted from November 2024 to July 2025 with a specific period for data collection, analysis, and reporting. 3.2. Study design Institution-based cross sectional study was conducted. 3.3. Population 3.3.1. Target population All patients older than or equal to 18 years with musculoskeletal pain in Addis Ababa, Ethiopia. International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 314 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 both language and back translated to English to see its consistency. Clinical Assessment, was Conducted by trained personnel using standardized equipment available at the facility. For the serum level of vitamin D, secondary data was taken from the patient card or laboratory registration. A record unit for serum vitamin D was consistently (ng/ml or nmol/L) as per study protocol.(11, 22, 31, 41) 3.12. Data collection methods Data was collected by three trained qualified nurses who were assigned at each of the three selected hospitals and were supervised by one General medical practitioner (MD) at each respective hospital. The principal investigator was responsible for the overall management of the project; the development of the final questionnaire; securing participation of selected patients; identifying, training and assignment of data collectors. The purpose of the training was to ensure that all the data collectors should have the same information about the study instrument and followed the same interview procedures. The training was delt with the purpose of the study, confidentiality and how to approach and forward questions to clients. 3.13. Data quality assurance Both the data collectors and supervisors were trained for one day in the objective and methodology of the research, data collection approach. The questionnaire was translated to Amharic language and back translated into English by another person to check for consistency. Pretest was conducted in 5% of the samples at Zewuditu Hospital. The data collection instrument was assessed for completeness, consistency, and applicability and was ratified accordingly. The study procedures were protected the patient's privacy by allowing anonymous and voluntary participation. The Fast Alcohol Screening Test (FAST) – (Cronbach‟s alpha = 0.77; Test–retest reliability = 0.8) which is a short version of the Alcohol Use Disorders Identification Test (AUDIT) was used to assess moderation of alcohol consumption.(83) It contains 4 items and a score of 0 for never‟, International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 315 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 1 for „Less than monthly‟, 2 for „Monthly‟, 3 for „Weekly‟ and 4 for „Daily or almost daily‟ was given. 3.14. Data processing and analysis Data checked and cleaned after entered in to KOBO tool box, then imported to SPSS version 27.0 software for analysis. Incomplete and inconsistent data excluded from the analysis. Descriptive statistics were used to describe the data. The results of the descriptive statistics were expressed as percentages and frequencies. Associations between independent and dependent variables were analyzed first using bi-variable analysis to identify factors which were associated with the outcome variable. Those variables which were found to have an association with the outcome variable at P<0.25.(84) Were entered to multi-variable logistic regression to test for independent association. The magnitude of the association between the different independent variables in relation to dependent was measured using odds ratios and 95% confidence interval (CI) and P values below 0.05 were considered to be statistically significant. 3 .15. Ethical consideration Ethical clearance was obtained from Research Review Board of Karvard College. Official letters of support was obtained from public health department of Karvard College and was given to Addis Ababa City Administration health Bureau and then the official letter was given to all the three selected public hospitals under Addis Ababa city administration health bureau. On the data collecting tool itself, the first page of the questionnaire was provide full information to the study participants regarding the purpose, nature of the research, beneficence, maleficent and then written Consent was obtained from each participant. Participation to the study was on voluntary basis, and participants were informed about their right not to participate in the study or withdraw at any time. Moreover, privacy and confidentiality of information was kept properly and names were not recorded. International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 316 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 3.16. Result dissemination The findings disseminated to Karvard College Public Health Department using hard copy. The document will also be submitted to governmental and non-governmental stakeholders such as Addis Ababa health bureau serving on nutrition program. Finally; it will be submitted for publication. International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 317 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 4. RESULT 4.1. Socio-demographic characteristics of participants Out of the total patients who were presented with musculoskeletal pain at the 3 hospitals during the study period, 385 eligible clients were included in the study, with response rate of 100%. Analysis was made based on the 385 completed questionnaires. The study consisted of 195 (50.6%) males which was almost equal to females. Among the female participants only less than half of them, 59(31.1%) and 38(29%) were pregnant and lactating respectively. The majority of participants were married, 240 (62.3%), the mean age of the respondents was 40.14(25.81, 54.47) years and lived in urban areas, 338 (87.8%) respectively. Additionally most of them had attained college or university-level education, 175 (45.5%) and governmental employee 129 (33.5%) with monthly income majorly, 234 (60.8%) earning between 5,000–20,000 Ethiopian birr. TABLE 1: DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS OLDER THAN OR EQUAL TO 18 YEARS PRESENTED WITH MUSCULOSKELETAL PAIN AT PUBLIC HOSPITALS UNDER ADDIS ABABA CITY ADMINISTRATION HEALTH BUREAU, ADDIS ABABA,ETHIOPIA,2025(N=385) Variables Frequency n=385 Percent Age 18-40 234* 60.8 41-60 102 26.5 >60 49 12.7 Sex Female 190 49.4 Male 195* 50.6 Marital status Single 83 21.6 Married 240* 62.3 Divorced 34 8.8 Widowed 28 7.3 Educational status Can’t read and write 31 8.1 Read and write 69 17.9 Primary 40 10.4 Secondary 70 18.2 International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 318 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 College/University 175* 45.5 Occupational status Unemployed 100 26 Gov’t employee 129* 33.5 Private employee 70 18.2 Private business 76 19.7 Retired 10 2.6 Income <5000 121 31.4 5000-20000 234* 60.8 >20000 30 7.8 Residency Pregnancy Lactation Urban Rural Yes No Yes No 338* 47 59 131* 38 93* 87.8 12.3 31.1 68.9 29 71 *=Dominant number in the category of variable 4.2. PREVALENCE OF VITAMIN D DEFICIENCY Among the 385 adult respondents (≥18 years) seen for musculoskeletal pain at public hospitals under the Addis Ababa City Administration Health Bureau in 2025, the overall prevalence of vitamin D deficiency was found to be 68.1% (95% CI: 63.1%–72.7%), whereas only 31.9% International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 319 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 (95%CI: 27.3%–36.9%) of respondents were classified as sufficient with vitamin D. FIGURE 3: PREVALENCE OF VITAMIN D DEFICIENCY AMONG RESPONDENTS OLDER THAN OR EQUAL TO 18 YEARS PRESENTED WITH MUSCULOSKELETAL PAIN AT PUBLIC HOSPITALS UNDER ADDIS ABABA CITY ADMINISTRATION HEALTH BUREAU, ADDIS ABABA,ETHIOPIA,2025(N=385). 3. Personal characteristics of participants Among the 385 adult respondents presenting with musculoskeletal pain, a majority 279 (72.5%) had daily sunlight exposure of 30 minutes or more. The use of sunscreen was reported by 90(24.7%) of participants and 116(30.1%) of respondents had comorbidities. In terms of knowledge about vitamin D, 168(43.6%) had good knowledge. Concerning dietary habits, 234(60.8%) consumed vitamin D-rich foods such as fish, milk, or eggs. And 64 (16.6%) reported taking vitamin D supplements. Only 30(7.8%) , 31(8.1%), 111(28.8%), 62(16.1%), 113(29.4%), and 140(36.4%) of respondents were on HAART ,used antiepileptic medications, reported using proton pump inhibitors, smokers, consumed alcohol and engaged in regular physical exercise respectively. International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 320 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 TABLE 2: Personal characteristics of respondents older than or equal to 18 years presented with musculoskeletal pain at public hospitals under Addis Ababa city administration health bureau, Addis Ababa,Ethiopia,2025(n=385). Variables Frequency n=385 Percent Sunlight exposure < 30 minutes 106 27.5% >/= 30 minutes 279* 72.5% Use of sunscreen Yes 90 24.7% No 295* 75.3% Comorbidities Present 116 30.1% Absent 269* 69.9% Knowledge about vitamin D Good 168 43.6% Poor 217* 56.4% Consumption of fish, milk or egg Yes 234 60.8% Vitamin D supplement Use of HAART Use of antiepileptic Use of proton pump inhibitors Smoking No Yes No Yes No Yes No Yes No Yes 151 64 321* 30 355* 31 354* 111 274* 62 39.2% 16.6% 83.4% 7.8% 92.2% 8.1% 91.9% 28.8% 71.2% 16.1% International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 321 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 Alcohol Exercise No Yes No Yes No 323* 113 272* 140 245* 83.9% 29.4 70.6 36.4% 63.6% 4. Factors associated with vitamin D deficiency After bivariate and mutivariate binary logistic regression was done for each variables and for all variables with p< 0.25 respectively. Age, Residency and marital status (being single and widowed) of respondents were found to be significantly associated (P-value<0.05) with prevalence of vitamin D deficiency. Respondents aged above 60 years were 4 times more likely to have vitamin D deficiency compared to those aged 18–40 years (AOR = 4.412, 95% CI: 1.745–11.154).Respondents living in urban were 3.58 times more likely to be vitamin D deficient compared to residents rural areas (AOR = 3.580, 95% CI: 1.288–9.949).Respondents who were single and widowed were 70%(AOR=0.302, 95% CI: 0.111, 0.826) and 80 %( AOR=0.190, CI: 0.053, 0.680) less likely to develop vitamin D deficiency as compared with widowed. TABLE 3: shows the demographic, personal and behavioral factors associated with vitamin d deficiency among respondents older than or equal to 18 years presented with musculoskeletal pain at public hospitals under Addis Ababa city administration health bureau, Addis Ababa,Ethiopia,2025(n=385). Variables Vitamin D status COR (95% CI) AOR (95% CI) Sufficient N (%) Deficient N (%) Age in years 18-40 179(76.5) 55(23.5) 1.00 1.00 41-60 62(60.8) 40(39.2) 2.100(1.274-3.459) 1.716(0.936,3.146) >60 21(42.9) 28(51.7) 4.339(2.285-8.241) 4.412(1.745,11.154)** Marital status Divorced 17(50.0) 17(50.0) 1.00 1.00 International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 322 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 Married Single Widowed Education College-university Illiterate Primary Read and write Secondary Occupational status Governmental employee Private business Private employee Retired Unemployed Income <5,000 5,000-20,000 >20,000 Residency Rural Urban Sunscreen No Yes Knowledge Poor knowledge 158(65.8) 66(79.5) 21(75%) 132(75.4) 21(67.7) 25(62.5) 37(53.6) 47(67.1) 91(70.5) 55(72.4) 49(70.0) 6(60) 61(61.0) 70(57.9) 168(71.8) 24(80.0) 41(87.2) 221(65.4) 185(63.8%) 77(81.1) 7(9.8) 82(34.2) 17(20.5) 7(25%) 43(24.6) 10(32.3) 15(37.5) 32(46.4) 23(32.9) 38(29.5) 21(27.6) 21(30) 4(40) 39(39.0) 51(42.1) 66(28.2) 6(20.0) 6(12.8) 117(34.6) 105(36.2) 18(18.9) 57(16.6) 0.519.(0.52,1.070) 0.258(0.109,0.607) 0.333(.112,0.989) 1.00 1.462(0.639,3.346) 1.842(0.890,3.810) 2.655(1.479,4.766) 1.502(0.820,2.754) 1.00 0.914(0.487,1.716) 1.026(0.543,1.939) 1.596(0.426,5.980) 1.531(0.882,2.659) 1.00 0.539(0.341,0.854) 0.343(0.131,0.900) 1.00 3.618(1.492,8.770) 1.00 2.888(1.580,5.277) 1.00 0.429(0.181,1.017) 0.302(0.111,0.826)** 0.190(0.053,0.680)** 1.00 0.413(0.128,1.332) 1.345(0.567,3.192) 1.188(0.216,6.533) 1.324(0.619,2.832) 1.00 1.186(0.554,2.536) 1.816(0.851,3.877) 1.188(0.216,6.533) 1.324(0.619,2.832) 1.00 0.823(0.436,1.553) 0.432(0.128,1.455) 1.00 3.580(1.288,9.949)** 1.00 0.588(0.289,1.197) 1.00 Good knowledge 64(90.2) 286(83.4) 0.505(0.322,0.790) 0.666(0.372,1.192) Comorbidity International Journal of Research (IJR) e-ISSN: 2348-6848 p-ISSN: 2348-795X Vol. 12 Issue 09 September 2025 Received: 20 September 2025 323 Revised: 25 September 2025 Accepted:28 September 2025 Copyright  authors 2025 DOI: HTTPS://DOI.ORG/10.5281/ZENODO.17286795 No Yes Smoking No Yes Alcohol No Yes Exercise No Yes BMI <18.5 18.5-24.9 >24.9 188(69.9) 74(63.8) 210(65.0) 52(83.9) 175(64.3) 87(77.0) 160(65.3) 102(72.9) 109(76.2) 20(66.7) 133(62.7) 81(30.1) 42(36.2) 113(35.0) 10(16.1) 97(35.7) 26(23.0) 85(34.7) 38(27.1) 34(23.8) 10(33.3) 79(37.3) 1.00 1.317(0.832,2.086) 1.00 0.357(0.175,0.730) 1.00 0.539(0.326,.892) 1.00 0.701(0.444,1.106) 1.00 1.603(0.684,3.755) 1.904(1.184,3.062) 1.00 1.459(0.777,2.738) 1.00 0.404(0.138,1.186) 1.00 0.972(0.490,1.930) 1.00 1.544(0.816,2.922) 1.00 1.597(0.587,4.342) 1.356(0.777,2.365) *AOR= statistically significant at p<0.05 5. DISCUSSION This study assessed the prevalence and associated factors of vitamin D deficiency (VDD) among adults with musculoskeletal pain in selected public hospitals in Addis Ababa. The prevalence of VDD was found to be 68.1%, markedly higher than the global pooled estimate of 15.7% (6) and the African pooled prevalence of 17.3% (7). Although studies suggest 30–80% deficiency in pain-related subgroups (35), the magnitude observed here is striking and likely reflects both the study population and contextual factors of urban living. The result is in line with Ethiopian studies, which report adult prevalence between 50–70%, with especially high rates in urban areas, such as 39% among pregnant women in Sodo (23) and 96% among multiple sclerosis patients in Addis Ababa (11). These findings reinforce that VDD is a critical public health problem in Ethiopia despite abundant sunlight.