ABSTRACT
Objectives: Describe the prevalence of anemia in Nepali non-pregnant women of reproductive age by agroecological zone and potential risk factors. Methods: We randomly sampled 21 Village Development Committees, each with 3 wards, proportionate to size across the mountains, hills and terai. In 4509 households with children <5 years or newlyweds we assessed anthropometry, 7-day diet frequency, morbidity, participation in health services and altitude-adjusted hemoglobin measurement (n=887). Household SES and empowerment questions were asked. Regression analyses were used to evaluate risk factors of anemia. Results: Anemia affected 53.3% of all women, and 42.3%, 35.8% and 66.1% in the mountains, hills and terai, respectively. Lowest vs. higher castes in the terai were at higher risk of anemia (OR=1.58, CI: 1.04-2.40). A secondary education (6-9 years) and overweightness (BMI > 24.9) appeared protective against anemia (OR=0.59, CI: 0.39-0.90 and OR=0.49, CI: 0.27-0.90, respectively). Women who accessed skilled health care workers in the past year had an increased risk of anemia (OR=1.36, CI: 0.99-1.85), likely reflecting their illness. Knowledge of deworming and iron-folic acid supplementation, SES and diversity of recent diet were unrelated to anemia risk. Conclusions: Approximately half of women of reproductive age have anemia in Nepal, with the highest risk in the terai. Anemia was less likely in educated, higher caste and better nourished women. Lack of association with recent diet may reflect inadequate duration of assessment with 7- day frequencies or causes of anemia other than iron deficiency. Health care providers are more likely to see anemic women, representing an opportunity to screen and treat anemia.
ABSTRACT
Objectives: This study analyzes the potential for high-value peanut production, processing and marketing in Ghana, identifying opportunities for new investment and interventions to improve nutrition and livelihoods on a commercial scale. Methods: Our research combined an extensive desk review of the available data from 75 project reports and articles, followed by 40 key informant interviews in Ghana during July and August of 2013. Our focus is on the nutritional content of peanut-based products, particularly regarding the extent of aflatoxin contamination and opportunities for aflatoxin control. Results: Our central finding is that new investments to produce micronutrient-fortified, aflatoxin-free peanut products can be commercially viable, helping to improve livelihoods and nutritional status among farm households in northern Ghana, and contributing to improved nutrition among consumers. The most robust new supply chain for aflatoxin-free peanuts is likely to involve aggregators' spot and contract purchases from rainfed smallholder producers, including particularly women farmers, potentially supplemented by other sources such as imports and contracts for production under irrigation. Conclusions: Ghana is a promising site for new peanut-based products, offering both sufficient scale of production in the north, and sufficient demand in the south, with adequate infrastructure as well as institutional frameworks for development. Building supply for this new value chain will require equipping farmers and aggregators with select new technologies to which they do not yet have access, including improved seed varieties and techniques for aflatoxin control, but the result could be commercially viable and offer potentially large gains in livelihoods and nutritional status especially for women and children.