Risk Factors for Anemia in Non-pregnant Women across the Agroecological Zones of Nepal.

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.

Hypoxemia in children with pneumonia and its clinical predictors.

OBJECTIVES: To assess the prevalence of hypoxemia in children, 2 months to 5 years of age, with pneumonia and to identify its clinical predictors. METHODS: Children between 2-60 months of age presenting with a complaint of cough or difficulty breathing were assessed. Hypoxemia was defined as an arterial oxygen saturation of < 90% recorded by a portable pulse oximeter. Patients were categorized into groups: cough and cold, pneumonia, severe pneumonia and very severe pneumonia. RESULTS: The prevalence of hypoxemia (SpO2 of < 90%) in 150 children with pneumonia was 38.7%. Of them 100% of very severe pneumonia, 80% of severe and 17% of pneumonia patients were hypoxic. Number of infants with respiratory illness (p value = 0.03) and hypoxemia (Odds ratio = 2.21, 95% CI 1.03, 4.76) was significantly higher. Clinical predictors significantly associated with hypoxemia on univariate analysis were lethargy, grunting, nasal flaring, cyanosis, and complaint of inability to breastfeed/drink. Chest indrawing with 68.9% sensitivity and 82.6% specificity was the best predictor of hypoxemia.CONCLUSION: The prevalence and clinical predictors of hypoxemia identified validate the WHO classification of pneumonia based on severity. Age < 1 year in children with ARI is an important risk factor for hypoxemia.