Age, Ethnicity, Glucose-6-Phosphate Dehydrogenase Deficiency, Micronutrient Powder Intake, and Biomarkers of Micronutrient Status, Infection, and Inflammation Are Associated with Anemia Among Children 6-59 Months in Nepal.

BACKGROUND: Anemia is a major concern for children in Nepal; however, little is known about context-specific causes of anemia. OBJECTIVE: We used cross-sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anemia in a nationally representative, population-based sample of children 6-59 mo (n = 1367). METHODS: Hemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood samples. Soil-transmitted helminth (STH) and Helicobacter pylori infections were assessed from stool. Anthropometry was measured with standard procedures. Sociodemographic and household characteristics, diet, micronutrient powder (MNP) intake, pica, and morbidity recall were ascertained by caregiver interview. Multivariable logistic regression that accounted for complex sampling design, determined predictors of anemia (hemoglobin <11.0 g/dL, altitude adjusted); candidate predictors were variables with P < 0.05 in bivariate models. RESULTS: Anemia prevalence was 18.6% (95% CI: 15.8, 21.4). MNP intake [adjusted OR (AOR): 0.25, 95% CI: 0.07, 0.86], log (ln) ferritin (µg/L) (AOR: 0.49, 95% CI: 0.38, 0.64), and ln RBP (µmol/L) (AOR: 0.42, 95% CI: 0.18, 0.95) were associated with reduced odds of anemia. Younger age (6-23 mo compared with 24-59 mo; AOR: 2.29, 95% CI: 1.52, 3.46), other Terai ethnicities (AOR: 2.59, 95% CI: 1.25, 5.35) and Muslim ethnicities (AOR: 3.15, 95% CI: 1.30, 7.65) relative to Brahmin/Chhetri ethnicities, recent fever (AOR: 1.68, 95% CI: 1.08, 2.59), ln C-reactive protein (mg/L) (AOR: 1.23, 95% CI: 1.03, 1.45), and glucose-6-phosphate dehydrogenase deficiency (AOR: 2.84, 95% CI: 1.88, 4.30) were associated with increased odds of anemia. CONCLUSION: Both nonmodifiable and potentially modifiable factors were associated with anemia. Thus some but not all anemia might be addressed through effective public health policy, programs, and delivery of nutrition and infection prevention and control.

Clinical profile of tuberculosis in children.

Childhood tuberculosis is common in our community. The diagnosis in most cases is still based on clinical evidence alone. The present study was designed to study clinical profile, laboratory investigations and outcome of pediatric tuberculosis. A prospective study was conducted among the children admitted in Nepal Medical College from April 2007 to March 2011. The prevalence of tuberculosis was 1.5%. Pulmonary tuberculosis was common (53.7%) than extra pulmonary (46.3%) tuberculosis. BCG scar was present in 48.8%. History of tuberculosis contact was present in 36.6% and Mantoux test was positive in 39.0%. The most common symptoms were fever (75.6%), cough (63.4%) and weight loss (41.5%). Confirmed diagnosis was made (bacteriological or histological) only in 14.6%. This study supports the use of history and clinical features to diagnose childhood tuberculosis.

Neonatal status in Nepal Medical College Teaching Hospital.

The objective of this study was to know the state of newborns in Nepal Medical College Teaching Hospital. This was a retrospective study of newborns delivered in Nepal Medical College Teaching Hospital from mid April 2008 to mid April 2009. There were 793 births with male: female ratio being 1.08:1. Almost 90 % were term babies and 6.9% preterm. Low birth weight comprised of 9.1%. Seventy five babies were admitted in neonatal unit during that period. Neonatal sepsis (33.7%), neonatal hyperbilirubinemia (30.7%), prematurity (12.0%) were major cause of admission to neonatal unit. Mortality occurred in 3 of these babies and all of them were preterm babies with gestation 29-31 weeks. Therefore it is very important to upgrade our level II care neonatal unit to level III care to improve the neonatal care.

Overview of neonatal hyperbilirubinemia at Nepal Medical College Teaching Hospital.

This study was done to assess the prevalence of neonatal jaundice, underlying risk factors and efficacy of phototherapy, which would be of value in identifying and implementing strategies to prevent morbidity and mortality from this condition. A retrospective study was carried out in 86 neonates admitted to neonatal intensive care unit at Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu from May, 2005 to April 2008. All of the newborns who developed hyperbilirubinemia and required phototherapy and/or exchange blood transfusion (EBT) were included in this study. Case records were evaluated for details of maternal and babies birth history and clinical examinations. The initiation of phototherapy and/or EBT were done by using standard guidelines. Out of total of 820 NICU admissions, 86 (10.5%) had significant hyperbilirubinemia. Amongst them 59.3% were male and 40.7% female. Septicemia, prematurity and ABO incompatibility were observed in 33.7%, 23.2% and 13.9% cases respectively. Phototherapy was required in 95.5% and EBT in 4.6% cases. In our study, septicemia, prematurity and ABO incompatibility were found to be the most common risk factors of neonatal jaundice. The data showed, phototherapy as an effective procedure in management of neonatal hyperbilirubinemia.