We used data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia (World Health Organization cut-points using altitude-and smoking-adjusted haemoglobin [Hb]) among nationally representative samples of adolescents 10-19 years. Hb, biomarkers of micronutrients, infection and inflammation were assessed from venous blood. Sociodemographic and household characteristics, dietary diversity, pica and recent morbidity were ascertained by interview. We explored bivariate relationships between candidate predictors and anaemia among boys (N = 967) and girls (N = 1,680). Candidate predictors with P < 0.05 in bivariate analyses were included in sex-specific multivariable logistic regression models. Anaemia prevalence was 20.6% (95% confidence interval [CI] [17.1, 24.1]) among girls and 10.9% (95% CI [8.2, 13.6]) among boys. Among girls, living in the Mountain and Hill ecological zones relative to the Terai (adjusted odds ratio [AOR] 0.28, 95% CI [0.15, 0.52] and AOR 0.42, 95% CI [0.25, 0.73], respectively), ln ferritin (μg/L) (AOR 0.53, 95% CI [0.42, 0.68]) and ln retinol binding protein (RBP) (μmol/L) (AOR 0.08, 95% CI [0.04, 0.16]) were associated with reduced anaemia odds. Older age (age in years AOR 1.19, 95% CI [1.12, 1.27]) and Janajati ethnicity relative to the Muslim ethnicity (AOR 3.04, 95% CI [1.10, 8.36]) were associated with higher anaemia odds. Among boys, ln RBP [μmol/L] (AOR 0.25, 95% CI [0.10, 0.65]) and having consumed flesh foods (AOR 0.57, 95% CI [0.33, 0.99]) were associated with lower anaemia odds. Open defecation (AOR 2.36, 95% CI [1.15, 4.84]) and ln transferrin receptor [mg/L] (AOR 3.21, 95% CI [1.25, 8.23]) were associated with increased anaemia odds. Anaemia among adolescents might be addressed through effective S Chitekwe, S Rijal and N Paudyal are United Nations Children's Fund staff members. The opinions and statements in this article are those of the authors and may not reflect official United Nations Children's Fund policies. Use of trade names is for identification only and does not imply endorsement by the US Department of Health and Human Services. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the US Agency for International Development, the Centers for Disease Control and Prevention, or the US government.

We used cross-sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anaemia among a nationally representative sample of nonpregnant women 15-49 years (n = 1, 918). Haemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood. Soil-transmitted helminth and Helicobacter pylori infections were assessed from stool. Sociodemographic, household, and health characteristics and diet were ascertained by interview. We conducted bivariate analyses between candidate predictors and anaemia (haemoglobin <12.0 g/ dL, altitude-and smoking-adjusted). Candidate predictors that were significant in bivariate models (P < 0.05) were included in the multivariable logistic regression model, accounting for complex sampling design. Anaemia prevalence was 20.2%

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 &lt;11.0 g/dL, altitude adjusted); candidate predictors were variables with P &lt; 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.

Introduction: GeneXpert MTB/Rif assay is an automated, cartridge-based nucleic acid amplification test that can accurately detect both tuberculosis and Rifampicin resistance. Since its introduction, there has been a steady uptake of this technology by the National Tuberculosis Program of Nepal. Nevertheless, a large number of drug-resistant TB cases remains undiagnosed. This study aims to examine the challenges in diagnosis of drug-resistant tuberculosis by the GeneXpert MTB/Rif assay in Nepal and explore the possible solutions. Methods: This was a cross-sectional study consisting of two parts – a quantitative part assessing the individual details and a qualitative part assessing the challenges on the diagnosis of drug-resistant TB by GeneXpert MTB/Rif assay. Data were collected from the GeneXpert operators, clinicians and program managers from 16 centers across the country and analyzed by IBM SPSS for Windows v23 and QDA Miner 4 Lite. Descriptive statistics were used to summarize the sociodemographic and other characteristics of the study participants using mean, standard deviation and proportions as appropriate. Results: A total of 48 technical manpower participated in the study. The mean age was 39.95 years and a majority of them (77.3%) were male. The major challenges identified were inadequate training, frequent power failure, difficulty in maintaining appropriate steady temperature, module failure which is often not replaced in time, issues with calibration and timely availability of cartridges as well as appropriate ways to store the new cartridges and safe disposal of the used cartridges. Conclusion: A number of challenges limit the optimal utilization of GeneXpert MTB/Rif assay warranting action.

Background: Globally, more than half of all TB cases are not detected. If they are not diagnosed and get treatment infection transmission may continue and patients suffer and may eventually die. Pulmonary TB either smear positive or negative is normally diagnosed by Ziehl-Neelsen stained sputum smear examination microscopy. Since the culture is the gold standard, evaluation of smear negative TB cases by this method is likely to detect more cases. Objectives: The objective of this study is to find out culture positivity among smear negative patients. Methods: All the three sputum samples reported negative by Ziehl-Neelsen microscopy from a total of 138 new TB suspected cases more than 15 years of age at NTC Laboratory. Nepal were cultured on Lowenstein-Jensen media. Tubes showing sufficient growth (culture positive) were recorded and all the culture positive results were informed to NTC. The culture positive samples were processed for DST on first line drugs using proportion method. Results: The culture positivity rate was 5.1% (7 of 138 cases) All the positive cultures were processed for DST on first line anti-TB drugs and none showed resistance of the total 138 suspected Tuberculosis patients, 94 (68.1%) were males and 44 were females (31.9%) with male: female ratio 1:047. The mean age of the total patients were 30.69. Nearly 42% of them belonged to 31-50 years. Mean age of the male patients was significantly higher than total of the female (p<.001). Conclusions: Seven smear negative cases among the total of 138 suspected TB patients attending NTC were culture positive. Similar study has to be done in other parts of the country.