1 Original Article Nepal Med Coll J 2011; 13(1): 1-6 Health status of married women residing five communities in Nepal: Unexpectedly high prevalence of anemia in a well-off community of Kathmandu S Konishi, 1,2 RP Parajuli, 1 E Takane, 1 M Maharjan, 3 S Sharma, 4 K Tachibana, 5 H Jiang, 6 K Pahari, 4 BD Pandey 7 and C Watanabe 1 1 Department of Human Ecology, University of Tokyo, Tokyo, Japan, 2 Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA, 3 Environment and Public Health Organization (ENPHO), Kathmandu, Nepal, 4 Nepal Development Research Institute (NDRI), Kathmandu, Nepal, 5 College of Social Sciences, Ritsumeikan University, Kyoto, Japan, 6 Research Institute for Humanity and Nature, Kyoto, Japan, 7 Sukra Raj Tropical and Infectious Disease Hospital/Everest International Clinic and Research Centre, Kathmandu, Nepal Corresponding author: Dr. Shoko Konishi, Department of Human Ecology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; e-mail: moe@humeco.m.u-tokyo.ac.jp ABSTRACT The high prevalence of anemia and underweight among reproductive age women is a serious health concern in Nepal. The objective of the present study was to describe anemia prevalence and nutritional status of married women in Nepal. Total of 278 women were included in the present analysis. The five communities included an urban commercial area (W) in Kathmandu, an agricultural village (K) in Lalitpur District, an agricultural village in Chitwan District (C) and one in Ilam District (I) with intensive cash cropping, and another rural village in Kaski District (P) with high number of international out-migration of males. The study procedure included anthropometric measurements, blood collection for hemoglobin measurement, and stool collection for examination of hookworm infection, and a structured interview on their reproductive history including contraceptive use. The altitude adjusted prevalence of anemia was 65%, 23%, 16%, 49% and 58% in communities C, I, K, P and W respectively. The hookworm prevalence of each community was not associated with the anemia prevalence. In the urban well-off community W, although 38% of the women had BMI≥25 and only 2% of women had BMI<18.5, 58% of the women were anemic. A logistic regression analysis on the anemia risk at the individual level showed no effect of helminth infection, but a significant negative effect of Depo- Provera (depot-medroxyprogesterone acetate) use. Causes of high anemia prevalence among the women resided in the urban well-off area should be investigated in future studies. Keywords: Nepal, anemia, Depo-Provera. INTRODUCTION Anemia and underweight is a serious health concern among Nepali women of reproductive age. Anemia during pregnancy increases the risk of low birth weight and preterm delivery, 1 and increases infant and maternal mortality. 2,3 The anemia prevalence of pregnant, breastfeeding, and non-pregnant and non-breast feeding women aged 15–49 in Nepal was 42.4%, 40.3%, and 34.0% respectively, in 2006. 4 Low-iron intake and hookworm infection, which is a major public health problem in Nepal, 5-7 are the major risk factors of anemia in the country. 8 It has also been reported that use of Depo- Provera injections are associated with higher hemoglobin concentrations among Nepali women of reproductive age. 9 Undernutrition of women increases the risk for maternal and infant mortality. 10 Prepregnancy underweight is associated with increased risk for spontaneous abortion, 11 and the infants born to underweight mothers are at increased risk for fetal growth deficits associated with infant morbidity. 12 The proportion of underweight (body mass index; BMI<18.5) Nepali women of reproductive age was high in rural areas (25.9%) compared to that in urban areas (16.6%) in 2006. 4 When the women are grouped by BMI categories, the prevalence of anemia among women with BMI<18.5 was 44.6%, which was almost double the prevalence among women with BMI ≥25 (23.3%). 4 Therefore, it is suspected that underweight women in rural areas are at increased risk of anemia. While underweight is still being a serious health problem, overweight has been continuously increasing in the women of developing countries. 13 It is also reported that many of the overweight women do not meet the iron intake requirement and suffer from anemia. 14 In Nepal, between 1996 and 2006 the prevalence of overweight (BMI≥25) among women 15-49 years increased from 1.6% to 10.1%, whereas the prevalence of underweight (BMI<18.5) did not show much decrease. 15 This data suggests that underweight and overweight coexist among Nepali women.