Articles and issues

Background. Anemia affects more than half of adolescent girls in India despite national programs for weekly iron and folic acid supplementation (WIFS) and deworming. Evidence on local determinants is needed to target interventions in rural and tribal communities. Methods. We conducted a community-based cross-sectional study among girls aged 10–19 years in 30 villages of Junnar and Ambegaon talukas, Pune district, between November 2025 and February 2026. Hemoglobin was measured in venous blood with an automated hematology analyzer, and anemia was defined using World Health Organization age-specific thresholds. Sociodemographic, dietary, menstrual and program exposure data were collected by interview, and determinants were assessed with multilevel logistic regression. Results. Of 880 eligible girls, 836 (95.0%) participated. The prevalence of anemia was 53.9% (451/836): 29.5% mild, 22.2% moderate and 2.2% severe. In adjusted analysis, anemia was associated with heavy or prolonged menstrual bleeding (adjusted odds ratio, aOR 2.05, 95% CI 1.36–3.09), thinness (aOR 1.72, 1.17–2.53) and scheduled tribe status (aOR 1.41, 1.03–1.93). Consuming at least 8 of 12 WIFS tablets in the previous 3 months (aOR 0.61, 0.45–0.83), minimum dietary diversity (aOR 0.66, 0.48–0.91) and deworming in the past year (aOR 0.74, 0.55–0.99) were associated with lower odds of anemia. Conclusions. Anemia remains highly prevalent among rural adolescent girls in western Maharashtra. Improving adherence to weekly supplementation, addressing heavy menstrual bleeding and thinness, and promoting dietary diversity, especially in tribal communities, should be priorities for the Anemia Mukt Bharat program.

Introduction. Scrub typhus, caused by Orientia tsutsugamushi, is a common cause of acute febrile illness in South and Southeast Asia and can involve multiple organs. Acute acalculous cholecystitis is a rare manifestation that may lead to unnecessary surgery when the underlying infection is not recognized. Case presentation. A 24-year-old male rice farmer from Sunsari district, Nepal, presented in September with 7 days of fever, headache and myalgia and 2 days of right upper quadrant pain and vomiting. He was febrile (39.2 °C) and tachycardic, with right upper quadrant tenderness and a positive Murphy sign. Investigations showed neutrophilic leukocytosis, thrombocytopenia (68 × 10⁹/L), raised transaminases and a C-reactive protein of 148 mg/L. Ultrasound demonstrated a distended gallbladder with 6.2-mm wall thickening and pericholecystic fluid but no calculi. A repeat examination revealed an eschar in the right inguinal fold, and scrub typhus IgM ELISA and eschar PCR for the 56-kDa antigen gene were positive. Oral doxycycline led to defervescence within 48 hours and resolution of abdominal pain by day 5, and follow-up ultrasound showed a normal gallbladder. Surgery was avoided. Conclusion. Scrub typhus should be considered in patients from endemic areas who present with fever and acalculous cholecystitis. A deliberate search for an eschar and early doxycycline can prevent unnecessary cholecystectomy.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease in South Asia, paralleling the region's rapid rise in type 2 diabetes and central obesity. South Asian adults develop hepatic steatosis, insulin resistance and diabetes at a lower body mass index than European populations, a pattern that reflects greater visceral and ectopic fat, early-life nutritional influences and genetic variants such as PNPLA3 I148M. As a result, many affected individuals are not obese by conventional criteria and may be missed by screening based on weight alone. This narrative review summarizes evidence on the epidemiology and risk phenotype of MASLD in South Asian populations, both in the region and in diaspora communities, and examines how the 2023 nomenclature, with its ethnicity-specific cardiometabolic criteria, applies to them. We discuss noninvasive fibrosis risk stratification with the FIB-4 index and vibration-controlled transient elastography, and the practical constraints of resource-variable health systems. Management centers on sustained weight loss through culturally adapted dietary change and physical activity, together with active treatment of diabetes, hypertension and dyslipidemia, since cardiovascular disease remains the leading cause of death. We review emerging pharmacotherapy, including resmetirom and glucagon-like peptide-1 receptor agonists, and note the limited representation of South Asian patients in pivotal trials. We conclude with priorities for practice: risk-based case finding in primary care and diabetes clinics, ethnicity-appropriate anthropometric thresholds and integrated cardiometabolic care.