Volume 7, Issue 5

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.