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Introduction: Understanding socio-economic correlates and inequality of underweight and overweight is crucial to develop interventions to prevent adverse health outcomes. Materials and methods: We analysed Nepal Demographic and Health Survey 2016 data from 6,069 women aged 15–49 years. WHO cut-offs for Body Mass Index categorised as: underweight (<18.5 kg/m2), normal weight (18.5kg/m2 to 24.9kg/m2) and overweight/ obesity (> = 25.0 kg/m2) were used. We used multinomial logistic regression to explore associations of factors with Body Mass Index and concentration indices to estimate socio-economic inequalities. Results: Higher risk of underweight was found in age group 15–19 (RRR 3.08, 95% CI: 2.29–4.15), 20–29 (RRR 1.64, 95% CI: 1.29–2.08) and in lowest (RRR 1.60, 95% CI: 1.03–2.47) and second wealth quintiles (RRR 1.77 (95% CI: 1.18–2.64). Education, occupation, urban/rural residence and food security were not associated with underweight (p>0.05). Lower risk of overweight/obesity was found in age group 15–19 (RRR 0.07, 95% CI: 0.05–0.10), 20–29 (RRR 0.40, 95% CI: 0.32–0.51), in manual occupation (RRR 0.58, 95% CI: 0.46–0.74) and in lower quintiles. Women with primary (RRR 1.91, 95% CI: 1.36–2.67), secondary education (RRR 1.42, 95% CI 1.00, 2.01) were at increased risk of overweight/obesity. Household food security and urban/rural residence were not associated with overweight/obesity (p>0.05). Socioeconomic inequalities were detected, with overweight/obesity strongly concentrated (concentration index: 0.380) amongst the higher quintiles and underweight concentrated (concentration index: -0.052) amongst the poorest. Conclusion: Nutrition programmes should target younger and poor women to address undernutrition and higher wealth group women to address overnutrition. Equity based nutrition interventions improving socio-economic status of poor households may benefit undernourished women. Interventions to encourage physical activity as women age and among wealthier women as well as healthy eating for prevention of under- and over-nutrition are needed. [ABSTRACT FROM AUTHOR]

Background: In Nepal, since 2004, 19,388 people living with HIV (PLHIV) have been enrolled on antiretroviral therapy (ART). The aim of this study was to measure mortality rate and to identify predictors of mortality in adult (≥15 years) PLHIV who initiated ART between 2004 and 2013 in five large ART centers of Nepal. Methods: This retrospective cohort study of 3,799 (60.5% male) adult PLHIV uses secondary data collected from standard ART registers. Time from ART initiation (baseline) to death or censoring (loss to follow-up or December 31, 2013) was assessed. Mortality rates per 100 person-years were calculated. Kaplan-Meier models were used to estimate the probability of mortality over time. Predictors of mortality were determined using Cox-regression models. Results: The overall mortality rate was 6.98 (95% CI: 6.46–7.54) per 100 person-years, 4.11 (95% CI: 3.53–4.79) in females and 9.14 (95% CI: 8.36–9.99) in males. Mortality rates were higher in early months after ART initiation, particularly in the first three months. Baseline predictors of mortality were ART center, male gender (adjusted HR = 2.08, 95% CI: 1.69–2.57), residence outside the ART district (AHR = 1.45, 95% CI:1.19–1.76), World Health Organization clinical stage III (AHR = 1.67, 95% CI: 1.13–2.46) and IV (AHR = 2.21, 95% CI: 1.45–3.36), bedridden <50% time in the last month (AHR = 1.92, 95% CI: 1.52–2.41), bedridden >50% time in the last month (AHR = 3.82, 95% CI: 2.95–4.94), lower bodyweight/kg (AHR = 1.04, 95% CI: 1.03–1.05), CD4 count <150 cell/mm3 (AHR = 2.14, 95% CI: 1.05–4.34) and treatment not switched to second-line regimen (AHR = 3.05, 95% CI: 1.35–6.90). Conclusions: Mortality rates were higher soon after ART initiation, particularly in males and gradually decreased over time. Poor baseline clinical characteristics were significantly associated with higher mortality. Increased ART coverage with decentralization of sites to lower levels including community dispensing, differentiated and improved service delivery and initiation of ART at a less advanced disease stage may reduce early mortality. [ABSTRACT FROM AUTHOR]

Background: Undernutrition during pregnancy leads to low birthweight, poor growth and inter-generational undernutrition. We did a non-blinded cluster-randomised controlled trial in the plains districts of Dhanusha and Mahottari, Nepal to assess the impact on birthweight and weight-for-age z-scores among children aged 0–16 months of community-based participatory learning and action (PLA) women’s groups, with and without food or cash transfers to pregnant women. Methods: We randomly allocated 20 clusters per arm to four arms (average population/cluster = 6150). All consenting married women aged 10–49 years, who had not had tubal ligation and whose husbands had not had vasectomy, were monitored for missed menses. Between 29 Dec 2013 and 28 Feb 2015 we recruited 25,092 pregnant women to surveillance and interventions: PLA alone (n = 5626); PLA plus food (10 kg/month of fortified wheat-soya ‘Super Cereal’, n = 6884); PLA plus cash (NPR750≈US$7.5/month, n = 7272); control (existing government programmes, n = 5310). 539 PLA groups discussed and implemented strategies to improve low birthweight, nutrition in pregnancy and hand washing. Primary outcomes were birthweight within 72 hours of delivery and weight-for-age z-scores at endline (age 0–16 months). Only children born to permanent residents between 4 June 2014 and 20 June 2015 were eligible for intention to treat analyses (n = 10936), while in-migrating women and children born before interventions had been running for 16 weeks were excluded. Trial status: completed. Results: In PLA plus food/cash arms, 94–97% of pregnant women attended groups and received a mean of four transfers over their pregnancies. In the PLA only arm, 49% of pregnant women attended groups. Due to unrest, the response rate for birthweight was low at 22% (n = 2087), but response rate for endline nutritional and dietary measures exceeded 83% (n = 9242). Compared to the control arm (n = 464), mean birthweight was significantly higher in the PLA plus food arm by 78·0 g (95% CI 13·9, 142·0; n = 626) and not significantly higher in PLA only and PLA plus cash arms by 28·9 g (95% CI -37·7, 95·4; n = 488) and 50·5 g (95% CI -15·0, 116·1; n = 509) respectively. Mean weight-for-age z-scores of children aged 0–16 months (average age 9 months) sampled cross-sectionally at endpoint, were not significantly different from those in the control arm (n = 2091). Differences in weight for-age z-score were as follows: PLA only -0·026 (95% CI -0·117, 0·065; n = 2095); PLA plus cash -0·045 (95% CI -0·133, 0·044; n = 2545); PLA plus food -0·033 (95% CI -0·121, 0·056; n = 2507). Amongst many secondary outcomes tested, compared with control, more institutional deliveries (OR: 1.46 95% CI 1.03, 2.06; n = 2651) and less colostrum discarding (OR:0.71 95% CI 0.54, 0.93; n = 2548) were found in the PLA plus food arm but not in PLA alone or in PLA plus cash arms. Interpretation: Food supplements in pregnancy with PLA women’s groups increased birthweight more than PLA plus cash or PLA alone but differences were not sustained. Nutrition interventions throughout the thousand-day period are recommended. Trial registration: . [ABSTRACT FROM AUTHOR]