Background Water, Sanitation, and Hygiene (WASH) practices may affect the growth and nutritional status among adolescents. Therefore, this paper assesses WASH practices and its association with nutritional status among adolescent girls. Methods As a part of an intervention programme, this study is based on baseline cross-sectional data. It was conducted between May 2016–April 2017 in three Indian states (Bihar, Odisha, and Chhattisgarh). From a sample of 6352 adolescent girls, information on WASH practices, accessibility to health services and anthropometric measurements (height, weight and mid upper arm circumference (MUAC)) was collected. Descriptive statistics were used to examine WASH practices, and nutritional status among adolescent girls. Determinants of open defecation and menstrual hygiene were assessed using logistic regression. Association between WASH and nutritional status of adolescent girls was determined using linear regression. Results Findings showed 82% of the adolescent girls were practicing open defecation and 76% were not using sanitary napkins. Significant predictors of open defecation and non use of sanitary napkin during menstruation were non Hindu households, households with poorer wealth, non availability of water within household premise, non visit to Anganwadi Centre, and non attendance in Kishori group meetings. One-third of adolescent girls were stunted, 17% were thin and 20% had MUAC < 19 cm. Poor WASH practices like water facility outside the household premise, unimproved sanitation facility, non use of soap after defecation had significant association with poor nutritional status of adolescent girls. Conclusions Concerted convergent actions focusing on the provision of clean water within the household premise, measures to stop open defecation, promotion of hand washing, accessibility of sanitary napkins, poverty alleviation and behavior change are needed. Health, nutrition and livelihood programmes must be interspersed, and adolescents must be encouraged to take part in these programmes.

Feasibility and diagnostic accuracy of using armband mid-upper arm circumference as a simple screening tool for maternal wasting in rural India Rural and Remote Health 17: 4221. (Online) 2017 Available: http://www.rrh.org.au Dear EditorLack of a single, universally accepted, and widely accessible approach to diagnosing and documenting adult malnutrition has impeded accurate estimations of human and financial burdens associated with prevention and treatment of malnutrition 1 . In January 2016 we tested the feasibility of armband mid-upper arm circumference (MUAC)<23 cm as a simple screening tool for maternal nutritional status and its diagnostic accuracy during a monthly village health and nutrition day in Bihar state, India. Using standard methods, weight, height and MUAC measurements were taken for 99 adolescent and adult women by trained health workers. Measurement time for armband MUAC, MUAC by non-stretchable tape and height by a stadiometer were compared. MUAC diagnostic accuracy was tested against body mass index (BMI)<18.5 kg/m 2 as the gold standard. A total of 82.5% of participants had a BMI of less than 18.5 kg/m 2 with the mean BMI of the sample population being 16.37 kg/m 2 and the mean age 20.5±5 years. The result shows that the proportions of women with MUAC<23 cm and MUAC<21 cm were 29% and 69%, respectively. MUAC<23 cm in women (area under curve=0.75) had the highest Youden's index (0.64), which corresponds to BMI<18.5 kg/m 2 . A strong significant power of association (r) between MUAC and BMI<18.5 kg/m 2 was found in adolescent girls (r=0.64; p<0.0001), but only a slightly moderate association for adult women (r=0.47; p=0.005). Taking the MUAC cut-off, 49% adult women were found to be under-nourished compared to 51% using the BMI underweight cut-off. Similarly, 81% of adolescent girls were found to be under-nourished taking the MUAC