Delbiso, Tefera Darge
[UCL]
Rodriguez-Llanes, José
[UCL]
Altare, Chiara
[UCL]
Masquelier, Bruno
[UCL]
Guha-Sapir, Debarati
[UCL]
Background: Women’s malnutrition, particularly undernutrition, remains an important public health challenge in Ethiopia. Although various studies examined the levels and determinants of women’s nutritional status, the influence of living close to an international border on women’s nutrition has not been investigated. Yet, Ethiopian borders are regularly affected by conflict and refugee flows, which might ultimately impact health. Objective: To investigate the impact of living close to borders in the nutritional status of women in Ethiopia, while considering other important covariates. Design: Our analysis was based on the body mass index (BMI) of 6,334 adult women aged 20–49 years, obtained from the 2011 Ethiopian Demographic and Health Survey (EDHS). A Bayesian multilevel multinomial logistic regression analysis was used to capture the clustered structure of the data and the possible correlation that may exist within and between clusters. Results: After controlling for potential confounders, women living close to borders (i.e. ≤100 km) in Ethiopia were 59% more likely to be underweight (posterior odds ratio [OR]=1.59; 95% credible interval [CrI]: 1.32–1.90) than their counterparts living far from the borders. This result was robust to different choices of border delineation (i.e. ≤50, ≤75, ≤125, and ≤150 km). Women from poor families, those who have no access to improved toilets, reside in lowland areas, and are Muslim, were independently associated with underweight. In contrast, more wealth, higher education, older age, access to improved toilets, being married, and living in urban or lowlands were independently associated with overweight. Conclusions: The problem of undernutrition among women in Ethiopia is most worrisome in the border areas. Targeted interventions to improve nutritional status in these areas, such as improved access to sanitation, economic and livelihood support, are recommended.
- WHO. Physical status: the use and interpretation of anthropometry. 1995; Geneva, Switzerland: World Health Organization. Technical Report Series, No. 854.
- WHO. The World Health Report 2005: make every mother and child count. 2005; Geneva, Switzerland: World Health Organization.
- Central Statistical Agency [Ethiopia] and ICF International. Ethiopia Demographic and Health Survey 2011. 2012; Addis Ababa, Ethiopia: Central Statistics Agency and ICF International.
- Mukuria A, Aboulafia C, Themme A. The context of women's health: results from the demographic and health surveys, 1994–2001. 2005; Calverton, MD: ORC Macro. Comparative Reports. Report No: 11.
- Bitew FH, Telake DS. Undernutrition among women in Ethiopia. DHS working papers. 2010; Calverton, MD: ORC Macro. Report No: 77.
- Girma W, Determinants of nutritional status of women and children in Ethiopia (2002)
- Feyissa D, Hoehne MV. Resourcing state borders and borderlands in the horn of Africa. Report No: 107. 2008; Halle, Germany: Max Planck Institute for Social Anthropology.
- Markakis J. Borders and borderland communities in the horn: the failure of integration. In conference ‘Divided they stand: the affordances of state borders in the Horn of Africa’.
Max Planck Institute for Social Anthropology, Halle, Germany, 7–8 September 2006.
- Institute of Security Studies. Africa's international borders as potential sources of conflict and future threats to peace and security. Report No: 233. 2012; Addis Ababa, Ethiopia: Institute for Security Studies (ISS).
- Baez Javier E., Civil wars beyond their borders: The human capital and health consequences of hosting refugees, 10.1016/j.jdeveco.2010.08.011
- UNHCR. UNHCR Global Report 2014: hosting the world's refugees. 2014; Geneva, Switzerland: United Nations High Commissioner for Refugees.
- Cogneau D, Mesple-somps S, Spielvogel G. Development at the border: a study of national integration in post-colonial West Africa. 2010. G-MonD Working Paper. Report No: 15. Paris, France: Paris School of Economics;
- Goldstein H. Multilevel statistical models. 2011. Chichester, UK: John Wiley & Sons Ltd;
- Browne WJ, Center for multilevel modeling (2014)
- Leckie George, Charlton Chris, runmlwin: A Program to Run theMLwiNMultilevel Modeling Software from withinStata, 10.18637/jss.v052.i11
- Lanz TJ, Afr Today, 43, 157 (1996)
- Pantuliano S, Wekesa M. Improving drought response in pastoral regions of Ethiopia: Somali and Afar regions and Borena Zone in Oromiya region. 2008; London, United Kingdom: Humanitarian Policy Group, Overseas Development Institute.
- Rettberg S, Pastoralism, 1, 248 (2010)
- Devereux S. Vulnerable livelihoods in Somali Region, Ethiopia. 2006; Brighton, UK: University of Sussex. IDS Research Report. Report No: 57.
- Dereje F, Proceedings of the 16th International Conference of Ethiopian Studies, 641 (2009)
- Hagmann T, Africa Spectr, 43, 19 (2008)
- World Bank. World development report 2011: conflict, security, and development. 2011; Washington, DC: The World Bank.
- Jacobsen Karen, Can refugees benefit the state? Refugee resources and African statebuilding, 10.1017/s0022278x02004081
- Alix-Garcia J., Saah D., The Effect of Refugee Inflows on Host Communities: Evidence from Tanzania, 10.1093/wber/lhp014
- Montalvo Jose G., Reynal-Querol Marta, Fighting against Malaria: Prevent Wars while Waiting for the “Miraculous” Vaccine, 10.1162/rest.89.1.165
- Sadler K, Kerven C, Calo M, Manske M, Catley A. Milk matters: a literature review of pastoralist nutrition and programming responses. 2009; Addis Ababa, Ethiopia: Feinstein International Center, Tufts University and Save the Children.
- Demissie T, Ethiop J Heal Dev, 17, 189 (2003)
- WHO. Poverty and health. 2003; Geneva: Organisation for Economic Co-operation and Development (OECD), World Health Organization.
Bibliographic reference |
Delbiso, Tefera Darge ; Rodriguez-Llanes, José ; Altare, Chiara ; Masquelier, Bruno ; Guha-Sapir, Debarati. Health at the borders: Bayesian multilevel analysis of women’s malnutrition determinants in Ethiopia. In: Global Health Action, Vol. 9, no.30204, p. 1-8 (4 July 2016) |
Permanent URL |
http://hdl.handle.net/2078.1/175317 |