title: Health at the borders: Bayesian multilevel analysis of women's malnutrition determinants in Ethiopia.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Centre for Research on the Epidemiology of Disaster (CRED), Institute of Health and Society (IRSS), Université catholique de Louvain (UCL), Brussels, Belgium; teferadarge@gmail.com.
authors.forename: Tefera Darge
authors.initials: TD
authors.lastname: Delbiso
authors.affiliation: Centre for Research on the Epidemiology of Disaster (CRED), Institute of Health and Society (IRSS), Université catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Rodriguez-Llanes
authors.affiliation: Centre for Research on the Epidemiology of Disaster (CRED), Institute of Health and Society (IRSS), Université catholique de Louvain (UCL), Brussels, Belgium.|Action Contre la Faim, Paris, France.
authors.forename: Chiara
authors.initials: C
authors.lastname: Altare
authors.affiliation: Centre de Recherche en Démographie, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Masquelier
authors.affiliation: Centre for Research on the Epidemiology of Disaster (CRED), Institute of Health and Society (IRSS), Université catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Debarati
authors.initials: D
authors.lastname: Guha-Sapir
keywords: conflict; natural disaster; overweight; refugee; underweight