Inequalities in Child Survival in Ethiopia: A two-decade experience
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Date
2024-04
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Addis Ababa University
Abstract
Introduction: Globally, 269 million children aged 6-59 months were anemic globally in 2019; 149.2 million under-five children were affected by undernutrition in 2020; and five million children also died before reaching the age of five years in 2021 alone. Children residing in Sub-Saharan African countries had 15- and 19-times higher risk of mortality than children in Europe and Northern America, and the region of Australia and New Zealand, respectively. Ethiopia, one of the Sub-Saharan African countries, is home to a high burden of under-five mortality and is ranked third in Africa and tenth in the world. The objective of this thesis was to examine trends and key predictors of inequalities in under-five mortality, undernutrition, and anemia in Ethiopia for the period 2000 to 2019) including population-level impacts of risk factors and spatial patterns.
Methods: The repeated cross-sectional study design was based on a total pooled sample of 48,782 underfive children drawn from five rounds of the Ethiopian Demographic and Health Surveys (2000-2019). The present thesis employed dominance analysis to identify the most dominant drivers of childhood undernutrition, anemia, and under-five mortality. Multilevel binary logistic regression was used to estimate the effect of the determinants of childhood undernutrition, anemia, and under-five mortality among underfive children at individual, household, and community levels. Blinder-Oaxaca decomposition techniques, concentration index, Theil and multivariate decomposition and decomposition rate analyses techniques were used to examine inequality in childhood anemia, undernutrition, and under-five mortality. Population Attributable Fractions (PAFs) were used to estimate the proportion of under-five children that could be prevented from childhood undernutrition, anemia, and under-five mortality by removing inequalities. From spatial analysis, Moran’s I and Getis-Ord Gi* statistics were employed to examine spatial patterns and clustering of childhood undernutrition, childhood anemia, and under-five mortality in the country.
Results: Maternal education, place of residence, and household wealth status accounted for 83.48% of the predicted variances for childhood undernutrition. The regional category was found to be the dominant driver of inequalities in childhood anemia, accounting for 50.56% of the predicted variance. Maternal education, child sex, and place of residence were found to be the most dominant drivers of inequality in under-five mortality, accounting for 89.3% of the predicted variance. Absolute socioeconomic inequality in childhood undernutrition prevalence was declined by 9.72 during the study period (2000 to 2019). The total relative inequality in childhood anemia declined from 0.620 in 2005 to 0.548 in 2016. The present thesis also showed that there would be 47 deaths per 1000 children for urban poor and 21 deaths per 1000 children for urban non-poor, resulting in 26 deaths per 1000 children change in urban poor when applying the urban non-poor coefficient and characteristics to urban poor behavior. About 72% of the reported under-five mortality could possibly be averted by removing the use of unimproved toilet facilities, early age childbirth (<18 years old mothers), and a large number of children ever born to mothers and less than six months breastfeeding practice at population-level. Childhood undernutrition, childhood anemia, and under-five mortality had statistically significant positive spatial autocorrelation, and clustered patterns with the Z-score value of 18.52, 22.45, and 6.56, respectively, in 2016. Conclusion: Childhood anemia, undernutrition, and under-five mortality were unequally among underfive children in Ethiopia, and largely concentrated among low socioeconomic status population groups. The thesis strongly suggests the implementation of multidimensional, multisectoral, and geographicspecific interventions to significantly reduce the inequalities in child survival.
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Drivers, inequalities, childhood anemia, undernutrition, under-five mortality, Ethiopia.