Inequality in Perinatal Mortality and its Covariates: Secondary Analysis of the Ethiopian Demographic Health Surveys from 2005-2016
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Date
2020-07
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Addis Abeba University
Abstract
Background: Perinatal mortality is an important indicator of health and the quality of health care.
Countries or regions are often compared using perinatal mortality rate. The aim of the study is to
determine the trends and inequality in perinatal mortality and its covariates in Ethiopia by using
the three round of Ethiopian Demographic Health Survey (EDHS) data (2005, 2011 and 2016).
Method: EDHS sample designs were stratified, clustered and two-stage probability sampling. The
trend of perinatal mortality rate was computed using the annual rate of reduction and the 95%
confidence interval also used to indicate statistically significant reduction. The inequality in
perinatal mortality was measured by using both the simple (ratio and difference) and complex
measure of inequality (relative concentration index). The concentration index was decomposed
using the “decomp” package in R studio.
Result: The trend of perinatal mortality rate in Ethiopia showed slow rate of reduction with 0.72
percent reduction per annuum. Annual rate of reduction for the stillbirth rate was -1.3% whereas
the early neonatal mortality was 1.5%. The ratio and difference inequality summary measure for
the region showed high disparity across region with highest mortality (Oromiya) and lowest
mortality (Harari region), difference (D)= -0.0070, 95% CI (-0.0117, -0.0023) and the ratio(R) =
0.7868 95% CI (0.6619, 0.9354). However, place of residence showed insignificant disparity
(difference (D)= -0.0118, 95% CI (-0.0276, 0.0041) and ratio (R)= 0.7254, 95% CI (0.4962,
1.0605)). The results indicated that the concentration index for wealth-based inequality across the
three survey years were 0.0158926, -0.0117815 and 0.01130234, respectively. While the
concentration index for the level of maternal education over the three-survey year was (-0.00011,
-0.0013 and 0.0010), respectively.
Conclusion and Recommendation: Even though trend show some rate of reduction in PNMR,
the rate remains high in the country. In all survey years (2005,2011 and 2016) there was wealth
and level of maternal education-based inequality in perinatal mortality. In order to minimize the
inequality in perinatal mortality in Ethiopia effort should be made narrowing the economic
variation within population (regions).
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Keywords
Perinatal mortality, stillbirth, early neonatal mortality, inequality, trend and EDHS