AccScience Publishing / IJPS / Volume 9 / Issue 2 / DOI: 10.36922/ijps.427
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RESEARCH ARTICLE

Exploring the most dominant drivers of inequalities in child survival in Ethiopia: Dominance analysis

Negussie Shiferaw Tessema1* Nigatu Regassa Geda2,3
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1 Center of Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
2 College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
3 College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
IJPS 2023, 9(2), 12–25; https://doi.org/10.36922/ijps.427
Submitted: 19 December 2022 | Accepted: 29 March 2023 | Published: 14 April 2023
© 2023 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Abstract

Inequalities in child survival are a global public health concern. Over the past decade, Ethiopia has made remarkable progress in improving child survival. Despite this promising development, inequalities in child survival among the various population groups remained a pressing public health concern. The purpose of this paper is to examine the dominant drivers of inequality in child survival indicators (undernutrition, anemia, and under-five mortality) in Ethiopia. Dominance analysis was used based on a pooled total sample of 48,422 under-five children drawn from five rounds of Ethiopia Demographic and Health Surveys conducted from year 2000 to 2019. Childhood undernutrition, childhood anemia, and under-five mortality were the three outcome variables, and the five dimensions of inequality were considered as key predictor variables. The dominance analysis revealed that maternal education, place of residence, and household wealth index were the three most dominant drivers of inequalities in childhood undernutrition, accounting for 83.48% of the predicted variances. The regional category was found to be the first-ranked key driver of inequalities in childhood anemia, accounting for 50.56% of the predicted variance. The dominance analysis also indicated that maternal education, child sex, and place of residence were the three most dominant drivers of inequality in under-five mortality, accounting for 89.3% of the predicted variance. This study provides empirical evidence that maternal education (individual level), household asset based wealth index (household level), and place of residence (community level) were the most dominant drivers of inequality in child survival. This suggests interventions in reducing inequalities in child survival need to start at the community level, notwithstanding the importance of household and individual level influences.

Keywords
Dominant drivers
Dominance analysis
Inequalities
Child survival
Under-five mortality
Ethiopia
Funding
None.
References

Adeyinka, D.A., Olakunde, B.O., & Muhajarine, N. (2019). Evidence of health inequity in child survival: Spatial and Bayesian network analyses of stillbirth rates in 194 countries. Scientific Reports, 9(1): 19755. https://doi.org/10.1038/s41598-019-56326-w

 

Agbadi, P., Agbaglo, E., Tetteh, J.K., Adu, C., Ameyaw, E.K., & Nutor, J.J. (2021). Trends in under-five mortality rate disaggregated across five inequality dimensions in Ghana between 1993 and 2014. Public Health, 196: 95-100. https://doi.org/10.1016/j.puhe.2021.04.024

 

Alao, R., Nur, H., Fivian, E., Shankar, B., Kadiyala, S., & Harris- Fry, H. (2021). Economic inequality in malnutrition: A global systematic review and meta-analysis. BMJ Global Health, 6(12): e006906. https://doi.org/10.1136/bmjgh-2021-006906

 

Amegbor, P.M., Borges, S.S., Pysklywec, A., & Sabel, C.E. (2022). Effect of individual, household and regional socioeconomic factors and PM2.5 on anaemia: A cross-sectional study of sub-Saharan African countries. Spatial and Spatio-Temporal Epidemiology, 40: 100472. https://doi.org/10.1016/j.sste.2021.100472

 

Anteneh, Z.A., & Van Geertruyden, J.P. (2021). Spatial variations and determinants of anemia among under-five children in Ethiopia, EDHS 2005-2016. PLoS One, 16: 0249412. https://doi.org/10.1371/journal.pone.0249412

 

Azen, R., & Traxel, N. (2009). Using dominance analysis to determine predictor importance in logistic regression. Journal of Educational and Behavioral Statistics, 34(3): 319-347. https://doi.org/10.3102/1076998609332754

 

Balaj, M., York, H.W., Sripada, K., Besnier, E., Vonen, H.D., Aravkin, A., Friedman, J., Griswold, M., Jensen, M.R., Mohammad, T., Mullany, E.C., Solhaug, S., Sorensen, R., Stonkute, D., Tallaksen, A., Whisnant, J., Zheng, P., Gakidou, E., & Eikemo, T.A. (2021). Parental education and inequalities in child mortality: A global systematic review and meta-analysis. Lancet, 398(10300): 608-620. https://doi.org/10.1016/S0140-6736(21)00534-1

 

Bareke, M.L., Agezew, B.H., Dedho, N.H., Herut, A.H., Demissie, M.M., Yimer, B.M., & Lebeta, M.F. (2022). Education inequalities in Ethiopia : A macro-level analysis and its policy implications. Preprints, 2022060341. https://doi.org/10.20944/preprints202206.0341.v1

 

Bras, H., & Mandemakers, J. (2022). Maternal education and sibling inequalities in child nutritional status in Ethiopia. SSM-Population Health, 17: 101041. https://doi.org/10.1016/j.ssmph.2022.101041

 

Brault, M.A., Mwinga, K., Kipp, A.M., Kennedy, S.B., Maimbolwa, M., Moyo, P., Ngure, K., Haley, C.A., & Vermund, S.H. (2020). Measuring child survival for the Millennium Development Goals in Africa: What have we learned and what more is needed to evaluate the Sustainable Development Goals? Global Health Action, 13(1): 1732668. https://doi.org/10.1080/16549716.2020.1732668

 

Central Statistical Agency (CSA), & ICF. (2016). Ethiopia Demographic and Health Survey. Addis Ababa, Rochville: CSA and IFC.

 

Central Statistical Agency (CSA), & United Nations Fund for Children (UNICEF). (2020). Faces of Poverty: Studying the Overlap Between Monetary and Multidimensional Child Poverty in Ethiopia. Ethiopia: Central Statistical Agency. Available from: https://www.unicef.org/esa/media/10266/ file/UNICEF-Ethiopia-Faces-of-Poverty-Report-2020.pdf

 

Cha, S., & Jin, Y. (2020). Have inequalities in all-cause and cause-specific child mortality between countries declined across the world? International Journal for Equity in Health, 19(1): 1-13. https://doi.org/10.1186/s12939-019-1102-3

 

Dheresa, M., Roba, H.S., Daraje, G., Abebe, M., Tura, A.K., Yadeta, T.A., Dessie, Y., & Dingeta, T. (2022). Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of Millennium Development Goal in Eastern Ethiopia. Journal of Global Health, 12: 04010. https://doi.org/10.7189/JOGH.12.04010

 

Ekholuenetale, M., Okonji, O.C., Nzoputam, C.I., & Barrow, A. (2022). Inequalities in the prevalence of stunting, anemia and exclusive breastfeeding among African children. BMC Pediatrics, 22(1): 333. https://doi.org/10.1186/s12887-022-03395-y

 

Ekholuenetale, M., Tudeme, G., Onikan, A., & Ekholuenetale, C.E. (2020). Socioeconomic inequalities in hidden hunger, undernutrition, and overweight among under-five children in 35 sub-Saharan Africa countries. Journal of the Egyptian Public Health Association, 95(1): 9. https://doi.org/10.1186/s42506-019-0034-5

 

Endris, B.S., Dinant, G.J., Gebreyesus, S.H., & Spigt, M. (2021). Geospatial inequality of anaemia among children in Ethiopia. Geospatial Health, 16(2): 1036. https://doi.org/10.4081/gh.2021.1036

 

Ethiopian Public Health Institute (EPHI), & ICF. (2021). Ethiopia Mini Demographic and Health Survey 2019: Final Report. Available from: https://dhsprogram.com/pubs/pdf/FR363/ FR363.pdf

 

Federal Democratic Republic of Ethiopia (FDRE). (2016). National Nutrition Program 2016-2020. Addis Ababa: Federal Democratic Republic of Ethiopia, p.88. Available from: https://www.unicef.org/ethiopia/national_nutrition_ programme.pdf

 

Federal Democratic Republic of Ethiopia. (2018). Food and Nutrition Policy Ethiopia. Addis Ababa: Federal Democratic Republic of Ethiopia.

 

Federal Ministry of Health (FMOH)-Federal Democratic Republic of Ethiopia (FDRE). (2016). National Strategy for Child Survival in Ethiopia 2015/16-2019/20 Maternal. Abuja, Nigeria: Federal Ministry of Health. p.7-66.

 

Fenta, H.M., Zewotir, T., & Muluneh, E.K. (2021). Disparities in childhood composite index of anthropometric failure prevalence and determinants across Ethiopian administrative zones. PLoS One, 16: e0256726. https://doi.org/10.1371/journal.pone.0256726

 

Food and Agriculture Organization (FAO). (2016). AQUASTAT country profile-Ethiopia. Food and Agriculture Organization of the United Nations (FAO). In: FAO, AQUSAT Reports. Rome, Italy: Food and Agriculture Organization. p11-12.

 

Forde, I., & Tripathi, V. (2018). Association of place of residence and under-five mortality in middle-and low-income countries: A meta-analysis. Children (Basel), 5(4): 51. https://doi.org/10.3390/children5040051

 

Gebreegziabher, T., Regassa, N., Wakefield, M., Pritchett, K., & Hawk, S. (2020). Disparities in the prevalence and risk factors of anaemia among children aged 6-24 months and 25-59 months in Ethiopia. Journal of Nutritional Science, 9: e36. https://doi.org/10.1017/jns.2020.29

 

Hasan, M.M., Magalhaes, R.J.S., Ahmed, S., Pervin, S., Tariqujjaman, M., Fatima, Y., & Mamun, A.A. (2021). Geographical variation and temporal trend in anemia among children aged 6-59 months in low-and middle-income countries during 2000-2018: Forecasting the 2030 SDG target. Public Health Nutrition, 24(18): 6236-6246. https://doi.org/10.1017/S1368980021002482

 

Hasan, M.M., Uddin, J., Pulok, M.H., Zaman, N., & Hajizadeh, M. (2020). Socioeconomic inequalities in child malnutrition in Bangladesh: Do they differ by region? International Journal of Environmental Research and Public Health, 17(3): 1079. https://doi.org/10.3390/ijerph17031079

 

Hosseinpoor, A.R., Nambiar, D., Schlotheuber, A., Reidpath, D., & Ross, Z. (2016). Health Equity Assessment Toolkit (HEAT): Software for exploring and comparing health inequalities in countries. BMC Medical Research Methodology, 16(1): 141. https://doi.org/10.1186/s12874-016-0229-9

 

Houweling, T.A.J., & Kunst, A.E. (2010). Socio-economic inequalities in childhood mortality in low- and middle-income countries: A review of the international evidence. British Medical Bulletin, 93(1): 7-26. https://doi.org/10.1093/bmb/ldp048

 

Jember, T.A., Teshome, D.F., Gezie, L.D., & Agegnehu, C.D. (2021). Spatial variation and determinants of childhood anemia among children aged 6 to 59 months in Ethiopia: Further analysis of Ethiopian demographic and health survey 2016. BMC Pediatrics, 21(1): 497. https://doi.org/10.1186/s12887-021-02901-y

 

Kennedy, E., Mersha, G.A., Biadgilign, S., Tessema, M., Zerfu, D., Gizaw, R., & Kershaw, M. (2020). Nutrition policy and governance in Ethiopia: What difference does 5 years make? Food and Nutrition Bulletin, 41(4): 494-502. https://doi.org/10.1177/0379572120957218

 

Lee, S.E., & Dahinten, V.S. (2021). Using dominance analysis to identify the most important dimensions of safety culture for predicting patient safety. International Journal of Environmental Research and Public Health, 18(15): 7746. https://doi.org/10.3390/ijerph18157746

 

Lemessa, R., Aga, G., Tafese, A., & Senbeto, T. (2022). Malnutrition in Ethiopia: Pattern analysis and associated factors among under-five children. Nutrition and Food Science, 53: 564-577. https://doi.org/10.1108/NFS-12-2021-0393

 

Liyew, A.M., Kassie, A., Teshale, A.B., Alem, A.Z., Yeshaw, Y., & Tesema, G.A. (2021). Exploring spatiotemporal distribution of under-five mortality in Ethiopia: Further analysis of Ethiopian Demographic and Health Surveys 2000, 2005, 2011 and 2016. BMJ Paediatrics Open, 5(1): e001047. https://doi.org/10.1136/bmjpo-2021-001047

 

Luchman, J.N. (2021). Determining relative importance in Stata using dominance analysis: Domin and domme. Stata Journal, 21(2): 510-538. https://doi.org/10.1177/1536867X211025837

 

Ministry of Health (MOH). (2020). Realizing Universal Health Coverage Through Primary Health Care. A Roadmap for Optimizing the Ethiopian Health Extension Program 2020- 2035. Addis Ababab, Ehtiopia: Ministry of Health.

 

Moradhvaj, & Samir, K.C. (2023). Differential impact of maternal education on under-five mortality in rural and urban India. Health and Place, 80: 102987. https://doi.org/10.1016/j.healthplace.2023.102987

 

Mosley, W.H., & Chen, L.C. (2003). An analytical framework for the study of child survival in developing countries. 1984. Bulletin of the World Health Organization, 81(2): 140-145. https://doi.org/10.1590/S0042-96862003000200012

 

Nahalomo, A., Iversen, P.O., Andreassen, B.A., Kaaya, A.N., Rukooko, A.B., Tushabe, G., Nateme, N.C., & Rukundo, P.M. (2022). Malnutrition and associated risk factors among children 6-59 months old in the landslide-prone Bududa District, Eastern Uganda: A cohort study. Current Developments in Nutrition, 6(2): nzac005. https://doi.org/10.1093/cdn/nzac005

 

Tessema, N.S., Desta, C.G., Geda, N.R., & Boshera, T.D. (2021). Residential inequalities in child mortality in Ethiopia: Multilevel and decomposition analyses. International Journal of Population Studies, 7(2): 47-59. https://doi.org/10.36922/ijps.v7i2.392

 

Nkosi-Gondwe, T., Calis, J., van Hensbroek, M.B., Bates, I., Blomberg, B., & Phiri, K.S. (2021). A cohort analysis of survival and outcomes in severely anaemic children with moderate to severe acute malnutrition in Malawi. PLoS One, 16(2): e0246267. https://doi.org/10.1371/journal.pone.0246267

 

Pearce, A., Dundas, R., Whitehead, M., & Taylor-Robinson, D. (2019). Pathways to inequalities in child health. Archives of Disease in Childhood, 104(10): 998-1003. https://doi.org/10.1136/archdischild-2018-314808

 

Pongou, R. (2013). Why is infant mortality higher in boys than in girls? A new hypothesis based on preconception environment and evidence from a large sample of twins. Demography, 50(2): 421-444. https://doi.org/10.1007/s13524-012-0161-5

 

Rebouças, P., Falcão, I.R., & Barreto, M.L. (2022). Social inequalities and their impact on children’s health: A current and global perspective. Jornal de Pediatria, 98: S55-S65. https://doi.org/10.1016/j.jped.2021.11.004

 

Rono, J., Kamau, L., Mwangwana, J., Waruguru, J., Aluoch, P., & Njoroge, M. (2022). A policy analysis of policies and strategic plans on maternal, newborn and child health in Ethiopia. International Journal for Equity in Health, 21(1): 73. https://doi.org/10.1186/s12939-022-01656-x

 

Senaviratna, N.A.M., & Cooray, T.M.J. (2019). Diagnosing multicollinearity of logistic regression model. Asian Journal of Probability and Statistics, 5(2): 1-9. https://doi.org/10.9734/ajpas/2019/v5i230132

 

Sharrow, D., Hug, L., You, D., Alkema, L., Black, R., Cousens, S., Croft, T., Gaigbe-Togbe, V., Gerland, P., Guillot, M., Hill, K., Masquelier, B., Mathers, C., Pedersen, J., Strong, K.L., Suzuki, E., Wakefield, J., & Walker, N. (2022). Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: A systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. The Lancet Global Health, 10(2): e195-e206. https://doi.org/10.1016/S2214-109X(21)00515-5

 

Tangcharoensathien, V., Sudhakar, M., Birhanu, Z., Abraham, G., Bawah, A., Kyei, P., Biney, A., Shroff, Z.C., Witthayapipopsakul, W., & Panichkriangkrai, W. (2022). Health policy and systems research capacities in ethiopia and Ghana: Findings from a self-assessment. Global Health, Science and Practice, 10: e2100715. https://doi.org/10.9745/GHSP-D-21-00715

 

Tesema, M.T., & Braeken, J. (2018). Regional inequalities and gender differences in academic achievement as a function of educational opportunities: Evidence from Ethiopia. International Journal of Educational Development, 60: 51-59. https://doi.org/10.1016/j.ijedudev.2017.10.023

 

Tighe, E., & Schatschneider, C. (2014). A dominance analysis approach to determining predictor importance in third, seventh, and tenth grade reading comprehension skills. Reading and Writing, 27(1): 101–127. https://doi.org/10.1007/s11145-013-9435-6

 

Tonidandel, S., & LeBreton, J.M. (2010). Determining the Relative importance of predictors in logistic regression: An extension of relative weight analysis. Organizational Research Methods, 13(4): 767-781. https://doi.org/10.1177/1094428109341993

 

United Nations Development Program (UNDP). (2021). Multidimensional Poverty Index 2021: Unmasking Disparities by Ethnicity, Caste and Gender. United States: United Nations Development Program, p.1-2.

 

United State Aid for International Development (USAID). (2021). Fact Sheet: Northern Ethiopia Crisis. November 2020, 2020- 2021. United States: United States Agency for International Development.

 

Wang, Y., Sibaii, F., Lee, K., J. Gill, M., & L. Hatch, J. (2021). Inequities in childhood anaemia in Mozambique: Results from multilevel Bayesian analysis of 2018 National Malaria Indicator Survey. MedRxiv, 165: 1-13.

 

World Bank. (2020). Ethiopia Poverty Assessment: Harnessing Continued Growth for Accelerated Poverty Reduction. United States: World Bank, p.1-288. Available from: https://openknowledge.worldbank.org/ent it ies/ publication/0f3facdd-95b0-5d05-a72d-943471763051

 

World Health Organization (WHO), & International Center for Equity in Health. (2015). State of Inequality. Geneva: World Health Organization.

 

World Health Organization (WHO). (2020). Children: Improving Survival and Well-Being. Geneva: World Health Organization.

 

World Health Organization. (2022). World Health Statistics 2022 (Monitoring Health of the SDGs). Geneva: World Health Organization. Available from: https://apps.who.int/iris/ handle/10665/356584

 

Yadav, J., & Nilima, N. (2021). Geographic variation and factors associated with anemia among under-fives in India: A multilevel approach. Clinical Epidemiology and Global Health, 9: 261-268. https://doi.org/10.1016/j.cegh.2020.09.008

 

Yayo Negasi, M. (2021). Dynamics of inequality in child under-nutrition in Ethiopia. International Journal for Equity in Health, 20(1): 182. https://doi.org/10.1186/s12939-021-01478-3

 

Yourkavitch, J., Burgert-Brucker, C., Assaf, S., & Delgado, S. (2018). Using geographical analysis to identify child health inequality in sub-Saharan Africa. PLoS One, 13(8): e0201870. https://doi.org/10.1371/journal.pone.0201870

 

Zegeye, B., Shibre, G., Idriss-Wheeler, D., & Yaya, S. (2021). Trends in inequalities in childhood stunting in Ethiopia from 2000 to 2016: A cross sectional study. Journal of Public Health (Oxford), 43(3): 655-663. https://doi.org/10.1093/pubmed/fdaa051

Conflict of interest
The authors declare that they have no competing interest.
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