Examining changes in maternal and child health inequalities in Ethiopia

Abstract

BackgroundEthiopia has made considerable progress in maternal, newborn, and child health in terms of health outcomes and health services coverage. This study examined how different groups have fared in the process. It also looked at possible factors behind the inequalities.MethodsThe study examined 11 maternal and child health outcomes and services: stunting, underweight, wasting, neonatal mortality, infant mortality, under-5 mortality, measles vaccination, full immunization, modern contraceptive use by currently married women, antenatal care visits, and skilled birth attendance. It explored trends in inequalities by household wealth status based on Demographic and Health Surveys conducted in 2000, 2005, 2011, and 2014. The study also investigated the dynamics of inequality, using concentration curves for different years. Decomposition analysis was used to identify the role of proximate determinants.ResultsThe study found substantial improvements in health outcomes and health services: Although there is still a considerable gap between the rich and the poor, inequalities in health services have been reduced. However, child nutrition outcomes have mainly improved for the rich. The changes observed in wealth-related inequality tend to reflect the changing direct effect of household wealth on child health and health service use.ConclusionsThe country’s efforts to improve access to health services have shown some positive results, but attention should now turn to service quality and to identifying multisectoral interventions that can change outcomes for the poorest.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-017-0648-1) contains supplementary material, which is available to authorized users.

Inequalities and trends in Neonatal Mortality Rate (NMR) in Ethiopia: Evidence from the Ethiopia Demographic and Health Surveys, 2000–2016

“…Moreover, the region's economic growth over the last decade and the significant fall in the proportion of people living in extreme poverty [14] could be other drivers for decreasing the poor-rich NMR gap over time. Our finding that NMR disproportionately impacts the poor was aligned with some prior work [29] but not with others [13].…”

“…Third, previous studies used traditional regression methods [8,10,11] that do not follow the WHO recommendation for inequality studies [9] or were limited to certain specific areas in the country without including the national context [11,12]. Finally, it assessed NMR inequality for the four Ethiopia Demographic and Health Surveys (EDHS 2000(EDHS , 2005(EDHS , 2011(EDHS , 2016 and was not limited to the first and the last EDHS rounds, unlike prior studies [5,13]. This contributed to understanding the dynamics of NMR differentials in Ethiopia over sixteen years.…”

Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline

“…A combined measure of increases in coverage in ANC4+ and health facility births or skilled birth attendance accounted for 40%, 34%, and 29% of the change in HAZ in Pakistan ( 49 ), Senegal ( 50 ), and Rwanda ( 30 ), respectively. Associations between child growth and ANC4+, facility birth, or skilled attendance were analyzed in 14 different studies ( 19 , 22 , 23 , 30 , 33 , 46 , 48–51 , 74 , 75 , 83 , 93 ).…”

“…Improved vaccination coverage predicted between 4% ( 51 ) and 6% ( 33 ) of HAZ change in Nepal and 3% in Paraguay ( 40 ). A total of 11 studies ( 14 , 22 , 33 , 40 , 48 , 51 , 59 , 68 , 93 , 99 , 102 ) analyzed the relation between vaccination coverage and stunting.…”

Constraints to Get Access in Maternal Healthcare: A Review from Lower-middle-Income Countries

“…The decision of taking healthcare services is implanted and interweaved not only with social and cultural practices but also with the distance of the service provider institutions (Elmusharaf et al, 2015;McNamee et al, 2009;Walton & Schbley, 2013). The study of Blanchet et al (2012), Sahoo et al (2015) and unfold that the characteristics of the region like the doctor to population and nurse to population ratio along with feeble infrastructure, distance, fragile transportation making the health service to be utilized, particularly for the vulnerable groups living with limited medical resource facilities (Ambel et al, 2017;Faye et al, 2013;Gage, 2007;Haider et al, 2017;McKinnon et al, 2016;Shahjahan et al, 2017;. In the Ethiopian context, the distance between house and health service provider organizations had an impact on the use of maternal service including ANC, delivery, and PNC.…”