Page 19 - IJPS-9-2

International Journal of
Population Studies Dominant drivers of inequalities in child survival

in sustainable development goals (SDGs) (Yourkavitch et survival indicators (i.e., childhood undernutrition, anemia,
al., 2018), the inequality is widespread at global, regional and U5M) remains limited. Therefore, this paper seeks to
and national levels (Sharrow et al., 2022). According redress the literature gap on the most dominant drivers of
to the World Health Organization (WHO), children in inequalities in child survival indicators in Ethiopia. The
Africa region are 10 times more likely to die before their objective of this paper was to explore the dominant drivers
fifth birth day compared to children in European Region of inequality in child survival indicators (undernutrition,
(WHO, 2022). Two regions, sub-Saharan Africa and anemia, and U5M) in Ethiopia by applying the dominance
Central and Southern Asia, accounted for more than 80% analysis technique developed to estimate relative
of the 5.2 million under-five deaths, where sub-Saharan importance of all predictors in a regression model in
Africa remained the region with the highest under-five relation to an outcome variable (Azen & Traxel, 2009).
mortality (U5M) rate (a 1-in-13 rate) in the world in 2019
(WHO, 2020). 1.2. Conceptual framework
In Ethiopia, U5M rate varies across the administrative This study is mainly focused on five internationally
regions, ranging from 74 deaths/1000 live children in Afar conceptualized dimensions of inequality (WHO and
to 29 deaths/1000 live children in Addis Ababa (Ethiopian International Center for Equity in Health, 2015). The five
Public Health Institute & ICF, 2021). Geographic inequality inequality dimensions (household wealth index, maternal
in U5M was higher in Benishagul-Gumuz, followed by educational status, place of residence, regional distribution,
Amhara, Afar, Gambela, and South Nation Nationality and and child sex) are used as predictors of inequality in
People’s Region (Liyew et al., 2021). Inequality of anemia child survival to construct conceptual framework for
among under-five children also exists across regions this study. In addition, the five inequality dimensions
in the country (Anteneh & Geertruyden, 2021; Endris are commonly used to exploring and comparing health
et al., 2021). Inequalities in childhood undernutrition by inequalities in developing countries (Hosseinpoor et al.,
administrative region (Yayo Negasi, 2021) and maternal 2016). Furthermore, these inequality drivers are most
education status (Bras & Mandemakers, 2022) were also frequently reported predictors of child survival in Ethiopia
documented in the country. Thus, inequality in child (Bras & Mandemakers, 2022; Rebouças et al., 2022). It is
survival remains a challenge in the country to achieve essential to understand that since before birth, children
SDG targets, specifically among more disadvantageous whose parents live in a situation of socioeconomic and
population groups and emerging regions (Dheresa et al., geographic vulnerability may have worse health outcomes
2022). than who live in better situations (Pearce et al., 2019). The
ways in which living conditions affect child survival are
Despite the marked improvement in the prevalence complex and more driven by socioeconomic inequalities
of U5M in Ethiopia, substantial inequalities in child (Rebouças et al., 2022). To identify the dominant drivers
health outcomes among the different socioeconomic of inequality in child survival, it is essential to understand
subgroups persist and progress is uneven. On the top of the conditions under which children are born and live,
this, answering the question “what are the most dominant and consider socioeconomic and geographic stratifications
drivers of inequalities in child survival in Ethiopia?” is among population groups. In this regard, the five drivers
essential to identify the key inequalities drivers that can of inequality regrouped into socioeconomic (household
be minimized and/or prevented. In this paper, the child wealth index, maternal educational status, and place
survival indicators refer to childhood undernutrition and of residence) and geographic (administrative regional
childhood anemia (Nkosi-Gondwe et al., 2021) and U5M distribution) stratifications (Houweling & Kunst, 2010),
(Mosley & Chen, 2003). and the biological determinant (i.e., child sex) (Rebouças
To date, numerous studies (Agbadi et al., 2021; Alao et al., 2022). Furthermore, to consider the hierarchical
et al., 2021; Balaj et al., 2021; Ekholuenetale et al., 2020; nature of inequality drivers, the five drivers of inequality
Endris et al., 2021; Forde & Tripathi, 2018; Hasan et al., are grouped into community (administrative regions and
2021; Wang et al., 2021; Yayo Negasi, 2021; Zegeye et al., place of residence), household (household wealth index),
2021) have examined the determinants of inequality in and individual (maternal education and sex of child) levels.
child survival. However, these studies have used regression
modeling approaches that limit to identify the relative 1.3. Background of Ethiopia
importance of the determinants for predicting inequalities Ethiopia is one of the Sub-Saharan Africa countries with
in child survival. In addition, these studies have focused highest burden of U5M, ranking third in Africa, and tenth
only on one or two child survival indicators; accordingly, in the world (Dheresa et al., 2022). Ethiopia is a landlocked
identifying the dominant drivers of inequalities in child country, sharing frontiers with Eritrea to the north and

Volume 9 Issue 2 (2023) 13 https://doi.org/10.36922/ijps.427