Page 20 - IJPS-9-2

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

northeast, Djibouti to the east, Somalia to the east and has demonstrated a strong policy commitment to nutrition
southeast, Kenya to the south, and South Sudan and Sudan through development of a National Nutrition Strategy in
to the west (FAO, 2016). The country is ethnically and 2008, followed by implementation of National Nutrition
culturally diverse and the second most populous country Program I (2008 – 2015) and National Nutrition Program
in Africa, and among the least urbanized countries in the II (2016 – 2020) (Kennedy et al., 2020). Ethiopia also
world, with 82% of the population living in rural areas joined the Scaling Up Nutrition movement in 2012 and
(USAID, 2021). Administratively, Ethiopia has 11 regional endorsed the Seqota Declaration in 2015 with its high-level
states (including newly established regions: Sidama and commitment to end childhood undernutrition by 2030
South West) and two city administrations (Addis Ababa (FDRE, 2016). Furthermore, GoE has developed Food and
and Dire Dawa). These regional states possibly vary in Nutrition Policy to attain optimal nutritional status at all
their levels of economic development, sociocultural, stages of life (FDRE, 2018).
educational, and health service provision and settings
(Bareke et al., 2022). 2. Data and methods
Based on the development perspective, the old 2.1. Study design and data source
nine regional states and the two-city administrations Retrospective cross-sectional study design is used for
are categorized into three as emerging (Afar, Somali, the present study, using the five rounds of Ethiopia
Benishangul-Gumuz, and Gambela), established (Tigray, Demographic and Health Surveys (EDHS) conducted
Amhara, Oromia, Southern Nation Nationalities and in 2000, 2005, 2011, and 2016, including the 2019 mini
People [SNNP], and Harari), and central (Addis Ababa EDHS. The datasets were downloaded from DHS website
and Dire Dawa city administrations) (Bareke et al., 2022; (http://dhsprogram.com) based on secured online
Tesema & Braeken, 2018). The emerging regions are permission. The study used children’s files that contain
drought-affected areas, pastoralists, and marginalized in information about socioeconomic, demographic, and
terms of basic infrastructure development (Bareke et al., geographic characteristics for under-five children,
2022). their parents, households, as well as their communities.
Ethiopia is a low-income county having a gross However, anemia indicator was not collected in the 2000
domestic product per capital of US$ 855.80 in 2019 EDHS and 2019 mini EDHS in the country. A pooled
(Tangcharoensathien et al., 2022), making it one of the sample of 35,688, 19,699, and 48,422 under-five children
poorest countries in the world (World Bank, 2020). About were used for childhood undernutrition, childhood
69% of Ethiopia’s population is multidimensionally poor in anemia, and U5M analysis, respectively. The outcome
2019 (UNDP, 2021). The multidimensional child poverty and explanatory variables were extracted from pooled
incidence and intensity varies across regions and place data.
of residence in the country, where the multidimensional 2.2. Study variables
child poverty incidence ranges from 23% (lowest) in
Addis Ababa to 98% (highest) in Somali region (Central 2.2.1. Outcome variables
Statistical Agency [CSA] & UNICEF, 2020). Likewise, the Childhood undernutrition, childhood anemia, and U5M
monetary child poverty incidence and depth varies across were the three outcome variables of the study. Childhood
regions and areas with the highest incidence in Afar (39%) undernutrition status categorized as undernourished and
and Amhara regions (37%) and the lowest in Harari city coded as 1 if child had any form of anthropometric failure,
administration (14%) and considerably higher in rural and as nourished with assigned value of 0 if the child had
areas (31%) compared to large city areas (23%) (CSA & no failure. Childhood anemia was recoded into dummy
UNICEF, 2020). variable where a child is considered to be anemic and

Regarding child survival policies, the Government of assigned value of 1 if the child had severe, moderate, or
Ethiopia (GoE) has realized pro-poor policies and strategies mild anemia level, and 0 if child is not anemic. Under-five
for child survival (Rono et al., 2022). Since 2003, the mortality was coded as 1 if the child died between 0 and
country has implemented the Health Extension Program 59 months and 0 if the child was alive at least until age of
to improve child survival through primary healthcare 59 months (CSA and ICF, 2016).
(MOH, 2020). In addition, the country endorsed the first
comprehensive National Child Survival Strategy (2005 – 2.2.2. Predictor variables
2015), and the second strategic document the National The selection of predictor variables in the model was guided by
Strategy for Newborn and Child Survival (2016 – 2020) in the internationally conceptualized dimensions of inequality
2005 and 2015, respectively (FMOH-FDRE, 2016). GoE (WHO & International Center for Equity in Health, 2015)

Volume 9 Issue 2 (2023) 14 https://doi.org/10.36922/ijps.427