Page 24 - IJPS-9-2

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

Table 4. Dominance analysis of the outcome and inequality could have substantial impact on adopting better access to
indicators in Ethiopia, 2000 – 2019 child healthcare, uptake of preventive vaccines, and safe
water (Moradhvaj & Samir, 2023). Another reason could
Inequality drivers Dominance Standardized Ranking
statistics dominance be that the existing gap in place of residence might result
statistics* in disparity in accessing child health-care service, living
Undernutrition (N=35,688) standards, and child healthcare-seeking behavior (Tessema
Region 0.0040 0.1459 4 et al., 2021) that may directly affect child survival in the
country. Under-five mortality could be affected by sex
Place of residence 0.0084 0.3030 2 differences in genetic and biological makeup (Pongou,
Household wealth index 0.0057 0.2060 3 2013). This study finding emphasizes the importance of
Maternal education 0.0090 0.3258 1 robust, and influencing policies and interventions for
Child sex 0.0005 0.0193 5 reducing inequalities in child mortality and improving
Anemia (N=19,699) the overall child survival through addressing urban-rural
Region 0.0116 0.5056 1 and maternal education gaps at community and individual
Place of residence 0.0024 0.1041 3 levels.
Household wealth index 0.0075 0.3267 2 4.1. Strengths and limitations of the study
Maternal education 0.0014 0.0610 4 The strengths of the present study were its large sample drawn
Child sex 0.0001 0.0025 5 from five rounds of nationally representative cross-sectional
Under-five mortality (N=48,422) surveys and, use of dominance analysis to identify the key
Region 0.0001 0.0132 5 predictors of inequality in child survival indicators. There
Place of residence 0.0010 0.1994 3 are some limitations in this study. First, this study shows
Household wealth index 0.0004 0.0522 4 drivers that are associated with inequalities in childhood
Maternal education 0.0037 0.4158 1 undernutrition, anemia, and U5M and magnitude of
associations, but no causal interpretation of the results is
Child sex 0.0016 0.2778 2 implied here as the cross-sectional survey data preclude
Note: *Standardized dominance statistics do not total to 1 due to causal inferences. Second, although the study focused
rounding. Source: Ethiopia Demographic and Health Surveys: 2000, on the five internationally accepted drivers of inequality,
2005, 2011, 2016, and 2019.
there might be some of important drivers of inequality
that were not included in this paper, such as paternal
could be explained by existing disparities in geographical
location, socioeconomic status, access to resources, level education, household size, maternal and child health, and
some community and macro-socioeconomic development
of education, cultural, and feeding practices as childhood
anemia is nutritional disease (Gebreegziabher et al., 2020). indicators. Third, although dominance analysis is robust
In addition, place of residence strongly affects access for when all predictors are continuous variables, it has a
limitation in dealing with non-continuous variables. For
basic education, child healthcare, and source of income that example, we observed different result, particularly for
could be directly or indirectly related to poverty and risk of childhood anemia by changing classifications for region,
anemia (Gebreegziabher et al., 2020). Moreover, household maternal education and household wealth index and the
wealth index could be directly linked with nutritional result is annexed (Appendix C) for clarity.
intake and risk of childhood anemia, and the richest
households might have better chance to address their 5. Conclusions
children’s nutritional and health needs (Amegbor et al.,
2022). Therefore, this study underscores the importance This study provides empirical evidence that region and
of implementation of interventions, especially target to place of residence (community level), household asset
geographic, urban-rural setting, and household status based wealth index (household level), and maternal
variations for accelerated reduction in childhood anemia. education (individual level) were the most dominant
drivers of inequality in child survival in Ethiopia. This
Furthermore, our finding reveals that maternal suggests that reducing inequalities in child survival need
education, place of residence, and child sex were the three to start at higher hierarchical structure (regional and
most dominant drivers of inequalities under-five mortality, community levels), notwithstanding the importance
which is consistent with findings of other studies (Agbadi of household and individual level influences. Further,
et al., 2021; Balaj et al., 2021; Forde & Tripathi, 2018; improving the socioeconomic status of the poorest
Zegeye et al., 2021). It is evident that maternal education households, prioritizing emerging regions and rural areas

Volume 9 Issue 2 (2023) 18 https://doi.org/10.36922/ijps.427