Understanding Inequalities in Child Health in Ethiopia: Health Achievements Are Improving in the Period 2000–2011

Objective In Ethiopia, coverage of key health services is low, and community based services have been implemented to improve access to key services. This study aims to describe and assess the level and the distribution of health outcomes and coverage for key services in Ethiopia, and their association with socioeconomic and geographic determinants. Methods Data were obtained from the 2000, 2005 and 2011 Ethiopian Demographic and Health Surveys. As indicators of access to health care, the following variables were included: Under-five and neonatal deaths, skilled birth attendance, coverage of vaccinations, oral rehydration therapy for diarrhoea, and antibiotics for suspected pneumonia. For each of the indicators in 2011, inequality was described by estimating their concentration index and a geographic Gini index. For further assessment of the inequalities, the concentration indices were decomposed. An index of health achievement, integrating mean coverage and the distribution of coverage, was estimated. Changes from 2000 to 2011 in coverage, inequality and health achievement were assessed. Results Significant pro-rich inequalities were found for all indicators except treatment for suspected pneumonia in 2011. The geographic Gini index showed significant regional inequality for most indicators. The decomposition of the 2011 concentration indices revealed that the factor contributing the most to the observed inequalities was different levels of wealth. The mean of all indicators improved from 2000 to 2011, and the health achievement index improved for most indicators. The socioeconomic inequalities seem to increase from 2000 to 2011 for under-five and neonatal deaths, whereas they are stable or decreasing for the other indicators. Conclusion There is an unequal socioeconomic and geographic distribution of health and access to key services in Ethiopia. Although the health achievement indices improved for most indicators from 2000 to 2011, socioeconomic determinants need to be addressed in order to achieve better and more fairly distributed health.

[1]  Kiersten B. Johnson,et al.  The DHS wealth index , 2004 .

[2]  S. Galea,et al.  Minding the Immunization Gap: Family Characteristics Associated with Completion Rates in Rural Ethiopia , 2010, Journal of Community Health.

[3]  Y. Mekonnen,et al.  Neonatal mortality in Ethiopia: trends and determinants , 2013, BMC Public Health.

[4]  Bart Criel,et al.  Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia: a cross sectional study , 2013, International Journal for Equity in Health.

[5]  N. Kakwani,et al.  Socioeconomic inequalities in health: Measurement, computation, and statistical inference , 1997 .

[6]  Eyob Zere,et al.  Inequities in skilled attendance at birth in Namibia: A decomposition analysis , 2011, BMC pregnancy and childbirth.

[7]  D. Leon,et al.  How does progress towards the child mortality millennium development goal affect inequalities between the poorest and least poor? Analysis of Demographic and Health Survey data , 2005, BMJ : British Medical Journal.

[8]  Ethiopia,et al.  Ethiopia demographic and health survey, 2000 , 2006 .

[9]  Xianwei Feng,et al.  Regional inequality in health and its determinants: evidence from China. , 2010, Health policy.

[10]  A. Wagstaff,et al.  On Decomposing the Causes of Health Sector Inequalities with an Application to Malnutrition Inequalities in Vietnam , 2001 .

[11]  A. Barros,et al.  How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys , 2012, The Lancet.

[12]  E. van Doorslaer,et al.  Achieving better measles immunization in developing countries: does higher coverage imply lower inequality? , 2008, Social Science & Medicine (1967).

[13]  M. Naghavi,et al.  Decomposing socioeconomic inequality in infant mortality in Iran. , 2006, International journal of epidemiology.

[14]  Yohannes H/Michael Gacho,et al.  Utilization of Clean and Safe Delivery Service Package of Health Services Extension Program and Associated Factors in Rural Kebeles of Kafa Zone, Southwest Ethiopia , 2013, Ethiopian journal of health sciences.

[15]  O. Uthman.  Using extended concentration and achievement indices to study socioeconomic inequality in chronic childhood malnutrition: the case of Nigeria , 2009, International journal for equity in health.

[16]  Cesar G Victora,et al.  Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries , 2012, The Lancet.

[17]  S. Cousens,et al.  Effect of Geographical Access to Health Facilities on Child Mortality in Rural Ethiopia: A Community Based Cross Sectional Study , 2012, PloS one.

[18]  Alexander Hertel-Fernandez,et al.  The Chilean infant mortality decline: improvement for whom? Socioeconomic and geographic inequalities in infant mortality, 1990-2005. , 2007, Bulletin of the World Health Organization.

[19]  A. Storeygard,et al.  "Delivering" on the MDGs?: equity and maternal health in Ghana, Ethiopia and Kenya. , 2009, East African journal of public health.

[20]  Luche Tadesse Ejeta,et al.  Effect of Ethiopia’s Health Extension Program on Maternal and Newborn Health Care Practices in 101 Rural Districts: A Dose-Response Study , 2013, PloS one.

[21]  Punam Chuhan-Pole,et al.  Yes Africa Can: Success Stories from a Dynamic Continent , 2011 .

[22]  A. Barros,et al.  Towards universal health coverage: the role of within-country wealth-related inequality in 28 countries in sub-Saharan Africa. , 2011, Bulletin of the World Health Organization.

[23]  A. Sié,et al.  American Journal of Epidemiology Original Contribution the Effect of Distance to Health-care Facilities on Childhood Mortality in Rural Burkina Faso , 2022 .

[24]  O. Norheim,et al.  Health inequalities in Ethiopia: modeling inequalities in length of life within and between population groups , 2013, International Journal for Equity in Health.

[25]  Andrew M. Jones,et al.  Explaining income-related inequalities in doctor utilisation in Europe. , 2004, Health economics.

[26]  大韓民國統計廳,et al.  인구주택총조사보고서 = Population and housing census report , 1992 .

[27]  D. Abebaw,et al.  Impact evaluation of the Ethiopian Health Services Extension Programme , 2009 .

[28]  J. Pradhan,et al.  Socio-economic inequalities in child survival in India: a decomposition analysis. , 2010, Health policy.

[29]  A. Kunst,et al.  Socio-economic inequalities in childhood mortality in low- and middle-income countries: a review of the international evidence. , 2010, British medical bulletin.

[30]  J. Lawn,et al.  Sub-Saharan Africa's Mothers, Newborns, and Children: Where and Why Do They Die? , 2010, PLoS medicine.

[31]  M. Spigt,et al.  The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study , 2012, BMC Health Services Research.

[32]  Sharon Friel,et al.  Closing the gap in a generation: health equity through action on the social determinants of health , 2008, The Lancet.

[33]  Magnus Lindelow,et al.  Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation , 2007 .

[34]  Adam Wagstaff,et al.  Inequality Aversion, Health Inequalities, and Health Achievement , 2002, Journal of health economics.

[35]  O. Norheim,et al.  Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages , 2012, BMC Public Health.