Inequalities in child care practices and health outcomes in Ethiopia
Date
2020-11-06
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
ORCID
Type
Thesis
Degree Level
Doctoral
Abstract
Child health is one of the core components of the Sustainable Development Goals (SDGs), explicitly related to goal-3 “ensure healthy lives and promote well-being for all ages" which aims at reducing child health inequalities within and among countries by 2030. It particularly prioritizes reduction of the three most important child health outcomes: under five mortality, morbidity, and undernutrition. Evidence from developing countries indicates that three sets of childcare practices play leading roles in shaping these outcomes: child feeding, health service utilization and Water, Sanitation and Hygiene (WaSH). Ethiopia is one of the Sub-Saharan African countries with unacceptably high disparities in both child health outcomes and childcare practices/interventions. Research focusing on disparities in these subjects is relatively scarce in Ethiopia. The very few available studies on child health outcome and care practices were limited in addressing the risk factors of a single problem (such as undernutrition, child mortality; antenatal or postnatal care) and were based on a small sample size. Thus, this study was primarily aimed at examining the inequalities in key childcare practices/interventions and their effects on prominent child health outcomes (multiple nutritional deficiencies and child survival) in Ethiopia.
The study used data from 2016 Ethiopian Demographic and Health Survey (EDHS), a cross-sectional nationally representative survey conducted every five years. The sampling design for all the DHS surveys was a two-stage stratified cluster sampling. The study used the children’s file containing several sociodemographic and health related variables for 10641 under-five children. In the EDHS, mothers aged 15-49 were interviewed. The analysis presented in Chapters 4-8 employed a wide range of statistical analyses ranging from binary logistic regression (for binary outcome), proportional odds regression (for ordinal outcome) to mixed effect regression models. Purposeful model selection of explanatory variables was used for model building. All predictors with a p-value of <0.2 based on the bivariate analysis were subsequently included in the initial multivariable regression model. For all analyses conducted in Chapters 4-8, the model selection criterion was the Akaike Information Criterion (AIC), and the level of statistical error was set to be 5%.
The analysis began with examining the disparities in the three core childcare practices (Chapters 4-6). The findings indicated that Infant and Young Child Feeding (IYCF) practices are unacceptably poor, where about 80% of the children aged 6-23 months in Ethiopia did not adhere to the core WHO recommended feeding practices. The study indicated that the six components of health service utilization used to form the outcome variable in Chapter 5, were very low by any standard, resulting in overall low utilization scores. For instance, two-third of the most recent pregnancies had not the minimum antenatal care (ANC) visits, only 26% of last births occurred in health facilities and only 12% received postnatal care services. The intake of micronutrients (Vitamin A, Iron) and deworming pills was also unacceptably low. The findings confirmed that more than half of the households have very poor or poor sanitation and hygiene status as defined by a composite score based on four indicators (access to water, hygiene, household pollution and access to toilet facilities). The three sets of childcare practices were determined by individual characteristics, household characteristics and community variables.
Given 28% of deaths of under five children in the country is caused by easily preventable childhood diseases, such as acute respiratory infection (ARI) and diarrhea, Chapter seven of this thesis examined the health seeking behavior of mothers for the two childhood diseases. The finding revealed that 55.6% and 72.6% of mothers did not seek health care during the episode of diarrhea and ARI, respectively. This might have contributed for poor childhood undernutrition reported in Chapters 8. In Chapter 8, it was noted that the proportion of children stunted, underweight and wasted were 38%, 25% and 9%, respectively. About 58% of the sample children were anemic. The prevalence of children concurrently stunted and anemic was 24.8%. The incidence rate for multiple nutritional problems was determined by a range of individual, household, and behavioral factors. The three proximate variables (hygiene and sanitation score, feeding practice and child health service utilization score) were found to exert a strong influence on the incidence rate of multiple nutritional deficiencies.
The overall findings of the study strongly suggest that future reductions in inadequacies in the key child health outcomes (under 5 mortality and undernutrition) would largely depend on the country’s ability to significantly improve the desirable behaviors pertaining to the three core intermediate variables (child feeding practices, health service utilization and improving household Water, Sanitation and Hygiene (WASH) practices and indoor pollution. Therefore, more attention should be given to a child’s living context (those living in rural areas, those living with parents of poor education or in households with mothers having poor autonomy).
Description
Keywords
Childcare, health outcomes, inequalities, mortality, morbidity, undernutrition, stunting.
Citation
Degree
Doctor of Philosophy (Ph.D.)
Department
School of Public Health
Program
Epidemiology