Good governance, public health expenditures, urbanization and child undernutrition Nexus in Ethiopia: an ecological analysis

Sibhatu Biadgilign,Assaye Tolla,Arega Shumetie,Amare Deribew,Habtamu Yesigat Ayenew,Demewoz Haile,Stanley Chitekwe,Betemariam Gebre,Seifu Hagos Gebreyesus

doi:10.1186/s12913-018-3822-2

Abstract

BackgroundChild undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia.MethodsThis is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations’ World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition.ResultGovernment effectiveness (adjusted odd ratio (AOR) = 20.7; p = 0.046), regulatory quality (AOR = 0.0077; p = 0.026) and control of corruption (AOR = 0.0019; p = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p = 0.007), regulatory quality (AOR = 0.0015; p = 0.004) and control of corruption (AOR = 0.0005; p = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition.ConclusionThis study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence.

Highlights

Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia
This study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors
We obtained the data from the Ethiopia Demographic and Health Surveys (EDHS) conducted by Central Statistical Agency (CSA) and ICF International provided technical assistance as well as funding to the project through the MEASURE DHS project

Summary

Introduction

Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia. Child undernutrition remains one of the major challenges in low-income and middle-income countries [1]. Development as a whole and economic development in particular determines public health spending, and that in turn can play a vital role for improvement in health [2]. The effect of public health spending can further be enhanced by good governance, and efficient allocation of public health spending can reduce child mortality [2, 4]

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