Reduction in child mortality in Ethiopia: analysis of data from demographic and health surveys.

Tanya Doherty,Duduzile Nsibande,Igor Rudan,Samuel Manda,Tedbabe Degefie,David Sanders,Donela Besada,Mary Kinney,Marian Loveday,Sarah Rohde,Emmanuelle Daviaud,Natalie Leon,Wanga Zembe,Kate Kerber

doi:10.7189/jogh.06.020401

Abstract

BackgroundTo examine changes in under–5 mortality, coverage of child survival interventions and nutritional status of children in Ethiopia between 2000 and 2011. Using the Lives Saved Tool, the impact of changes in coverage of child survival interventions on under–5 lives saved was estimated.MethodsEstimates of child mortality were generated using three Ethiopia Demographic and Health Surveys undertaken between 2000 and 2011. Coverage indicators for high impact child health interventions were calculated and the Lives Saved Tool (LiST) was used to estimate child lives saved in 2011.ResultsThe mortality rate in children younger than 5 years decreased rapidly from 218 child deaths per 1000 live births (95% confidence interval 183 to 252) in the period 1987–1991 to 88 child deaths per 1000 live births in the period 2007–2011 (78 to 98). The prevalence of moderate or severe stunting in children aged 6–35 months also declined significantly. Improvements in the coverage of interventions relevant to child survival in rural areas of Ethiopia between 2000 and 2011 were found for tetanus toxoid, DPT3 and measles vaccination, oral rehydration solution (ORS) and care–seeking for suspected pneumonia. The LiST analysis estimates that there were 60 700 child deaths averted in 2011, primarily attributable to decreases in wasting rates (18%), stunting rates (13%) and water, sanitation and hygiene (WASH) interventions (13%).ConclusionsImprovements in the nutritional status of children and increases in coverage of high impact interventions most notably WASH and ORS have contributed to the decline in under–5 mortality in Ethiopia. These proximal determinants however do not fully explain the mortality reduction which is plausibly also due to the synergistic effect of major child health and nutrition policies and delivery strategies.

Highlights

To examine changes in under–5 mortality, coverage of child survival interventions and nutritional status of children in Ethiopia between 2000 and 2011
Improvements in the nutritional status of children and increases in coverage of high impact interventions most notably WASH and oral rehydration solution (ORS) have contributed to the decline in under–5 mortality in Ethiopia
According to the 2015 UN Inter–Agency Group for Child Mortality Estimation (IGME) report, Ethiopia reached its target for Millennium Development Goal 4 for child survival with an estimated under–five mortality rate of 59 per 1000 live births in 2015, a decline from 205 in 1990

Summary

Methods

Estimates of child mortality were generated using three Ethiopia Demographic and Health Surveys undertaken between 2000 and 2011. We used full birth and death history data collected from women aged 15 to 49 years in nationally representative surveys: namely the 2000 Demographic and Health Survey (DHS) the first DHS to be undertaken in Ethiopia, 2005 DHS and the 2011 DHS to calculate under–5 mortality. The analysis included all survey data sets available with full data, including sampling weights, to allow for re–analysis (see Table S1 in the Online Supplementary Document for further details on the surveys). To assess coverage of malaria interventions two separate Malaria Indicator Surveys (MIS) were used since these surveys sample from malaria endemic areas. All of the surveys provided cross–sectional data on intervention coverage in their respective years; for the MIS, primary data are not available and only point estimates are presented. Definitions and data sources for all indicators can be found in Table S2 in Online Supplementary Document

Results

Discussion

Conclusion