- Title
- Contextual determinants of infant mortality in Ethiopia
- Creator
- Kiross, Girmay Tsegay
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Even though the deaths of children under the age of one year remain unacceptably high in Ethiopia, infant mortality has reduced substantially over the past three decades. Currently, the infant mortality rate in Ethiopia is one of the highest globally, and, like many other low-income countries, the rate of reduction in infant mortality is far from achieving the Sustainable Development Goals by the end of 2030. Addressing the high rate of infant mortality in Ethiopia requires scientific evidence regarding how to best tackle its determinants. Previous studies have indicated that the individual-level determinants of infant mortality are not sufficient for addressing the problem, because infant survival can be affected by the characteristics of the household and community context in which the infant was born. Additionally, the community’s prevailing norms and attitudes about health behaviours could also influence the healthcare decisions made by individuals. In diversified communities like Ethiopia, differences in child health outcomes might not be due to variation in individual and household characteristics alone, but also due to differences in socio-economic and other contextual characteristics of the communities in which the child lives. Therefore, this study aims to identify these contextual level determinants of infant mortality in Ethiopia. Method: We used multiple data sources to investigate the contextual determinants of infant mortality in Ethiopia. Data from the Ethiopian Demographic and Health Survey in 2016 were used for this study. A multilevel logistic regression analysis was used to examine individual-level, household-level and community-level determinants while accounting for the hierarchal structure of the data. We used data from the World Bank’s World Development Indictors, between 2000 and 2015, covering 46 countries in sub-Saharan Africa. Random effects models were applied, based on the Hausman test, to assess the effect of healthcare expenditure on infants. A qualitative descriptive approach was also employed to explore the health-seeking behaviours of caregivers. A maximum-variation purposive sampling technique was used across the different study groups (caregivers, communities and healthcare providers). In-depth interviews and focus group discussions were conducted with healthcare providers and caregivers, respectively. We also employed a systematic review and meta-analysis to identify the effect of maternal education on infants. Findings: An increased level of maternal education was significantly associated with a reduced rate of infant mortality in Ethiopia. Additionally, panel data analysis showed that increased national healthcare spending per capita also decreased the rate of infant mortality. Both public and external health expenditure were significantly negatively associated with infant mortality. Spending more on healthcare systems could help to maintain and improve human welfare because, without financing, skilled and appropriate health workers would not be employed, medical equipment would not be available and health promotion or prevention of disease would not take place. Finding based on the Ethiopian Demographic and Health Survey indicated that individual-level and household-level variables such as infant sex, multiple pregnancies, the number of adverse pregnancy events and antenatal care visits were significantly associated with infant mortality. Additionally, community-level characteristics, such as the region in which the infant lived, were significantly associated with infant mortality. The main finding from the interviews and focus group discussions indicates that the health-seeking behaviours of caregivers can be influenced by different contextual factors such as their understanding of disease, access to health services and family pressures to seek care. Conclusions: From this study, we can conclude that the rate of infant mortality in Ethiopia can be determined by contextual determinants at different levels. Based on this comprehensive study, infant mortality is affected by different characteristics at the national level, community level, and household level and individual level. The rate of infant mortality is higher among socially and economically disadvantaged regions in Ethiopia. Individual characteristics of the mothers and infants, such as the level of maternal education and infant sex, are also important characteristics for determining infant mortality. To address the high rate of infant mortality in Ethiopia, a comprehensive strategy and intervention should be designed. Community-based interventions, such as focusing on socially and economically disadvantaged regions in Ethiopia, could help to reduce infant mortality.
- Subject
- infant mortality; individual factors; household factors; community factors; beliefs, caregivers; health multilevel analysis; health care–seeking; facilities; health expenditure Ethiopia
- Identifier
- http://hdl.handle.net/1959.13/1504236
- Identifier
- uon:55482
- Rights
- Copyright 2021 Girmay Tsegay Kiross
- Language
- eng
- Full Text
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| View Details Download | ATTACHMENT01 | Thesis | 1 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 283 KB | Adobe Acrobat PDF | View Details Download |