Exploring the most dominant drivers of inequalities in child survival in Ethiopia: Dominance analysis

Inequalities in child survival are a global public health concern. Over the past decade, Ethiopia has made remarkable progress in improving child survival. Despite this promising development, inequalities in child survival among the various population groups remained a pressing public health concern. The purpose of this paper is to examine the dominant drivers of inequality in child survival indicators (undernutrition, anemia, and under-five mortality) in Ethiopia. Dominance analysis was used based on a pooled total sample of 48,422 under-five children drawn from five rounds of Ethiopia Demographic and Health Surveys conducted from year 2000 to 2019. Childhood undernutrition, childhood anemia, and under-five mortality were the three outcome variables, and the five dimensions of inequality were considered as key predictor variables. The dominance analysis revealed that maternal education, place of residence, and household wealth index were the three most dominant drivers of inequalities in childhood undernutrition, accounting for 83.48% of the predicted variances. The regional category was found to be the first-ranked key driver of inequalities in childhood anemia, accounting for 50.56% of the predicted variance. The dominance analysis also indicated that maternal education, child sex, and place of residence were the three most dominant drivers of inequality in under-five mortality, accounting for 89.3% of the predicted variance. This study provides empirical evidence that maternal education (individual level), household asset based wealth index (household level), and place of residence (community level) were the most dominant drivers of inequality in child survival. This suggests interventions in reducing inequalities in child survival need to start at the community level, notwithstanding the importance of household and individual level influences.