AccScience Publishing / IJPS / Volume 7 / Issue 2 / DOI: 10.36922/ijps.v7i2.392
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Residential inequalities in child mortality in Ethiopia: Multilevel and decomposition analyses

Negussie Shiferaw Tessema1* Chalachew Getahun Desta1 Nigatu Regassa Geda1 Terefe Degefa Boshera1
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1 Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
IJPS 2021, 7(2), 47–59;
Submitted: 11 October 2022 | Accepted: 18 November 2022 | Published: 16 December 2022
© 2022 by the Author(s). Licensee AccScience Publishing, Singapore, Singapore. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC BY-NC 4.0) ( )

Ethiopia is among the five countries which account for half of the global under-five deaths, with the under-five mortality rate of 67 deaths/1000 live births in 2016. Ethiopia had significant inequalities in child mortality between rural and urban areas where the risk of child mortality is largely higher in rural than urban areas. Inequalities in the distribution of factors influencing child mortality need to explain the gap between and within urban-rural areas. The study used the risk of child mortality as an outcome variable. Multilevel logistic regression was used as a standard model for assessing the effect of socioeconomic and contextual factors on child mortality. Furthermore, the Blinder-Oaxaca decomposition technique was used to explain the urban-rural, intra-rural, and intra-urban inequalities in child mortality. The birth order and sanitation type seem to be the most important explanatory factors, followed by wealth status in explaining the rural-urban inequality of 39 deaths/1000 children. Mean proportion indicates that there would be 47 deaths/1000 children for urban poor and 21 deaths/1000 children for urban non-poor, resulting in 26 deaths/1000 children change in urban poor when applying the urban non-poor coefficient and characteristics to urban poor behavior. The findings showed that some residential inequalities in child mortality occur at a level that could be addressed by targeting children, households, and some occurs at a community level that could be addressed by targeting regions. Therefore, any residential sensitive and specific interventions should consider child’s and household’s characteristics, and geographical location.

Child mortality
Inequality; Residence

Adeyinka, D.A., Muhajarine, N., Petrucka, P., & Isaac, E.W. (2020). Inequities in child survival in Nigerian communities during the Sustainable Development Goal era: Insights from analysis of 2016/2017 multiple indicator cluster survey. BMC Public Health, 20(1):1613.


Ameyaw, E.K., Kareem, Y.O., Ahinkorah, B.O., Seidu, A.A., & Yaya, S. (2021). Decomposing the rural-urban gap in factors associated with childhood immunisation in sub-Saharan Africa: Evidence from surveys in 23 countries. BMJ Global Health, 6(1):e003773.


Antai, D., & Moradi, T. (2010). Urban area disadvantage and under-5 mortality in Nigeria: The effect of rapid urbanization. Environmental Health Perspectives, 118(6):877-883.


Bado, A.R., & Appunni, S.S. (2015). Decomposing wealth-based inequalities in under-five mortality in West Africa. Iranian Journal Public Health, 44(7):920-930.


Balluerka, N., Gorostiaga, A., Gómez-Benito, J., & Hidalgo, M.D. (2010). Use of multilevel logistic regression to identify the causes of differential item functioning. Psicothema, 22(4):1018-1025.


Bareke, M.L., Agezew, B.H., Dedho, N.H., Herut, A.H., Demissie, M.M., & Yimer, B.M. (2022). Education inequalities in Ethiopia: A macro-level analysis and its policy implications. Preprints, 2022: 2022060341


Bazen, S., Joutard, X., & Magdalou, B. (2016). An Oaxaca Decomposition for Nonlinear Models. IZA Discussion Papers 9909. Germany: Institute of Labor Economics (IZA).


Central Statistical Agency (CSA). [Ethiopia] and ICF. (2016). Ethiopia Demographic and Health Survey 2016. Ethiopia: Central Statistical Agency.


Das, U. (2021). Is Childhood Mortality Higher in Urban Poor Than in Rural India? United States: Research Square.


Dendup, T., Zhao, Y., & Putra, I.G.N. (2020). Rural-urban differentials in the determinants of under-five mortality in Bhutan. Journal of Health Research, 35(3):226-239.


Dheresa, M., Roba, H.S., Daraje, G., Abebe, M., Tura, A.K., Yadeta, T.A., Dessie, Y., & Dingeta, T. (2022). Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of millennium development goal in Eastern Ethiopia. Journal of Global Health, 12:04010.


Ekholuenetale, M., Tudeme, G., Onikan, A., & Ekholuenetale, C.E. (2020). Socioeconomic inequalities in hidden hunger, undernutrition, and overweight among under-five children in 35 sub-Saharan Africa countries. Journal of the Egyptian Public Health Association, 95(1):9.


Fairlie, R.W. (2005). An extension of the Blinder-Oaxaca decomposition technique to logit and probit models. Journal of Economic and Social Measurement, 30(4):305-316.


Fenta, S.M., & Fenta, H.M. (2020). Risk factors of child mortality in Ethiopia: Application of multilevel two-part model. PLoS One, 15(8):e0237640.


FMOH-FDRE. (2016). National Strategy for Child Survival in Ethiopia 2015/16-2019/20 Maternal. Nigeria: Federal Ministry of Health. p7-66.


Gebresilassie, Y.H., Nyatanga, P., & Gebreselassie, M.A. (2021). Determinants of rural-urban differentials in under-five child mortality in Ethiopia. European Journal of Development Research, 33(3):710-734.


Gelman, A., & Hill, J. (2010). Multilevel logistic regression. Data Analysis Using Regression and Multilevel/Hierarchical Models. Cambridge: Cambridge University Press. p301-324.


Heinze, G., & Dunkler, D. (2017). Five myths about variable selection. Transplant International, 30(1):6-10.


Jann, B. (2008). A Stata implementation of the Blinder-Oaxaca decomposition. The Stata Journal, 8(4):453-479.


Jayathilaka, R., Adikari, H., Liyanage, R., Udalagama, R., & Wanigarathna, N. (2021). Cherish your children: Socio-economic and demographic characteristics associated with child mortality. BMC Public Health, 21(1):1217.


Mosley, W.H., & Chen, L.C. (1984). An analytical framework for the study of child survival in developing countries. Populatation and Development Review, 10(Suppl: Child Survival: Strategy for Research): 25-45.


Noor, F.M., & Udddin, M.A. (2021). Determinants of Under-five Child Mortality : Evidence from Bangladesh Multiple Indicator Cluster Survey. United States: Research Square.p1-15.


Rahman, M.M., & Alam, K. (2021). The role of socio-economic and female indicators on child mortality rate in Bangladesh: A time series analysis. OMEGA Journal of Death and Dying,  1–24.


Sarkodie, A.O. (2021). Factors influencing under-five mortality in rural-urban Ghana: An applied survival analysis. Social Science and Medicine, 284:114185.


Schultz, T.P. (1984). Studying the impact of household economic and community variables on child mortality. Child Survival Strategies for Research, 10(1984):215-235.


Senaviratna, N.A.M., & Cooray, T.M.J. (2019). Diagnosing multicollinearity of logistic regression model. Asian Journal of Probability and Statistics, 5(2):1-9.


Shonazarova, S., & Eshchanov, B. (2020). The Determinants of Early Marriage and Under-five Child Mortality in Afghanistan. MPRA Paper. p107684.


Sinning, M., Hahn, M., & Bauer, T.K. (2008). The Blinder-Oaxaca decomposition for nonlinear regression models. Stata Journal, 8(4):480-492.


Touré, S., Weeks, J., Lopez-Carr, D., & Stow, D. (2020). Evaluating links between dynamic urban landscapes and underfive child mortality in Accra, Ghana. Demographic Research, 42(20):589-614.


UNDP. (2016). From the MDGs to Sustainable Development for All: Lessons from 15 Years’ Practice; New York: United Nations Development Program (UNDP).


UNICEF. (2015). Committing to Child Survival: A Promise Renewed Progress Report. United States: UNICEF.


United Nations Inter-agency Group for Child Mortality Estimation (UN IGME). (2020). ‘Levels & Trends in Child Mortality: Report 2020, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund.


United Nations. (1991). Child Mortality in Developing Countries : Socio-economic Differentials, Trends, and Implications. United States: United Nations.


United Nations. (1995). Population and Development. Depart ment of Economics and Social Affairs. In: Programme of Action adopted at the International Conference on Population and Development, Cairo.p5-13. Available from: [Last accessed on 2022 Nov 17].


United Nations. Department of International Economic and Social Affairs. (1985). Socio-Economic Differentials in Child Mortality in Developing Countries. United States: United Nations.


World Health Organization. (2015). Health in 2015: From MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals. Geneva: World Health Organization.


Yaya, S., Uthman, O.A., Okonofua, F., & Bishwajit, G. (2019). Decomposing the rural-urban gap in the factors of under-five mortality in sub-Saharan Africa? Evidence from 35 countries. BMC Public Health, 19(1):616.


Yohannes, M.A., Feleke, S.A., Mengesha, Z.B., & Workie, S.B. (2017). Childhood mortality: Trends and determinants in Ethiopia from 1990 to 2015-A systematic review. Advances in Public Health, 2017:1-10.


Zakaria, M., Tariq, S., & Iftikhar, M. (2019). Socio-economic, macroeconomic, demographic, and environmental variables as determinants of child mortality in South Asia. Environmental Science and Pollution Research Interenational, 27(1):954-964.


Zewudie, A.T., Gelagay, A.A., & Enyew, E.F. (2020). Determinants of under-five child mortality in Ethiopia: Analysis using ethiopian demographic health survey, 2016. International Journal of Pediatrics (United Kingdom), 2020:7471545.

Conflict of interest
The authors declare that they have no competing interests.
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International Journal of Population Studies, Electronic ISSN: 2424-8606 Print ISSN: 2424-8150, Published by AccScience Publishing