Research Article: Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia

Date Published: June 13, 2019

Publisher: Public Library of Science

Author(s): Atakelti Abraha, Anna Myléus, Peter Byass, Asmelash Kahsay, John Kinsman, Elizeus Rutebemberwa.


Despite the significant reductions seen in under-5 child mortality in Ethiopia over the last two decades, more than 10,000 children still die each year in Tigray Region alone, of whom 75% die from preventable diseases. Using an equity lens, this study aimed to investigate the social determinants of child health in one particularly vulnerable district as a means of informing the health policy decision-making process. An exploratory qualitative study design was adopted, combining focus group discussions and qualitative interviews. Seven Focus Group Discussions with mothers of young children, and 21 qualitative interviews with health workers were conducted in Wolkayit district in May-June 2015. Data were subjected to thematic analysis. Mothers’ knowledge regarding the major causes of child mortality appeared to be good, and they also knew about and trusted the available child health interventions. However, utilization and practice of these interventions was limited by a range of issues, including cultural factors, financial shortages, limited female autonomy on financial resources, seasonal mobility, and inaccessible or unaffordable health services. Our findings pointed to the importance of a multi-sectoral strategy to improve child health equity and reduce under-5 mortality in Wolkayit. Recommendations include further decentralizing child health services to local-level Health Posts, and increasing the number of Health Facilities based on local topography and living conditions.

Partial Text

The Millennium Development Goals (MDGs) were instrumental in increasing investment and action for child survival. Globally, the under-5 child mortality has decreased from an estimated 91 deaths per 1000 live births in 1990 to 43 per 1000 live births in 2015[1]. However, wide differences in the reduction of mortality and utilization of most maternal and child health indicators still exist within and across countries; these are often linked to underlying factors such as cultural and socio-economic characteristics. Such differences in health outcomes—which can also be seen as health inequities—are socially produced, systematic in their distribution across the population, and unfair [2]. On this basis, the World Health Organization (WHO) considers efforts to address inequities as key components of global efforts aimed at improving maternal, new-born and child health and survival rates [3]. Bringing an end to preventable deaths of new-borns and under- 5 year children is also a priority in the Sustainable Development Goals [4].

Our study area is very remote and rural, and is characterized by a high prevalence of communicable diseases as well as the loss of many children from vaccine preventable diseases, malaria and diarrhoea. The FGD participants demonstrated good levels of knowledge about the major causes of morbidity and mortality of under-5 year children and of strategies that can be used to promote child health. It appears that the awareness-raising component of the HEP, which was designed with women’s and children’s health specifically in mind, has been working as intended [30]. This finding is consistent with studies that have shown that the HEP has been successful in improving maternal knowledge about under-5 year child health[31–32], particularly in communities with little or no formal education [12,33]. However, consistent with previous studies conducted in Ethiopia, our study found lower knowledge when it comes to the causes of neonatal morbidity and mortality, and this may well contribute to the slow reduction of neonatal mortality [34].

This study has generated important findings regarding the social determinants of child health in Wolkayit Woreda. The Ethiopian HEP is successful in terms of gaining the trust of the community and improving mothers’ knowledge about the causes and prevention of child mortality, except in the case of neonatal mortality. Consequently, most of the child health services and interventions that are provided at the health post level are well utilized. However, latrine construction and use, and child feeding interventions are poorly practiced despite high levels of knowledge. Child health services provided at health centre and hospital level such as delivery and treatment of sick children are generally poorly utilized.




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