Coverage and equitability of interventions to prevent child mortality in rural Jimma and West Hararghe Zones, Oromia Region, Ethiopia.

BACKGROUND: Interventions to prevent childhood illnesses are important components of the Ethiopian Health Extension Program (HEP). Although the HEP was designed to reduce inequities in access to health care, there is little evidence on equitability of preventive interventions in Ethiopia. PURPOSE: This article describes coverage of preventive interventions and how many interventions individual children received We also examined which factors were associated with the number of preventive interventions received, and assessed the extent to which interventions were equitably distributed. METHODS: We conducted a cross-sectional survey in 3,200 randomly selected households in the rural Jimma and West Hararghe Zones of Ethiopia's Oromia Region. We calculated coverage of 10 preventive interventions and a composite of eight interventions (co-coverage) representing the number of interventions received by children. Mul- tiple linear regressions were used to assess associations between co-coverage and explanatory variables. Finally, we assessed the equitability of preventive interventions by comparing coverage among children in the poorest and the least poor wealth quintiles. RESULTS: Coverage was less than 50% for six of the 10 interventions. Children received on average only three of the eight interventions included in the co-coverage calculation. Zone, gender, caretaker age, religion, and household wealth were all significantly associated with co-coverage, controlling for key covariates. Exclusive breastfeeding, vaccine uptake, and vitamin A supplementation were all relatively equitable. On the other hand, coverage of insecticide-treated nets or indoor residual spraying (ITN/IRS) and access to safe water were significantly higher among the least poor children compared to children in the poorest quintile. CONCLUSION: Coverage of key interventions to prevent childhood illnesses is generally low in Jimma and West Hararghe. Although a number of interventions were equitably distributed, there were marked wealth-based inequities for interventions that are possessed at the household level, even among relatively homogeneous rural communities.

Coverage and Equitability of Interventions to Prevent Child Mortality in Rural Jimma and West Hararghe Zones; Oromia Region; Ethiopia

Background: Interventions to prevent childhood illnesses are important components of the Ethiopian Health Extension Program (HEP). Although the HEP was designed to reduce inequities in access to health care; there is little evidence on equitability of preventive interventions in Ethiopia. Purpose: This article describes coverage of preventive interventions and how many interventions individual children received. We also examined which factors were associated with the number of preventive interventions received; and assessed the extent to which interventions were equitably distributed. Methods: We conducted a cross-sectional survey in 3;200 randomly selected households in the rural Jimma and West Hararghe Zones of Ethiopia's Oromia Region. We calculated coverage of 10 preventive interventions and a composite of eight interventions (co-coverage) representing the number of interventions received by children. Multiple linear regressions were used to assess associations between co-coverage and explanatory variables. Finally; we assessed the equitability of preventive interventions by comparing coverage among children in the poorest and the least poor wealth quintiles. Results: Coverage was less than 50 for six of the 10 interventions. Children received on average only three of the eight interventions included in the co-coverage calculation. Zone; gender; caretaker age; religion; and household wealth were all significantly associated with co-coverage; controlling for key covariates. Exclusive breastfeeding; vaccine uptake; and vitamin A supplementation were all relatively equitable. On the other hand; coverage of insecticide-treated nets or indoor residual spraying (ITN/IRS) and access to safe water were significantly higher among the least poor children compared to children in the poorest quintile. Conclusion: Coverage of key interventions to prevent childhood illnesses is generally low in Jimma and West Hararghe. Although a number of interventions were equitably distributed; there were marked wealth-based inequities for interventions that are possessed at the household level; even among relatively homogeneous rural communities