Quantitative modeling results

Burden of Disease

The highest burden of under-five mortality in Ethiopia in 2000 was due to neonatal disorders, lower respiratory infections, and diarrheal diseases, representing 51 percent of all deaths. Throughout the study period these three diseases remained as the top disease areas. 46% of the reduction in under-five mortality rate was due to reduction in deaths due to these three diseases. Lastly, measles had the fourth-largest burden of under-five mortality in 2000, representing 12% of all deaths, but was substantially reduced and represented only 3% of deaths by 2017.

Caveats

Cause-of-death modeled estimates rely on available data sources, with limitations in data quality and completeness. The Institute for Health Metrics and Evaluation (IHME) provides a data-quality assessment rating of the quality and completeness of cause-of-death estimates ranging from 0 (worst) to 5 stars (best). Ethiopia’s rating is 2 out of 5 stars, indicating that its mortality estimates – especially its cause-of-death estimates – contain large degrees of uncertainty.¹

Quantitative Modeling Approach

The research team collaborated with IHME to look at quantitative modeling results using a decomposition method, and also collaborated with the Johns Hopkins Bloomberg School of Public Health to model results using the Lives Saved Tool (LiST). These analyses complement the primary research by looking at what the models suggest about the likely contribution of specific interventions in reducing child mortality. A summary of the results is presented in the following sections.

Modeling Results

The decomposition method estimates the percentage decline in U5M attributed to changes in risk factors and intervention coverage, based on efficacy assumptions derived from published literature.

From this method, the most significant contributor to the decline in Ethiopia's U5M rate is health systems, which includes  preventive measures like vaccines and curative treatments. Another significant contributor is program-related risk factors, which includes child growth failure, low birth weight, suboptimal breastfeeding, and vitamin A & zinc deficiency. 

The decomposition analysis found an additional 20 percent reduction in child mortality (37 percent of the total reduction during this period) was attributed to risk factors corresponding to other communicable diseases, other non-communicable diseases, and other injuries. This reflects the portion of reduction in each of these causes of death (CoD) that is not accounted for by health systems interventions (bottom row). 

We checked these results against LiST estimates of the number of lives saved attributed to each intervention based on estimates of disease incidence and deaths from the United Nations Inter-Agency Group for Child Mortality Estimation (IGME), as well as assumptions about effectiveness of interventions from published literature.

This model attributes a total of 1,243,000 lives saved between 2000 and 2016 to specific health interventions, with the largest contributors being vaccines & supplements (particularly Haemophilus influenzae type b [Hib] and Vitamin A); IMCI treatments including oral antibiotics for pneumonia and ORS, and neonatal/antenatal interventions (especially Tetanus toxoid vaccination and labor and delivery management).²

Summary

Across both modeling methods, vaccines are estimated to have had a significant impact on reducing under-five deaths in Ethiopia. Neonatal and antenatal interventions also contribute in both models. The results of the primary research findings on implementation outcomes for each intervention are presented in the next section. A description of the quantitative modeling methods can be found in the Methodology section.