Spatio-Temporal Trends of Maternal and Child Health Service Utilization and Child Mortality in Poor and Rich Districts of Addis Ababa city, Ethiopia

Abstract Although access and utilization of maternal, newborn, and child health (MNCH) services tend to be higher in urban areas compared to rural areas across SSA, previous studies suggest that large intra-urban inequalities exist. This study aims to examine temporal trends and spatial variations of maternal and child health service utilization between the poorest and richest districts of Addis Ababa. A World Bank district-based poverty index was used to classify districts into top 60% (non-poor) and bottom 40% (poor). Essential maternal and child health service coverage were estimated from routine health facility data for 2019–2021 and Five rounds of Ethiopian Demographic Health Survey (2000–2019) were used to estimate child mortality. Geospatial variation of the service coverage in poor and rich districts were estimated from DHIS 2 using QGIS. Results: Service coverage was substantially higher in the top 60% than bottom 40% districts. For example, four antenatal care(ANC4), skill birth attendance (SBA) and postnatal care (PNC) coverage was over 90% in the non-poor compared to 54–67% in the poor districts. Inequalities were less pronounced for childhood vaccinations with over 90% coverage levels across districts. District inequalities in mortality rates were considerable. Neonatal mortality was nearly twice as high in the bottom 40% as in the top 60% households. Similarly, the under 5 mortality rate was three times higher in the bottom 40% compared to top 60% of households. Addis Ababa has substantial inequalities in MNCH service utilization and child mortality. Greater focus on the city’s women and children living in the poorest households and districts in maternal, newborn and child health programs is urgently needed.