Abstract / Summary
Abstract Background; Child mortality in Ethiopia remains driven by preventable infectious conditions acute respiratory infections, diarrhea and fever. While demand side factors are widely studied, the impact of supply side health facility readiness specifically the consistent availability of essential pediatric medicines on care seeking and clinical treatment is less clear. This study evaluated the impact of essential commodity stock outs on child care seeking and treatment rates in Ethiopia using the 2024/2025 Ethiopia Demographic and Health Survey. Methods; A secondary multilevel analysis was conducted using linked data from the 2024/2025 Ethiopia Demographic and Health Survey and facility readiness audits. The sample included 8452 children under five who experienced acute respiratory infections, fever or diarrhea in the preceding two weeks. Outcomes modeled included formal care seeking and receipt of recommended treatment (oral rehydration salt/zinc, dispersible amoxicillin or Artemisinin based Combination). Multilevel mixed effects logistic regression models assessed adjusted odds ratios at a 95% confidence interval. Results; Formal care seeking occurred for 48.2% of sick children and appropriate treatment was received by 36.5%. Overall, 41.3% of local primary health facilities experienced essential pediatric medicine stock outs in the preceding month. Children served by facilities with stock outs had 42% lower odds of formal care seeking (adjusted odds ratio = 0.58) and 56% lower odds of receiving appropriate clinical treatment (adjusted odds ratio = 0.44). Maternal education, household wealth and urban residence were strong positive predictors of care seeking. Community level differences accounted for 28.4% of the total variance in care seeking. Conclusion; Health facility commodity stock outs act as a major structural bottleneck in Ethiopia, suppressing treatment rates and eroding care seeking behavior. National authorities must emphasize supply chain digitization and support primary healthcare logistics to increase child survival.