Nine Years of Change in One Report: Reading the 2024–25 EDHS

Every so often the ground you're standing on gets re-surveyed. The Ethiopia Demographic and Health Survey 2024–25 — fieldwork across 22,540 households from August 2024 to April 2025, key indicators published in January 2026 — is the first full EDHS since 2016. Nine years of assumptions were up for revision at once.

The headline story is progress, and it is genuinely remarkable. The second story, quieter and less comfortable, is about what happens after the first contact with the health system. For anyone running a clinic, the second story is the one with instructions in it.

What moved

Skilled birth attendance reached 64% of live births, up from just 12% in 2011. Sixty-one percent of births took place in a health facility. There are very few national indicators anywhere that move that far in thirteen years.
The pregnancy-related mortality ratio is 169 deaths per 100,000 live births for the seven years before the survey — down from 412 in the equivalent 2016 estimate, and 1,039 in 2000.
Under-5 mortality is 51 per 1,000 live births; infant mortality 39; neonatal mortality 25.
Fertility is 4.0 children per woman, down from 5.5 in 2000 — 3.2 in urban areas, 4.5 in rural.
Contraceptive use among married women is 35%, from 8% in 2000, dominated by injectables (20%) and implants (10%).

All of the above is from the 2024–25 EDHS Key Indicators Report.

That is a health system that has become dramatically better at getting people through the door.

What didn't

Now the second story.

Childhood vaccination went backwards. Only 30% of children aged 12–23 months were fully vaccinated with basic antigens — down from 39% in 2016. Twenty percent had received no vaccinations at all. Urban coverage was 50%; rural, 22%.

Look at how it falls apart along the series:

Antigen	Coverage, children 12–23 months
BCG	72%
DTwP-Hib-HepB, third dose	40%
Measles, first dose	51%

Seventy-two percent of children reached a facility for their first vaccine. Fewer than half completed the third dose of the pentavalent series. That is not a coverage failure — the child arrived. It's a continuation failure, and it happens in the gap between visits, where nobody is watching.

The same shape appears in maternal care. 78% of women received antenatal care from a skilled provider, but only 53% had four or more ANC visits. First contact, again, comfortably ahead of completed care.

And on nutrition, the plateau: 40% of under-5s are stunted, against 38% in 2016 — no movement in nine years, after a long decline from 58% in 2000.

Ethiopia has largely solved the problem of the first visit. What the 2024–25 EDHS measures is the cost of the second, third and fourth — the ones nobody reminds you about.

Why this is an operations problem, not a policy problem

A first visit is driven by things a clinic barely controls: distance, cost, awareness, whether a mother trusts the facility. A fourth visit is driven almost entirely by things a clinic controls completely.

Does anyone know the child is due? Is there a list of who was expected this week and didn't come? When a mother arrives, can you see her last two visits, or are you starting again from her word and a card that may or may not be in the building? When she leaves, does she know the date of the next visit, and does anyone follow up if she misses it?

Every one of those is a records question. Which is why the drop between BCG and the third pentavalent dose is, in a very concrete sense, an administrative statistic.

The chronic-care evidence points the same way. Among 401 hypertensive patients across four South Gondar hospitals, 39.2% were non-adherent to appointment follow-up. The strongest predictor was the absence of perceived symptoms (AOR 4.98, 95% CI 2.89–8.59), followed by pill burden (3.50), poor awareness of complications (2.62) and living far from the facility (2.53). Patients who feel fine stop coming — and a system with no recall list never notices.

In HIV care, where retention has been measured for two decades, the pattern is well documented: one Northwest Ethiopian cohort recorded loss to follow-up at 13.45 per 100 person-years, and in one rural pre-ART cohort 28.4% of patients were lost, 93% of them within the first six months. Early, and quiet.

What a clinic can take from a national survey

Treat the series, not the visit, as the unit of care. An immunisation schedule, an ANC package, a hypertension follow-up plan — these are courses of care with a start and an end. If your records can only tell you about today, you can't see whether anyone finished.

Keep a defaulter list and work it. Who was expected this week and didn't arrive? Ten minutes with that list and a phone recovers patients that no amount of advertising will. Note that the biggest chronic-care predictor was patients feeling well: the message that brings them back is about why the next visit matters, not that they missed it.

Book the next appointment before they leave. A date the patient carries, and that your system also holds, is worth more than an instruction to "come back in a month."

Assume your rural caseload behaves differently. A 50% versus 22% urban–rural vaccination gap is a reminder that distance changes everything. Longer intervals, more reminders, more visits bundled into one trip.

Date every number you rely on. Ethiopian health data moves fast enough that an undated figure is usually a wrong figure. Anything you quoted from the 2016 EDHS in a proposal, plan or grant application is now nine years stale — and in the case of vaccination coverage, points the wrong way.

The honest summary

The national picture is one of real, hard-won gains at the front door, and unfinished work down the corridor. Mothers are reaching facilities; children are getting a first vaccine; far fewer women are dying in childbirth. The next increment of progress is less about reach and more about follow-through — completed ANC, completed immunisation series, chronic patients still in care at month twelve.

That work is not glamorous, and it doesn't take a new policy. It takes knowing who is due, who didn't come, and doing something about it before the next survey.