Prevalence, Regional Disparities, and Multilevel Determinants of Adequate Caregiving Practices among Children Under Five in Ethiopia: Evidence from the 2024–25 Ethiopian Demographic and Health Survey

Abstract Background Nurturing care during early childhood shapes individuals’ lifelong health, learning, and productivity. However, the individual-, household-, and community-level determinants of adequate caregiving practices among Ethiopian children have not been adequately examined. This study therefore assessed the national prevalence, regional variation, and determinants of adequate caregiving practices among children under five years of age in Ethiopia. Methods This was a cross-sectional study of 6,274 children under five years of age from the 2024–25 EDHS. Adequate caregiving practice was constructed from care-seeking for illness, safe stool disposal, breastfeeding, vaccination status, and living arrangement with the biological mother, with children meeting at least 75% of applicable indicators classified as having adequate caregiving. A four-level multilevel logistic regression model, incorporating sampling weights and clustering, was used to identify individual-, household-, and community-level determinants, reported as adjusted odds ratios with 95% confidence intervals. Results The national prevalence of adequate caregiving practices was 77.3% (95% CI: 74.9–79.5%), ranging from 55.8% in Afar to 86.5% in Central Ethiopia, and was higher in urban areas (80.8%) than in rural areas (75.9%). The null model showed an intraclass correlation coefficient of 22.9%, which remained substantial (25.2%) in the final model. Older child age (AOR range 1.76–2.54) and health insurance coverage (AOR = 1.52, 95% CI: 1.04–2.23) were significant individual-level predictors. Current maternal smoking (AOR = 0.35, 95% CI: 0.15–0.80), large household size (AOR = 0.50), having five under-five children (AOR = 0.06), and older household headship were associated with lower odds of adequate caregiving. Residing in Afar, Somali, or Dire Dawa was associated with significantly lower odds of adequate caregiving relative to Tigray. Conclusion Although a greater proportion of Ethiopian children receive adequate caregiving, substantial regional and community-level disparities persist. Priority child caregiving should be given to younger infants, children in large households, and pastoralist and historically underserved regions, alongside continued expansion of health insurance and community health infrastructure to close these gaps.