Indicators of Health PDF

INDICATORS OF HEALTH DR. Reham ElKalla Learning Objectives ▪ Explain the need to use “indicators” to measure “health” status ▪ State the characteristics of health indicators ▪ List the uses of health indicators ▪ State with examples the types of health indicators ▪ Compute indicators of mortality...

INDICATORS OF HEALTH DR. Reham ElKalla Learning Objectives ▪ Explain the need to use “indicators” to measure “health” status ▪ State the characteristics of health indicators ▪ List the uses of health indicators ▪ State with examples the types of health indicators ▪ Compute indicators of mortality ▪ Interpret the result of the indicator INTRODUCTION Health is defined as “a state of complete physical, mental & social wellbeing, and not merely an absence of disease or infirmity” (WHO) • This statement has been amplified to include the ability to lead a “socially and economically productive life” • Health cannot be measured in exact measurable forms. •Measurement have been framed in terms of illness (or lack of health), consequences of ill-health (morbidity, mortality) & economic, occupation & domestic factors that promote ill health- all the antithesis of health. INDICATORS OF HEALTH • Indicator also termed as Index or Variable. • It is only an indication of a given situation or a reflection of that situation. • Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community. • Indicators help to measure the extent to which the objectives and targets of a programmed are being attained. • Health status indicators: measure different aspects of the health of a population. Examples: life expectancy, infant mortality, disability or chronic disease rates. • Health determinant indicators: measure things that influence health. Examples: include diet, smoking, water quality, income and access to health services Social determinants of health (SDOH) The conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH can be grouped into 5 domains USES OF INDICATORS OF HEALTH 1. Assessment of health care needs. 2. Compare health status of different areas or groups of people over time. 3. Compare health status of one country with other countries or worldwide. 4. Contribute towards planning proper allocation of human and nonhuman resources by identifying the needs. 5. Monitoring and evaluation of health services, activities, and programs – Access, Quality, Effectiveness, Equity. CHARACTERISITS OF A GOOD INDICATOR • Valid – they should actually measure what they are supposed to measure. • Reliable – the results should be the same when measured by different people in similar circumstances. • Sensitive – they should be sensitive to changes in the situation concerned. • Specific – they should reflect changes only in the situation concerned. • Feasible – they should have the ability to obtain data when needed. • Relevant – they should contribute to the understanding of the phenomenon of interest. • Realistic, applicable and feasible. • Measurable and observable. • Known and agreed to by the organizations and staff whose performance is being assessed. • Clear and targeted to date or period. • Used in assessment continuously over time. CLASSIFICATION OF INDICATORS 1. Mortality Indicators 2. Morbidity Indicators 3. Disability Rates 4. Nutritional Indicators 5. Health Care Delivery Indicators 6. Health Care Utilization Indicators 7. Social And Mental Health care Indicators. 8. Socio-economic Indicators 9. Environmental Indicators. 10. Indicators of Quality of Life 11. Health Policy Indicators 1-MORTALITY INDICATORS ❖ Mortality rate is a measure of the frequency of occurrence of death in a defined population during a specified period of time. ❖ The crude mortality rate (CDR) is the mortality rate from all causes of death for an entire population. usually expressed as per 1000 or 100. ❖ Mid-year population: is important to use the population size at the midpoint of the time interval as an estimate of the average population at risk especially if: a denominator population is growing or shrinking during the period of time for which a rate is to be computed. e.g. If a death rate is to be calculated for the year 2012, then the population of July 1, 2012 is used as denominator. 1-MORTALITY INDICATORS ❖ Expectation of life is the average number of years that will be lived by those born alive into a population if the current age specific mortality rates persist. • It is a statistical abstraction based on existing age- specific death rates. • Estimated for both sexes separately. • Good indicator of socioeconomic development ❖ Infant mortality rate : The ratio of deaths under 1yr of age in a given year to the total number of live births in the same year, usually expressed as a rate per 1000 live births. • Indicator of health status of not only infants but also whole population & socioeconomic conditions • Sensitive indicator of availability, utilization & effectiveness of health care, particularly perinatal and postnatal care. 1-MORTALITY INDICATORS ❖ Under-5 Mortality rate as no. of deaths occurring in the under-5 age group per 1000 live births. Reflects both infant and child mortality ❖ Perinatal mortality rate: Deaths between 28th week of gestation to less than 7 days of life expressed as per 1000 of total births (live and still) ❖ Neonatal mortality rate: Deaths in the first 28 days of life expressed as per 1000 of total live births ❖ Post-neonatal mortality rate: Deaths between 28 days of life to less than 1 year expressed as per of total live births ❖ Maternal mortality rate and ratio: Ratio of number of deaths arising during pregnancy or puerperal period per 100000 live births ❖ Cause specific mortality rate is mortality rate which is computed for specific diseases. ❖ Proportionate mortality rate is the proportion of all deaths attributed to the specific disease ❖ E.g. Coronary heart disease causes 25 to 30 % of all deaths in developed world. 2-MORBIDITY INDICATORS Morbidity Indicators reveal the burden of ill health in a community, but do not measure the subclinical or inapparent disease states. Incidence and Prevalence Incidence • Incidence: The number of new events or new cases of a disease in a defined population, within a specified period of time. • Prevalence: • The total number of all individuals who have an attribute or disease at a particular time divided by population at risk of having attribute or disease at this point of time. • Reflects the chronicity of the disease. 2-MORBIDITY INDICATORS Notification rates is calculated from the reporting to public authorities of certain diseases e.g. yellow fever , poliomyelitis - They provide information regarding geographic clustering of infections, quality of reporting system etc. • Attendance rates at OPDs and at health centers. • Admission, Re-admission and discharge rates. • Duration of stay in hospital. • Spells of sickness or absence from work or school. - reflects economical loss to the community 3-DISABILITY RATES Disability Rates are of two categories A- Event type Indicators - Number of days of restricted activity - Bed disability days - work-loss days within a specified period • B- Person type Indicators - limitation of mobility e.g. confined to bed, confined to house, special aid in getting around. - limitation of activity e.g. limitation to perform the basic activities of daily living (ADL) e.g. eating, washing, dressing, etc. 3-DISABILITY RATES • Sullivan’s Index refers to “expectation of life free of disability”. • Sullivan’s Index = life expectancy of the country - Probable duration of bed disability and inability to perform major activities. • It is considered as one of the most advanced indicators currently available. . 4-NUTRITIONAL STATUS INDICATORS Nutritional Status is a positive health indicator. They reflect the maternal nutrition status ❖ Newborns are measured for their A. Birth weight B. Length C. Head circumference ❖ Anthropometric measurements of pre-school children A. Weight -for-age– measures acute malnutrition B. Height -for-age– measures chronic malnutrition C. Chest circumference & Mid-arm circumference - measures chronic malnutrition ❖ In adults: Underweight, Obesity and Anemia are generally considered reliable nutritional indicators 5-Health Care Delivery Indicators These indicators reflect the equity of distribution of health resources in different parts of the country and of the provision of health care. • Doctor-population Ratio – 6/10000 (World Health Statistics Report 2011) • Nurse-population ratio – 13/10000 • Population-bed Ratio – 8.9/10000 The WHO Joint Learning Initiative has established a threshold of 25 health workers (doctors, nurses and midwives) per 10,000 population. 6-Healthcare utilization indicators ✓ Utilization Rates is the proportion of people in need of a service who actually receive it in a given period, usually a year • Percentage of children attending for immunization. • Percentage of children attending for routine check-up. • Percentage of pregnant female attending for ante-natal care. • Percentage of pregnant female attended by a trained birth attendant. • Percentage of female attending family planning clinics. • Bed occupancy rate. • Bed turn over ratio. 7-INDICATORS OF SOCIAL AND MENTAL HEALTH These indicators provide a guide to social action for improving the health of people. • These include rates of suicide, homicide, other crimes • Road traffic accident • juvenile delinquency • Alcohol and substance abuse • Domestic violence • Battered-baby syndrome, etc. • Social and mental health of the children depend on their parents. • E.g. Substance abuse in orphan children 8-SOCIOECONOMIC INDICATORS ✓ These do not directly measure health but are important in interpreting health indicators. • Rate of population growth • Per-capita gross national production (GNP):the dollar value of a country's final output of goods and services in a year, divided by its population. • Percentage of unemployed • Percentage of literacy • Average family size • Crowding index: The household crowding index (HCI) was defined as the total number of co-residents per household, excluding the newborn infant, divided by the total number of rooms, excluding the kitchen and bathrooms. • Dependency ratio: demographic measure of the ratio of the number of dependents to the total working-age population in a country or region 9- ENVIRONMENTAL INDICATORS These reflect the quality of physical and biological environment in which diseases occur and people live ❖ The most important are those • measuring the proportion of population having access to safe drinking water and sanitation facilities. • These indicators explains the prevalence of communicable diseases in a community. • Measuring the pollution of air and water, radiation, noise pollution, exposure to toxic substances in food and water. 10-INDICATORS OF QUALITY OF LIFE ❖ Life expectancy is now less important. ❖ The Quality of Life has gained its importance. Physical Quality of Life Index • It consolidates infant mortality, life expectancy at age of 1yr and literacy. • For each component the performance of individual country is placed on a scale of 1 to 100. • The composite index is calculated by averaging the three indicators giving equal weight to each of them. • The result is placed on the 0 to 100 scale. • The PQLI does not consider the GNP. 10-INDICATORS OF QUALITY OF LIFE Human Development Index It is defined as a composite index combining indicators representing 3 dimensions 1. Longevity ( life expectancy at birth) 2. Education (mean and expected years of schooling) 3. Gross national income (GNI) per capita 11-HEALTH POLICY INDICATORS The single most important indicator of political commitment is allocation of adequate resources. ❖ The relevant indicators are 1. Proportion of GNP (gross national product) spent on health services. 2. Proportion of GNP spent on health-related activities like water supply and sanitation & housing and nutrition. 3. Proportion of total health resources devoted to primary health care. SUMMARY • Health not measured directly but using indicators. • Indicator should be valid, sensitive, specific, reliable, relevant and feasible. Used in measuring, describing, comparing, identifying health needs and planning and evaluation of health services. • No single comprehensive indicator of a nation’s health. • Each available indicator reflects an aspect of health. • Search for a single global index of health status continues. • Use of multiple indicators arranged in profiles or patterns used to make comparisons between areas , regions and nations.