STEP

Analyze data

Credit: WHO / Blink Media - Amanda Mustard

 A. Prepare disaggregated data

STEP
3
B. Calculate summary measures of
inequality

Analyze data
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

KEY QUESTION
What is the HIV, TB or malaria indicator value in
each population subgroup?
CHECKLIST
o Prepare the dataset for analysis
o Define how HIV, TB and malaria indicators are calculated
o For each dimension of inequality, determine criteria for
how to define subgroups
o Calculate disaggregated data by subgroup
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

• Carry out quality checks and

KEY QUESTION
account for any outlier or
What is the HIV, TB or malaria indicator value in missing values.
each population subgroup?
CHECKLIST • Structure data in the right
o Prepare the dataset for analysis format for analysis, including
o Define how HIV, TB and malaria indicators are calculated removing non-relevant parts
of the data.
o For each dimension of inequality, determine criteria for
how to define subgroups
o Calculate disaggregated data by subgroup
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

KEY QUESTION
What is the HIV, TB or malaria indicator value in
each population subgroup?
CHECKLIST
o Prepare the dataset for analysis
o Define how HIV, TB and malaria indicators are calculated
o For each dimension of inequality, determine criteria for
how to define subgroups
o Calculate disaggregated data by subgroup
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

KEY QUESTION
What is the HIV, TB or malaria indicator value in
each population subgroup?
CHECKLIST
o Prepare the dataset for analysis
o Define how HIV, TB and malaria indicators are calculated
o For each dimension of inequality, determine criteria for
how to define subgroups
o Calculate disaggregated data by subgroup
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

Economic status Education Place of residence
2 5 10 2 3 4 2 5
subgroups subgroups subgroups subgroups subgroups subgroups subgroups subgroups

Quintile 1 Decile 1 No No Remote

(poorest) education education rural
Decile 2 No or
Poorest Rural
primary
40% Decile 3 education Primary Primary
Main rural
Quintile 2 education education
Decile 4
Peri-urban
Decile 5 Secondary
Quintile 3 Secondary Secondary education
Decile 6 or higher Urban Suburban
or higher
education education Higher
Richest Decile 7 education Main
Quintile 4 urban
60% Decile 8

Quintile 5 Decile 9
(richest)
Decile 10
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

KEY QUESTION
What is the HIV, TB or malaria indicator value in
each population subgroup?
CHECKLIST
o Prepare the dataset for analysis
o Define how HIV, TB and malaria indicators are calculated
o For each dimension of inequality, determine criteria for
how to define subgroups
o Calculate disaggregated data by subgroup
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

Prompt care-seeking for

children aged <5 years with
fever in Mali (%) (DHS 2018)
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

Prompt care-seeking for

children aged <5 years with
fever in Mali (%) (DHS 2018)

Source: State of inequality: HIV, tuberculosis and malaria. WHO, 2021.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

Economic-related inequality
in prompt care-seeking for
children aged <5 years with
fever in Rwanda (%)
(DHS 2007 and MIS 2017)

Source: State of inequality: HIV, tuberculosis and malaria. WHO, 2021.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

A. Prepare disaggregated data

• When using survey data, consider sample sizes. Additional resources

• Flag small sample sizes; • Statistical codes to calculate
• Drop subgroup estimates with small sample sizes; or disaggregated estimates using
• Recategorize the population to form subgroups with household surveys.
a larger sample size.
• State of inequality: HIV,
tuberculosis and malaria report
• Calculate the standard error or confidence intervals.
and technical annex.

• Consider the specifications of the data source, such as • Links to the HEAT Plus Data
survey sampling design. Repository, DHS Program
STATcompiler, AIDSinfo, and
PHIA Project available in the
‘Additional resources’ section.
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

KEY QUESTION
What are the absolute and relative levels of
inequality in HIV, TB and malaria?
CHECKLIST
o For each HIV, TB and malaria indicator and dimension of
inequality combination, calculate absolute inequality
o For each HIV, TB and malaria indicator and dimension of
inequality combination, calculate relative inequality
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

KEY QUESTION
What are the absolute and relative levels of
inequality in HIV, TB and malaria?
CHECKLIST
o For each HIV, TB and malaria indicator and dimension of
inequality combination, calculate absolute inequality
o For each HIV, TB and malaria indicator and dimension of
inequality combination, calculate relative inequality
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

Absolute measures Relative measures
• Indicate the magnitude of • Indicate the proportional inequality
inequality in health between in health among subgroups
subgroups
• Do not have a unit
• Retain the same unit of measure as
• Can be used to compare inequality
the health indicator
in indicators with different units
• Cannot be used to compare
• Example: Ratio
inequality in indicators with different
units
• Example: Difference
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

• Simple measures: make

KEY QUESTION
pairwise comparisons
What are the absolute and relative levels of between two subgroups.
inequality in HIV, TB and malaria?
CHECKLIST • Complex measures: use data
o For each HIV, TB and malaria indicator and dimension of from all subgroups to assess
inequality combination, calculate absolute inequality inequality.
o For each HIV, TB and malaria indicator and dimension of
inequality combination, calculate relative inequality
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

à Measuring inequality for dimensions with two subgroups

Pregnant women tested for HIV during antenatal care visit or

labour and received results in Uganda (%) (DHS 2006 and 2016)

Source: State of inequality: HIV, tuberculosis and malaria. WHO, 2021.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

à Measuring inequality for dimensions with two subgroups

Pregnant women tested for HIV during antenatal care visit or

labour and received results in Uganda (%) (DHS 2006 and 2016)

Source: State of inequality: HIV, tuberculosis and malaria. WHO, 2021.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

à Measuring inequality for dimensions with more than two subgroups that have a natural ordering

BCG immunization coverage among children aged 1 year in Chad

(%) (DHS 2004 and 2014)

Source: State of inequality: HIV, tuberculosis and malaria. WHO, 2021.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

à Measuring inequality for dimensions with more than two subgroups that have a natural ordering

BCG immunization coverage among children aged 1 year in Chad

(%) (DHS 2004 and 2014)

Source: State of inequality: HIV, tuberculosis and malaria. WHO, 2021.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

Two situations to look out for and consider using complex measures:

Prompt treatment of children aged <5 years with fever with • When the situation in the
antimalarial medicines in Kenya (DHS 2015) middle subgroups shows a
different pattern. Complex
measures take into account
the situation in all subgroups.

Source: State of inequality: HIV, tuberculosis and malaria. WHO, 2021.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

Two situations to look out for and consider using complex measures:

BCG immunization coverage among children aged 1 year in Chad • When population shares of
(%) (DHS 2004 and 2014) subgroups are very
different. Some complex
measures take into account
the population share of each
subgroup through weighting.

• Calculate both simple and

complex measures to
determine whether they
support the same
The size of the circle reflects the population share conclusions.

Source: State of inequality: HIV, tuberculosis and malaria. WHO, 2021.

STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

Examples of complex summary measures of inequality

Absolute measures Relative measures

• Absolute Concentration Index (ACI)* • Population Attributable Fraction (PAF)*
Ordered
• Population Attributable Risk (PAR)* • Relative Concentration Index (RCI)*
dimensions
• Slope Index of Inequality (SII)* • Relative Index of Inequality (RII)*
• Between-group standard deviation • Coefficient of variation (COV)*
(BGSD)* • Index of disparity (IDIS)**
• Between-group variance (BGV)* • Mean log deviation (MLD)*
Non-ordered
• Mean difference from best performing • Population attributable fraction (PAR)*
dimensions
subgroup (MDB)**
• Theil index (TI)*
• Mean difference from mean (MDM)**
• Population attributable risk (PAR)*

Additional resources *Weighted measures

More information available in Appendix 2. **Can be weighted or unweighted
STEP 1 STEP 2 STEP 3 STEP 4 STEP 5

Determine scope of monitoring Obtain data Analyze data Report results Knowledge translation

B. Calculate summary measures of inequality

Health Equity Assessment Toolkit Plus (HEAT Plus)

Facilitates the calculation of simple and complex
measures of inequality, based on disaggregated data.

Technical notes contain detailed information about

the calculation and interpretation of summary
measures of inequality.

www.who.int/data/gho/health-equity/assessment-toolkit

Additional resources
More information about multiple regression and
compounded vulnerability available in Appendix 3.
 üA. Prepare disaggregated data

STEP
3 üB. Calculate summary measures of
inequality

Analyze data
 Best practices for Step 3
• Record in detail the methods used during data
analysis to ensure that the analysis step can be
replicated for ongoing monitoring; note the
rationale behind the choices, and any limitations.

• Assess the sample sizes of the subgroups and

STEP the population share; if needed and appropriate,
redefine the criteria for the subgroup to ensure
3 adequate sample sizes.

• Become familiar with the characteristics of the

disaggregated data that will inform the choice of
Analyze data appropriate summary measures of inequality.

• Calculate both absolute and relative measures of

inequality, using a variety of suitable summary
measures of inequality.