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Health Indicators

 A Health indicator is a characteristic of

an individual, population, or environment which is subject to measurement (directly or indirectly) and can be used to describe one or more aspects of the health of an individual or population (quality, quantity and time).

 Health indicators can be used to define

public health problems at a particular point in time, to indicate change over time in the level of the health of a population or individual, to define differences in the health of populations, and to assess the extent to which the objectives of a program are being reached.

or health expectancy). . Health indicators may include measurements of illness or disease which are more commonly used to measure health outcomes. life skills. or positive aspects of health (such as quality of life.

family . description. analysis of data among individual . It also helps for comparisons .According to the and country. It indicates status and situation of certain community. health indicator can be defined as a variables which helps to measure changes occurred to the community. .

for monitoring and evaluation of health services. activities and program me. Indicator are required not only to measure the health status of the community . for assessment of health care need . . but also compare the health status of one country with that of another. for allocation of resources .

 should be reliable and objective.. . i.e.Characteristics of Indicators:  should be valid. they should actually measure what they are supposed to measure. the answers should be the same if measured by different people in similar circumstances..e. i.

predict all people from the sick group as sick) .e.e. the percentage of sick people who are correctly identified as having the condition).Characteristics of Indicators:  should be sensitive. A perfect predictor would be described as 100% sensitivity (i..g. they should measures the proportion of actual positives which are correctly identified as such (e. i.

g.. they should measures the proportion of negatives which are correctly identified (e. the percentage of healthy people who are correctly identified as not having the condition).e. not predict anyone from the healthy group as sick) .e. i. 100% specificity (i. should be specific.

they should have the ability to obtain data needed." .e. . accomplished or carried out).  should be relevant.. i. they should contribute to the understanding of the phenomenon of interest.e. should be feasible“(capable of being done.. i.

Classification of health Indicators  Mortality indicators  Morbidity indicators  Disability rates  Nutritional status indicators  Health care delivery indicators  Utilization rates .

 Indicators of social and mental health  Environmental indicators  Socio-economic indicators  Health policy indicators  Indicators of quality of life  Other indicators .

Mortality Indicators  Mortality Rates . ( death certificate is a legal requirement in many countries) . .The traditional measures of health status.Widely used because of their ready availability.

        Crude death rate Infant mortality rate Fetal death rate Neonatal mortality rate Under 5 proportionate mortality rate Maternal mortality rate specific death rates : age/disease Proportionate mortality rate .

Crude Death Rate It is defined as the no of death per 1000 population per year in a given community. . It indicate the rate at which people are dying.

.000 Estimated population as of Jul 1 of same year * Strictly speaking . But in many countries crude death rate is only available indicator for health. of deaths registered in a given calendar year____ X 1. health should not be measured by no of death that occur in the Community.Total no.

.When used for international comparison the usefulness of crude death rate is restricted because it is influenced by the age sex composition of the population . a decrease in death rate provide a good tool for assessing the overall health improvement in a population. Although not a perfect measure of health status .

Infant Mortality Rate
 Death rate under one

year is high due to illiteracy and low socioeconomic condition of the parents.

The IMR is the number of deaths under one year of age per 1000 live births during a year. Although it is called a rate, in fact, it is the probability of dying before the first birthday. Several factors affect the IMR of a country: a) Nutrition of mothers b) Nutrition of children

c) Parity d) Age of mother at child’s birth e) Mother’s education and economic status f) Basic health services including: i. Immunization ii. ARI iii. Diarrhea iv. Safe motherhood program v. Environment etc

Total no. of deaths under 1 year of age occoured in a year____ X 1.000 No of live birth in that year .

Death of the product of conception occurs prior to its complete expulsion.Fetal Death Rate  Measures pregnancy wastage. . irrespective of duration of pregnancy.

Total no. of fetal deaths registered in a given calendar year Total number of live births registered of same year X1000 .

Neonatal Death Rate Measures the risk of dying in the first month of life or before reaching 28 completed days of life. .

Causes of neonatal death in Nepal are: • Infection • Birth trauma • Prematurity or low birth wt babies • Hypothermia etc .

No.000 . of deaths under 28 days of age registered in a given calendar year Number of live births registered as of Jul 1 of same year X 1.

the proportion is less than 2 per cent. In communities with poor hygiene. the proportion may exceed 60 per cent. These rate can be used to reflect both infant and child mortality cases. In some European countries. High rate reflects high birth rates. . high child mortality rates and shorter life expectancy .Under 5 proportionate mortality rate It is the proportion of total deaths occurring in the under-5 age group .

child birth and puerperium. .Maternal Mortality Rate It measures the risk of dying from causes related to pregnancy.

MMR is very high in developing countries because of poor standard of living .MMR is defined by WHO as “ the death of women while pregnant or within 42 days of termination of pregnancy . . illiteracy. from any cause aggravated by the pregnancy or its management ”. irrespective of duration and site of injury . . poor socio economic condition and poor health care services in country.

Total no. of deaths from maternal causes registered in a given calendar year x1000 Total number of women of reproductive Age in the population( generally defined As 15-44 yrs of age) .

Age Specific Death Rate .

of deaths in a particular age group Registered in a given calendar year X1000 Estimated population as of Jul 1 of same year in the same age group .No.

Sex Specific Death Rate .

No. of deaths of the certain sex _ registered in a given calendar year Estimated population as of July 1 of the same sex in the same year X 1000 .

As burden of communicable diseases increases . have emerged as measures of specific disease problems .Disease-specific mortality ate Mortality rates can be computed for specific diseases. number of other indicators such as deaths from cancer. accidents. diabètes. etc. cardiovascular diésasse.

The term morbidity is equivalent to such term such as sickness. illness . . disability.Morbidity Indicators  Morbidity has been defined as “ any departure from a state of physical or psychological well beings ”.

To describe health in terms of mortality rates only is misleading. . Therefore morbidity indicators are used to supplement mortality data to describe the health status of a population. as for example mental illness and rheumatoid arthritis. mortality indicators do not reveal the burden of ill-health in a community. This is because.

Morbidity Indicators  Morbidity  Incidence rate and prevalence rate  Attendance rates: out-patient rates clinics or health centers.  Admission and discharge rates  Hospital stay duration rates .

g. E. Incidence of ARI IR = No of new cases of specific disease during a given time period (year) x 1000 Estimated mid-year population . Incidence rate: Incidence rate is defining as “ the no of new cases of disease occurring in a defined population during a specified period of time.

6 So incidence rate =16. Using formula IR = No of new cases of ARI 600 x 1000 Population at risk 3600 =500/3 = 16. Example: Ramkot PHC has been 600 new cases of ARI in 2063 and the population at risk(mid year population) in that year is 3600.6/1000 per year .

PREVALENCE RATE The term "disease prevalence" refers specifically to all current cases (old and new) existing at a given point in time. . or over a period of time in a given population.

The commonly used disability rates fall into two groups: (a) Event-type indicators and (b) person-type .Disability Indicators Since death rates have not changed markedly in recent years. disability rates related to illness and injury have come into use to supplement mortality and morbidity indicators. despite massive health expenditures.

(a) Event-type indicators : I) Number of days of restricted activity ii) Bed disability days iii) Work-loss days (or school loss days) within a specified period .

confined to bed . moving about. .b) Person-type indicators : I) Limitation of mobility: For example. ability to work at a job.. dressing. special aid in getting around either inside or outside the house.g. etc.. limitation to perform the basic activities of daily living (ADL)-e. limitation in major activity. going to toilet . confined to the house. ability to housework etc. e. washing. eating. ii) Limitation of activity: For example.g.

mid arm circumference.g. Hypothyroidism. Night blindness . ht .Nutritional Indicators  Nutritional Status Indicators . •Height of children at school entry •Prevalence of low birth weight •Clinical surveys: Anemia. wt.It is an indicator of positive health •Anthropometrics measurements of preschool children's e.

Health Care Delivery Indicators  Health Care Delivery Indicators .Reflect the Equity / Provision of health care Doctor/population ratio Doctor / Nurse ratio Population / Bed ratio Population / per health center .

Extent of use of health services . usually a year. .Utilization of services or actual coverage is expressed as the proportion of people in need of service who actually receive it in a given period .Utilization Indicators  Health care utilization Rates .

In other words. a relationship exists between utilization of health care services and health needs and status. Health care utilization is also affected by factors such as availability and accessibility of health services and the attitude of an individual towards his health and the health care system. A few examples of utilization rates are cited below: .lt is argued that utilization rates give some indication of the care needed by a population.

i.e.( average daily in patient census/average number of beds) ..  Percentage of population using the various methods of family planning. Proportion of infants who are fully immunized in the 1st year of life.  Hospital-Beds occupancy rate.  Proportion of pregnant women who receive ANC.immunization coverage.

it is necessary to use indirect measures. road traffic accidents.g.Social/Mental Health Indicators As long as valid positive indicators of social and mental health are scarce. other acts of violence and crime. property crime . indicators of social and mental pathology. These include suicide. homicide. viz. juvenile delinquency( is a antisocial act carried by a person who is typically under the age of 18 otherwise would have been charged as a crime if they were an adult e. violent crimes etc) .

. neglected and abandoned youth in the neighbourhood . smoking etc .. alcohol and drug abuse. To these may be added family violence.

.Environmental Indicators  Environmental health Indicators .Reflect the quality of physical and biological environment in which the disease occurs and in which the people live.

exposure to toxic agent to food or drinks.  The proportion of people having access to safe water and sanitation facilities . solid waste . radiation .They includes  Measures of Pollution of water and air.

Socio-economic Indicators  Socio-economic Indicators - These indicators do not directly measure health. they are of great importance in the interpretation of the indicators of health care. Nevertheless. These inclde .

No. Rate of population increase  Per capita GNP  Level of unemployment  Literacy rates . of persons per room  dependency ratio  Per capita “calorie ” availability .g.females  Family size  Housing condition e.

Health Policy Indicators  Health Policy Indicators . Proportion of total health resources devoted to primary health care . Proportion of GNP spent on health related activities.Allocation of adequate resources.  Proportion of GNP spent on health services.

The previous emphasis on using increase life expectancy as an indicator of health is no longer considered adequate especially in developed countries and attention has been shifted more towards concern about quality of life enjoyed by individual and communities. morbidity and mortality data have been questioned as to whether they fully reflect the health status of a population . .Indicator of quality of life Increasingly .

Obviously more work is needed to develop indicators of quality of life. infant mortality. The physical quality of life index is one such index which helps to measure quality of life .Quality of life is difficult to define and even more difficult to measure . It consolidates three indicators viz. life expectancy at age one. . and literacy.

 Millennium Development Goal Indicators .  Health for all indicators.Other Indicators  Other health indicators  Social indicator.  Basic needs indicators.

 learning and educational services.Social indicators : Social indicators.  families and households.  family formation. .  earning activities. as defined by the United Nations Statistical Office.  distribution of income. have been divided into 12 categories:  population.

social stratification and mobility . social security and welfare services. leisure and culture. public order and safety. time use. and accumulation. health services and nutrition. housing and its environment.        consumption.

access to water. rooms per person. doctors and nurses per population. life expectancy. . Those mentioned in "Basic needs performance" include calorie consumption. GNP per capita.       Basic needs indicators : Basic needs indicators are used by ILO. deaths due to disease: illiteracy.

the WHO has listed the following four categories of indicators .Health for AII indicators : For monitoring progress towards the goal of Health for All by 2000 AD.

( 1 ) Health policy indicators: .income distribution .housing .the degree of equity of distribution of health services community involvement Organizational framework and managerial process (2) Social and economic indicators related to health: .rate of population increase .GNP .work conditions .adult literacy rate .political commitment to Health for All .food availability .resource allocation .

incidence and prevalence  Disability .(3) Indicator for the provision of health care: availability accessibility Utilization quality of care (4)Health Status Indicator  LBW  Nutritional status and psychological Development of children  Infant mortality rate  Child mortality rate  Maternal mortality rate  Disease specific mortality  Morbidity.

The health related goals and their indicators of progress are listed in Table .Millennium Development Goal Indicators : The Millennium Development Goal adopted by the United Nations in the year 2000 provides an opportunity for taking action to improve global health.

Reduce child mortality Indicator: Under-five mortality rate Infant mortality rate Proportion of 1-year-old children immunized against measles .Health -related millennium Development Goal indicators 1. 4. Eredicate extreme poverty and hunger Indicator: Prevalence of underweight children under five years Proportion of population below minimum level of dietary energy consumption.

Improve maternal health Indicator: Maternal mortality ratio Proportion of births attended by skilled health personnel 6. malaria and other diseases indicator: •HIV prevalence among young people aged L5 to 24 years •Condom use rate of the contraceptive prevalence rate •Number of children orphaned by HIV/AIDS •Prevalence and death rates associated with malaria •Proportion of population in malaria-risk areas using •effective malaria prevention and treatment measures •Prevalence and death rates associated with •tuberculosis •Proportion of tuberculosis cases detected and cured . Combat HIV/AIDS.5.

urban and rural Proportion of urban population with access to improved sanitation 8. Develop a global partnership for development Proportion of population with access to affordable essential drugs on a sustainable basis . Ensure environmental sustainability Indicator: Proportion of population using solid fuel Proportion of population with sustainable access to an improved water source.7.

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