Health and Nutrition Bratislava, 8-10 May 2003 Angela Me Statistical Division UNECE.

Health and Nutrition

Bratislava, 8-10 May 2003Angela Me

Statistical Division UNECE


NHDR TrainingBratislava, May 2003

Nutrition

1. Supply2. Outcome (weight and height)3. Prevention4. Quality



Nutrition and relation to MDG 1

Outcome indicators

1. Prevalence of underweight children

2. Proportion of population below minimum level of dietary energy consumption



Nutrition and relation to MDG 1: Methods

Prevalence of underweight children

population-based surveys (MICS, DHS)

Proportion of population below minimum level of dietary energy consumption (proportion of undernourished population) estimates based on: food supply,

inequality to access to food (household surveys), and country food needs



Nutrition: two methods, two messages Source: UNICEF and FAO



Nutrition: methods and indicators

The quality of the data affect the message

select the indicator that use standard methodologies (underweight)

But two indicators may carry two different messages, ex:

inputs outcomes



Nutrition: Per capita supply of calories per day

Source: FAO



Nutrition: Stunting Prevalence (under height)

Source: UNICEF



Health

Input (expenditures) Prevention Status

Morbidity Mortality Disability (?)

Accessibility to services Potential access Realized access



Accessibility to health services

Potential access1. Availability of services

1. MD/population2. Bed/population3. Dentist/population4. Geographical distribution

2. Financing1. Income2. Visit costs3. Insurance benefits




Potential access

3. Organization1. Travel time2. Waiting time3. Time with MD

4. Need 1. Perceived health2. Illness episode




Realized access1. Utilization (objective)

1. MD/Dental visits 2. Hospital admission3. Preventive examination 4. Time since examination

2. Preference (subjective)1. MD courtesy 2. Quality3. Overall satisfaction



Accessibility to health services: Sources

Administrative records Providers view

They may be biased toward the public sector

Health surveys Customers view

Health surveys DHS LSMS WHS

Geographic information system (GIS)



Health Expenditure per capita in PPP$ Source: The WB



Hospital beds per 1,000 people Source: The WB



Comparability of data

Differences in definitions there is no universally accepted definition

of hospital beds physicians are defined differently

particularly between West and East countries

Subjective perceptions are always difficult to measure and compare health status (to note the WHO work on

the WHS in standardizing the reporting of health status)

quality of services



Health: WHO Health Report

Health system responsiveness and performance

Health system attainment: conceptual and measurement problems Disability-adjusted life expectancy (DALE) Disability-adjusted life years (DALY)

Eurostat: Disability-free life expectancy

Main issue: lack of reliable data on disability



Maternal mortality

obstetric risk associated with each pregnancy

difficult indicator to measure it needs a comprehensive

registration system of deaths and causes of death

UNICEF/WHO: guidelines on how to estimate it

difficult to measure trends

Is it the best indicator to measure maternal health in the region?



1995 maternal mortality ratios Source: WHO/UNICEF



Maternal health: process indicators

proportion of women who deliver with the assistance of a medically-trained health care provider (doctor, nurse, midwife) or skilled attendants in addition: consider the assistance of a

doctor (it can measure the adequacy to solve complications)

proportion of all deliveries that are by caesarian section

use of antenatal and postpartum care unsafe abortion



% deliveries attended by skilled personnel Source:

WHO/UNICEF



Child mortality: MDG 4 Under-five mortality rate

probability of children surviving to age 5 Infant mortality rate

number of infants dying before reaching the age of one year per 1,000 live births in a given year

Proportion of 1 year old children immunized against measles



Child mortality: Sources

Under-five and infant mortality rate death registration system, estimates: household surveys, census

Proportion of 1 year old children immunized against measles administrative records household surveys



Child mortality

If estimated, Under-five mortality provides better quality data then infant mortality



Under-five mortality Source: UNICEF

Health and Nutrition Bratislava, 8-10 May 2003 Angela Me Statistical Division UNECE.

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Transcript of Health and Nutrition Bratislava, 8-10 May 2003 Angela Me Statistical Division UNECE.