Health indicators Prof. Ashry Gad Mohamed Dr. Salwa Tayel Department of family and Community...
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Transcript of Health indicators Prof. Ashry Gad Mohamed Dr. Salwa Tayel Department of family and Community...
Health indicators
Prof. Ashry Gad Mohamed Dr. Salwa Tayel
Department of family and Community Medicine
At the end of the lecture students should be able to:
1.Recognize the concept of health indicators.
2.Define health indicators.
3.Understand uses of health indicators.
4.Classify types of health indicators and give examples of these indicators.
OBJECTIVES OF THE LECTURE
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• Health indicator is a variable that reflects the state of health of persons in a community. (Oxford Dictionary of Epidemiology)
• They are quantitative measures that can be used as a guide to monitor and evaluate the quality of health care.
• Linguistically indicator is an indication of a given situation
What is health indicator?
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• Valid – measures what it is supposed to measure.• Reliable – provides same information under
different observations, conditions • Sensitive – sensitive to changes in the situation • Specific – reflects changes only in that situation• Relevant: relevant to the community needs &
problems.
Characteristics of a good indicator:
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• Realistic, applicable and feasible.• Measurable and observable.• Known and agreed to by the staff
whose performance is being assessed.• Clear and targeted to date or period.• Used in assessment continuously over time.
Characteristics of a good indicator:
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Uses of Health Indicators
1. Compare health status of one country with other countries or worldwide.
2. Compare health status of different areas or groups of people over time.
3. Assessment of health care needs.
4. Proper allocation of human and non human resources according to the needs.
5. Monitoring and evaluation of health services, activities, and programs.
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Types of Health Indicators
1. Mortality indicators
2. Morbidity indicators
3. Disability indicators
4. Nutritional status indicators
5. Health care delivery indicators
6. Utilization rates
7. Social and mental health indicators
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8. Environmental indicators
9. Socioeconomic indicators
10.Health policy indicators
11.Indicators of quality of life
12.Other indicators
Types of Health Indicators
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What Are the Leading Health Indicators?
• Physical Activity • Overweight and Obesity • Tobacco Use • Substance Abuse • Responsible Sexual Behavior • Mental Health • Injury and Violence • Environmental Quality • Immunization • Access to Health Care.04/21/23
A mortality rate is a measure of the frequency of
occurrence of death in a defined population during a
specified period of time.
Mortality Rates
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Crude Death Rate (CDR)
The crude mortality rate is the mortality rate from all causes of death for an entire population.
We usually multiply by 1000.
1000Xlocality)andyear(SamepopulationyearmidEstimated
localityandyearcertainaindeathsofnumberTotal
RateDeathCrude
= … Deaths/1000 individual in the specified year and locality.
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• It 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 2014, then the population of July 1, 2014 is used for the denominator.
Mid-year population
Age-specific mortality rates
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• An age-specific mortality rate is a mortality rate limited to a particular age group.
• The numerator is the number of deaths in that age group• The denominator is the number of persons in that age group
in the population. • Examples of age-specific mortality rates are neonatal, post-
neonatal, infant and under 5-years mortality rates.
1000
area same andyear same in the
group age same in thenumber Total
area andyear certain a and age
certain ain dying persons ofNumber
ratedeath specific Age x
Infant mortality rate (per 1 000 live births)
Infant mortality rate is the probability of a child born in a specific year or period dying before reaching the age of one.
In Saudi Arabia (2011)• both sexes 16.5
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1000
locality andyear same the
in births live ofnumber Total
localitygiven ain andyear
a duringyear one than less toup zero
from deaths ofnumber Total
ratemortality Infant x
Infant Mortality RateInfant Mortality Rate
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Neonatal mortality rate (per 1 000 live births)
The number of deaths of neonates (infants <28 days of age) in a calendar year, divided by number of live births in that year, multiplied by 1000.
In Saudi Arabia (2004):• Neonatal Mortality Rate =11
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1000
locality andyear same thein births live ofnumber Total
localitygiven ain andyear a during days 28 than less toup zero
from deaths ofnumber Total ratemortality Neonatal
x
1000
locality andyear same the
in births live ofnumber Total
localitygiven ain andyear
a duringyear one than less toup days 28
from deaths ofnumber Total
ratemortality Neonatal-Post x
Post-Neonatal mortality rate
(per 1 000 live births)
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Post-neonatal mortality rate is the number of deaths among
infants from 28 days up to 1 year of age during a given time
period divided by the number of live births during the same
time period multiplied by 1,000
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NeonatalNeonatal Post-NeonatalPost-Neonatal
28 day28 day(0 day)(0 day) 1year1yearBirthBirth
Period of Infancy
InfancyInfancy
Stillbirth rate (per 1000 total births)
• For international comparison purposes, stillbirths are defined as third trimester fetal deaths (> or = 1000 grams or > or = 28 weeks).
• Total births : Total births is defined as the sum of live births and still births.
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1000
locality andyear same the
in births) stillbirths (live births Total•
localitygiven ain andyear
a during births still ofNumber
ratebirth Still x
Still birth ratio (per 1000 total births)
Number of fetal deaths of 28 weeks of gestation or more in certain year and locality per
1000 live births
1000locality andyear same in the births live ofNumber
localitygiven ain andyear
ain moreor gestation of weeks28 of deaths fetal ofNumber
ratiobirth Still
x
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It is expressed as the sum number of still births and early neonatal deaths (less than 7 days of life) per 1000 total births (still births plus live births).
X1000localityandyearsamethein )livebirthsand(StillbirthsTotal
localityandyearcertainindeathsneonatalearlyNo.ofsstillbirthNo.of
M.R.Perinatal
It the best indicator of Maternal and Child Health services
Perinatal Mortality Rate
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Under-5 mortality rate(per 1 000 live births)
Under-five mortality rate is the probability of a child born in a specific year or period dying before reaching the age of five.
In Saudi Arabia (2006) • both sexes 26 • female 23 • male 28
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1000
locality andyear same the
in births live ofnumber Total
localitygiven ain andyear a during age of years-5
underchildren among deaths ofnumber Total
ratemortality years-5under The
x
Child Mortality RatesChild Mortality Rates(deaths of children under age five per 1,000 live births)(deaths of children under age five per 1,000 live births)
183
86
13
57
48
54
11
0 50 100 150 200
Sub-Saharan Africa
Middle East/North Africa
South Asia
East Asia/Pacific
Central America/Caribbean
South America
Industrialized Countries
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Adult mortality rate (per 1000 population)
• Probability that a 15 year old person will die before reaching his/her 60th birthday.
• In Saudi Arabia (2006)• both sexes 178• female 136 male 205
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1000
area same andyear same in the
60-15between population ofnumber Total
area andyear certain ain
60-15between dying persons ofNumber
ratemortality Adult
x
Adult Mortality Rates(probability of death between ages 15 and 60)
39.70%
19.40%
23.50%
17.90%
14.80%
20.30%
9.70%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00%
Sub-Saharan Africa
Middle East/North Africa
South Asia
East Asia/Pacific
South America
Europe/Centtral Asia
Industrialized Countries
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Maternal mortality ratio (per 100 000 live births)
The number of maternal deaths per 100 000 live births during a specified time period, usually 1 year.
• In Saudi Arabia (2005)• MMR= 18
Maternal death is the death of a woman while pregnant or within 42 days after termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
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Maternal mortality ratio (per 100 000 live births)
100,000X
localityandyearsame theinbirths live of Number
localityandyeargivenain pregnancy
to relatedcauses to asigneddeaths Maternal of Number
ratiomortality Maternal
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Cause-specific mortality rate
• The number of deaths attributed to a specific
cause divided by the population at the midpoint
of the time period multiply by 100,000.
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100,000XlocalityandyearsameinpopulationyearmidEstimated
localityandyeargivenaincausespecificaofDeaths
Example of Cause-specific mortality rates
• Deaths due to tuberculosis (per 100 000 population) • In Saudi Arabia (2006) =5.0
100,000X
localityandyearsameinpopulationyearmidEstimated
localityandyearcertainainTBofdeathsofNo.
istuberculostodueratedeathSpecific
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Proportionate mortality rates
Defined as the number of deaths assigned to a specific
cause in a calendar year, divided by the total number of
deaths in that year, the quotient multiplied by 100
100x
locality andyear same in the
disease same thehaving cases ofnumber Total
localitygiven ain andyear ain
diseasecertain a from deaths ofnumber Total
ratefatality Case
Case fatality rate (Death to case ratio)
It reflects severity and virulence of diseasesIt reflects severity and virulence of diseases
Morbidity Rates
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Morbidity indicators are used to supplement mortality data.
The following morbidity parameters can be used as health indicators:
• a) Incidence rate• b) Prevalence rate• c) Disease Notification rates,…..
Morbidity Rates
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Incidence Rate
• Incidence measures the number of new cases of a disease (or other health-related phenomenon) that occur during a specified period of time in a population at risk
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Prevalence Rate
• Prevalence measures the number of cases (new and old) of the disease (or other health-related phenomenon) at a point or period in time.
• It measures the status of the disease in the population.
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3. Disability rates:
Health implies full range of daily activities, thus limitations in these activities are used as indicators of health status.
These indicators include:• a) Bed disability days• b) Work or school loss days during a certain period• c) limitation of daily activities as cooking, washing,
cleaning, dressing, etc.
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4. Nutritional indicators
Nutritional status is a positive health indicator.
These include:
• a) Anthropometric measurements of infants and preschool children (Height and weight,…
• c) Prevalence of low birth weight
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5. Health care delivery indicators
These reflect the equity of distribution of health resources in the country.
The frequently used indicators of health care delivery are:
• a) Doctor / population ratio• b) Population / bed ratio• c) Population / health center ratio
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6. Utilization rates
These show the extent of utilization of the health services or the actual coverage.
These rates are affected by availability and accessibility of health services as well as attitude of the population towards these services.
Examples of these indicators include:• a) Vaccination coverage• b) Antenatal visits• c) Utilization rates of contraceptives• d) Bed occupancy rates• e) Average length of stay in hospitals
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7. Social and mental health indicators
• These include Violence rates against women, child abuse, suicide, homicide, as well as drug abuse and smoking.
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8. Environmental indicators
These reflect the quality of physical, chemical, and biological environment.
The most useful of these are:• a) Percentage of houses supplied with safe water
supply• b) percentage of houses supplied with public
sewerage system• c) Air pollution indicators can also be used especially
in developed countries.
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9. Socioeconomic indicators
These are indirect measures of health. They are behind the changes of other health indicators. These include:
• a) Percent of illiteracy in the country, especially among young women.
• b) Rates of unemployment• c) National income per capita• d) Rate of natural of increase• e) Total dependency ratio
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10. Health policy indicators
The most important indicators are:• a) Adequacy of the total budget assigned to the
health activities.• b) Proportion of total health resources devoted
to basic and primary health care services in the community.
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11. Indicators of quality of life:
• This indicator measures not only how long an individual will live, but also the high quality of life during this period.
• There are many scales that measure the health related quality of life of he individual.
• E.g. Looking after physical health , Eating a balanced diet , Freedom from anxiety, Understanding right and wrong , Access to community places,….
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• Last JM, editor. Dictionary of epidemiology. 4th ed. New York: Oxford University Press; 2001
• Principles of EPIDEMIOLOGY in Public Health Practice Third Edition An Introduction to Applied Epidemiology and Biostatistics. Centers for Disease Control and Prevention (CDC)
Reference book & page number for the lecture resource
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