Indicators For Monitoring Child Health

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Indicators For Monitoring Child Health

  1. 1. Indicators for monitoring child health Core indicators Policy goal Indicator and Definition, measure, period and data source reason for use Reduce the Type 1 Indicator: Definition & Measure: Proportion of children in number of Child Status households experiencing the following: children living in Child poverty • Living in a household that has a household equivalent poverty. Reasons for use: Child income below R10 189 per annum (2006 value); poverty is associated • Living in a household without a refrigerator; with the widest range • Living in a household with neither a TV nor a radio. of insults to child Sources: Census and other household surveys (Statistics survival, health and South Africa); provincial poverty data. development, Period: Every 10 years including mortality. Notes: This measure is used in the Provincial Indices of Free download from www.hsrcpress.ac.za Appropriate for Multiple Deprivation (PIMD) developed by Noble, Babita national and et al. (2006). See Chapter 3 in this volume.1 international A PIMD for children (PIMDC) will be available once this reporting: State of the volume is published and should be seriously considered World’s Children; for these purposes as it will permit description of areas Millennium below provincial level and will take into account a range of Development Goals deprivations experienced by children in poverty. (MDGs). Accelerate implementation of the National Action Plan for HIV and AIDS Reduce HIV Type 1 Indicator: Definition & Measure: Proportion of sampled pregnant prevalence among Child Status women aged 15–24 years attending antenatal clinics who young people aged HIV prevalence in test positive for HIV. 15–24 years. 15–24-year age group. Source: Annual HIV antenatal seroprevalence survey Reason for use: (DoH) Measure of the Period: Annual prevalence of the disease in a high-risk age group. Type 1 Indicator: Definition & Measure: Number of HIV-positive pregnant Child Status children (<18 years) per 100 pregnant children. HIV prevalence in Source: Antenatal HIV seroprevalence survey (DoH) pregnant children. Period: Annual Reason for use: Measure of the prevalence of the disease in a high-risk group. core indicators for monitoring child health • 379
  2. 2. Policy goal Indicator and Definition, measure, period and data source reason for use Reduce the Type 1 Indicator: Definition: Children born to HIV-positive women who are incidence of HIV Child Status polymerase chain reaction (PCR) positive at 6 weeks of infection in Infant HIV incidence age in a given period. children. rate Measure: Proportion of children born to HIV-positive Reasons for use: women who are PCR positive at 6 weeks of age. Measure of an Source: Provincial Prevention of Mother to Child important cause of Transmission (PMTCT) Programme child morbidity. Period: Annual Expand treatment for infected children and their primary caregivers Increase the Type 4 Indicator: Definition & Measure: Number of newborns receiving PMTCT coverage Service Access prophylactic ART per 100 babies born to HIV-positive (to 95% by 2010). Antiretroviral therapy pregnant mothers. (ART) cover in Source: PMTCT surveillance (DoH) eligible newborns. Period: Annual Reasons for use: Free download from www.hsrcpress.ac.za Marker of health systems’ ability to prevent new HIV infections in children. Increase access to Type 4 Indicator: Definition & Measure: Number of children (aged 0–12 ART for children Service Access and 13–17 years) receiving HAART per 100 children (to reach 55 000 Highly active anti- eligible for HAART. children by 2009). retroviral therapy Source: ART roll-out surveillance (DoH) (HAART) cover in Period: Annual eligible children aged 0–12 and 13–17 years. Reasons for use: Marker of health systems’ ability to manage symptomatic HIV infection/AIDS in children. Increase access to Type 4 Indicator: Definition & Measure: Number of adults (>18 years) ART for adults – Service Access receiving HAART per 100 adults eligible for HAART in particular for HAART cover in (stratified by gender and into adults with children as far as caregivers with eligible adults. possible). children (to reach Reasons for use: Adult Source: ART roll-out surveillance (DoH) 450 000 by 2009). access to ART will Period: Annual reduce orphaning. Marker of health systems’ ability to manage symptomatic HIV infection/AIDS in adults. 380 • monitoring child well-being
  3. 3. Policy goal Indicator and Definition, measure, period and data source reason for use Reduce child mortality Reduce the Type 1 Indicator: Definition: Deaths <28 days of age per 1 000 live births in number of infants Child Status same calendar year. dying in the first Neonatal mortality Measure: Proportion of deaths <28 days of age in same 28 days of life. rate calendar year. Reason for use: Sources: Stats SA; South African Demographic and Health Measure of care and Survey (SADHS); Maternal Registry. support provided to Period: Annual newborns and young infants. Reduce the Type 1 Indicator: Definition: Diarrhoea is defined as 3 or more watery incidence of Child Status stools in 24 hours, but any episode diagnosed and/or diarrhoeal disease Proportion of treated as diarrhoea after an interview with the adult in children under diarrhoea in <5s at accompanying the child should be counted. Free download from www.hsrcpress.ac.za 5 years. health facilities. Measure: Children <5 years presenting to health facilities Reason for use: with diarrhoea per 1 000 <5-year-old attendances in a Measure of an given period. important cause of Sources: District Health Information System (DHIS); child morbidity. SADHS. Period: Monthly Reduce the Type1 Indicator: Definition & Measure: Children <5 years presenting to incidence of Child Status health facilities with acute lower respiratory tract respiratory disease Proportion of acute infections (pneumonia) per 1000 <5-year-old attendances in children under 5 lower respiratory in a given period. years. tract infections Sources: DHIS; SADHS. (pneumonia) in <5s Period: Monthly at health facilities. Reason for use: Measure of important cause of child morbidity. Vaccinate 90% of Type 5 Indicator: Definition: Children <1 year who received measles first children against Service Quality dose. measles. Measles 1st dose Measure: Proportion of children <1 year who received coverage. measles first dose per population of infants eligible for the Reason for use: vaccine (Denominator: Mid-year estimate of target Measure of quality of population [<1 year olds]). health service Source: DHIS (immunisation). Period: Annual core indicators for monitoring child health • 381
  4. 4. Policy goal Indicator and Definition, measure, period and data source reason for use Combat non-communicable diseases Increase the Type 1 Indicator: Definition: Children at age 6 with no caries. percentage of Child Status Measure: Proportion of children at age 6 with no caries. children at age 6 Children at age 6 Source: DHS Oral Health Survey years who are free with no caries. Period: Annual of caries (to 50% Reasons for use: by 2010). Measure of oral health. Reduce the mean Type 1 Indicator: Definition: Children with DMFT at 12 years. number of Child Status Measure: Proportion of children with DMFT at 12 years. decayed, missing Mean number of Source: DHS Oral Health Survey and filled teeth DMFT in children Period: Annual (DMFT) at age at age 12 years. 12 years (to 1 by Reasons for use: 2010). Measure of oral Free download from www.hsrcpress.ac.za health. Improve the nutritional status of children Reduce the Type 1 Indicator: Definition & Measure: Children under 5 years with more prevalence of Child Status than 2 standard deviations below the median height for stunting among Stunting rate age reference value in a defined population of <5s in a children less than Reasons for use: given period (per 100 children in that population in the 5 years. Measure of same period). nutritional status of Sources: Provincial and national departments of Health children. May indicate (DoH); SADHS; Food Consumption Survey; periodic economic hardship, nutrition surveys. infection or neglect. Period: Annual To identify children in Early Childhood Development services to be monitored for follow-up action. Appropriate for national and international reporting: State of the World’s Children; Convention on the Rights of the Child; United Nations Children’s Fund; Multiple Indicator Cluster Survey; MDGs. 382 • monitoring child well-being
  5. 5. Policy goal Indicator and Definition, measure, period and data source reason for use Reduce the Type 1 Indicator: Definition & Measure: Proportion of children more than prevalence of Child Status 2 standard deviations below the median weight for height wasting among Wasting rate reference value in a defined population of under-5s per children under Reasons for use: 100 children under the age of 5 years in that population in 5 years. Measure of the same period. nutritional status of Sources: Provincial and national DoH; SADHS; Food children. Consumption Survey; periodic nutrition surveys. Period: Annual Reduce childhood Type 1 Indicator: Definitions: 1: Overweight: Children with weight for overweight and Child Status height over 2 standard deviations from the norm obesity. Overweight and (reference population median). obesity rates 2: Obesity: Children with a body mass index (body mass Reasons for use: in kg divided by the square of the height in m) equal to Measure of or more than 30kg/m2. nutritional status of Measure: Children at school entry who are overweight or Free download from www.hsrcpress.ac.za children. obese per 100 children in the relevant age group in that population in the same period; optionally also at 10 and 15 years. Sources: Provincial and national DoH; SADHS; Food Consumption Survey; periodic nutrition surveys. Period: Annual Reduce severe Type 1 Indicator: Definition & Measure: Children aged 0–5 years who weigh malnutrition in Child Status below 60% expected weight for age (new cases that children under 5 Severe malnutrition month/year) per 1 000 children in the target age group. years. rate Source: DHIS Reasons for use: Period: Annual Measure of nutritional status of children. Promote Type 1 Indicator: Definition: Exclusive breastfeeding rate: Percentage of breastfeeding. Child Status living children receiving only breast milk from birth to Breastfeeding: various ages. 1. Initiation rates Measures: 1. Proportion of newborn children exclusively 2. Exclusive breastfed at hospital discharge or immediately after birth. breastfeeding rate 2. Proportion of 6-month-old children receiving only 3. Duration of breast milk or expressed breast milk. breastfeeding 3. Proportion of 12-month-old children receiving Reasons for use: breastfeeding at 12 months. Measure of uptake Each of above per 100 live births in the same period. and success of (Denominator for all: Live births in the same period.) breastfeeding. Sources: SADHS; periodic nutrition surveys. Period: Annual core indicators for monitoring child health • 383
  6. 6. Policy goal Indicator and Definition, measure, period and data source reason for use Reduce the Type 1 Indicator: Definition & Measure: Number of children <5 years of prevalence of iron Child Status age with evidence of iron deficiency anaemia in a defined deficiency among Iron deficiency rate population per 100 children under the age of 5 years in children under Reasons for use: that population in the same period. 5 years. Measure of Sources: SADHS; periodic nutrition surveys. nutritional status and Period: Annual dietary intake. Reduce the Type 1 Indicator: Definition & Measure: Number of children <5 years of prevalence of Child Status age with biochemical evidence of vitamin A deficiency in a vitamin A Vitamin A deficiency defined population and a given period per 100 children deficiency among rate under the age of 5 years in that population in the same children under Reasons for use: period. 5 years. Measure of Sources: SADHS; periodic nutrition surveys. nutritional status and Period: Annual dietary intake. Free download from www.hsrcpress.ac.za Reduce the Type 1 Indicator: Definition & Measure: Number of children <5 years of prevalence of Child Status age with evidence of iodine deficiency in a defined iodine deficiency Iodine deficiency rate population and a given period per 100 children under the among children Reasons for use: age of 5 years in that population in the same period. under 5 years. Measure of Sources: SADHS; periodic nutrition surveys. nutritional status and Period: Annual dietary intake. Reduce the Type 1 Indicator: Definition & Measure: Number of children born with a prevalence of low Child Status birth weight <2.5 kg in a defined population and in a birth weight Low birth weight rate given period per 100 live births in the same population (<2.5 kg). Reasons for use: and period. Indicator of the Sources: Stats SA; Maternal Registry; SADHS; periodic socio-economic surveys; hospital midwife obstetric unit records; Perinatal status and health of Problem Identification Programme (PPIP). the community in Period: Annual general. Also a measure of maternal health during pregnancy. 384 • monitoring child well-being
  7. 7. Policy goal Indicator and Definition, measure, period and data source reason for use To improve youth and adolescent health Reduce proportion Type 1 Indicator: Definition & Measure: Proportion of all live births during of births Child Status a specific year which are to women who are between 15 attributable to girls Teenage birth rate and 20 years of age, irrespective of marital status per 100 aged 15–19 years. Reason for use: births among women of all ages. Teenage pregnancy Source: SADHS; Maternal Registry. disrupts the life of a Period: Annual child and her offspring. Reduce the Type 1 Indicator: Definition: Women aged 13–19 who are mothers or who number of teenage Child Status have ever been pregnant. The number of women who are pregnancies. Teenage pregnancy mothers at the time of the survey is a more restrictive rate definition. Reason for use: Measure: Number of pregnancies in females aged 13–19 Free download from www.hsrcpress.ac.za Teenage pregnancy years per 1 000 females aged 13–19 years in the same disrupts the life of a period. child and her Source: SADHS offspring. Period: Annual Improve clinical management and care at all levels of the healthcare delivery system Promote Type 5 Indicator: Definition & Measure: Number of accredited baby- breastfeeding by Service Quality friendly hospitals and maternity facilities per 100 health accrediting Baby-friendly facilities with maternity beds. maternity units hospitals and Source: DoH: Baby-friendly hospital initiative assessments with ‘baby- maternity facilities Period: Annual friendly’ status Reason for use: (60% by 2009). Measures ability of midwife obstetric units and hospitals to promote successful breastfeeding. Implement the Type 5 Indicator: Definition & Measure: Number of facilities with at least Integrated Service Quality 60% of their staff who are IMCI trained in a given period Management of Primary healthcare per 100 primary healthcare facilities. Childhood Illness facilities equipped to Source: DoH national IMCI co-ordinator statistics (IMCI) strategy implement IMCI. Period: Annual (90% of facilities Reason for use: IMCI are saturated – i.e. is the approach >60% coverage – chosen by the health with IMCI trained department to deliver healthcare primary care to providers by 2009). children <5. core indicators for monitoring child health • 385
  8. 8. Policy goal Indicator and Definition, measure, period and data source reason for use Improve the use of Type 5 Indicator: Definition & Measure: Number of children correctly drugs in children Service Quality managed by primary health-care nurses in spot aged under 5 years Sick children assessments at selected primary health-care clinics in a in primary care receiving drug given period per 100 nurses evaluated for prescribing facilities. management that practices during the same period. conforms to IMCI Sources: DoH IMCI health facility survey; supervisory guidelines. visit reports. Reason for use: IMCI Period: Annual is the approach chosen by the health department to deliver primary care to children <5. Increase the Type 5 Indicator: Definition & Measure: Number of clinics which are youth number of PHC Service Quality friendly per 100 clinics. Free download from www.hsrcpress.ac.za clinics offering Youth-friendly clinic Source: DoH provincial reports youth-friendly cover Period: Annual services (to 100% Reason for use: by 2009). Youth-friendly clinics have been established to promote access to, and utilisation by, youth of appropriate health services. Increase Type 4 Indicator: Definition & Measure: Number of designated facilities availability of Service Access providing TOP in the public sector per 100 designated termination of TOP facility cover TOP facilities. pregnancy (TOP) Reason for use: Source: DoH TOP statistics services at While facilities have Period: Annual community health TOP-designated centres (to 50% of status, they often do all centres by not provide this 2009). service. Increase the Type 5 Indicator: Definition & Measure: Percentage of districts rendering a proportion of Service Quality basic genetic service as part of the comprehensive primary districts with at Genetics services healthcare service. least one cover Source: DoH provincial reports genetically trained Reason for use: Period: Annual healthcare provider Genetically trained (to 70% of districts staff required to by 2009). provide basic genetic services. 386 • monitoring child well-being
  9. 9. Policy goal Indicator and Definition, measure, period and data source reason for use Increase the Type 5 Indicator: Definition: Sites are required to report on Neural Tube proportion of Service Quality Defects, Albinism, Down Syndrome and cleft lip and districts Compliance with palate birth defects. implementing the birth defect Measure: Proportion of sites that report birth defects. new standardised surveillance policy. Source: DoH Birth Defects Surveillance System birth defects data Reason for use: Period: Annual collection tool (to Measure of success of 50% by 2009). the surveillance system. Note: 1 See also <http://www.statssa.gov.za/census01/html/C2001Deprivation.asp>. Additional indicators Free download from www.hsrcpress.ac.za Policy goal Indicator and Definition, measure, period and data source reason for use Reduce child mortality Reduce the Type 1 Indicator: Definition & Measure: The infant mortality rate is the number of infants Child Status number of deaths of infants <1 year of age, in a given dying in the first Infant mortality rate period of time, per 1 000 live births in the same period. year of life. Reasons for use: Sources: Stats SA; Health and Demographic Surveillance Important System. Presently available at national and provincial level determinants of only. infant mortality are Period: Annual access to safe water, Notes on data collection: Unless the birth registration sanitation, nutrition system is complete, infant deaths in particular may not be and the level of registered, which may seriously bias the result. mothers’ education. Retrospective questions about the survival of children ever Determining factors born included in censuses and surveys, and analysed using within the health indirect estimation procedures, are considered to be system include the reliable sources. quality of maternal Surveys using maternity histories, in which women are care, availability of asked to give the date of birth and age of death (if vaccines given in the applicable) of each live-born child, are used in many first year of life, and household surveys, but care must be taken to avoid age effective referral misreporting and to be sure that there is a complete report systems. of infant deaths. Proxy measure of determinants of survival, including socio-economic and health service status of a country. additional indicators for monitoring child health • 387
  10. 10. Policy goal Indicator and Definition, measure, period and data source reason for use Reduce the Type 1 Indicator: Definition: The number of perinatal deaths per 1 000 number of Child Status births. stillbirths and early Perinatal mortality Measure: Sum of stillbirths (≥28 weeks gestation or 1 000g neonatal deaths. rate or more) + early neonatal deaths (≤7 days of age) per Reason for use: 1 000 live births + stillbirths in same calendar year. Measure of antenatal Note: Current World Health Organisation definition of care as well as perinatal mortality rate is different from the definition neonatal services. used in South Africa, being the number of deaths from 24 weeks gestation/500g to 28 days neonatal life. Sources: Stats SA; SADHS; DHIS; hospital data; PPIP; Maternal Registry. Presently available at national and provincial level only. Period: Annual Free download from www.hsrcpress.ac.za 388 • monitoring child well-being
  11. 11. Policy goal Indicator and Definition, measure, period and data source reason for use Reduce the Type 1 Indicator: Definition: The <5 mortality rate is the probability of number of Child Status children dying between birth and their fifth birthday, children dying Under-5 mortality expressed per 1 000 children born alive. in the first 5 years rate (U5MR) Measure: Number of deaths between birth and exactly of life. Reasons for use: 5 years of age per 1 000 live births in same calendar year. Principal indicator of Sources: Stats SA; SADHS. Presently available at national human and economic and provincial level only. progress used by Period: Annual UNICEF. U5MR Notes on data collection: Complete vital registration measures an end systems, sample registration systems and demographic result of the surveillance systems, where available, provide good development process estimates of child mortality. rather than an ‘input’ Retrospective questions about the survival of previous such as per capita children from censuses and surveys, analysed using calorie availability. indirect estimation techniques, are considered reliable U5MR reflects a wide sources. Free download from www.hsrcpress.ac.za variety of inputs: the Demographic surveys using maternity histories, in which nutritional health and women are asked to give the date of birth and age of death the health knowledge (if applicable) of each live-born child, are used in many of mothers; the level household surveys. of immunisation and The preceding birth technique can be used in antenatal ORT use; the clinics, maternity clinics, and at the time of immunisation, availability of to provide a useful recent estimate of the probability of maternal and child dying by age 2 years at a local level. health services (including prenatal care); income and food availability in the family; the availability of clean water and sanitation; and the overall safety of the child’s environment. The U5MR is less susceptible to averages, it is more difficult for a wealthy minority to affect a nation’s U5MR, and it therefore presents a more accurate picture of the health status of the majority of children. additional indicators for monitoring child health • 389
  12. 12. Policy goal Indicator and Definition, measure, period and data source reason for use Reduce the Type 1 Indicator: Definition: Mortality from a specific cause in children number of Child Status aged <5 years. children dying of Cause-specific Measure: Dependent on the specific cause, but similar to preventable causes mortality rates <5 mortality rate. in the first 5 years Reasons for use: Sources: Stats SA; SADHS. Presently available at national of life. Measurement of and provincial level only. cause-specific Period: Annual mortality is needed: • To establish the relative public health importance of the different causes of death; • To evaluate trends over time, especially as a Free download from www.hsrcpress.ac.za method of evaluating the probable impact of intervention programmes; • To investigate the circumstances surrounding the deaths of children for devising effective actions to decrease mortality; • To investigate reasons for differing rates of infant and child mortality among geographic areas, and to evaluate the effectiveness of specific public health interventions in controlled settings. 390 • monitoring child well-being
  13. 13. Policy goal Indicator and Definition, measure, period and data source reason for use Combat communicable diseases and reduce mortality and morbidity Eradicate polio (by Type 1 Indicator: Definition & Measure: Number of confirmed cases of 2008). Child Status polio in given period.. Declared polio free. Sources: DoH disease notification system; polio Reason for use: surveillance system; National Health Laboratory service. Confirmation of Period: Quarterly eradication of polio. Eliminate measles Type 1 Indicator: Definition & Measure: Number of confirmed cases of (by 2008). Child Status measles in given period. Annual confirmed Sources: DoH disease notification system; measles cases of measles. surveillance system; National Health Laboratory service. Reason for use: Period: Quarterly Confirmation of eradication of measles. Free download from www.hsrcpress.ac.za Eliminate neonatal Type 1 Indicator: Definition & Measure: Number of confirmed cases of tetanus. Child Status tetanus during the first 28 days of life in a given period Annual confirmed and defined population. cases of neonatal Source: DoH disease notification system tetanus. Period: Quarterly Reason for use: Confirmation of eradication of tetanus. Improve the nutritional status of children Reduce the Type 1 Indicator: Definition & Measure: Number of children more than 2 prevalence of Child Status standard deviations below the median weight for age underweight Underweight rate. reference value per 100 children under the age of 5 years among children Reason for use: in that population in the same period. less than 5 years Measure of Sources: SADHS; DHIS; periodic nutrition surveys. (to <4.7% by nutritional status of Period: Annual 2015). children. MDG target. additional indicators for monitoring child health • 391
  14. 14. Policy goal Indicator and Definition, measure, period and data source reason for use Improve clinical management and care at all levels of the healthcare delivery system Increase the Type 4 & 5 Definition: Fully immunised children have received all the number of health Indicators: Service Expanded Programme of Immunisation (EPI) vaccines by districts with more Access and Service the age of 5 years. than 90% full Quality Measure: The number of children 0–5 years inclusive who immunisation Proportion of are fully immunised, divided by the population <5 years coverage (to 95% children <5 years (based on mid-year estimates of number of children of districts by who have been fully <5 years and number of required doses for each vaccine). 2009). vaccinated. Source: DHIS Reason for use: Period: Monthly; annual. Measure of coverage and success of immunisation programme and of health system Free download from www.hsrcpress.ac.za functioning. 392 • monitoring child well-being

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