Whs2012 indicator compendium

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Whs2012 indicator compendium

  1. 1. World Health Statistics 2012IIndicator compendium
  2. 2. World Health Statistics 2012
  3. 3. World Health Statistics 2012Page 2 / 263 Printed 7/3/2012 5:15:06 PMTable of Contents• Density of environment and public health workers (per 10 000 population)• Density of dentistry personnel (per 10 000 population)• Density of nursing and midwifery personnel (per 10 000 population)• Density of physicians (per 10 000 population)• Density of pharmaceutical personnel (per 10 000 population)• Density of computed tomography units (per million population)• Crude birth rate (per 1000 population)• Contraceptive prevalence• Deaths due to HIV/AIDS (per 100 000 population)• Density of community health workers (per 10 000 population)• Deaths due to malaria (per 100 000 population)• Density psychiatrists• Density of radiotherapy units (per million population)• Diphtheria tetanus toxoid and pertussis (DTP3) immunization coverage among 1-year-olds (%)• Distribution of causes of death among children aged <5 years (%)• Civil registration coverage of cause-of-death (%)• Antiretroviral therapy coverage among HIV-infected pregnant women for PMTCT (%)• Antenatal care coverage - at least one visit (%)• Antiretroviral therapy coverage among people with advanced HIV infection (%)• Births by caesarean section (%)• Births attended by skilled health personnel (%)• Antenatal care coverage - at least four visits (%)• Adult mortality rate (probability of dying between 15 to 60 years per 1000 population)• Adolescent fertility rate (per 1000 women)• Age-standardized mortality rate (per 100 000 population)• Annual population growth rate (%)• Children aged <5 years with diarrhoea receiving oral rehydration therapy (%)• Children aged <5 years with ARI symptoms taken to facility (%)• Children aged <5 years with fever who received treatment with any antimalarial (%)• Civil registration coverage of births (%)• Children aged 6-59 months who received vitamin A supplementation (%)• Children aged <5 years with ARI symptoms receiving antibiotics (%)• Children aged <5 years overweight (%)• Cellular subscribers (per 100 population)• Children aged <5 years sleeping under insecticide-treated nets (%)• Children aged <5 years underweight (%)• Children aged <5 years stunted (%)
  4. 4. World Health Statistics 2012Page 3 / 263 Printed 7/3/2012 5:15:06 PM• Number of dentistry personnel• Number of community health workers• Number of environment and public health workers• Number of pharmaceutical personnel• Number of nursing and midwifery personnel• Neonatal mortality rate (per 1000 live births)• Most recent census year• Neonates protected at birth against neonatal tetanus (PAB) (%)• Notified cases of tuberculosis• Net primary school enrolment rate (%)• Number of physicians• Number of reported cases of leprosy (Number of newly detected cases of leprosy)• Number of reported cases of japanese encephalitis• Number of reported cases of measles• Number of reported cases of cholera• Number of psychiatrists• Number of reported cases of congenital rubella syndrome• Number of reported cases of H5N1 influenza• Number of reported cases of diphtheria• External resources for health as a percentage of total expenditure on health• Exclusive breastfeeding under 6 months (%)• General government expenditure on health as a percentage of total expenditure on health• Gross national income per capita (PPP int. $)• General government expenditure on health as a percentage of total government expenditure• Estimated deaths due to tuberculosis, excluding HIV (per 100 000 population)• Distribution of years of life lost by broader causes (%)• Estimated incidence of tuberculosis (per 100 000 population)• Estimated prevalence of tuberculosis (per 100 000 population)• Estimated pregnant women living with HIV who received antiretroviral medicine for preventingmother-to-child transmission (%)• Hepatitis B (HepB3) immunization coverage among 1-year-olds (%)• Low-birth-weight newborns (%)• Maternal mortality ratio (per 100 000 live births)• Median availability of selected generic medicines (%)• Measles (MCV) immunization coverage among 1-year-olds (%)• HIV prevalence among adults aged 15-49 years (%)• Hib (Hib3) immunization coverage among 1-year-olds (%)• Hospital beds (per 10 000 population)• Life expectancy at birth• Life expectancy at age 60 (years)
  5. 5. World Health Statistics 2012Page 4 / 263 Printed 7/3/2012 5:15:06 PM• Private expenditure on health as a percentage of total expenditure on health• Private prepaid plans as a percentage of private expenditure on health• Rate of psychiatric beds• Proportion of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS (%)• Population using solid fuels• Population using improved sanitation facilities (%)• Postnatal care visit within two days of childbirth (%)• Prevalence of current tobacco use among adolescents aged 13-15 years (%)• Prevalence of condom use by adults (15-49 years) at higher-risk sex (%)• Social security expenditure on health as a percentage of general government expenditure on health• Unmet need for family planning (%)• Total expenditure on health as a percentage of gross domestic product• Stillbirth rate (per 1000 total births)• Total fertility rate (per woman)• Under-five mortality rate (probability of dying by age 5 per 1000 live births)• Tuberculosis case detection rate for new smear-positive cases (%)• Number of reported cases of total tetanus• Number of reported cases of rubella• Number of reported cases of yellow fever• Number of suspected meningitis cases reported• Number of reported confirmed cases of malaria• Number of reported cases of neonatal tetanus• Number of reported cases of mumps• Number of reported cases of pertussis• Number of reported cases of poliomyelitis• Number of reported cases of plague• Out-of-pocket expenditure as a percentage of private expenditure on health• Population median age (years)• Population living on <$1 (PPP int. $) a day (%)• Population proportion over 60 (%)• Population using improved drinking-water sources (%)• Population proportion under 15 (%)• Per capita government expenditure on health at average exchange rate (US$)• Per capita government expenditure on health (PPP int. $)• Per capita total expenditure on health (PPP int. $)• Population living in urban areas (%)• Per capita total expenditure on health at average exchange rate (US$)
  6. 6. World Health Statistics 2012Page 5 / 263 Printed 7/3/2012 5:15:06 PM• Population (in thousands) total• Case detection rate for all forms of tuberculosis• Infant mortality rate (probability of dying between birth and age 1 per 1000 live births)• prevalence of raised fasting blood glucose• Crude death rate (per 100,000 population)
  7. 7. World Health Statistics 2012Page 6 / 263 Printed 7/3/2012 5:15:06 PMAdolescent fertility rate (per 1000 women)Data Type Representation RateTopic Demographic and socio-economic statisticsISO Health IndicatorsFrameworkIndicator name Adolescent fertility rate (per 1000 women)Name abbreviated Adolescent fertility rateRationale The adolescent birth rate, technically known as the age-specific fertility rateprovides a basic measure of reproductive health focusing on a vulnerable groupof adolescent women. There is substantial agreement in the literature thatwomen who become pregnant and give birth very early in their reproductivelives are subject to higher risks of complications or even death duringpregnancy and birth and their children are also more vulnerable. Therefore,preventing births very early in a woman’s life is an important measure toimprove maternal health and reduce infant mortality. Furthermore, womenhaving children at an early age experience a curtailment of their opportunitiesfor socio-economic improvement, particularly because young mothers areunlikely to keep on studying and, if they need to work, may find it especiallydifficult to combine family and work responsibilities. The adolescent birth rateprovides also indirect evidence on access to reproductive health since theyouth, and in particular unmarried adolescent women, often experiencedifficulties in access to reproductive health care.Other possible data sources Population censusHousehold surveysDefinition The annual number of births to women aged 15-19 years per 1,000 women inthat age group.It is also referred to as the age-specific fertility rate for women aged 15-19.Associated termsPreferred data sources Civil registration with complete coverageIndicator ID 3
  8. 8. World Health Statistics 2012Page 7 / 263 Printed 7/3/2012 5:15:06 PMLimitations For civil registration, rates are subject to limitations depending on thecompleteness of birth registration, the treatment of infants born alive but deadbefore registration or within the first 24 hours of life, the quality of the reportedinformation relating to age of the mother, and the inclusion of births fromprevious periods. The population estimates may suffer from limitationsconnected to age misreporting and coverage.For survey and census data, the main limitations concern age misreporting,birth omissions, misreporting the date of birth of the child, and samplingvariability in the case of surveys.(http://mdgs.un.org/unsd/mdg/Metadata.aspx, accessed 19 October 2009)Expected frequency of datacollectionExpected frequency of datadisseminationAnnualM&E Framework ImpactMethod of estimation The United Nations Population Division compiles and updates data onadolescent fertility rate for MDG monitoring. Estimates based on civilregistration are provided when the country reports at least 90 per centcoverage and when there is reasonable agreement between civil registrationestimates and survey estimates. Survey estimates are only provided whenthere is no reliable civil registration. Given the restrictions of the UN MDGdatabase, only one source is provided by year and country. In such casesprecedence is given to the survey programme conducted most frequently at thecountry level, other survey programmes using retrospective birth histories,census and other surveys in that order.(http://mdgs.un.org/unsd/mdg/Metadata.aspx, accessed 19 October 2009)Method of measurement The adolescent birth rate is generally computed as a ratio. The numerator is thenumber of live births to women 15 to 19 years of age, and the denominator anestimate of exposure to childbearing by women 15 to 19 years of age. Thenumerator and the denominator are calculated differently for civil registration,survey and census data.(a) In the case of civil registration the numerator is the registered number oflive-births born to women 15 to 19 years of age during a given year, and thedenominator is the estimated or enumerated population of women aged 15 to19.(b) In the case of survey data, the adolescent birth rate is generally computedbased on retrospective birth histories. The numerator refers to births to womenthat were 15 to 19 years of age at the time of the birth during a referenceperiod before the interview, and the denominator to person-years lived betweenthe ages of 15 and 19 by the interviewed women during the same referenceperiod. Whenever possible, the reference period corresponds to the five yearspreceding the survey. The reported observation year corresponds to the middleof the reference period. For some surveys, no retrospective birth histories areavailable and the estimate is based on the date of last birth or the number ofbirths in the 12 months preceding the survey.(c) In the case of census data, the adolescent birth rate is generally computedbased on the date of last birth or the number of births in the 12 monthspreceding the enumeration. The census provides both the numerator and thedenominator for the rates. In some cases, the rates based on censuses areadjusted for underregistration based on indirect methods of estimation. Forsome countries with no other reliable data, the own-children method of indirectestimation provides estimates of the adolescent birth rate for a number of yearsbefore the census.(http://mdgs.un.org/unsd/mdg/Metadata.aspx, accessed 19 October 2009)Method of estimation of globaland regional aggregatesGlobal and regional estimates are based on population-weighted averages usingthe number of women aged 15-19 years as the weight. They are presented onlyif available data cover at least 50% of total number of women aged 15-19 yearsin the regional or global groupings.Unit MultiplierUnit of Measure Births per 1000 women in the respective age groupDisaggregation
  9. 9. World Health Statistics 2012Page 8 / 263 Printed 7/3/2012 5:15:06 PMComments The adolescent birth rate is commonly reported as the age-specific fertility ratefor ages 15 to 19 in the context of calculation of total fertility estimates. Arelated measure is the proportion of adolescent fertility measured as thepercentage of total fertility contributed by women aged 15-19.(http://mdgs.un.org/unsd/mdg/Metadata.aspx, accessed 19 October 2009)Contact PersonThe official United Nations site for MDG indicatorsLinks Manual X: Indirect Techniques for Demographic Estimation (United Nations,1983)Handbook on the Collection of Fertility and Mortality Data (United Nations,2004)
  10. 10. World Health Statistics 2012Page 9 / 263 Printed 7/3/2012 5:15:06 PMAdult mortality rate (probability of dying between 15 to 60 years per1000 population)Method of estimation of globaland regional aggregatesThe numbers of deaths estimated from life table and population by age groupsare aggregated by relevant region in order to compute age specific mortalityrates, then the adult mortality rate.Disaggregation SexTopic Health statusISO Health IndicatorsFrameworkRationale Disease burden from non-communicable diseases among adults - the mosteconomically productive age span - is rapidly increasing in developing countriesdue to ageing and health transitions. Therefore, the level of adult mortality isbecoming an important indicator for the comprehensive assessment of themortality pattern in a population.Data Type Representation RateM&E Framework ImpactIndicator name Adult mortality rate (probability of dying between 15 to 60 years per 1000population)Name abbreviated Adult mortality rateDefinition Probability that a 15 year old person will die before reaching his/her 60thbirthday.The probability of dying between the ages of 15 and 60 years (per 1 000population) per year among a hypothetical cohort of 100 000 people that wouldexperience the age-specific mortality rate of the reporting year.Sample or sentinel registration systemsMethod of measurement Civil or sample registration: Mortality by age and sex are used to calculate agespecific rates.Census: Mortality by age and sex tabulated from questions on recent deathsthat occurred in the household during a given period preceding the census(usually 12 months).Census or surveys: Direct or indirect methods provide adult mortality ratesbased on information on survival of parents or siblings.Method of estimation Empirical data from different sources are consolidated to obtain estimates ofthe level and trend in adult mortality by fitting a curve to the observedmortality points. However, to obtain the best possible estimates, judgementneeds to be made on data quality and how representative it is of thepopulation. Recent statistics based on data availability in most countries arepoint estimates dated by at least 3-4 years which need to be projected forwardin order to obtain estimates of adult mortality for the current year.In case of inadequate sources of age-specific mortality rates, life tables arederived from estimated under-5 mortality rates using a modified logit system, amodel developed by WHO to which a global standard is applied.Predominant type of statistics: predictedPopulation censusAssociated terms Life table : A set of tabulations that describe the probability of dying, the deathrate and the number of survivors for each age or age group. Accordingly, lifeexpectancy at birth and adult mortality rates are outputs of a life table.Preferred data sources Civil registration with complete coverageOther possible data sources Household surveysIndicator ID 64
  11. 11. World Health Statistics 2012Page 10 / 263 Printed 7/3/2012 5:15:06 PMLimitations There is a dearth of data on adult mortality, notably in low income countries.Methods to estimate adult mortality from censuses and surveys areretrospective and possibly subject to considerable measurement error.Expected frequency of datacollectionAnnualExpected frequency of datadisseminationAnnualLinks Methods for estimating adult mortality (UN Population Division, 2002)Contact PersonCommentsWHO Mortality DatabaseWealth : Wealth quintileEducation levelDisaggregation Location (urban/rural)Boundaries : Administrative regionsUnit MultiplierUnit of Measure Deaths per 1000 populationBoundaries : Health regions
  12. 12. World Health Statistics 2012Page 11 / 263 Printed 7/3/2012 5:15:06 PMAge-standardized mortality rate (per 100 000 population)Rationale <p>The numbers of deaths per 100 000 population are influenced by the agedistribution of the population. Two populations with the same age-specificmortality rates for a particular cause of death will have different overall deathrates if the age distributions of their populations are different. Age-standardizedmortality rates adjust for differences in the age distribution of the population byapplying the observed age-specific mortality rates for each population to astandard population.</p>ISO Health IndicatorsFrameworkAssociated terms WHO Standard Population : The WHO World Standard Population was based onthe average world population structure for the period 2000-2025 as assessedevery two years by the United Nations Population Division for each country byage and sex. Estimates from the UN Population Division 1998 assessment(being the latest one at the time the WHO Standard Population was chosen)based on population censuses and other demographic sources, adjusted forenumeration errors were used. The use of an average world population as wellas a time series of observations removes the effects of historical events such aswars and famine on population age composition. WHO Standard Population isdefined to reflect the average age structure of the worlds population over thenext generation, from the year 2000 to 2025.( http://www.who.int/healthinfo/paper31.pdf )Definition <p>The age-standardized mortality rate is a weighted average of the age-specific mortality rates per 100 000 persons, where the weights are theproportions of persons in the corresponding age groups of the WHO standardpopulation.</p>Topic Health statusIndicator name Age-standardized mortality rate (per 100 000 population)Data Type Representation RateName abbreviated Age-standardized mortality rate (per 100 000 population)Surveillance systemsSpecial studiesMethod of estimation <p>Life tables specifying all-cause mortality rates by age and sex for WHOMember States are developed from available death registration data, sampleregistration systems (India, China) and data on child and adult mortality fromcensuses and surveys.</p> <p>&nbsp;</p> <p>Cause-of-deathdistributions&nbsp;are estimated from death registration data, and data frompopulation-based epidemiological studies, disease registers and notificationssystems for selected specific causes of death. Causes of death for populationswithout useable death-registration data were estimated using cause-of-deathmodels together with data from population-based epidemiological studies,disease registers and notifications systems for 21 specific causes of death.</p>Method of measurement <p><span style="font-size: 10pt; color: black; font-family: Arial;">Data ondeaths by cause, age and sex collected using national death registrationsystems or sample registration systems</span></p>Sample or sentinel registration systemsOther possible data sources Civil registration with complete coveragePreferred data sources Vital registration with complete coverage and medical certification of cause ofdeathPopulation censusHousehold surveysIndicator ID 78
  13. 13. World Health Statistics 2012Page 12 / 263 Printed 7/3/2012 5:15:06 PMCounting the dead and what they died from: an assessment of the global statusof cause of death data (Mathers et al, 2005)Global burden of disease and risk factors (Lopez et al, 2006)Links Global Burden of Disease (WHO website)Age Standardization of Rates: A New WHO Standard (WHO, 2001)Global Burden of Disease (GBD): 2002 estimates (WHO)Comments <p>Uncertainty in estimated all-cause mortality rates ranges from around&plusmn;1% for high-income countries to &plusmn;15&ndash;20% for sub-Saharan Africa, reflecting large differences in the availability and quality of dataon mortality, particularly for adult mortality. Uncertainty ranges are generallylarger for estimates of death rates from specific diseases. For example, therelative uncertainty for death rates from ischaemic heart disease ranges fromaround &plusmn;12% for high-income countries to &plusmn;25&ndash;35% forsub-Saharan Africa. The relatively large uncertainty for high-income countriesreflects a combination of uncertainty in overall mortality levels, in cause-of-death assignment, and in the attribution of deaths coded to ill-definedcauses.</p>Contact PersonThe Global Burden of Disease: 2004 update (WHO, 2008)Mortality and Burden of Disease Estimates for WHO Member States in 2004(WHO, 2009)LimitationsDisaggregation CauseAgeM&E Framework ImpactMethod of estimation of globaland regional aggregates<p>Aggregation of estimates of deaths by cause, age and sex for WHO MemberStates to estimate regional and global age-sex-cause specific mortalityrates.</p>SexExpected frequency of datadisseminationEvery 2-3 yearsExpected frequency of datacollectionContinuousUnit of Measure Deaths per 100 000 populationUnit Multiplier
  14. 14. World Health Statistics 2012Page 13 / 263 Printed 7/3/2012 5:15:06 PMDisaggregationUnit of Measure Litres of pure alcohol per person per yearMethod of estimation of globaland regional aggregatesMethod of estimation Recorded adult per capita consumption of pure alcohol is based on data fromdifferent sources, including government statistics, alcohol industry statistics inthe public domain and the Food and Agriculture Organization of the UnitedNations statistical database (FAOSTAT).Predominant type of statistics: unadjustedM&E Framework OutcomeUnit MultiplierLinks Global Information System on Alcohol and Health (WHO)CommentsLimitations It is important to note that these figures comprise, in most cases, the recordedalcohol consumption only. Factors that influence the accuracy of per capita dataare: informal production, tourist and overseas consumption, stockpiling, wasteand spillage, smuggling, duty-free sales, and variations in beverage strengthand the quality of the data on which it is based.Expected frequency of datadisseminationExpected frequency of datacollectionContact PersonData Type Representation RateTopic Risk factorsName abbreviatedMethod of measurement Estimated amount of pure ethanol in litres of total alcohol, and separately,beer, wine and spirits consumed per adult (15 years and older) in the countryduring a calendar year, as calculated from official statistics on production, sales,import and export, taking into account stocks whenever possible.Indicator nameISO Health IndicatorsFrameworkPreferred data sources Administrative reporting systemOther possible data sources Special studiesAssociated termsRationale Harmful use of alcohol is related to many diseases and health conditions,including chronic diseases such as alcohol dependence, cancer and livercirrhosis, and acute health problems such as injuries. The level of per capitaconsumption of alcohol across the population aged 15 years and older is one ofthe key indicators for monitoring the magnitude of alcohol consumption in thepopulation and likely trends in alcohol-related problems.Definition Litres of pure alcohol, computed as the sum of alcohol production and imports,less alcohol exports, divided by the adult population (aged 15 years and older).Indicator ID 127
  15. 15. World Health Statistics 2012Page 14 / 263 Printed 7/3/2012 5:15:06 PM
  16. 16. World Health Statistics 2012Page 15 / 263 Printed 7/3/2012 5:15:06 PMAnnual population growth rate (%)DisaggregationUnit of Measure N/AUnit MultiplierMethod of estimation Population data are taken from the most recent UN Population Divisions "WorldPopulation Prospects".M&E Framework DeterminantMethod of estimation of globaland regional aggregatesLinks United Nations Population DivisionWorld Population Prospects: The 2008 Revision (UN Population Division, 2009)CommentsExpected frequency of datadisseminationExpected frequency of datacollectionLimitationsContact PersonData Type Representation RateTopic Demographic and socio-economic statisticsISO Health IndicatorsFrameworkMethod of measurement It is calculated as ln(Pt/Po) where t is the length of the period.Indicator name Annual population growth rate (%)Name abbreviated Annual population growth rate (%)Preferred data sources Civil registrationPopulation censusOther possible data sourcesRationaleDefinition Average exponential rate of annual growth of the population over a givenperiod.Associated termsIndicator ID 79
  17. 17. World Health Statistics 2012Page 16 / 263 Printed 7/3/2012 5:15:06 PMAntenatal care coverage - at least four visits (%)Topic Health service coverageISO Health IndicatorsFrameworkRationale Antenatal care coverage is an indicator of access and use of health care duringpregnancy. The antenatal period presents opportunities for reaching pregnantwomen with interventions that may be vital to their health and wellbeing andthat of their infants. Receiving antenatal care at least four times, asrecommended by WHO, increases the likelihood of receiving effective maternalhealth interventions during antenatal visits. This is an MDG indicator.Data Type Representation PercentIndicator name Antenatal care coverage - at least four visits (%)Name abbreviated Antenatal care coverage - at least four visits (%)Other possible data sources Facility reporting systemDefinition The percentage of women aged 15-49 with a live birth in a given time periodthat received antenatal care four or more times.Due to data limitations, it is not possible to determine the type of provider foreach visit.Numerator:The number of women aged 15-49 with a live birth in a given time period thatreceived antenatal care four or more times.Denominator:Total number of women aged 15-49 with a live birth in the same period.Associated terms Live birth : The complete expulsion or extraction from its mother of a product ofconception, irrespective of the duration of the pregnancy, which, after suchseparation, breathes or shows any other evidence of life such as beating of theheart, pulsation of the umbilical cord, or definite movement of voluntarymuscles, whether or not the umbilical cord has been cut or the placenta isattached. (ICD-10)Preferred data sources Household surveysIndicator ID 80
  18. 18. World Health Statistics 2012Page 17 / 263 Printed 7/3/2012 5:15:06 PMM&E Framework OutcomeMethod of estimation of globaland regional aggregatesUNICEF and the WHO produce regional and global estimates. These are basedon population-weighted averages weighted by the total number of births. Theseestimates are presented only if available data cover at least 50% of total birthsin the regional or global groupings.Method of measurement The number of women aged 15-49 with a live birth in a given time period thatreceived antenatal care four or more times during pregnancy is expressed as apercentage of women aged 15-49 with a live birth in the same period.(Number of women aged 15-49 attended at least four times during pregnancyby any provider for reasons related to the pregnancy/ Total number of womenaged 15-49 with a live birth) *100The indicators of antenatal care (at least one visit and at least four visits) arebased on standard questions that ask if and how many times the health of thewoman was checked during pregnancy.Unlike antenatal care coverage (at least one visit), antenatal care coverage (atleast four visit) includes care given by any provider, not just skilled healthpersonnel. This is because the key national level household surveys do notcollect information on type of provider for each visit.The indicators of antenatal care (at least one visit and at least four visits) arebased on standard questions that ask if, how many times, and by whom thehealth of the woman was checked during pregnancy. Household surveys thatcan generate this indicator includes Demographic and Health Surveys (DHS),Multiple Indicator Cluster Surveys (MICS), Fertility and Family Surveys (FFS),Reproductive Health Surveys (RHS) and other surveys based on similarmethodologies.Service/facility reporting system can be used where the coverage is high,usually in industrialized countries.Method of estimation WHO and UNICEF compiles empirical data from household surveys. At theglobal level, data from facility reporting are not used. Before data are includedinto the global databases, UNICEF and WHO undertake a process of dataverification that includes correspondence with field offices to clarify anyquestions regarding estimates.Predominant type of statistics: adjustedDisaggregationExpected frequency of datadisseminationBiennial (Two years)Expected frequency of datacollectionBiennial (Two years)Unit of Measure N/AUnit Multiplier
  19. 19. World Health Statistics 2012Page 18 / 263 Printed 7/3/2012 5:15:06 PMReproductive health indicators: Guidelines for their generation, interpretationand analysis for global monitoring (WHO, 2006)Reproductive Health Monitoring and Evaluation (WHO)Millennium Development Goal IndicatorsContact Person Doris Chou (choud@who.int)Comments WHO recommends a standard model of four antenatal visits based on a reviewof the effectiveness of different models of antenatal care. WHO guidelines arespecific on the content of antenatal care visits, which should include clinicalexamination, blood testing to detect syphilis & severe anemia (and others suchas HIV, malaria as necessary according to the epidemiological context),gestational age estimation, uterine height, blood pressure taken, maternalweight / height, detection of sexually transmitted infections (STI)s, urine test(multiple dipstick) performed, blood type and Rh requested, tetanus toxoidgiven, iron / Folic acid supplementation provided, recommendation foremergencies / hotline for emergencies.ANC coverage figures should be closely followed together with a set of otherrelated indicators, such as proportion of deliveries attended by a skilled healthworker or deliveries occurring in health facilities, and disaggregated bybackground characteristics, to identify target populations and planning ofactions accordingly.Links Childinfo: Monitoring the Situation of Children and Women (UNICEF)Limitations It is important to note that the MDG indicators do not capture the componentsof care described under "Comments" below. Receiving antenatal care duringpregnancy does not guarantee the receipt of all of the interventions that areeffective in improving maternal health. Receipt of antenatal care at least fourtimes, which is recommended by WHO, increases the likelihood of receiving theinterventions during antenatal visits.Although the indicator for “at least one visit” refers to visits with skilled healthproviders (doctor, nurse, midwife), “four or more visits” usually measures visitswith any provider because national-level household surveys do not collectprovider data for each visit. In addition, standardization of the definition ofskilled health personnel is sometimes difficult because of differences in trainingof health personnel in different countries.Recall error is a potential source of bias in the data. In household surveys, therespondent is asked about each live birth for a period up to five years beforethe interview. The respondent may or may not know or remember thequalifications of the person providing ANC.Discrepancies are possible if there are national figures compiled at the healthfacility level. These would differ from global figures based on survey datacollected at the household level.In terms of survey data, some survey reports may present a total percentage ofpregnant women with ANC from a skilled health professional that does notconform to the MDG definition (for example, includes a provider that is notconsidered skilled such as a community health worker). In that case, thepercentages with ANC from a doctor, a nurse or a midwife are totaled andentered into the global database as the MDG estimate.Demographic and Health Surveys (DHS)Antenatal care in developing countries: promises, achievements and missedopportunities (WHO-UNICEF, 2003)WHO Antenatal Care Randomized Trial: Manual for the Implementation of theNew Model (WHO, 2002)
  20. 20. World Health Statistics 2012Page 19 / 263 Printed 7/3/2012 5:15:06 PMAntenatal care coverage - at least one visit (%)Expected frequency of datadisseminationBiennial (Two years)Expected frequency of datacollectionBiennial (Two years)LimitationsUnit MultiplierMethod of estimation of globaland regional aggregatesDisaggregation AgeUnit of Measure N/ALinks Childinfo: Monitoring the Situation of Children and Women (UNICEF)Topic Health service coverageISO Health IndicatorsFrameworkRationaleData Type Representation PercentM&E Framework OutcomeIndicator name Antenatal care coverage - at least one visit (%)Name abbreviated Antenatal care coverage - at least one visit (%)Other possible data sources Facility reporting systemMethod of measurementMethod of estimation UNICEF and the WHO produce regional and global estimates. These are basedon population-weighted averages weighted by the total number of births. Theseestimates are presented only if available data cover at least 50% of total birthsin the regional or global groupings.Preferred data sources Household surveysDefinition The percentage of women aged 15-49 with a live birth in a given time periodthat received antenatal care provided by skilled health personnel (doctors,nurses, or midwives) at least once during pregnancy.Numerator:The number of women aged 15-49 with a live birth in a given time period thatreceived antenatal care provided by skilled health personnel (doctors, nurses ormidwives) at least once during pregnancyDenominator:Total number of women aged 15-49 with a live birth in the same period.Associated terms Live birth : The complete expulsion or extraction from its mother of a product ofconception, irrespective of the duration of the pregnancy, which, after suchseparation, breathes or shows any other evidence of life such as beating of theheart, pulsation of the umbilical cord, or definite movement of voluntarymuscles, whether or not the umbilical cord has been cut or the placenta isattached. (ICD-10)Skilled birth personnel : An accredited health professional—such as a midwife,doctor or nurse—who has been educated and trained to proficiency in the skillsneeded to manage normal (uncomplicated) pregnancies, childbirth and theimmediate postnatal period, and in the identification, management and referralof complications in women and newborns. Traditional birth attendants (TBA),trained or not, are excluded from the category of skilled attendant at delivery.Indicator ID 81
  21. 21. World Health Statistics 2012Page 20 / 263 Printed 7/3/2012 5:15:06 PMReproductive Health Monitoring and Evaluation (WHO)CommentsContact Person Doris Chou (choud@who.int)Millennium Development Goal IndicatorsLinks Demographic and Health Surveys (DHS)WHO Antenatal Care Randomized Trial: Manual for the Implementation of theNew Model (WHO, 2002)Reproductive health indicators: guidelines for their generation, interpretationand analysis for global monitoring (WHO, 2006)
  22. 22. World Health Statistics 2012Page 21 / 263 Printed 7/3/2012 5:15:06 PMAntiretroviral therapy coverage among HIV-infected pregnant womenfor PMTCT (%)Topic Health service coverageISO Health IndicatorsFrameworkRationale In the absence of any preventative interventions, infants born to and breastfedby HIV-infected women have roughly a one-in-three chance of acquiringinfection themselves. This can happen during pregnancy, during labour anddelivery or after delivery through breastfeeding. The risk of mother-to-childtransmission can be significantly reduced through the complementaryapproaches of antiretroviral regimens for the mother with or withoutprophylaxis to the infant, implementation of safe delivery practices and use ofsafer infant feeding practices.The purpose of this indicator is to assess progress in preventing mother-to-childtransmission of HIV (PMTCT).Data Type Representation PercentIndicator name Antiretroviral therapy coverage among HIV-infected pregnant women for PMTCT(%)Name abbreviated Antiretroviral therapy coverage among HIV-infected pregnant women for PMTCT(%)Definition The percentage of HIV-infected pregnant women who received antiretroviralmedicines to reduce the risk of mother-to-child transmission, among theestimated number of HIV-infected pregnant women.Numerator:Number of HIV-infected pregnant women who received antiretroviral medicinesto reduce the risk of mother-to-child transmission in the last 12 monthsDenominator:Estimated number of HIV-infected pregnant women in the last 12 monthsAssociated terms Antiretroviral treatment : The use of a combination of 3 or more antiretroviraldrugs for purpose of treatment in accordance with nationally approvedtreatment protocols (or WHO/UNAIDS standards). ARV regimen prescribed forpost exposure prophylaxis are excluded.Preferred data sources Facility reporting systemOther possible data sourcesIndicator ID 82
  23. 23. World Health Statistics 2012Page 22 / 263 Printed 7/3/2012 5:15:06 PMMethod of estimation of globaland regional aggregatesM&E Framework OutcomeMethod of measurement NumeratorThere are four general antiretroviral categories that HIV-infected women canreceive for the prevention of mother-to-child transmission (PMTCT):a) Single-dose Nevirapine onlyb) Prophylactic regimens using a combination of two antiretroviral drugsc) Prophylactic regimens using a combination of three antiretroviral drugsd) Antiretroviral therapy for HIV-infected pregnant women eligible for treatmentHIV-infected women receiving any antiretroviral therapy, including specificallyfor prophylaxis, meet the definition for the numerator. Countries should reportthe total number of HIV-infected pregnant women who were provided with anyantiretrovirals as the numerator. Countries can compile data for the numeratorfrom patient registers at antenatal clinics, delivery and care sites, and post-partum care and HIV service sites. This should be disaggregated by regimentype. Women receiving antiretroviral drugs in both the private sector and thepublic sector should be included in the numerator where data for both areavailable.DenominatorThe denominator is generated by estimating the number of HIV-infected womenwho were pregnant in the last 12 months. This is based on surveillance datafrom antenatal clinics.Two methods are possible for generating the estimate for the denominator:1. Estimates generated by a projection model such as Spectrum (seeEpidemiological software and tools, 2009); or2. Multiplying:(a) the total number of women who gave birth in the last 12 months, which canbe obtained from the Central Statistics Office estimates of births or estimatesfrom the UN Population Division, by(b) the most recent national estimate of HIV prevalence in pregnant women,which can be derived from HIV sentinel surveillance antenatal clinic estimates.(UNAIDS/WHO, 2010)Method of estimation Estimating the numeratorThe number of pregnant women living with HIV receiving antiretrovirals forPMTCT is based on national programme data aggregated from facilities or otherservice delivery sites and as reported by the country.Estimating the denominatorThe number of pregnant women living with HIV who need antiretroviralmedicine for PMTCT is estimated using standardized statistical modelling basedon UNAIDS/WHO methods that consider various epidemic and demographicparameters and national programme coverage of antiretroviral therapy in thecountry (such as HIV prevalence among women of reproductive age, effect ofHIV on fertility and antiretroviral therapy coverage). These statistical modellingprocedures are used to derive a comprehensive population-based estimate ofthe number of all pregnant women living with HIV who need antiretrovirals forPMTCT in the country.Estimating the coverage of antiretrovirals for PMTCTThe coverage of antiretrovirals for PMTCT is calculated by dividing the numberof pregnant women living with HIV who received antiretrovirals for PMTCT ofHIV by the estimated number of pregnant women living with HIV who needantiretrovirals for PMTCT in the country. Estimates of coverage are based onthe standardized estimates of pregnant women living with HIV who needantiretrovirals for PMTCT derived using UNAIDS/WHO methods. Point estimatesare given for countries with a generalized epidemic, these estimates arepresented here.Point estimates and ranges for countries with a generalized epidemic, andranges for countries with a concentrated epidemic are available in the report"Towards universal access - Scaling up priority HIV/AIDS interventions in thehealth sector". (WHO/UNAIDS/UNICEF, 2009)Predominant type of statistics: predicted
  24. 24. World Health Statistics 2012Page 23 / 263 Printed 7/3/2012 5:15:06 PMEpidemiological software and tools (UNAIDS website, 2009)Towards universal access - Scaling up priority HIV/AIDS interventions in thehealth sector (WHO/UNAIDS/UNICEF, 2009)2008 Report on the Global AIDS epidemics (UNAIDS, 2008)Guidelines on Construction of Core Indicators: 2010 Reporting (UNAIDS, 2009)Comments In 2006, international guidelines were updated to recommend more efficaciousregimens for prevention of mother-to-child transmission, and countries may beat different phases in adopting the newer recommendations.In some countries, large numbers of pregnant women do not have access toantenatal clinic services or choose not to make use of them. Pregnant womenliving with HIV may be more or less likely to use antenatal clinic services (orpublic rather than private antenatal clinic services) than those who are notinfected, particularly where antiretroviral therapy can be accessed via suchservices or where levels of stigma are particularly high. National estimates ofHIV-infected pregnant women should be derived by adjusting surveillance datafrom antenatal clinic sentinel sites and other sources, taking into considerationcharacteristics such as rural/urban patterns of HIV prevalence that may affectthe representation of surveillance sites.Methods for monitoring coverage of this service are therefore also evolving. Toaccess the most current information available please consult:http://www.who.int/hiv/topics/mtct/guidelines/en/index.html(UNAIDS, 2009)Contact PersonTools for collecting data on the health sector response to HIV/AIDS in 2010(WHO, 2010)Antiretroviral drugs for treating pregnant women and preventing HIV infectionin infants: towards universal access (WHO, 2006)Unit MultiplierExpected frequency of datadisseminationAnnualDisaggregationUnit of Measure N/ALinks HIV/AIDS Data and Statistics (WHO)Methods and assumptions for HIV estimates (UNAIDS)Expected frequency of datacollectionLimitations This indicator permits monitoring trends in antiretroviral drug provision thataddresses PMTCT. However, since countries provide different regimens ofantiretroviral drugs for PMTCT, cross-country comparisons of aggregateestimates must be interpreted with caution and with reference to the regimensprovided.(UNAIDS/WHO, 2010)
  25. 25. World Health Statistics 2012Page 24 / 263 Printed 7/3/2012 5:15:06 PMAntiretroviral therapy coverage among people with advanced HIVinfection (%)ISO Health IndicatorsFrameworkTopic Health service coverageDefinition The percentage of adults and children with advanced HIV infection currentlyreceiving antiretroviral combination therapy in accordance with the nationallyapproved treatment protocols (or WHO/UNAIDS standards) among theestimated number of adults and children with advanced HIV infection.Numerator: Number of adults and children with advanced HIV infection who arecurrently receiving antiretroviral combination therapy in accordance with thenationally approved treatment protocol (or WHO/UNAIDS standards) at the endof the reporting periodDenominator: Estimated number of adults and children with advanced HIVinfectionRationale As the HIV epidemic matures, increasing numbers of people are reachingadvanced stages of HIV infection. Antiretroviral therapy (ART) has been shownto reduce mortality among those infected and efforts are being made to make itmore affordable within low- and middle-income countries. This indicatorassesses the progress in providing antiretroviral combination therapy to allpeople with advanced HIV infection.Indicator name Antiretroviral therapy coverage among people with advanced HIV infection (%)Data Type Representation PercentName abbreviated Antiretroviral therapy coverage among people with advanced HIV infection (%)Associated terms Antiretroviral treatment : The use of a combination of 3 or more antiretroviraldrugs for purpose of treatment in accordance with nationally approvedtreatment protocols (or WHO/UNAIDS standards). ARV regimen prescribed forpost exposure prophylaxis are excluded.Other possible data sourcesPreferred data sources Facility reporting systemHuman Immunodeficiency Virus (HIV) : A virus that weakens the immunesystem, ultimately leading to AIDS, the acquired immunodeficiency syndrome.HIV destroys the body’s ability to fight off infection and disease, which canultimately lead to death.Surveillance systemsAdministrative reporting systemIndicator ID 12
  26. 26. World Health Statistics 2012Page 25 / 263 Printed 7/3/2012 5:15:06 PMMethod of measurement NumeratorThe numerator can be generated by counting the number of adults and childrenwho received antiretroviral combination therapy at the end of the reportingperiod. Antiretroviral therapy taken only for the purpose of prevention ofmother-to-child transmission and post-exposure prophylaxis are not included inthis indicator. HIV-infected pregnant women who are eligible for antiretroviraltherapy and on antiretroviral therapy for their own treatment are included inthis indicator.The number of adults and children with advanced HIV infection who arecurrently receiving antiretroviral combination therapy can be obtained throughdata collected from facility-based antiretroviral therapy registers or drug supplymanagement systems. These are then tallied and transferred to cross-sectionalmonthly or quarterly reports which can then be aggregated for national totals.Patients receiving antiretroviral therapy in the private sector and public sectorshould be included in the numerator where data are available.DenominatorThe denominator is generated by estimating the number of people withadvanced HIV infection requiring (in need of/eligible for) antiretroviral therapy.This estimation must take into consideration a variety of factors including, butnot limited to, the current numbers of people with HIV, the current number ofpatients on antiretroviral therapy, and the natural history of HIV from infectionto enrolment on antiretroviral therapy. A standard modelling method isrecommended. The Estimation and Projection Package (EPP)* and Spectrum*,softwares have been developed by the UNAIDS/WHO Reference Group onEstimates, Models and Projections. Need or eligibility for antiretroviral therapyshould follow the WHO definitions for the diagnosis of advanced HIV (includingAIDS) for adults and children.(UNAIDS, 2009)
  27. 27. World Health Statistics 2012Page 26 / 263 Printed 7/3/2012 5:15:06 PMDisaggregation SexAgeMethod of estimation of globaland regional aggregatesRegional and global estimates are calculated as weighted averages of thecountry level indicator where the weights correspond to each country’s share ofthe total number of people needing antiretroviral therapy. Although WHO andUNAIDS collect data on the number of people receiving antiretroviral therapy inhigh-income countries, as of 2007, no need numbers have been established forthese countries. Aggregated coverage percentages are based solely on low- andmiddle-income countries.Method of estimation WHO, UNAIDS and UNICEF are responsible for reporting data for this indicatorat the international level, and have been compiling country specific data since2003.The data from countries are collected through three international monitoringand reporting processes.1. Health sector response to HIV/AIDS (WHO/UNAIDS/UNICEF)3. UNGASS Declaration of Commitment on HIV/AIDS (UNAIDS)Both processes are linked through common indicators and a harmonizedtimeline for reporting.Estimating the numeratorData for the calculation of the numerator are compiled from the most recentreports received by WHO and/or UNAIDS from health ministries or from otherreliable sources in the countries, such as bilateral partners, foundations andnongovernmental organizations that are major providers of treatment services.Estimating the denominatorThe number of people who need antiretroviral therapy in a country is estimatedusing statistical modelling methods.In response to the emergence of new scientific evidence, in December 2009WHO updated its antiretroviral therapy guidelines for adults and adolescents.According to the new guidelines, which were developed in consultation withmultiple technical and implementing partners, all adolescents and adults,including pregnant women, with HIV infection and a CD4 count at or below 350cells/mm3 should be started on antiretroviral therapy, regardless of whether ornot they have clinical symptoms. Those with severe or advanced clinical disease(WHO clinical stage 3 or 4) should start antiretroviral therapy irrespective ofCD4 cell count.In order to compare the impact of the new guildelines, both sets of needs forthe year 2009 are included, i.e. estimated needs estimated based on athreshold for initiation of antiretroviral therapy with < 200 cells/mm3 (oldguidelines) as well as < 350 cells/mm3 (new guidelines).Estimating antiretroviral therapy coverageThe estimates of antiretroviral therapy coverage presented here are calculatedby dividing the estimated number of people receiving antiretroviral therapy asof December by the number of people estimated to need treatment in sameyear (based on UNAIDS/WHO methods).Predominant type of statistics: predictedM&E Framework OutcomeExpected frequency of datadisseminationAnnualExpected frequency of datacollectionUnit MultiplierProvider type (public/private)Unit of Measure N/A
  28. 28. World Health Statistics 2012Page 27 / 263 Printed 7/3/2012 5:15:06 PMin Current Opinion in HIV and AIDS: Vol.5 Issue 1 p 97–102)Tools for collecting data on the health sector response to HIV/AIDS in 2010(WHO, 2010)Towards universal access - Scaling up priority HIV/AIDS interventions in thehealth sector (WHO/UNAIDS/UNICEF, 2010)Contact PersonComments This indicator permits monitoring trends in coverage but does not attempt todistinguish between different forms of antiretroviral therapy or to measure thecost, quality or effectiveness of treatment provided. These will each vary withinand between countries and are liable to change over time.The degree of utilization of antiretroviral therapy will depend on factors such ascost relative to local incomes, service delivery infrastructure and quality,availability and uptake of voluntary counseling and testing services, andperceptions of effectiveness and possible side effects of treatment.(UNAIDS, 2009)Latest country specific coverage for 2008 were not published as treatmentguidelines have been revised, and the effects on treatment need for adults arecurrently being assessed.Links HIV/AIDS Data and Statistics (WHO)Limitations Estimating the number of people receiving antiretroviral therapy involves someuncertainty in countries that have not yet established regular reporting systemsthat can capture data on people who initiate treatment for the first time, ratesof adherence among people who receive treatment, people who discontinuetreatment, and those who die.To analyse and compare antiretroviral therapy coverage across countries,international agencies use standardized estimates of treatment need.Specialized software is used to generate uncertainty ranges around estimatesfor antiretroviral therapy need. Depending on the quality of surveillance data,the ranges for some countries can be large.Methods and assumptions for HIV estimates (UNAIDS)Guidelines on Construction of Core Indicators: 2010 Reporting (UNAIDS, 2009)2008 Report on the Global AIDS epidemics (UNAIDS, 2008)
  29. 29. World Health Statistics 2012Page 28 / 263 Printed 7/3/2012 5:15:06 PMBirths attended by skilled health personnel (%)ISO Health IndicatorsFrameworkTopic Health service coverageDefinition The proportion of births attended by skilled health personnel.Numerator:The number of births attended by skilled health personnel (doctors, nurses ormidwives) trained in providing life saving obstetric care, including giving thenecessary supervision, care and advice to women during pregnancy, childbirthand the post-partum period; to conduct deliveries on their own; and to care fornewborns.Denominator:The total number of live births in the same period.Rationale All women should have access to skilled care during pregnancy and childbirth toensure prevention, detection and management of complications. Assistance byproperly trained health personnel with adequate equipment is key to loweringmaternal deaths. As it is difficult to accurately measure maternal mortality, andmodel-based estimates of the maternal mortality ratio cannot be used formonitoring short-term trends, the proportion of births attended by skilledhealth personnel is used as a proxy indicator for this purpose. This is an MDGindicator.Indicator name Births attended by skilled health personnel (%)Data Type Representation PercentName abbreviated Births attended by skilled health personnelMethod of measurement The percentage of births attended by skilled health personnel is calculated asthe number of births attended by skilled health personnel (doctors, nurses ormidwives) expressed as total number of births in the same period.Births attended by skilled health personnel = (Number of births attended byskilled health personnel / Total number of live births) x 100In household surveys, such as the Demographic and Health Surveys, theMultiple Indicator Cluster Surveys, and the Reproductive Health Surveys, therespondent is asked about each live birth and who had helped them duringdelivery for a period up to five years before the interview.Service/facility records could be used where a high proportion of births occur inhealth facilities and therefore they are recorded.Skilled birth personnel : An accredited health professional—such as a midwife,doctor or nurse—who has been educated and trained to proficiency in the skillsneeded to manage normal (uncomplicated) pregnancies, childbirth and theimmediate postnatal period, and in the identification, management and referralof complications in women and newborns. Traditional birth attendants (TBA),trained or not, are excluded from the category of skilled attendant at delivery.Associated terms Live birth : The complete expulsion or extraction from its mother of a product ofconception, irrespective of the duration of the pregnancy, which, after suchseparation, breathes or shows any other evidence of life such as beating of theheart, pulsation of the umbilical cord, or definite movement of voluntarymuscles, whether or not the umbilical cord has been cut or the placenta isattached. (ICD-10)Other possible data sources Facility reporting systemPreferred data sources Household surveysIndicator ID 25
  30. 30. World Health Statistics 2012Page 29 / 263 Printed 7/3/2012 5:15:06 PMThe State of the World Children (UNICEF)State of World Population (UNPFA)Reproductive health indicators: Guidelines for their generation, interpretationand analysis for global monitoring (WHO, 2006)Demographic and Health Surveys (DHS)The World Health Report 2005: Make every mother and child count (WHO,2005)Disaggregation AgeUnit of Measure N/AMethod of estimation of globaland regional aggregatesRegional and global aggregates are weighted averages of the country data,using the number of live births for the reference year in each country as theweight. No figures are reported if less than 50 per cent of the live births in theregion are covered.Method of estimation Data for global monitoring are reported by UNICEF and WHO. These agenciesobtain the data from national sources, both survey and registry data. Beforedata can be included in the global databases, UNICEF and WHO undertake aprocess of data verification that includes correspondence with field offices toclarify any questions.In terms of survey data, some survey reports may present a total percentage ofbirths attended by a type of provider that does not conform to the MDGdefinition (e.g., total includes provider that is not considered skilled, such as acommunity health worker). In that case, the percentage delivered by aphysician, nurse, or a midwife are totaled and entered into the global databaseas the MDG estimate.Predominant type of statistics: adjustedM&E Framework OutcomeLimitations The indicator is a measure of a health system’s ability to provide adequate careduring birth, a period of elevated mortality and morbidity risk for both motherand newborn. However, this indicator may not adequately capture women’saccess to good quality care, particularly when complications arise. In order toeffectively reduce maternal deaths, skilled health personnel should have thenecessary equipment and adequate referral options.Standardization of the definition of skilled health personnel is sometimesdifficult because of differences in training of health personnel in differentcountries. Although efforts have been made to standardize the definitions ofdoctors, nurses, midwives and auxiliary midwives used in most householdsurveys, it is probable that many skilled attendants’ ability to provideappropriate care in an emergency depends on the environment in which theywork.Recall error is another potential source of bias in the data. In householdsurveys, the respondent is asked about each live birth for a period up to fiveyears before the interview. The respondent may or may not know or rememberthe qualifications of the attendant at delivery.In the absence of survey data, some countries may have health facility data.However, it should be noted that these data may overestimate the proportion ofdeliveries attended by a skilled professional because the denominator might notcapture all women who deliver outside of health facilities.Links Childinfo: Monitoring the Situation of Children and Women (UNICEF)Expected frequency of datacollectionBiennial (Two years)Unit MultiplierExpected frequency of datadisseminationBiennial (Two years)
  31. 31. World Health Statistics 2012Page 30 / 263 Printed 7/3/2012 5:15:06 PMComments The indicator is a measure of a health system’s ability to provide adequate carefor pregnant women. Concerns have been expressed that the term skilledattendant may not adequately capture women’s access to good quality care,particularly when complications arise.In addition, standardization of the definition of skilled health personnel issometimes difficult because of differences in training of health personnel indifferent countries. Although efforts have been made to standardize thedefinitions of doctors, nurses, midwives and auxiliary midwives used in mosthousehold surveys, it is probable that many skilled attendants’ ability toprovide appropriate care in an emergency depends on the environment inwhich they work.Contact Person Doris Chou (choud@who.int)Reproductive Health Monitoring and Evaluation (WHO)Links Millennium Development Goal IndicatorsMaking pregnancy safer: The critical role of the skilled attendant: A jointstatement by WHO, ICM and FIGO
  32. 32. World Health Statistics 2012Page 31 / 263 Printed 7/3/2012 5:15:06 PMBirths by caesarean section (%)Unit of Measure N/AUnit MultiplierExpected frequency of datadisseminationBiennial (Two years)M&E Framework OutcomeMethod of estimation of globaland regional aggregatesRegional estimates are weighted averages of the country data, using thenumber of live births for the reference year in each country as the weight. Nofigures are reported if less than 50 per cent of live births in the region arecovered.DisaggregationExpected frequency of datacollectionBiennial (Two years)Limitations This indicator does not provide information on the reason for undergoingcaesarean section, and includes caesarean sections that were performedwithout a clinical indication as well as those that were medically indicated. Theextent to which caesarean sections are performed according to clinical need,therefore, is not possible to determine.Data Type Representation PercentTopic Health service coverageISO Health IndicatorsFrameworkMethod of estimation WHO compiles empirical data from household surveys and facility reportingsystems for this indicator.Predominant type of statistics: adjustedIndicator name Births by caesarean section (%)Name abbreviated Births by caesarean sectionRationale The percentage of births by caesarean section is an indicator of access to anduse of health care during childbirth.Household surveysOther possible data sourcesMethod of measurement Household surveys: birth history—detailed questions on the last-born child orall children a woman has given birth to during a given period preceding thesurvey (usually 3 to 5 years), including characteristics of the birth(s). Thenumber of live births to women surveyed provides the denominator.Service or facility records: the number of women having given birth bycaesarean section (numerator). Census projections or, in some cases, vitalregistration data can be used to provide the denominator (numbers of livebirths).Definition Percentage of births by caesarean section among all live births in a given timeperiod.Associated terms Live birth : The complete expulsion or extraction from its mother of a product ofconception, irrespective of the duration of the pregnancy, which, after suchseparation, breathes or shows any other evidence of life such as beating of theheart, pulsation of the umbilical cord, or definite movement of voluntarymuscles, whether or not the umbilical cord has been cut or the placenta isattached. (ICD-10)Preferred data sources Facility reporting systemIndicator ID 68
  33. 33. World Health Statistics 2012Page 32 / 263 Printed 7/3/2012 5:15:06 PMReproductive Health Monitoring and Evaluation (WHO)Comments An approximate figure of less than 5% indicates that all women who are inneed may not be receiving caesarean section at birth.Contact Person Doris Chou (choud@who.int)Links The world health report 2005—make every mother and child count (WHO,2005)Demographic and Health SurveysReproductive health indicators: Guidelines for their generation, interpretationand analysis for global monitoring (WHO, 2006)
  34. 34. World Health Statistics 2012Page 33 / 263 Printed 7/3/2012 5:15:06 PMCellular subscribers (per 100 population)DisaggregationUnit of MeasureMethod of estimation of globaland regional aggregatesRegional and global totals are calculated as unweighted sums of the countryvalues. Regional and global penetration rates (per 100 inhabitants) areweighted averages of the country values weighted by the population of thecountres/regions.Method of estimation ITU collects its data through an annual questionnaire that is sent to thegovernment agency in charge of telecommunications/ICT, usually the Ministryor the regulatory agency. In some cases (especially in countries where there isstill only one operator), the questionnaire is sent to the incumbent operator.Data are available for about 90 percent of countries, either through their replyto ITU questionnaires or from information available on the Ministry/Regulatorwebsite. For another 10 percent of countries, the information can beaggregated through operators’ data (mainly through annual reports) andcomplemented by market research reports.The data, which are mainly based on administrative records, are verified toensure consistency with data from previous years. When countries do not replyto the questionnaire, ITU carries out research and collects missing values fromgovernment web sites, as well as from Annual Reports by operators.Data are usually not adjusted but discrepancies in the definition, reference yearor the break in comparability in between years are noted in a data note. Forthis reason, data are not always strictly comparable.M&E FrameworkUnit MultiplierExpected frequency of datadisseminationExpected frequency of datacollectionData Type Representation RateTopicName abbreviatedMethod of measurementIndicator name Cellular subscribers (per 100 population)ISO Health IndicatorsFrameworkPreferred data sources Administrative reporting systemOther possible data sourcesAssociated termsRationaleDefinition The number of mobile cellular subscriptions is divided by the country’spopulation and multiplied by 100.A mobile cellular subscription refers to the subscription to a public mobilecellular service which provides access to the Public Switched Telephone Network(PSTN) using cellular technology. It includes postpaid and prepaid subscriptionsand includes analogue and digital cellular systems. This should also includesubscriptions to IMT-2000 (Third Generation, 3G) networks.Indicator ID 2974
  35. 35. World Health Statistics 2012Page 34 / 263 Printed 7/3/2012 5:15:06 PMCommentsContact PersonLimitations Data on mobile cellular subscriptions are considered to be reliable, timely andcomplete data. They are derived from,administrative data that countries(usually the regulatory telecommunication authority or the Ministry in charge oftelecommunication) regularly, and at least annually, collect from theirtelecommunications operators. Data for this indicator are readily available forabout 90 percent of countries, either through replies sent to ITU’s WorldTelecommunication/ICT Indicators questionnaires or from official informationavailable on the Ministry or Regulator’s website. For another 10 percent ofcountries, the information can be aggregated through operators’ data (mainlythrough annual reports) and complemented by market research reports.However there are comparability issues for mobile cellular subscriptions owingto the prevalence of prepaid subscriptions. These issues arise from determiningwhen a prepaid subscription is considered no longer active.Links Information and Communication Technology (ICT) Statistics
  36. 36. World Health Statistics 2012Page 35 / 263 Printed 7/3/2012 5:15:06 PMChildren aged <5 years overweight (%)Rationale This indicator belongs to a set of indicators whose purpose is to measurenutritional imbalance and malnutrition resulting in undernutrition (assessed byunderweight, stunting and wasting) and overweight.Child growth is the most widely used indicator of nutritional status in acommunity and is internationally recognized as an important public-healthindicator for monitoring health in populations. In addition, children who sufferfrom growth retardation as a result of poor diets and/or recurrent infectionstend to have a greater risk of suffering illness and death.ISO Health IndicatorsFrameworkAssociated terms Child overweight : Weight-for-height greater than +2 standard deviations of theWHO Child Growth Standards median.Definition Percentage of overweight (weight-for-height above +2 standard deviations ofthe WHO Child Growth Standards median) among children aged 0-5 yearsTopic Risk factorsIndicator name Children aged <5 years overweight (%)Data Type Representation PercentName abbreviated Children aged <5 years overweightOther possible data sourcesSurveillance systemsMethod of measurement Percentage of children aged <5 years overweight for age = (Number of childrenaged 0-5 years that are over two standard deviations from the median weight-for-height of the WHO Child Growth Standards / Total number of children aged0-5 years that were measured) * 100.Children`s weight and height are measured using standard technology, e.g.children less than 24 months are measured lying down, while standing height ismeasured for children 24 months and older.The data sources include national nutrition surveys, any other nationally-representative population-based surveys with nutrition modules, and nationalsurveillance systems.Specific population surveysStunting : Height-for-age less than -2 standard deviations of the WHO ChildGrowth Standards median.Child underweight : Weight-for-age less than -2 standard deviations of theWHO Child Growth Standards median.Preferred data sources Household surveysWasting : Weight-for-height less than -2 standard deviations of the WHO ChildGrowth Standards median.Indicator ID 74
  37. 37. World Health Statistics 2012Page 36 / 263 Printed 7/3/2012 5:15:06 PMWHO Child Growth Standards websiteWHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods anddevelopmentLinks WHO Global Database on Child Growth and MalnutritionExpected frequency of datacollectionEvery 5 yearsLimitationsMethodology for estimating regional and global trends of child malnutrition (deOnis et al, 2004b)The WHO Global Database on Child Growth and Malnutrition: methodology andapplications (de Onis & Blössner, 2003)Estimates of global prevalence of childhood underweight in 1990 and 2015 (deOnis et al, 2004a)Expected frequency of datadisseminationBimonthlyDisaggregation AgeSexMethod of estimation of globaland regional aggregatesA well-established methodology for deriving global and regional trends andforecasting future trends, have been published (de Onis et al., 2004a, 2004b)Method of estimation WHO maintains the Global Database on Child Growth and Malnutrition, whichincludes population-based surveys that fulfill a set of criteria. Data are checkedfor validity and consistency and raw data sets are analysed following a standardprocedure to obtain comparable results. Prevalence below and above definedcut-off points for weight-for-age, height-for-age, weight-for-height and bodymass index (BMI)-for-age, in preschool children are presented using z-scoresbased on the WHO Child Growth Standards.A detailed description of the methodology and procedures of the databaseincluding data sources, criteria for inclusion, data quality control and databasework-flow, are described in a paper published in 2003 in the InternationalJournal of Epidemiology (de Onis & Blössner, 2003).Predominant type of statistics: adjustedM&E Framework ImpactUnit of Measure N/AUnit MultiplierBoundaries : Health regionsLocation (urban/rural)Boundaries : Administrative regions
  38. 38. World Health Statistics 2012Page 37 / 263 Printed 7/3/2012 5:15:06 PMContact Person WHO Global Database on Child Growth and Malnutrition(whonutgrowthdb@who.int)Comments The percentage of children with low height-for-age reflects the cumulativeeffects of under-nutrition and infections since birth, and even before birth. Thismeasure, therefore, should be interpreted as an indication of poorenvironmental conditions and/or long-term restriction of a child`s growthpotential. The percentage of children with low weight-for-age may reflect theless common ‘wasting’ (i.e. low weight-for-height) indicating acute weight loss,and/or the much more common ‘stunting’ (i.e. low height-for-age). Thus, it is acomposite indicator that is difficult to interpret. Overweight (i.e. high weight-for-height) is an indicator of malnutrition at the other extreme. Some countrypopulations are facing a double-burden with high prevalence of under- andoverweight simultaneously.An international set of standards (i.e. the WHO Child Growth Standards) is usedto calculate prevalence for the indicators low weight-for-age, low height-for-age, and high weight-for-height. The International Pediatric Association (IPA),the Standing Committee on Nutrition of the United Nations System (SCN), andthe International Union of Nutritional Sciences (IUNS), have officially endorsedthe use of the WHO standards, describing them as an effective tool fordetecting and monitoring undernutrition and overweight, thus addressing thedouble burden of malnutrition affecting populations on a global basis. The WHOChild Growth Standards, launched in 2006, replaces the NCHS/WHOinternational reference for the analysis of nutritional surveys.National nutrition surveys and national nutrition surveillance systems are thepreferred primary data sources for child nutrition indicators. If these sourcesare not available, any random, nationally representative, population-basedsurvey with a sample size of at least 400 children that presents results basedon the WHO standards or provides access to the raw data enabling re-analysiscould be used.Generally national surveys are recommended to be conducted about every 5years. But this also depends on the nutritional status as well as on the changein the economical situation, the perceived change of nutritional status, and theoccurrence of human made crisis and natural disasters.
  39. 39. World Health Statistics 2012Page 38 / 263 Printed 7/3/2012 5:15:06 PMChildren aged <5 years sleeping under insecticide-treated nets (%)ISO Health IndicatorsFrameworkTopic Health service coverageDefinition Percentage of children under five years of age in malaria endemic areas whoslept under an insecticide-treated nets (ITN) the previous night.Rationale In areas of intense malaria transmission, malaria-related morbidity andmortality are concentrated in young children, and the use of insecticide-treatednets (ITN) by children under 5 has been demonstrated to considerably reducemalaria disease incidence, malaria-related anaemia and all cause under 5mortality.In addition to being listed as an MDG indicator under Goal 6, the use of ITNs isidentified by WHO as one of the main interventions to reduce the burden ofmalaria.Indicator name Children aged <5 years sleeping under insecticide-treated nets (%)Data Type Representation PercentName abbreviated Children aged <5 years sleeping under insecticide-treated netsOther possible data sourcesMalaria : An infectious disease caused by the parasite Plasmodium andtransmitted via the bites of infected mosquitoes. Symptoms of uncomplicatedmalaria usually appear between 10 and 15 days after the mosquito bite andinclude fever, chills, headache, muscular aching and vomiting.Malaria can be treated with artemisinin-based combination and other therapies.Malaria responds well if treated with an effective antimalarial medicine at anearly stage. However, if not treated, the falciparum malaria may progress tosevere case and death. Less than one person in a thousand may die from thedisease. Symptoms of severe disease include: coma (cerebal malaria),metabolic acidosis, severe anemia, hypoglycemia (low blood sugar levels) andin adults, kidney failure or pulmonary oedmea (a build up of fluid in thelungs). By this stage 15-20% of people receiving treatment will die. Ifuntreated, severe malaria is almost always fatal.The symptoms of malaria overlap with other diseases so one can not always becertain that a death is due to malaria particularly as many deaths occur inchildren who may simultaneously suffer from a range conditions includingrespiratory infections, diarrhoea, and malnutrition. Effective interventions existto reduce the incidence of malaria including the use of insecticide treatedmosquito nets and indoor residual spraying with insecticide.Associated terms Insecticide-treated net (ITN) : A mosquito net that has been treated within 12months or is a long-lasting insecticidal net (LLIN)Preferred data sources Household surveysMalaria-risk areas : Areas of stable malaria transmission (allowing thedevelopment of some level of immunity) and areas of unstable malariatransmission (seasonal and less predictable transmission impeding thedevelopment of effective immunity)Indicator ID 13
  40. 40. World Health Statistics 2012Page 39 / 263 Printed 7/3/2012 5:15:06 PMExpected frequency of datacollectionEvery 3-5 yearsLimitations The accuracy of reporting in household surveys may vary. Also, seasonalinfluences related to fluctuations in vector and parasite prevalence may affectlevel of coverage depending on timing of the data collection.Because of issues of date recall of last impregnation with insecticide, thisindicator may not provide reliable estimates of net retreatment status.Furthermore, the standard survey instrument does not collect information onwhether the net was washed after treatment, which can reduce itseffectiveness. Typically, estimates are provided for the national level, whichmay underestimate the level of coverage among subpopulations living inlocalized areas of malaria transmission.Expected frequency of datadisseminationAnnualUnit of Measure N/AUnit MultiplierComments It is important to note that while the MDG indicator only refers to children aged<5 years, WHO recommends that all household members sleep under ITNs inmalaria-risk areas.Contact PersonThe United Nations official site for the MDG indicatorsLinks WHO/Roll Back Malaria websiteWorld Malaria Report 2008 (WHO)Method of estimation of globaland regional aggregatesRegional and global estimates are based on population-weighted averagesweighted by the total number of children under five years of age. Theseestimates are presented only if available data cover at least 50% of totalchildren under five years of age in the regional or global groupings.Disaggregation AgeM&E Framework OutcomeMethod of measurement The number of children <5 years sleeping under insecticide-treated mosquitonets = (The number of children aged 0-59 months who slept under aninsecticide-treated mosquito net the night prior to the survey / The totalnumber of children aged 0-59 months included in the survey) x 100Data are derived from nationally-representative household surveys such asDemographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys(MICS), Malaria Indicator Surveys (MIS), and `rider` questions on otherrepresentative population-based surveys, that include questions on whetherchildren under five years of age slept under an ITN the previous night.Method of estimation Data from nationally-representative household surveys, including MultipleIndicator Cluster Surveys (MICS), Demographic Health Surveys (DHS) andMalaria Indicator Surveys (MIS), are compiled in the UNICEF global databases.The data are reviewed in collaboration with Roll Back Malaria (RBM)partnership, launched in 1998 by the World Health Organization (WHO), theUnited Nations Children’s Fund (UNICEF), the United Nations DevelopmentProgramme (UNDP) and the World Bank.Predominant type of statistics: adjustedBoundaries : Administrative regionsBoundaries : Health regionsWealth : Wealth quintileLocation (urban/rural)Education level : Maternal education
  41. 41. World Health Statistics 2012Page 40 / 263 Printed 7/3/2012 5:15:06 PM
  42. 42. World Health Statistics 2012Page 41 / 263 Printed 7/3/2012 5:15:06 PMChildren aged <5 years stunted (%)Rationale This indicator belongs to a set of indicators whose purpose is to measurenutritional imbalance and malnutrition resulting in undernutrition (assessed byunderweight, stunting and wasting) and overweight.Child growth is the most widely used indicator of nutritional status in acommunity and is internationally recognized as an important public-healthindicator for monitoring health in populations. In addition, children who sufferfrom growth retardation as a result of poor diets and/or recurrent infectionstend to have a greater risk of suffering illness and death.ISO Health IndicatorsFrameworkAssociated terms Child overweight : Weight-for-height greater than +2 standard deviations of theWHO Child Growth Standards median.Definition Percentage of stunting (height-for-age less than -2 standard deviations of theWHO Child Growth Standards median) among children aged 0-5 yearsTopic Risk factorsIndicator name Children aged <5 years stunted (%)Data Type Representation PercentName abbreviated Children aged <5 years stuntedChild underweight : Weight-for-age less than -2 standard deviations of theWHO Child Growth Standards median.Other possible data sourcesSurveillance systemsMethod of measurement Percentage of children aged <5 years stunted for age = (Number of childrenaged 0-5 years that fall below minus two standard deviations from the medianheight-for-age of the WHO Child Growth Standards / Total number of childrenaged 0-5 years that were measured) * 100.Children`s weight and height are measured using standard technology, e.g.children less than 24 months are measured lying down, while standing height ismeasured for children 24 months and older.The data sources include national nutrition surveys, any other nationally-representative population-based surveys with nutrition modules, and nationalsurveillance systems.Specific population surveysStunting : Height-for-age less than -2 standard deviations of the WHO ChildGrowth Standards median.Severe stunting : Height-for-age less than -3 standard deviations of the WHOChild Growth Standards median.Preferred data sources Household surveysWasting : Weight-for-height less than -2 standard deviations of the WHO ChildGrowth Standards median.Indicator ID 72
  43. 43. World Health Statistics 2012Page 42 / 263 Printed 7/3/2012 5:15:06 PMWHO Child Growth Standards websiteWHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods anddevelopmentLinks WHO Global Database on Child Growth and MalnutritionExpected frequency of datacollectionEvery 5 yearsLimitationsMethodology for estimating regional and global trends of child malnutrition (deOnis et al, 2004b)The WHO Global Database on Child Growth and Malnutrition: methodology andapplications (de Onis & Blössner, 2003)Estimates of global prevalence of childhood underweight in 1990 and 2015 (deOnis et al, 2004a)Expected frequency of datadisseminationBimonthlyDisaggregation AgeSexMethod of estimation of globaland regional aggregatesA well-established methodology for deriving global and regional trends andforecasting future trends, have been published (de Onis et al., 2004a, 2004b)Method of estimation WHO maintains the Global Database on Child Growth and Malnutrition, whichincludes population-based surveys that fulfill a set of criteria. Data are checkedfor validity and consistency and raw data sets are analysed following a standardprocedure to obtain comparable results. Prevalence below and above definedcut-off points for weight-for-age, height-for-age, weight-for-height and bodymass index (BMI)-for-age, in preschool children are presented using z-scoresbased on the WHO Child Growth Standards.A detailed description of the methodology and procedures of the databaseincluding data sources, criteria for inclusion, data quality control and databasework-flow, are described in a paper published in 2003 in the InternationalJournal of Epidemiology (de Onis & Blössner, 2003).Predominant type of statistics: adjustedM&E Framework ImpactUnit of Measure N/AUnit MultiplierBoundaries : Health regionsLocation (urban/rural)Boundaries : Administrative regions
  44. 44. World Health Statistics 2012Page 43 / 263 Printed 7/3/2012 5:15:06 PMContact Person WHO Global Database on Child Growth and Malnutrition(whonutgrowthdb@who.int)Comments The percentage of children with low height-for-age reflects the cumulativeeffects of under-nutrition and infections since birth, and even before birth. Thismeasure, therefore, should be interpreted as an indication of poorenvironmental conditions and/or long-term restriction of a child`s growthpotential. The percentage of children with low weight-for-age may reflect theless common ‘wasting’ (i.e. low weight-for-height) indicating acute weight loss,and/or the much more common ‘stunting’ (i.e. low height-for-age). Thus, it is acomposite indicator that is difficult to interpret. Overweight (i.e. high weight-for-height) is an indicator of malnutrition at the other extreme. Some countrypopulations are facing a double-burden with high prevalence of under- andoverweight simultaneously.An international set of standards (i.e. the WHO Child Growth Standards) is usedto calculate prevalence for the indicators low weight-for-age, low height-for-age, and high weight-for-height. The International Pediatric Association (IPA),the Standing Committee on Nutrition of the United Nations System (SCN), andthe International Union of Nutritional Sciences (IUNS), have officially endorsedthe use of the WHO standards, describing them as an effective tool fordetecting and monitoring undernutrition and overweight, thus addressing thedouble burden of malnutrition affecting populations on a global basis. The WHOChild Growth Standards, launched in 2006, replaces the NCHS/WHOinternational reference for the analysis of nutritional surveys.National nutrition surveys and national nutrition surveillance systems are thepreferred primary data sources for child nutrition indicators. If these sourcesare not available, any random, nationally representative, population-basedsurvey with a sample size of at least 400 children that presents results basedon the WHO standards or provides access to the raw data enabling re-analysiscould be used.Generally national surveys are recommended to be conducted about every 5years. But this also depends on the nutritional status as well as on the changein the economical situation, the perceived change of nutritional status, and theoccurrence of human made crisis and natural disasters.
  45. 45. World Health Statistics 2012Page 44 / 263 Printed 7/3/2012 5:15:06 PMChildren aged <5 years underweight (%)Rationale This indicator belongs to a set of indicators whose purpose is to measurenutritional imbalance and malnutrition resulting in undernutrition (assessed byunderweight, stunting and wasting) and overweight.Child growth is the most widely used indicator of nutritional status in acommunity and is internationally recognized as an important public-healthindicator for monitoring health in populations. In addition, children who sufferfrom growth retardation as a result of poor diets and/or recurrent infectionstend to have a greater risk of suffering illness and death.ISO Health IndicatorsFrameworkAssociated terms Child overweight : Weight-for-height greater than +2 standard deviations of theWHO Child Growth Standards median.Definition Percentage of underweight (weight-for-age less than -2 standard deviations ofthe WHO Child Growth Standards median) among children aged 0-5 years.Topic Risk factorsIndicator name Children aged <5 years underweight (%)Data Type Representation PercentName abbreviated Children aged <5 years underweightChild severe underweight : Weight-for-age less than -3 standard deviations ofthe WHO Child Growth Standards median.Other possible data sourcesSurveillance systemsMethod of measurement Percentage of children aged < 5 years underweight for age = (Number ofchildren aged 0-5 years that fall below minus two standard deviations from themedian weight-for-age of the WHO Child Growth Standards / Total number ofchildren aged 0-5 years that were measured) * 100.Children`s weight and height are measured using standard technology, e.g.children less than 24 months are measured lying down, while standing height ismeasured for children 24 months and older.The data sources include national nutrition surveys, any other nationally-representative population-based surveys with nutrition modules, and nationalsurveillance systems.Specific population surveysStunting : Height-for-age less than -2 standard deviations of the WHO ChildGrowth Standards median.Child underweight : Weight-for-age less than -2 standard deviations of theWHO Child Growth Standards median.Preferred data sources Household surveysWasting : Weight-for-height less than -2 standard deviations of the WHO ChildGrowth Standards median.Indicator ID 27
  46. 46. World Health Statistics 2012Page 45 / 263 Printed 7/3/2012 5:15:06 PMWHO Child Growth Standards websiteWHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods anddevelopmentLinks WHO Global Database on Child Growth and MalnutritionExpected frequency of datacollectionEvery 5 yearsLimitationsMethodology for estimating regional and global trends of child malnutrition (deOnis et al, 2004b)The WHO Global Database on Child Growth and Malnutrition: methodology andapplications (de Onis & Blössner, 2003)Estimates of global prevalence of childhood underweight in 1990 and 2015 (deOnis et al, 2004a)Expected frequency of datadisseminationBimonthlyDisaggregation AgeSexMethod of estimation of globaland regional aggregatesA well-established methodology for deriving global and regional trends andforecasting future trends, have been published (de Onis et al., 2004a, 2004b)Method of estimation WHO maintains the Global Database on Child Growth and Malnutrition, whichincludes population-based surveys that fulfill a set of criteria. Data are checkedfor validity and consistency and raw data sets are analysed following a standardprocedure to obtain comparable results. Prevalence below and above definedcut-off points for weight-for-age, height-for-age, weight-for-height and bodymass index (BMI)-for-age, in preschool children are presented using z-scoresbased on the WHO Child Growth Standards.A detailed description of the methodology and procedures of the databaseincluding data sources, criteria for inclusion, data quality control and databasework-flow, are described in a paper published in 2003 in the InternationalJournal of Epidemiology (de Onis & Blössner, 2003).Predominant type of statistics: adjustedM&E Framework ImpactUnit of Measure N/AUnit MultiplierBoundaries : Health regionsLocation (urban/rural)Boundaries : Administrative regions
  47. 47. World Health Statistics 2012Page 46 / 263 Printed 7/3/2012 5:15:06 PMContact Person WHO Global Database on Child Growth and Malnutrition(whonutgrowthdb@who.int)Comments The percentage of children with low height-for-age reflects the cumulativeeffects of under-nutrition and infections since birth, and even before birth. Thismeasure, therefore, should be interpreted as an indication of poorenvironmental conditions and/or long-term restriction of a child`s growthpotential. The percentage of children with low weight-for-age may reflect theless common ‘wasting’ (i.e. low weight-for-height) indicating acute weight loss,and/or the much more common ‘stunting’ (i.e. low height-for-age). Thus, it is acomposite indicator that is difficult to interpret. Overweight (i.e. high weight-for-height) is an indicator of malnutrition at the other extreme. Some countrypopulations are facing a double-burden with high prevalence of under- andoverweight simultaneously.An international set of standards (i.e. the WHO Child Growth Standards) is usedto calculate prevalence for the indicators low weight-for-age, low height-for-age, and high weight-for-height. The International Pediatric Association (IPA),the Standing Committee on Nutrition of the United Nations System (SCN), andthe International Union of Nutritional Sciences (IUNS), have officially endorsedthe use of the WHO standards, describing them as an effective tool fordetecting and monitoring undernutrition and overweight, thus addressing thedouble burden of malnutrition affecting populations on a global basis. The WHOChild Growth Standards, launched in 2006, replaces the NCHS/WHOinternational reference for the analysis of nutritional surveys.National nutrition surveys and national nutrition surveillance systems are thepreferred primary data sources for child nutrition indicators. If these sourcesare not available, any random, nationally representative population-basedsurvey with a sample size of at least 400 children that presents results basedon the WHO standards or provides access to the raw data enabling re-analysiscould be used.Generally national surveys are recommended to be conducted about every 5years. But this also depends on the nutritional status as well as on the changein the economical situation, the perceived change of nutritional status, and theoccurrence of human made crisis and natural disasters.
  48. 48. World Health Statistics 2012Page 47 / 263 Printed 7/3/2012 5:15:06 PMChildren aged <5 years with ARI symptoms receiving antibiotics (%)DisaggregationUnit of MeasureUnit MultiplierContact PersonM&E Framework OutcomeMethod of estimation of globaland regional aggregatesLinks Demographic and Health SurveysMultiple Indicator Cluster SurveysComments This indicator constitutes one of the 11 indicators selected to monitor the statusof womens and childrens health by the Commission on Information andAccountability (CoIA).Expected frequency of datadisseminationExpected frequency of datacollectionLimitations This indicator is usually collected in DHS and MICS surveys. It is subject tovariation as the denominator – children with suspected pneumonia in the twoweeks preceding the survey – will vary by season and caretaker reporting. Interms of the numerator, this indicator does not measure timing or dosage oftreatment, or the type of antibiotic used.Notably, the responses on antibiotic use will be dependent upon the mother orcaretaker’s knowledge about the drugs used to treat the illness and complianceto the treatment.Data Type Representation PercentTopic Health service coverageISO Health IndicatorsFrameworkMethod of estimation WHO compiles empirical data from household surveys.Predominant type of statistics: adjustedIndicator name Children aged <5 years with ARI symptoms receiving antibiotics (%)Name abbreviatedPreferred data sources Household surveysOther possible data sourcesMethod of measurementRationale Pneumonia accounts for an estimated 18% of deaths among children underfive. Appropriate care of the sick child is defined as providers that can correctlydiagnose and treat pneumonia. Antibiotics have an essential role in reducingdeaths due to pneumonia. Pneumonia prevention and treatment is thereforeessential to the achievement of MDG4.Definition Percentage of children ages 0-59 months with suspected pneumonia receivingantibiotics.Associated termsIndicator ID 2973
  49. 49. World Health Statistics 2012Page 48 / 263 Printed 7/3/2012 5:15:06 PM

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