Measures of popn.HEALTH.pptx

DEPARTMENT OF PUBLIC HEALTH
PRESENTATION ON:
-MEASURES OF POPULATION HEALTH
BY: MESFIN Y.(Bsc. In PH)
:FIRHEWOT FIKRU( Bsc. In PH)
Dec.2020
MTU
1
12/26/2022 Introduction to PH

Group member
S.n Name ID Department
1. Mesfin Yimam GSR/038/2013 EPIDEMIOLOGY
2. Firhewot Fikru GSR/0 /2013 GMPH
12/26/2022 2
Introduction to PH

Outline of the Presentation
 Introduction
Source of Health information
Types of information
Approaches to obtaining health information
Indicators of health status of the population
Demographic and socioeconomic indicators related
to health
Summary measures of population health
12/26/2022 3
Introduction to PH

Learning Objectives
At the end of the presentation you will able to:
Explain Why do we need measuring of population health
Describe the source of health information
Discuss about approaches to obtaining health
information
List indicators of health status of the population
List indicators of health policy
Describe Summary measures of population health
12/26/2022 4
Introduction to PH

Introduction
• Measurement: is the assignment of numbers to
objects or events according to a set of rules.
 It involves the concept of summarizing
phenomena quantitatively
Health related event is measured on
various levels (scale) measurement
• Population-is a collection of entities, usually
people, however; consists of animals,
machines, places, or cells.
12/26/2022 5
Introduction to PH

Requirements for Measures
The information that to be the element of measures to
measure population health status, it must fulfill the
requirement of :-
• Relatively easy to explain to the public
• 10 years of trend data
• Available annually
• Ability to break out data by demographic
characteristics is valued
12/26/2022 6
Introduction to PH

Why do we need measures of population
health?
Governments wish to monitor health of citizens
– To set priorities for health services & policies
– To evaluate social and health policies
– To compare health of different regions
– To identify pressing health needs
– To draw attention to inequalities in health
– Highlight balance between length and quality of life
– Numerical index desirable: a “GNP of Health”
12/26/2022 7
Introduction to PH

Sources of health information
•There are essentially two broad categories of data
sources:
(a) population based; and
(b) institution based. Or
1. Primary data: collected from the items or individual
respondents directly by the researcher
2. Secondary data: collected from the records or
reports /from other documents that primarily
collected by others.
12/26/2022 8
Introduction to PH

Cont…
•Population-based data sources
include:
information on every individual in a
population (for example, censuses or
vital registration systems)
sources that have information on a
representative sample of the
population (for example, household
surveys)..
12/26/2022 9
Introduction to PH

Cont…
•Institution-based data sources:
Which is gathered data in the course of
administrative and operational activities,
Examples of institution-based data sources
include :-
hospitals,
clinics,
service or individual records
12/26/2022 10
Introduction to PH

Types of information source
All
information
for
health
Population-based
sources
Censuses
Vital registration
systems
Household
surveys
Institution-based
sources
Resource records
(e.g. number of hospitals)
Service records
(e.g. number of immunizations
provided)
Individual records
(e.g. hospital charts)
12/26/2022 11
Introduction to PH

Population-based sources:
censuses
• Census is defined s a periodic count or enumeration of a
population.
• Data cover the entire population
• Censuses may be a good source of information about
equity stratifiers
• Possible improvements:
– include individual or small-area identifiers
– include mortality and cause of death questions
12/26/2022 12
Introduction to PH

Cont….
o Census data are necessary for accurate description of
population’s health status and are principal source of
denominator for rates of Birth, disease & death.
 It provides information on:
– Size and composition of a population
– The trends anticipated in the future.
o In Ethiopia census is conducted every 10 years.
12/26/2022 13
Introduction to PH

vital registration systems
 This is a system by which all births , marriage , divorce and
deaths occurring nation wide are registered, reported and
compiled centrally.
 Certificate is issued for each birth marriage, divorce and
death.
 It is the source of information for the calculation of birth and
death rates.
o NB: In Ethiopia, vital events registration was officially started
in 2016GC (2008 E.C)
12/26/2022 14
Introduction to PH

cont…
The main characteristics of vital statistics
are(4C):
1. Comprehensive – all births and deaths
should be registered.
2. Compulsory by law – should be enforced by
law.
3. Compiled centrally - so that it can serve as a
source of information.
4. Continuous – it should be an ongoing
process.
12/26/2022 15
Introduction to PH

Vital cont…
Time frame for registration of vital events:
1. Birth =within 90 days
2. Marriage = within 30 days
3. Divorce = within 30 days
4. Death = within 30 days
12/26/2022 16
Introduction to PH

household surveys
• Data are representative for a specific population
• Have rich data on a specific health topic as well as living
standards .
• Often repeated over time, allowing for measurement of
time trends
12/26/2022 17
Introduction to PH

Cont…
– Repeat surveys on a regular basis
– Enhance comparability over time and between
countries by harmonizing survey questions
– Increase sample sizes
12/26/2022 Introduction to PH 18

Institution-based data sources
• Data are readily and quickly available
• Can be used at lower administrative levels (e.g.
district level)
• Data may be fragmented or of poor quality
• Often data cannot be linked to other sources
12/26/2022 19
Introduction to PH

Cont….
• Data may not be representative of the whole
population
– Include individual or small-area identifiers
– Standardize electronic records across institutions

Institution-based……
Health Service Records
All health institutions report their activities to the
Ministry of Health through the regional health
bureaus.
The Ministry compiles, analyzes and publishes it
in the health service directory.
It is therefore the major source of health
information in Ethiopia.
12/26/2022 21
Introduction to PH

Approaches to obtaining Health information
• Approaches to obtaining information on population size
and characteristics, births and deaths, and episodes of
illness :-
• Can be obtained from:
– Routinely kept records, literature
– Surveys
– Counting
– Reports and Observation
12/26/2022 22
Introduction to PH

Approaches …
• But, In many parts of the world routinely available data
that describe:
 population size and characteristics,
 births and deaths, and
 episodes of illness and disease, are not available. Or
 if they are available, they often suffer from serious
problems of incompleteness or inaccuracy that render
them not very useful.
12/26/2022 23
Introduction to PH

Approaches….
• So, Various approaches have been used to provide
types of data in such situations
1. Demographic surveillance
2. Epidemiological surveys
3. Rapid evaluation methods
12/26/2022 24
Introduction to PH

Approaches….
1. Demographic surveillance
Characteristics
• Regular censuses of community or sub-section
of a population.
• May include system for describing cause of death.
Examples : Population size, age and sex structure;
migration in and out of the population; measures of
fertility and mortality.
12/26/2022 25
Introduction to PH

Approaches ……
2. Epidemiological surveys
characteristics
• Representative sample of larger population selected.
• Survey participants interviewed and/or examined.
Examples : Assesses the prevalence of a disease; may be
used to estimate fertility and mortality.
12/26/2022 26
Introduction to PH

Approaches …..
3. Rapid evaluation methods
Characteristics
• Variety of methods may be used, such as:
– participant observation;
– focus group discussions;
– key informant interviews;
– patients interviews; and
– health staff interviews.
12/26/2022 27
Introduction to PH

Approaches….
Examples :Can provide a qualitative assessment of the :
major health problems,
their causes and solutions.
• Commonly used to assess quality of health care
delivery.
12/26/2022 28
Introduction to PH

Classification of health indicators
An indicator:
• is a key statistical measure selected to help describe
(indicate) a situation concisely, track progress and
performance, and act as a guide to decision making
• Health status indicators- are a set of surveillance
data that has been analyzed in a way that permits
assessment of the health status of the population.
12/26/2022 29
Introduction to PH

Cont…
• The term “indicator” is derived from the Latin
“indicare”, which means to announce, point out or
indicate.
• Other defines as an indicator as “A parameter, or a
value derived from parameters, which points to
provides information about the state of a
phenomenon.
12/26/2022 30
Introduction to PH

Common Frameworks for Health Indicators
1. Broad “Determinants of Health” - emphasizes the
physical environment, social environment, health
behaviors, medical care.
2. “Life Course” - emphasizes experiences early in life
and interactions at developmental stages throughout
life.
3. “Social Determinants” emphasizes educational,
economic, and social conditions.
12/26/2022 31
Introduction to PH

How are health indicators used?
Indicators are used to support :
 Planning (identify priorities, develop and target
resources, identify benchmarks)
 Track progress toward broad community objectives.
 Engagement of partners into civic and collaborative
action (build awareness of problems and trends,
generate interventions).
 Inform policy and policy makers.
12/26/2022 32
Introduction to PH

Indicators of health status of the population
• Measuring health, is a multidimensional concept. One of the
commonest indicators are:
• Divided in to:
1. Health status indicator
 disease specific mortality,
 morbidity and disability
2. Determinants of health indicator
 biological risk factors and
 health behaviors
12/26/2022 33
Introduction to PH

Cont…
3. Health system indicators
– Health service coverage , medication use,….
Characteristics of indicators:
• Reliable-Reproducibility or reliability is the
degree of stability of the data when the
measurement is repeated under similar
conditions.
• Sensitive –the ability to express/address the
intended issue easily.
• Valid –to the degree that a measurement
actually measures what it claims to measure.

Cont,…
• Specific: Indicator is concrete, detailed, focused, and
well defined
• Measurable: Indicator tells how many or how much
and can be measured with identified
measurement sources
• Feasible- the resources (human, physical,
financial) needed are available?

Indicators of heath…
• Morbidity indicators
• Mortality indicators
• Disability rates
• Nutritional status indicators
• Healthy care delivery indicators
• Utilization rates
12/26/2022 36
Introduction to PH

Indicators of heath…….
• Indicators of social & mental health
• Environmental indicators
• Socio‐economic indicators
• Healthy policy indicators
• Indicators of quality of life.
12/26/2022 37
Introduction to PH

Mortality Indicators
• These includes :‐
– Crude Death Rate
– Expectation of Life
– Maternal Mortality Rate
– Infant Mortality Rate
– Under 5 mortality rate, etc
12/26/2022 38
Introduction to PH

Mortality ….
Crude Death Rate:
• The number of deaths in a given interval (usually a
year) divided by the population at mid-year.
• usually expressed per 1000 population.

Cont…
Crude death rate is influenced by:
– Individual’s probability of dying
– Population age distribution

Mortality ….
Expectation of Life:
 Is the estimate of the average number of additional
years that a person of a given age can expect to live.
 The most common measure of life expectancy is life
expectancy at birth.
 Is calculated by constructing a life table.

Cont….
• A life table incorporates data on age-specific death
rates for the population in question, which requires
enumeration data for the number of people, and the
number of deaths at each age for that population.

Life expe…
s.n Country Life
expectancy
(both sex)
Life
expectancy
(female sex)
Life
expectancy
(male sex)
1. Hong Kong 85.29 88.17 82.38
2 Japan 85.03 88.09 81.91
3 Ethiopia 67.81 69.80 65.86 147 rank
from the
world (2020
WHO)
4 Kenya 67.47 69.87 65.04
5 Pakistan 67.79 68.90 66.77
6

Maternal Mortality rate
Reflect health care access and socioeconomic factors
Number of live births during the
same interval
X 100,000
Number of deaths assigned to
causes related to pregnancy
during a given interval
Maternal
Mortality
Rate =

Neonatal Mortality Rate …
Estimates events immediately after birth, primarily
congenital malformations, prematurity and low birth
weight
Number of live births during
the same interval
X 1,000
Number of deaths of neonates
(28 days or less) in a given
interval
Neonatal
Mortality Rate =

Infant mortality rate …
Used for international comparisons; high rates
indicate unmet public health needs and poor
socioeconomic and environmental conditions
Number of live births
during the same interval
X 1,000
Number of deaths under 1
year during a given interval
Infant Mortality
Rate =

Under 5 mortality rate …
Used for international comparisons; high rates indicate
unmet public health needs and poor socioeconomic and
environmental conditions
Number of live births in
the same year
X 1,00
Number of deaths of
children under 5 years in a
year
U5 Mortality
Rate =

Morbidity Indicators
• Morbidity rates used for assessing ill health in
community are:
– Incidence
– Prevalence
– Attendance rate at OPDs, health centers etc.
– Admission, readmission and discharge rates
12/26/2022 48
Introduction to PH

Morbidity …
Incidence :
• Quantifies number of new cases of disease that
develop in a population at risk during a specified time
period’
♦ Two forms,
1. Cumulative incidence: It assumes that the entire
population is at risk and is followed up for specified time
of period.

Con…
2. Incidence density:is a rate at w/c new cases
develops in apopulation relatives to the size of
the population .

Morbidity…
No. of new cases of disease during a given period
• CI = ------------------------------------------------------ x100
Total population at risk during the given period
No. new cases of disease during a given period
ID = ----------------------------------------------------------- x100
Total “person-time” of observation

Prevalence rate
•is the proportion of persons in a population who have
a particular disease at a specified point in time or over a
specified period of time.
It has two forms :1. piont prevalence
2. period prevalence
The formula for presence of disease is:

Prepared by Amare Deribew,
MD,MPHE
53
Point and period prevalence
• Point prevalence: is the amount of disease present in a
population at a single point in time.
Point prevalence =all the cases of factor of interest at a given
time x 10n
total population
• Period prevalence : The numerator in period prevalence is the
number of persons who had a particular disease or attribute at
any time during a particular interval .
Period prevalence = all cases (old and new) of the factor of x 10n
interest during the time period
average population during the given period of time

Cont….
• Period prevalence : The numerator in period
prevalence is the number of persons who had a
particular disease or attribute at any time
during a particular interval .
Period prevalence = all cases (old and new) of the
factor of x 10n
interest during the time period
average population during the given period of
time

Disability Rates
• A disability is any condition of the body or mind
(impairment) that makes it more difficult for the
person with the condition to do certain activities
12/26/2022 55
Introduction to PH

Cont…
• Sullivan’s Index
– Expectation of life free of disability:
is the average number of years an individual is
expected to live free of disability
Unlike life expectancy, DFLE cannot be estimated
from a period life table alone without obtaining
additional information about disability prevalence
12/26/2022 56
Introduction to PH

Cont…
• DALY (Disability Adjusted Life Year):
– Number of years lost due to disability or ill‐health.
– represents the loss of the equivalent of one year of full
health.
– years of life lost due to premature mortality (YLLs) and
– the years lived with a disability (YLDs) due to prevalent
cases of the disease or health condition in a
population
12/26/2022 57
Introduction to PH

Cont…
• QALY (Quality adjusted life year)
– Number of years of life that would be added by a medical
intervention.
– The QALY is a measure of the value of health outcomes.
– Can be expressed as lost (to disease ) gained (through
intervention )
– Common out come measurement in clinical trail, program
evaluation, recording extra years of life provided by therapy
plus the quality of

Nutritional Status Indicators
• It includes :‐
– Anthropometric measurement of pre‐ school
children.
e.g Mauc , W/A, W/H…
– Prevalence of low birth weight.
12/26/2022 59
Introduction to PH

Health Care provision Indicators
It includes :‐
Coverage
• Outpatient consultation rate - measured using
program data
• Proportion of illness episodes for which
appropriate care was sought - often measured
during surveys by interview
• Average delay in seeking health care - also
measured in surveys
12/26/2022 60
Introduction to PH

Cont…
– Nurses : population ratio (1:5000)
– Doctor : population ratio (1:10000)
– Expressed as proportion of people in need of health
care services who actually receive it in a given period.
• Proportion of infants who are fully immunized
against the EPI diseases.
• Percentage of population using the various
methods of family planning.

Cont…
Effectiveness of health services
-Case-fatality ratio among inpatients
-Diagnostic accuracy

Indicators of Social & Mental Health
• Indirect measures
• It includes indicators of social pathology:‐
– Suicide
– Homicide
– Other acts of violence
– Other crime etc.
– Alcohol and drug abuse, etc.
12/26/2022 63
Introduction to PH

Environmental Indicators
• Reflects quality of physical & biological
environment.
– Proportion of population having access to safe
water
– Proportion of population having access to
sanitation facilities
– Indicators relating to pollution of air and
water, radiation, solid wastes, noise
12/26/2022 64
Introduction to PH

Socio Economic Indicators
• It Includes :‐
– Rate of population decrease
– Level of unemployment
– Dependency ratio etc.
12/26/2022 65
Introduction to PH

Health Policy Indicators
Are Indicator of political commitment like :
• Addressing universal health coverage and patient-
centred health care
• Addressing the reduction of health inequities or
tackling the social determinants of health
• Allocation of adequate resources:-
– Proportion of GNP(gross national production )
spent upon health services.
– Proportion of GNP spent upon health‐related
activities
– Proportion of total health resources devoted to
primary health care.
12/26/2022 66
Introduction to PH

Summary measures of population health
Health Outcomes- high-level indicators
Access- availability and use of services
 Healthy Behaviors- choices by individuals and
communities
Prevention- screening and early intervention
Social Environment- health literacy and
attention to disparities
Physical Environment- built infrastructure and
natural

Health Outcomes
• Examples
 Mortality
 Longevity
 Infant mortality; low birth weight; preterm birth
 Injuries;accident, home suicide

Access
• Health insurance status; primary care access; access
to needed services; condition specific hospital
admissions
-Examples : Children with Inconsistent Health Insurance
Coverage in the Past 12 Months
-Children Who Had Problems Obtaining Referrals When
Needed

Healthy Behaviors
• Preventive Care and Screening :
Addictive substances assessment
weight assessment and
physical activity
 healthy life style level

Prevention
• Disease and condition screening;
immunizations,maternity care; newborn
and child development
• Examples : Colorectal Cancer Screening

Refernce
12/26/2022
1. United states,national library of medicine, health
indicators ,part 1 .
2. https://www.healthknowledge.org.uk/public-health-
textbook/health-information/3c-
applications/common-measures
3. HSCRC Performance Measurement , Charles Street
Suite 200 Baltimore, MD 21201 (410) 542 -4470 www
4. Handbook on Health Inequality Monitoring ,WHO,2012.
5. https://www.worldometers.info/demographics/life-
expectancy/
6. An Introduction to Public Health and Epidemiology,
second edition(2008)
72
Introduction to PH

Social Environment
• education (e.g., graduation rate);
• community safety ,
• poverty level and
• disparities

12/26/2022 74
Introduction to PH

Measures of popn.HEALTH.pptx

Recommended

Recommended

More Related Content

Similar to Measures of popn.HEALTH.pptx

Similar to Measures of popn.HEALTH.pptx (20)

More from AMANUELMELAKU5

More from AMANUELMELAKU5 (20)

Recently uploaded

Recently uploaded (20)

Measures of popn.HEALTH.pptx