Health indicators

1. HEALTH INDICATORS
Prepared by
Dr.Mohammed Ali Aljradey
(MBBS,MPH ,TA –IUA)

2. Contents
• Objectives
• Introduction
• Indicators of Health
• Characteristics
• Uses
• Classification of Indicators of Health
• Health indictors in Sudan
• Summary
• References
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3. SESSObjectives
N 1 : Learning Objectives
•At the end of the session, participants should
be able to
 Define and identify relevant health indicators
 Mention characteristics of good indicators
 Give examples of good indicators
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4. Introduction
• Health is defined as “a state of complete
physical, mental & social wellbeing, and not
merely an absence of disease or infirmity”
(WHO)
• This statement has been amplified to include
the ability to lead a “socially and economically
productive life”
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5. Indicators of Health
• Health Indicator is a variable, susceptible to
direct measurement, that reflects the state of
health of persons in a community.
 a variable (its value changes)
 that measures (objective calculation of value)…
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6. Characteristics
1. Valid – they should actually measure that
they are supposed to measure
2. Reliable – the results should be the same
when measured by different people in similar
circumstances
3. Sensitive – they should be sensitive to
changes in the situation concerned
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7. 4. Specific – they should reflect changes only in
the situation concerned
5. Feasible – they should have the ability to
obtain data when needed
6. Relevant – they should contribute to the
understanding of the phenomenon of interest
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8. Uses of Indicators of Health
• Measurement the health of the community.
• Description the health of the community.
• Comparison the health of different
communities.
• Identification health needs and prioritizing
them.
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9. Cont. Uses of Indicators of Health
• Concurrent evaluation and terminal evaluation
of health services
• Planning and allocation of health resources.
• Measurement of health successes.
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10. Classification of Indicators of Health
• Mortality Indicators
• Morbidity Indicators
• Disability Rates
• Nutritional Status or Nutritional Indicators
• Health Care Delivery Indicators
• Utilization Rates
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11. Cont. Classification of Indicators of Health.
• Indicators of Social And Mental Health
• Environmental Indicators
• Socio-economic Indicators
• Health Policy Indicators
• Indicators of Quality of Life
• Other Indicators
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12. Mortality Indicators
1.Crude Death Rate
• It is defined as the number of deaths per
1000 population per year in a given
community, usually the mid-year population
• fair indicator of the comparative health of the
people.
• Useful in detecting the etiologic factor
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13. Cont. Mortality Indicators
2.Expectation of life
• refers to the number of years a person can
expect to live.
• Estimated for both sexes separately.
• Good indicator of socioeconomic development
• In Sudan :Male: 64 years
• female: 66 years
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14. Cont. Mortality Indicators
Infant mortality rate:
• The ratio of deaths under 1yr of age in a
given year to the total number of live births
in the same year, usually expressed as a rate
per 1000 live births.
• Sensitive indicator of availability, utilization
&effectiveness of health care, particularly
perinatal care.
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15. Cont. Mortality Indicators
Child Mortality Rate
• The number of deaths at ages 1-4yrs in a
given year, per 1000 children in that age
group at the mid-point of the year.
• Correlates with inadequate MCH services,
malnutrition, low immunization coverage and
environmental factors
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16. Cont. Mortality Indicators
• Other indicators are
• Perinatal mortality rate,
• Neonatal mortality rate,
• Stillbirth rate, etc.
 Correlates with inadequate antenatal care and
perinatal care
Disease Specific Death Rate :
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17. Morbidity Indicators
• Morbidity Indicators: The frequency with
which a disease appears in a population.
• Reveal the burden of ill health in a community,
but do not measure the subclinical states.
• Incidence :The number of new events or new
cases of a disease in a defined population,
within a specified period of time.
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18. Cont. Morbidity Indicators
• Prevalence : The number of new + old cases.
• Notification rates : is calculated from the
reporting to public authorities of certain
diseases.
• Admission, Readmission and discharge rates.
• Duration of stay in hospital – reflects the
virulence and resistance developed by the
etiological factor
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19. Disability Rates
• Disability Rates are of two categories
• Event type Indicators –
 number of days of restricted activity
 bed disability days
 work-loss days within a specified period
• Person type Indicators –
limitation of mobility e.g. confined to bed,
confined to house, special aid in getting around.
 limitation of activity e.g. limitation to perform
the basic activities of daily living (ADL) e.g.
eating, washing, dressing, etc.
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20. Cont. Disability Rates
• DALYs: Disability Adjusted Life Years.
• It is defined as the number of years of healthy
life lost due to all causes whether from
premature mortality or disability.
• DALY = years of life lost(YLL) + years lost to
disability(YLD)
• It is the simplest and the most commonly used
measure to find the burden of illness in a
defined population
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21. Nutritional Status Indicators
Newborns :
• are measured for their : i. Birth–weight ii. Length
Head circumference .
• They reflect the maternal nutrition status.
 Anthropometric measurements of pre-school
children.
i. Weight – measures acute malnutrition.
ii. Height – measures chronic malnutrition.
• Growth Monitoring of children is done by measuring
weight for-age, height-for-age, weight-for- height,etc
 In adults :MBI ( Underweight, Obesity) and Anemia
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22. Health Care Delivery Indicators
• These indicators reflect the equity of distribution of
health resources in different parts of the country and
of the provision of health care.
• Doctor-population Ratio
• Nurse-population ratio
• Population-bed Ratio
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23. CONT. Health Care Delivery
Indicators
• The WHO Joint Learning Initiative has
established a threshold of 25 health workers
(doctors, nurses and midwives) per 10,000
population, with a WHO endorsed lower
threshold of 23 workers per 10,000.
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24. Utilization Rates
• the proportion of people in need of a service
who actually receive it in a given period.
• It depends on availability & accessibility of health
services and the attitude of an individual towards
health care system.
E.g.
1. Proportion of infants who are fully immunized
2. Proportion of pregnant women who receive ANC
3. Percentage of population who adopt family
planning
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25. Indicators of Social and Mental Health
• These Include rates of suicide, homicide, other
crime, road traffic accident, alcohol and
substance abuse, domestic violence.
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26. Environmental Indicators
• These reflect the quality of physical and
biological environment in which diseases
occur and people live.
• The most important are those measuring the
proportion of population having access to safe
drinking water and sanitation facilities.
• These indicators explains the prevalence of
communicable diseases in a community
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27. Indicators of Quality of Life
• Life expectancy is no longer important
• The Quality Of Life has gained its importance
• Physical Quality of Life Index :s an attempt to measure
the quality of life or well-being of a country.
 basic literacy rate,
 infant mortality,
 and life expectancy
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28. CONT. Indicators of Quality of Life
• Human Development Index
– Longevity (life expectancy at birth)
– Education (mean and expected years of schooling)
– Gross national income (GNI) per capita
• The result is placed on the 0 to 1 scale
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29. SOCIOECONOMIC INDICATORS
• These do not directly measure health but are
important in interpreting health indicators.
These are:
– Rate of growth of population
– Per capita GNI (gross national income)
– Dependency ratio
– Literacy rates
– Housing – the number of persons per room
– Per capita “calorie” availability
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30. HEALTH POLICY INDICATORS
• The single most important indicator of political
commitment is allocation of adequate
resources.
• The relevant indicators are
• Proportion of GNP(gross national product)
spent on health services.
• Proportion of GNP spent on health related
activities like water supply and sanitation &
housing and nutrition.
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31. Health Indictors in Sudan
• Total population (2016) 39,579,000
• Life expectancy at birth m/f (years, 2016)
63/67
• Probability of dying under five (per 1 000 live
births, 2017) 63
• Probability of dying between 15 and 60 years
m/f (per 1 000 population, 2016) 253/195
• Total expenditure on health as % of GDP
(2014) 8.4
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32. Mortality rate in Sudan
• Neonatal mortality rate ( per 1000 live births)
29.8 ( both sexes) WHO 2017
• under 5 mortality rate ( per 1000 live births) :
63.2( both sexes) WHO 2017
• Maternal mortality ratio( per 100000 live
births) : 311 WHO 20175
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33. SUMMARY
• Health not measured directly but using
indicators
• Indicator should be valid, sensitive, specific,
reliable, relevant and feasible
• Used in measuring, describing, comparing,
identifying health needs and planning and
evaluation of health services
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34. References
• Park K. Textbook of preventive and social
medicine. 21st ed. Jabalpur, India
• health indicators IN SUDAN – WHO
https://apps.who.int/gho/data/node.cco.ki-
SDN?lang=en
• Lecture notes
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