The document discusses health indicators and provides definitions, characteristics, classifications, and examples of health indicators. It describes how health indicators can be used to measure community health status, describe health needs, compare communities, and evaluate and plan health services. Some key health indicators discussed include mortality rates, morbidity rates, nutritional status, health care access, and quality of life measures.

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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