Health indicators lecture 2

Prepared by
DR. NAIF IZZATULLAH ABDULJABBAR
MBBS
MSc of public health
HEALTH INDICATORS

18/04/1442HEALTH INDICATORS2
Contents
Objectives
Introduction
Indicators of Health
Characteristics
Uses
Classification of Indicators of Health
Health indictors in Sudan
References

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

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”

Indicators of Health
Health Indicator or index 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)…

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

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
Continue characteristic

Uses of Indicators of Health
• Measurement the health of the community.
• Description the health of the community.
• Comparison the health of different
communities.
• To assess the health needs

Cont. Uses of Indicators of Health
• To evaluate the health services
• Planning and allocation of health resources.
• Measurement of health successes.

Classification of Indicators of Health
• Mortality Indicators
• Morbidity Indicators
• Disability Rates
• Nutritional Status or Nutritional Indicators
• Health Care Delivery Indicators
• Utilization Rates

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

Very important tricks
• Rate: Numerator (a) is a part of denominator
(b) and multiplier is 1000 or 10,000 or 100,000
• Ratio: Numerator (a) is not a part of
denominator (b) and BOTH numerator and
denominator are unrelated
• Proportion: Numerator (a) is a part of
denominator (b) and multiplier is 100
Proportion is always expressed in percentage
(%)

Mortality Indicators

• 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
• CDR Sudan - 7.0 deaths/1,000 population
(high but better than in developing countries)
1.Crude Death Rate

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

3.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.
• Current IMR: Sudan - 40/1000 live birth

4.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

5.Under-5 Mortality Rate
• no. of deaths occurring in the under-5 age
group per 1000 live births.
• U5 mortality rate reflects both infant and child
mortality.
• Current rate – 60/1000 live births (very high).

6.Maternal Mortality Ratio
• is the number of deaths arising during
pregnancy or puerperal period per 100000 live
births.
• Accounts for the greatest number of deaths
among women of reproductive age in
developing countries. Current MMR – Sudan -
295/100000 live births (very high).

7.Maternal Mortality Rate
Number of deaths related to pregnancy during a
given period
Number of live births during the same period

8.Proportional Mortality Rate
• is the proportion of all deaths attributed to the
specific disease to total deaths
• Is the simplest meature of estimating the
burden of a disease
• CHD 35% (very high) of all deaths in
developed world.

9.Case Fatality Rate
Number of deaths assigned to specific disease
Number of cases of disease
*100
Power of killing
Usually expressed in percentage
Its is a proportion

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.

1.Incidence rate :
• The number of new events or new cases of a
disease in a defined population, within a
specified period of time. *1000
• The incidence of Tuberculosis in Sudan is 120
per 100000 (very high).
Can be determined from: Cohort study
Is the best measure of disease frequency

Cont.Incidence rate :
• Attack Rate:
Number of new cases at risk developed specific disease
during a specific time interval
Total population at risk during the same time interval
Secondary Attack Rate:
Number of exposed people developing the disease a
specified time period
total number of people exposed the primary cases

2.Prevalence
• The total number of all individuals who have
an attribute or disease at a particular time
divided by population at risk of having
attribute or disease at this point of time.
: a specific point in time
: a given time interval (can
be used to measure the health needs of the
community
Reflects the chronicity of the disease.

Cont. Prevalence
• PREVALENCE IS A PROPORTION
• always expressed in percentage
• can be determined from: Cross Sectional Study
• Prevalence : The number of new + old cases.

other Morbidity Indicators
3. Notification rates : is calculated from the
reporting to public authorities of certain diseases.
4. Admission, Readmission and discharge
rates.
5. Duration of stay in hospital – reflects the
virulence and resistance developed by the
etiological factor
6. Spells of sickness

Disability Rates

Sullivan's index
• Sullivan’s Index refers to “expectation of life
free of disability”.
• Life expectancy – duration of disability
Health Adjusted Life Expectancy
life expectancy at birth but includes an
adjustment for time spent in poor health

Disability Adjusted Life Years.
• 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 disease in a
defined population

Uses of DALYs
• To assist health service priorities
• To identify the disadvantaged groups
• Measuring the results of health interventions
• Providing comparable measures for planning
& evaluating programmes
• One DALY is one productive lost year of
healthy life

Quality Adjusted Life Year
• QALY is Quality Adjusted Life Year.
• It is the most commonly used to measure the
cost effectiveness of health interventions .
• It estimates the number of years of life added
by a successful treatment or adjustment for
quality of life.
• Each year in perfect health is assigned a value
of 1.0 down to a value of 0.0 for death.

Years of potential life lost
• Years of potential life lost (YPLL) or potential
years of life lost through premature (PYLL).
• It is an estimate of the average years a person
would have lived if they had not died
prematurely.
• Reference age is generally 60 years

NUTRITIONAL
STATUS
INDICATORS

NUTRITIONAL STATUS
INDICATORS
• Nutritional Status is a positive health indicator.
Newborns are measured for their:
–Birth weight
–Length
–Head circumference

Continue Nutritional 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.
Mid-arm circumference - measures chronic
malnutrition

Cont. nutritional status
• Underweight: weight for age < –2 standard
deviations (SD) of the WHO Child Growth Standards
median
• Stunting: height for age < –2 SD of the WHO Child
Growth Standards median
• Wasting: weight for height < –2 SD of the WHO
Child Growth Standards median
• Overweight: weight for height > +2 SD of the WHO
Child Growth Standards median

Cont. nutritional status
• Growth Monitoring of children is done by
measuring weight – for - age, height - for -
age, weight – for - height, head & chest
circumference and mid-arm circumference.
• In adults Underweight, Obesity and Anemia
are generally considered reliable nutritional
indicators.

Health Care
Delivery
Indicators

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
• Health worker – population

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.

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
4. Bed occupancy

Indicators of
Quality of Life

Physical Quality of Life Index
• Is an attempt to measure the quality of life or well-
being of a country.
 basic literacy rate,
 infant mortality,
 life expectancy
The result is placed on the 0 to 100 scale

Human Development Index
• 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

SOCIOECONOMIC
INDICATORS

• These do not directly measure health but are important in
interpreting health indicators. These are: (HE
FLAGGD)
– Housing – the number of persons per room
– unemployment level
– Literacy rates
– Family zise
– Availability Per capita “calorie”
– GNI (gross national income)
– Growth rate
– Dependency ratio

Indicators of Social and Mental Health
• These Include rates of suicide, homicide, other
crime, road traffic accident, alcohol and
substance abuse, domestic violence.
Environmental Indicators
The most important are those measuring the
proportion of population having access to safe
drinking water and sanitation facilities.

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.

Thank you

Percentage of children receiving immunization is a type of
A. Health care delivery indicator
B. Socioeconomic indicator
C. Health policy indicator
D. Health service utilization indicator
The following indicates are used for measuring disability
except
A. Sullivan's index
B. DALYS
C. PQLI
Life expectancy at birth is
A. A morbidity indicator
B. Mortality indicator
Test your knowledge

Seventy percent of susceptible house hold contact of a child
with measles develop this disease
A. Case fatality rate
B. Secondary attack rate
Number of attack of sickness and absenteeism from work is a
type of
A. Morbidity indicator
B. Mortality indicator
Population at risk is used as denominator in calculation of
A. Incidence
B. Prevalence
Con.Test your knowledge

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

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

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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