Health indicators

Prof. Ashry Gad Mohamed Dr. Salwa Tayel

Department of family and Community Medicine

At the end of the lecture students should be able to:

1.Recognize the concept of health indicators.

2.Define health indicators.

3.Understand uses of health indicators.

4.Classify types of health indicators and give examples of these indicators.

OBJECTIVES OF THE LECTURE

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• Health indicator is a variable that reflects the state of health of persons in a community. (Oxford Dictionary of Epidemiology)

• They are quantitative measures that can be used as a guide to monitor and evaluate the quality of health care.

• Linguistically indicator is an indication of a given situation

What is health indicator?

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• Valid – measures what it is supposed to measure.• Reliable – provides same information under

different observations, conditions • Sensitive – sensitive to changes in the situation • Specific – reflects changes only in that situation• Relevant: relevant to the community needs &

problems.

Characteristics of a good indicator:

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• Realistic, applicable and feasible.• Measurable and observable.• Known and agreed to by the staff

whose performance is being assessed.• Clear and targeted to date or period.• Used in assessment continuously over time.

Characteristics of a good indicator:

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Uses of Health Indicators

1. Compare health status of one country with other countries or worldwide.

2. Compare health status of different areas or groups of people over time.

3. Assessment of health care needs.

4. Proper allocation of human and non human resources according to the needs.

5. Monitoring and evaluation of health services, activities, and programs.

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Types of Health Indicators

1. Mortality indicators

2. Morbidity indicators

3. Disability indicators

4. Nutritional status indicators

5. Health care delivery indicators

6. Utilization rates

7. Social and mental health indicators

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8. Environmental indicators

9. Socioeconomic indicators

10.Health policy indicators

11.Indicators of quality of life

12.Other indicators

Types of Health Indicators

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What Are the Leading Health Indicators?

• Physical Activity • Overweight and Obesity • Tobacco Use • Substance Abuse • Responsible Sexual Behavior • Mental Health • Injury and Violence • Environmental Quality • Immunization • Access to Health Care.04/21/23

A mortality rate is a measure of the frequency of

occurrence of death in a defined population during a

specified period of time.

Mortality Rates

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Crude Death Rate (CDR)

The crude mortality rate is the mortality rate from all causes of death for an entire population.

We usually multiply by 1000.

1000Xlocality)andyear(SamepopulationyearmidEstimated

localityandyearcertainaindeathsofnumberTotal

RateDeathCrude

= … Deaths/1000 individual in the specified year and locality.

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• It is important to use the population size at the midpoint of the time interval as an estimate of the average population at risk especially if:

• a denominator population is growing or shrinking during the period of time for which a rate is to be computed.

• e.g. If a death rate is to be calculated for the year 2014, then the population of July 1, 2014 is used for the denominator.

Mid-year population

Age-specific mortality rates

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• An age-specific mortality rate is a mortality rate limited to a particular age group.

• The numerator is the number of deaths in that age group• The denominator is the number of persons in that age group

in the population. • Examples of age-specific mortality rates are neonatal, post-

neonatal, infant and under 5-years mortality rates.

1000

area same andyear same in the

group age same in thenumber Total

area andyear certain a and age

certain ain dying persons ofNumber

ratedeath specific Age x

Infant mortality rate (per 1 000 live births)

Infant mortality rate is the probability of a child born in a specific year or period dying before reaching the age of one.

In Saudi Arabia (2011)• both sexes 16.5

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1000

locality andyear same the

in births live ofnumber Total

localitygiven ain andyear

a duringyear one than less toup zero

from deaths ofnumber Total

ratemortality Infant x

Infant Mortality RateInfant Mortality Rate

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Neonatal mortality rate (per 1 000 live births)

The number of deaths of neonates (infants <28 days of age) in a calendar year, divided by number of live births in that year, multiplied by 1000.

In Saudi Arabia (2004):• Neonatal Mortality Rate =11

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1000

locality andyear same thein births live ofnumber Total

localitygiven ain andyear a during days 28 than less toup zero

from deaths ofnumber Total ratemortality Neonatal

x

1000

locality andyear same the

in births live ofnumber Total

localitygiven ain andyear

a duringyear one than less toup days 28

from deaths ofnumber Total

ratemortality Neonatal-Post x

Post-Neonatal mortality rate

(per 1 000 live births)

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Post-neonatal mortality rate is the number of deaths among

infants from 28 days up to 1 year of age during a given time

period divided by the number of live births during the same

time period multiplied by 1,000

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NeonatalNeonatal Post-NeonatalPost-Neonatal

28 day28 day(0 day)(0 day) 1year1yearBirthBirth

Period of Infancy

InfancyInfancy

Stillbirth rate (per 1000 total births)

• For international comparison purposes, stillbirths are defined as third trimester fetal deaths (> or = 1000 grams or > or = 28 weeks).

• Total births : Total births is defined as the sum of live births and still births.

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1000

locality andyear same the

in births) stillbirths (live births Total•

localitygiven ain andyear

a during births still ofNumber

ratebirth Still x

Still birth ratio (per 1000 total births)

Number of fetal deaths of 28 weeks of gestation or more in certain year and locality per

1000 live births

1000locality andyear same in the births live ofNumber

localitygiven ain andyear

ain moreor gestation of weeks28 of deaths fetal ofNumber

ratiobirth Still

x

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It is expressed as the sum number of still births and early neonatal deaths (less than 7 days of life) per 1000 total births (still births plus live births).

X1000localityandyearsamethein )livebirthsand(StillbirthsTotal

localityandyearcertainindeathsneonatalearlyNo.ofsstillbirthNo.of

M.R.Perinatal

It the best indicator of Maternal and Child Health services

Perinatal Mortality Rate

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Under-5 mortality rate(per 1 000 live births)

Under-five mortality rate is the probability of a child born in a specific year or period dying before reaching the age of five.

In Saudi Arabia (2006) • both sexes 26 • female 23 • male 28

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1000

locality andyear same the

in births live ofnumber Total

localitygiven ain andyear a during age of years-5

underchildren among deaths ofnumber Total

ratemortality years-5under The

x

Child Mortality RatesChild Mortality Rates(deaths of children under age five per 1,000 live births)(deaths of children under age five per 1,000 live births)

183

86

13

57

48

54

11

0 50 100 150 200

Sub-Saharan Africa

Middle East/North Africa

South Asia

East Asia/Pacific

Central America/Caribbean

South America

Industrialized Countries

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Adult mortality rate (per 1000 population)

• Probability that a 15 year old person will die before reaching his/her 60th birthday.

• In Saudi Arabia (2006)• both sexes 178• female 136 male 205

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1000

area same andyear same in the

60-15between population ofnumber Total

area andyear certain ain

60-15between dying persons ofNumber

ratemortality Adult

x

Adult Mortality Rates(probability of death between ages 15 and 60)

39.70%

19.40%

23.50%

17.90%

14.80%

20.30%

9.70%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00%

Sub-Saharan Africa

Middle East/North Africa

South Asia

East Asia/Pacific

South America

Europe/Centtral Asia

Industrialized Countries

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Maternal mortality ratio (per 100 000 live births)

The number of maternal deaths per 100 000 live births during a specified time period, usually 1 year.

• In Saudi Arabia (2005)• MMR= 18

Maternal death is the death of a woman while pregnant or within 42 days after termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.

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Maternal mortality ratio (per 100 000 live births)

100,000X

localityandyearsame theinbirths live of Number

localityandyeargivenain pregnancy

to relatedcauses to asigneddeaths Maternal of Number

ratiomortality Maternal

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Cause-specific mortality rate

• The number of deaths attributed to a specific

cause divided by the population at the midpoint

of the time period multiply by 100,000.

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100,000XlocalityandyearsameinpopulationyearmidEstimated

localityandyeargivenaincausespecificaofDeaths

Example of Cause-specific mortality rates

• Deaths due to tuberculosis (per 100 000 population) • In Saudi Arabia (2006) =5.0

100,000X

localityandyearsameinpopulationyearmidEstimated

localityandyearcertainainTBofdeathsofNo.

istuberculostodueratedeathSpecific

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Proportionate mortality rates

Defined as the number of deaths assigned to a specific

cause in a calendar year, divided by the total number of

deaths in that year, the quotient multiplied by 100

100x

locality andyear same in the

disease same thehaving cases ofnumber Total

localitygiven ain andyear ain

diseasecertain a from deaths ofnumber Total

ratefatality Case

Case fatality rate (Death to case ratio)

It reflects severity and virulence of diseasesIt reflects severity and virulence of diseases

Morbidity Rates

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Morbidity indicators are used to supplement mortality data.

The following morbidity parameters can be used as health indicators:

• a) Incidence rate• b) Prevalence rate• c) Disease Notification rates,…..

Morbidity Rates

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Incidence Rate

• Incidence measures the number of new cases of a disease (or other health-related phenomenon) that occur during a specified period of time in a population at risk

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Prevalence Rate

• Prevalence measures the number of cases (new and old) of the disease (or other health-related phenomenon) at a point or period in time.

• It measures the status of the disease in the population.

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3. Disability rates:

Health implies full range of daily activities, thus limitations in these activities are used as indicators of health status.

These indicators include:• a) Bed disability days• b) Work or school loss days during a certain period• c) limitation of daily activities as cooking, washing,

cleaning, dressing, etc.

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4. Nutritional indicators

Nutritional status is a positive health indicator.

These include:

• a) Anthropometric measurements of infants and preschool children (Height and weight,…

• c) Prevalence of low birth weight

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5. Health care delivery indicators

These reflect the equity of distribution of health resources in the country.

The frequently used indicators of health care delivery are:

• a) Doctor / population ratio• b) Population / bed ratio• c) Population / health center ratio

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6. Utilization rates

These show the extent of utilization of the health services or the actual coverage.

These rates are affected by availability and accessibility of health services as well as attitude of the population towards these services.

Examples of these indicators include:• a) Vaccination coverage• b) Antenatal visits• c) Utilization rates of contraceptives• d) Bed occupancy rates• e) Average length of stay in hospitals

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7. Social and mental health indicators

• These include Violence rates against women, child abuse, suicide, homicide, as well as drug abuse and smoking.

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8. Environmental indicators

These reflect the quality of physical, chemical, and biological environment.

The most useful of these are:• a) Percentage of houses supplied with safe water

supply• b) percentage of houses supplied with public

sewerage system• c) Air pollution indicators can also be used especially

in developed countries.

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9. Socioeconomic indicators

These are indirect measures of health. They are behind the changes of other health indicators. These include:

• a) Percent of illiteracy in the country, especially among young women.

• b) Rates of unemployment• c) National income per capita• d) Rate of natural of increase• e) Total dependency ratio

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10. Health policy indicators

The most important indicators are:• a) Adequacy of the total budget assigned to the

health activities.• b) Proportion of total health resources devoted

to basic and primary health care services in the community.

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11. Indicators of quality of life:

• This indicator measures not only how long an individual will live, but also the high quality of life during this period.

• There are many scales that measure the health related quality of life of he individual.

• E.g. Looking after physical health , Eating a balanced diet , Freedom from anxiety, Understanding right and wrong , Access to community places,….

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• Last JM, editor. Dictionary of epidemiology. 4th ed. New York: Oxford University Press; 2001

• Principles of EPIDEMIOLOGY in Public Health Practice Third Edition An Introduction to Applied Epidemiology and Biostatistics. Centers for Disease Control and Prevention (CDC)

Reference book & page number for the lecture resource

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