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A SELECTION OF IMPORTANT

HEALTH INDICATORS

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WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGIONAL OFFICE

Manila, Philippines April 2000

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INTRODUCTION

Health indicators measure changes and assess the extent to which objectives of health programmes are attained. They are also used to set health priorities and assist in policy formulation. This document describes a selection of health indicators. Most of these indicators have been used or recommended for use in health situation analysis and health services planning.

This catalogue is intended to be used as a reference document by countries which are interested in introducing health indicators to assess health performance and planning future health needs. Since indicator development is an evolving process, we welcome suggestions for future improvement.

CONTENTS

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HEALTH OUTCOME INDICATORS

1. Disability rate by age and gender

2. Prevalence of persons with handicaps, impairments and disabilities .................. 2

3. Prevalence of persons disabled due to work injury ............. ................ .............. 2

4. Disability-free life expectancy (DFLE) ....................................... ................. 3

5. Life expectancy at birth

6. Infant mortality rate (IMR)

7. Neonatal mortality rate

8. Under-five mortality rate (U5MR)

9. Percentage of still births

10. Maternal mortality ratio (MMR)

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11. Malaria mortality ................................................................................... ............ 7

12. Tuberculosis mortality 8

13. Cancer: mortality ................................................................................................. 8

14. Diseases of national or local significance: mortality.............................................. 9

15. Cholera: case fatality rate (CFR) 9

16. Cardiovascular disease (coronary heart): standardized and gender-specific mortality ............................................................................. ....... 10

17. Cardiovascular disease (stroke): standardized and gender-specific mortality........................................................................ 10

18. Mortality: motor and other vehicle accidents ............................................... 11

19. Mortality: suicide by age and gender

20. Mortality: homicide and violence by gender

21. Diseases of national or local significance: incidence and prevalence

22. Vaccine-preventable diseases (measles, whooping cough, tuberculosis, diphtheria, tetanus and neonatal tetanus): incidence and prevalence

23. Acute respiratory infection: proportion of children below five years of age who need assessment (ANA) are to an appropriate care provider

24. Incidence of diarrhoea in children below five years of age

25. Healthy teeth index (DMFT) at the age of 12 years (mean value)

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26. Rheumatic heart disease: incidence and prevalence

27. Malaria: incidence and prevalence

28. Leprosy: incidence and prevalence

29. Tuberculosis: incidence and prevalence

30. Sexually transmitted disease (STD): incidence and prevalence

31.

32.

HIV!AIDS: incidence and prevalence

Cancer: incidence and prevalence

33. Hypertension: incidence and prevalence

34. Diabetes mellitus: incidence and prevalence

35. Impaired glucose tolerance: incidence and prevalence

36. Percentage of newborn infants weighing at least 2500g at birth

37. Percentage of infants exclusively breast-fed for four

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to six months after birth ................................................................................... 20

38. Percentage of children with weight and height for age acceptable* by national standards .................................................................... 21

39. Percentage of children six months to six years of age with adequate Vitamin A status in suspected high-risk areas, based on clinical symptoms 21

40. Percentage of pregnant women with anaemia

41. Percentage of women of child-bearing age with anaemia

42. Percentage of women of child-bearing age with clinical evidence of

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22

iodine deficiency disorders ................................................... ..................... 23

43. Percentage of persons with a daily salt intake in excess of 7g 23

44. Percentage of overweight or obese (body mass index) persons by gender and by ten-year age groups ........................................................... 24

45. Percentage of persons with hyperlipidaemia

46. Total fertility rate (TFR)

47. Crude birth rate

48. Crude death rate

49. Rate of natural increase of population

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50. WHOQOL 100* ............................................................................................... 26

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INDICATORS THAT MEASURE HEALTH SERVICES AND QUALITY 27

51. Percentage of infants fully immunized with BCG, OPT3, OPV3, measles and hepatitis B ................................................................................... 27

52. Percentage of diarrhoeal cases in children below five years of age managed according to UNICEF diarrhoeal case management methods ............................................................................................................ 28

53. Cure rate of smear-positive tuberculosis or tuberculosis cure rate

54. Percentage of population with adequate health care facilities (including essentici1 drugs) within a reasonable distance from their residence ....................................................................................................... .

55. Availability of quality of care instruments and their use in

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hospital services . .... ...... ...... ...... ...... .... ...... .......... .... ...... .... ...... ........ .......... ........ 29

56. Availability of screening programmes for common country-specific illnesses ................................................................................... 30

57. Availability of screening programmes for common cancers 30

58. Percentage of pregnant women cared for by trained personnel during the antenatal period ........................................... ................ ............. 30

59. Percentage of pregnant women having at least three antenatal care consultations with trained personnel during the antenatal period ............................................................................................................. 31

60. Percentage of pregnant women cared for by trained personnel during del ivery . ........ .... ............ .... ...... .......... .............. ........ ................ ............. 31

61 . Percentage of pregnant women cared for by trained personal during the postnatal period ......................................................... ........................... 32

62. Percentage of complicated obstetric cases managed at health centres and district hospitals that provide essential obstetric care (EOC)

63. Percentage of caesarean sections

64. Percentage of women immunized with tetanus toxoid (TT2)

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during pregnancy ........................................................................... ............ ......... 33

65. Percentage of patients with access to rehabilitation services

66. Availability and type of community faci lities for the elderly

67. Hospital bed occupancy rates in public hospitals

68. Hospital bed occupancy rates in private hospitals

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Net death rates in public hospitals

Net death rates in private hospitals

Maternity-unit death rates in health facilities

Caesarian section rates in health facilities

Net infection rates in health facilities

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HEALTH POLICY AND RESOURCES INDICATORS

74. Percentage of gross national product (GNP) spent on health services

75. Health expenditure as percentage of government budget

76. Presence of a national policy for the elderly

77. Presence of a department, unit or focal person responsible for the care

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of the elderly within the government ........................................................... 39

78. Percentage of health budget spent on care of the elderly 39

79. Percentage of non-health budget spent on care of the elderly ....... ............. .......... 40

80. Total health expenditure per capita (US$) ........................................................... 40

81.

82.

83.

Percentage of total health expenditure: public sector

Percentage of total health expenditure: private sector

Percentage of total health expenditure: in-patients

84. Percentage of total health expenditure: primary health care

85. Percentage of total health expenditure - staff costs

86. Percentage of total health expenditure: drugs and supplies

87. Percentage of health insurance financed by government

88. Percentage of health insurance financed by the individual

89. Health insurance coverage for the population

90. Health insurance coverage for children below 15 years of age

91. Health insurance coverage for maternal health services for

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pregnant women ..... .... ...... .... ...... .... ............ .... ...................... .............................. 44

92. Health insurance coverage for persons above 60 years of age

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97.

Percentage of health insurance finances allocated to public health services

Number of doctors per 1000 population

Number of nurses per 1000 population

Public hospital beds per 1000 population

Private hospital beds per 1000 population

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98. Admission rate in public hospitals

99. Admission rate in private hospitals

100. Percentage of couples with adequate birth spacing

101. Percentage of couples using contraceptive methods

102. Percentage of children by gender attending school

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at the ages of 1 2, 15 and 18 years ... ....... ..... .... .............. ...... .... ... ......... ...... ........ 49

103. Age and gender-specific literacy rate 49

104. Gross national product (GNP) or gross domestic product (GOP) per capita 50

105. Percentage of elderly who receive an allowance from government or private sources ................... .......... .......................... ........ .... ..... 50

SOCIOECONOMIC, LABOUR, AND LIFESTYLE INDICATORS

106. Percentage of population below 15 years of age or above 65 years of age

107. Labour force as a percentage of population

108. Percentage of persons who use support groups and

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facilities to promote healthy lifestyles ........... .......................... ...................... 52

109. Percentage of mothers who follow desirable practices regarding infant and child (below five years of age) diseases, nutrition and healthy lifestyles

110. Percentage of mothers or other caretakers of children (below five years of age)

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with diarrhoea who know the three rules of home case management ..... ............. 53

111. Percentage of persons with hyperlipidaemia 53

112. Availability of government-sponsored programmes promoting regular exercise ............................................................................... 54

113. Percentage of schools promoting healthy lifestyles (health-promoting schools) 54

114. Percentage of persons by age and gender group who smoke tobacco

115. Percentage of healthy city projects in a country

116. Percentage of healthy town projects in a country

117. Percentage of healthy village projects in a country

118. Percentage of healthy workplace projects in a country

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ENVIRONMENTAL AND PSYCHOSOCIAL HEALTH INDICATORS

119. Presence of laws in regard to drinking water, air and noise pollution, food safety and chemical safety, occupational health and safety, and

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environmental/health impact assessment ........................................................... 57

120. Presence of environmental health policies, strategies and/or programmes incorporated with national development

121. Presence of monitoring mechanisms for health-related environmental

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qual ity (i .e. air quality, water quality, noise, food, occupational environment) 58

122. Percentage of population with reasonable access to a safe supply of drinking water ............................................................................................... 58

123. Percentage of municipalities that provide adequate solid waste disposal facilities ............................................................................................... 58

124. Percentage of population with access to reliable collection of solid waste 59

125. Percentage of population with access to solid waste disposal facilities 59

126. Percentage of population with access to excreta disposal facilities 59

127. Percentage of population in housing with safe water and sanitation facilities; adequate dwelling space, and safe structure and building materials ............. .... ..... 60

128. Incidence of diseases caused by contaminated foods or beverages, or polluted air or water .................................................................................. .

129. Incidence of injuries and deaths due to road traffic accidents

130. Incidence of work-related diseases, disabilities and accidents

131. Presence of laws to prevent work-related diseases, disabilities and accidents

132. Prevalence of child (below 15 years old of age) abuse

133. Percentage of street children in a defined area

134. Number or proportion of programmes that enhance social competencies

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among children and adolescents ... ................................ ........ .... ........................ 63

135. Prevalence of adolescent pregnancies

136. Prevalence of anxiety

137. Prevalence of depression

138. Prevalence of suicide

139. Prevalence of dementia among the elderly

140. Presence of a national mental health plan

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REFERENCES ...................................................... ··1··················································· ............ . 67

A SELECTION OF IMPORTANT HEALTH INDICATORS - 2000

HEALTH OUTCOME INDICATORS

1. Disability rate by age and gender

Definition of indicator: The number of persons with disabilities of at least six months' duration or of an irreversible nature for each age and gender group per 1000 population in the same age and gender group during a given period of time.

Numerator: Number of persons in the given age and gender group with a (specific) disability, lasting at least 6 months or irreversible, among those surveyed during a given period of time x 1000.

Denominator: Total population of the given age and gender group during the same period of time.

Use: At national or local level:

• Data on impairments and on disabilities may be used for planning and assessing prevention and rehabilitation programmes. Both impairments and disability data may also be used to measure trends. The nature of the primary disability should be specified as seeing; hearing/speaking; moving; learning/comprehending/remembering; performing normal activities, or other disabilities.

• Disability rates may also be used to calculate disability-free life expectancy.

Common data sources: National census; demographic and health, or disability, surveys; official registries; services data from hospitals, schools or community·based rehabilitation programmes.

D~inition of important terms:

Impairment: Loss or abnormality of psychological, physiological or anatomical structure or function (awareness of symptoms and signs at the organ or function level).

Disability: Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being (objective alteration of behaviour or performance at the level of the individual).

Handicap: A disadvantage for a given individual resulting from an impairment or a disability that limits or prevents the fulfilment of a role that is normal (depending on age, gender and social and cultural factors) for that individual (level of social i nteracti on).

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The following guidelines may be used to determine whether an individual has a disability or a handicap:

Difficulty in seeing includes persons with different levels of difficulty seeing, not only persons who are completely blind.

Difficulty hearing/speaking includes persons with different levels of difficulty hearing and lor speaking, not only persons who are completely deaf or completely unable to speak.

Difficulty moving includes persons who have difficulty moving the limbs and trunk, or difficulty moving from place to place.

Difficulty learning, comprehending or remembering includes persons who are not able to learn, comprehend or remember as well as other persons their age.

Difficulty performing normal activities because of emotional disorder or other unusual behaviour includes persons who have difficulty carrying out conventional activities due to unusual behaviour.

2. Prevalence of persons with handicaps, impairments and disabilities

Definition of indicator: The number of the persons with handicaps, impairments or disabilities in the total population during a given period of time.

Numerator Number of persons who are diagnosed as having handicaps or impairments or disabilities during a given period of time x 1000.

Denominator: Total population examined during the same period of time.

Use: Countries may use the prevalence of handicaps, impairments and disabilities for planning and asseSSing prevention, treatment, intervention and rehabilitation programmes.

Common data sources: National census; demographic and health, or disability, surveys; official registries; services data from hospitals, schools or community based-rehabilitation programmes.

3. Prevalence of persons disabled due to work injury

Definition of indicator: The number of persons disabled due to work injury per 1000 working population during a given period of time.

Numerator: Number of persons disabled due to work injury during a given period of ti me x 1000.

Denominator: Total working population in the same workplace examined during the same period of time.

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Use: Measurement of disability due to work injury may be used for national or local planning and assessment of prevention, treatment and rehabilitation programmes.

Common data sources: National health surveys; demographic and health, or disability surveys; surveys of the working population.

4. Disability-free life expectancy (DFLE) ./

Definition of indicator: The average number of years an individual is expected to live free of disability if current patterns of age-specific mortality and disability remain constant (during the person's life time).

Formula: Several methods have been proposed for the calculation of health expectancies. Basically, the years lived at various ages by the population of a life table are quantified on the basis of the institutionalization rate (usually from a recent census) and the prevalence of permanent and temporary limitation of activity (from national health or disability surveys). Once the table is modified, the period of life expectancy is calculated in the traditional manner, according to various states of functional disability, yielding the value of disability-free life expectancy.

Use: Measurement of disability-free life expectancy by age and gender at national or local level can be used.

• to prevent disability, especially for the elderly; and • to calculate and evaluate life expectancy without disability.

Common data sources: surveys.

5. life expectancy at birth

National census; special sampling surveys; demographic

Definition of indicator: The number of years a newborn infant would live if prevailing patterns of mortality at the time of birth were to stay the same throughout the child's life.

I Formula: Computed from Life Tables. Use: Life expectancy at birth is not only affected by health/illness but also by social factors, such as education and economics, and environmental factors, such as hOUSing, sanitation and safe water supply. The indicator can be used:

• to evaluate life expectancy in national or local level; • to calculate percentage of life expectancy with disability in each age and gender

group; and • for health policy planning.

Common data sources: National census; vital registration; demographic surveys.

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&. Infant mortality rate (lMR)

Definition of indicator: The number of deaths of infants below one year of age (between a to 364 days after birth) per 1000 live births during a given year.

Numerator: Number of deaths of infants below 1 year of age (between 0-364 days after birth) during 1 year x 1000.

Denominator: Number of live births during the same period of time.

Use: Measurement of specific causes of mortality, if possible, may serve several purposes. It can be used:

• to establish the relative public health importance of the different possible determinants or causes of death;

• to evaluate trends over time, especially as a method of evaluating the probable impact of intervention programmes;

• to select place and programme interventions; • to evaluate health service utilization for pregnant women and children; • to assess health services capability in health facilities; and • for planning priority health interventions.

Common data sources: National census; vital registration; sample registration system; infant death surveillance system; demographic surveys.

Definition of important term:

Live births: The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered live born.

7. Neonatal mortality rate

Definition of indicator: The number of deaths of newborn infants below 28 days of age (between a to 27 days after birth) per 1000 live births during a given period of time.

Numerator: Number of deaths of newborn infants below 28 days of age (between a to 27 days after birth) during a given period of time x 1000.


Use: Measurement of specific causes of neonatal death, if possible, may serve several purposes: It can be used:


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• to select place and programme interventions; • to evaluate health service utilization for pregnant women and newborn infants; • to assess health services supply capability in health facilities; and • to check data quality of infant mortality rate;

Common data sources: National census; vital registration; sample registration system; surveillance system; and demographic surveys.

8. Under-five mortality rate (U5MR)

Definition of indicator: The number of deaths of children below five years of age per 1000 live births during a given period of time. More specifically, the probability of dying between birth and exactly five years of age expressed per 1000 live births during a given period of time.

Numerator : Number of deaths of children below 5 of age during 1 year x 1000.


Use: Measurement of specific causes of death, if possible, may serve several purposes: It can be used:



• to select place and programme interventions; • to evaluate health service utilization for pregnant women and children; • to assess health services supply capability in health facilities; and • to evaluate health promotion programmes for mothers.

Common data sources: National census; vital registration; sample registration systems; surveillance system; demographic surveys.

9. Percentage of still births

Definition of indicator: given period of time.

The number of still births per 100 perinatal deaths during a

Numerator: Number of still births during a given period of time x 100.

Denominator: Number of perinatal deaths during the same period of time.

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Use: The percentage of still births is a measure of health care for pregnant women, particularly in prenatal and during delivery, and also a measure of the obstetrics skills in health facilities. It is also used to evaluate health education programmes for pregnant women.

Common data sources: Hospital registrations; national health surveys; infant mortality sampling surveys.

Definition of important terms:

Still birth: The birth of a baby, after 28 weeks' gestation, that shows no sign of life (no breathing; heart does not beat; umbilical cord does not pulse, whether or not the umbilical cord has been cut or the placenta is attached; no definite movement of the voluntary muscles).

Perinatal death: days of age).

Still birth or early neonatal death (death of newborn infants 0 to 6

10. Maternal mortality ratio (MMR)

Definition of indicator: during one year.

The total number of maternal deaths per 100000 live births

Numerator: Number of maternal deaths during 1 year x 100000.


Use: Maternal mortality is not only affected by health services, but also by social factors such as education and economics, and environmental factors such as housing, sanitation and safety water supply.

• The first use of a report of a maternal death is to trigger a~ investigation into the causes of death, and to determine whether there were defects in the care process which need correction. Many countries conduct maternal death audits both within care facilities and in communities.

• At higher levels of the health system (provincial, regional and national) both the number of deaths and maternal mortality ratio may provide a means to monitor trends in maternal health and service performance and to identify geographical areas and population groups that require more focused service attention and resources.

• Considerable care is needed in interpreting trends in m,:ternal mortality, particularly at regional and local levels and in countries With small populations where absolute numbers of maternal deaths are likely to be relatively small, even when maternal mortality ratios are high. In these circumstances, random fluctuations in the ratio may render trend assessment difficult.

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There may also be difficulties in interpreting maternal mortality ratios derived from community-based surveys because the estimates are bound to have very wide confidence intervals. For example, a household survey in Addis Ababa reported a maternal mortality ratio of 490 per 100 000 live births with a 95 % confidence interval of 350-630. A decline in the ratio to 300 per 100000 live births would still have a wide confidence interval of 190-410 so that it would not be possible to ascertain if a real reduction had, in fact, been achieved.

For small populations, maternal mortality ratio cannot be calculated .

Common data sources: registrations.

Civil registrations; survey-based information; hospital


Maternal death: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or the site of the pregnancy, from any causes related to or aggravated by the pregnancy or its management, but not from aCCidental or incidental causes. Maternal deaths should be divided into two groups.

Direct obstetric deaths are those resulting from obstetric complications of the pregnant state (pregnancy, labour and the puerperium), from interventions, omissions, incorrect treatment, or from a chain of events reSUlting from the above.

Indirect obstetric deaths are those resulting from previously existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but was aggravated by the physiological effects of pregnancy.

The lCD-to includes two further definitions of maternal mortality:

Late maternal death: The death of a woman from direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy.

Pregnancy-related death: The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.

11. Malaria mortality

Definition of indicator: The number of recorded or estimated deaths from malaria disease that have occurred in the general population during one year for which valid statistics are available. It is necessary to indicate the size of the population and the year to wh ich the data refer.

Numerator Number of deaths due to malaria in a specific area and during 1 year x 100000.

Denominator: Number of persons at risk in the same area and during the same period of time.

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Use: Measurement of the number of malaria deaths at national or local level can be used to:

• evaluate the impact of control measures aiming at reducing malaria mortality; • measure the workload on the health facilities due to malaria; and • allocate resources for malaria treatment.

Common data sources: Hospital registrations; screen surveys.

12. Tuberculosis mortality

Definition of indicator: The number of recorded or estimated deaths from tuberculosis that have occurred in the general population during one year for which valid statistics are available.

Numerator Number of deaths due to tuberculosis in a specific area and during 1 year x 10000.

Denominator: Number of persons at risk in the same area and during the same period of time.

Use: Measurement of the number of tuberculosis deaths at national or local level can be used to:

• evaluate the impact of control measures aiming at reducing tuberculosis mortality; • measure the workload on the health facilities due to tuberculosis; • allocate resources for tuberculosis treatment.; and • evaluate tuberculosis intervention programmes.

Common data sources: Hospital registrations; screen surveys.

13. Cancer: mortality

Definition of indicator: The number of recorded or estimated deaths from cancer (total and different kinds of cancer) that have occurred in the general population during one year for which valid statistics are available. It is necessary to indicate the size of the population and the year to which the data refer.

Numerator Number of deaths due to cancer in a specific area and during 1 year x 100000.

Denominator: Total population at risk in the same area and during the same period of time.

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Use: Measurement of cancer mortality at national or local level can be used to:

• evaluate the impact of control measures aiming at reducing cancer mortality; • allocate resources for cancer treatment and prevention; and • evaluate health education and promotion programmes.

Common data sources: cancer screening surveys.

Hospital registrations; national health surveys; special

14. Diseases of national or local significance: mortality

Definition of indicator: The number of recorded or estimated deaths from diseases of national or local significance during one year for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator Number of diseases of national or local significance during a given period of time x 10000 (or 100000).


Use: Measurement of diseases of special national or local significance at national or local level can be used to:

• identify national or local health problems; • evaluate prevention, treatment skills and health intervention programmes; • evaluate health services supplied by health facilities; and • for health policy planning.

Common data sources: National census; national health surveys; civil registrations.

15. Cholera: case fatality rate (CFR)

Definition of indicator: in the reference period.

The number of deaths due to cholera per 100 cholera cases

Numerator: Number of new cholera cases who died while on treatment during the reference period, regardless of cause x 100 ..

Denominator: Number of new cholera cases registered for treatment during the period in the same area.

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Use: Measurement of the case fatality rate for cholera can be used to:

• evaluate the impact of control measures aiming at improving treatment; • prevent cholera: and • improve health services supplied.

Common data sources: Hospital registrations; national case reports; special sampling surveys; demographic surveys.

16. Cardiovascular disease (coronary heart): standardized and gender-specific mortality

Definition of indicator: The number of deaths due to cardiovascular disease (coronary heart disease) per 100000 total population at risk by national or international age-standardized and gender-specific population or percentage during a given year.

Numerator: Number of deaths due to cardiovascular disease (coronary heart disease) during 1 year x 100000.

Denominator: Total population at risk during the same period of time.

Use: Measurement of cardiovascular disease status at different levels can be used:

• to compare cardiovascular disease (coronary heart disease) mortality among countries, or regions, etc.; and

• for allocation of resources for health planning.


National census; national health surveys; hospital


Age-standardized mortality includes direct and indirect age-standardized mortality, using national or international population or proportion-adjusted methods.

17. Cardiovascular disease (stroke): standardized and gender-specific mortality

Definition of indicator: The number of deaths due to cardiovascular disease (stroke) per 100 000 population at risk by national or international age-standardized and gender-specific population during a given year.

Numerator: Number of deaths due to cardiovascular disease (stroke) during 1 year x 100000.

Denominator: Total population at risk in same age and gender group during the same period of time.

Adjusted by national or international population or proportion

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Use: Measurement of stroke status at different levels can be used:

• to compare cardiovascular disease (coronary heart disease) mortality among countries, regions, etc; and

• for allocation of resources for health planning.


National census; national health surveys; hospital

18. Mortality: motor and other vehicle accidents

Definition of indicator: The number of deaths due to motor and other vehicle accidents per 100 000 total population at risk during a given year.

Numerator: Number of deaths due to malar and other vehicular accidents during 1 year x 100 000.


Use: Measurement of the number of motor and other vehicular accidents at different levels can be used to.

• identify high-risk areas for motor and other vehicle accidents; • improve planning for prevention of motor and other vehicle accidents; and • evaluate health promotion programmes.

Common data sources: National census; national health surveys; hospital records.

19. Mortality: suicide by age and gender

Definition of indicator: The number of deaths by suicide by age and gender per 100000 total population at risk in the same age and gender group during a given period of time.

Numerator: Number of deaths by suicide by age and gender during a given period of Ii me x 100 000.

Denominator: Total population at risk in the same group and during the same period of time.

Use: Measurement of suicide status by age and gender at national or local level can be used to:

• identify high-risk groups and areas of suicide; • improve health planning to prevent suicide; and • evaluate health promotion and education programmes.


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20. Mortality: homicide and violence by gender

Definition of indicator: The number of deaths due to homicide and violence by gender per 100000 total population at risk in the same group during a given period of time.

Numerator Number of deaths due to homicide and violence by gender during a given period of time x 100 000.

Denominator: Total population at risk in the same group and during the same period of time.

Use: Measurement of homicide and violence by gender at different levels can be used:

• to identify high-risk groups and areas; • to improve national planning to reduce homicide and violence mortality; and • to evaluate health promotion and education programmes.


21. Diseases of national or local significance: incidence and prevalence

Definition of indicator: The number of new and old cases of diseases of national or local significance recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator: (Incidence) Number of new cases of diseases of national or local significance during the same area and during a give period of time x K (100, or 1000, or 10 000, or 100 000). (Prevalence) Number of existing (new + old) cases of national or local significance disease in the same area and during the same period of time x K 100, 1000, 10 000, or 100 000).

Denominator: (Incidence and Prevalence) Total population at risk in the same age group and during the same period of time.

Use: Measurement of diseases of special national or local significance at national or local level can be used:

• to define national or local health problems; • to evaluate health services system; and • for planning health intervention programmes.

Common data sources: surveys.

National health surveys; civil registration; household

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DPiinition of important tl'rms:

Incidl'nce: The number of new cases over total population at risk during one year or a given period of time.

Prl'vail'ncl': The number of existing cases (new cases plus old cases) over total population at risk during one year or a given period of time.

22. Vaccine-preventable diseases (measll'S, whooping cough, tuberculosis, diphtheria, tetanus and neonatal tetanus): incidence and prevalence

Definition of indicator: Proportion of new (incidence) or existing cases (prevalence) of measll'S, whooping cough, tuberculosis, diphtheria or tetanus and neonatal tetanus in the population at risk during a given period of time.

Numerator: Number of new (incidence) or existing (new + old) prevalent cases of measles, whooping cough, tuberculosis, diphtheria, or tetanus and neonatal tetanus during a given period of time x 1000.

Denominator: Number of population at risk in the same area and during the same period of time.

Use: The indicators are useful for:

• identifying high-risk districts or communities for measles, whooping cough, tuberculOSiS, diphtheria or tetanus and neonatal tetanus;

• evaluating routine coverage of measles, whooping cough, tuberculosis, diphtheria or tetanus and neonatal tetanus control programmes; and

• monitoring the impact of measles, whooping cough, tuberculosis, diphtheria or tetanus and neonatal tetanus control programmes.

Common data sources: National disease surveillance registrations; health facility patient registers, individual patient records.

23. Acute respiratory infection: proportion of children below five years of age who need assessment (ANA) and are reported to have been taken to an appropriate care provider

Definition of indicator: The number of cases of acute respiratory infection of children that need assessment (ANA) and are reported to have been taken to an appropriate care provider per 1000 cases of acute respiratory infection of children examined during a given period of time.

Numerator Number of children below 5 years of age that need assessment (ANA), reported to have been taken to an appropriate care provider during a given period oftime x 1000.

Denominator: Number of children below five years of age with acute respiratory infection that are examined in same area and during the same period of time.

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Use: This indicator can be used to:

• evaluate health care supplied to children below five years of age; and • evaluate health promotion programmes.

Common data sources: National sampling surveys.

24. Incidence of diarrhoea in children below five years of age

Definition of indicator: The number of new cases of diarrhoea in children below five years of age per 1000 children below five years of age at risk during a given period of time.

Numerator Number of new cases of diarrhoea in children below 5 years of age during a given period of time x 1000.

Denominator: Number of children below 5 years of age at risk in the same area and during the same period of time.

Use: This indicator is useful for:

• identifying high-risk districts or communities for diarrhoea; • evaluating sanitation conditions among districts and communities; and • evaluating health promotion programmes at national level.

Common data sources: National disease surveillance registrations; health facility patient registers; individual patient records.

25. Healthy teeth index (DMFn at the age of 12 years (mean value)

Definition of indicator: The average number of teeth found decayed, missing or filled (DMFT) in children 12 years of age during a given period of time.

Numerator: Number of teeth found decayed, missing or filled in children 12 years of age during a given period of time.

Denominator: Number of children 12 years of age during the same period of time.

Use: The health status of children's teeth at national or local level can be used:

• for planning prevention of tooth decay among children; • to evaluate healthy teeth programmes; and • to evaluate health education programmes in schools.

Common data sources: National healthy teeth surveys; school health surveys.

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26. Rheumatic heart disease: incidence and prevalence

Definition of indicator: The number of new and old cases of rheumatic heart disease recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator: (Incidence) Number of rheumatic heart disease recorded during 1 year or a given period of time x 1000 (or 10000, or 100000) (Prevalence) Number of existing (new + old) cases of rheumatic heart disease during 1 year or a given period of time x 1000 (or 10000, or 100000 ).


Use: Measurement of rheumatic heart disease status may be used in health planning for prevention, treatment, and health education programmes at national or local level.

Common data sources: National health surveys; hospital records.

27. Malaria: incidence and prevalence

Definition of indicator: The number of new and old cases of malaria recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator (Incidence) Number of new cases of malaria recorded during 1 year or a given period of time x 10 000. (Prevalence) Number of existing (new + old) cases of malaria recorded during 1 year or a given period of time x 10 000.


Use: Measurement of malaria status can be used to:

• identify high-risk districts or communities; • evaluate sanitation among districts and communities; and • evaluate health promotion programmes.


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28. leprosy: incidence and prevalence

Definition of indicator: The number of new and old cases of leprosy recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator: (Incidence) Number of new cases of leprosy recorded during 1 year or a given period of time x 100 000. (Prevalence) Number of existing (new + old) cases of leprosy recorded during 1 year or a given period of time x 100000.


Use: Measurement of leprosy status can be used to:

• identify high-risk districts or communities; • assess treatment effectiveness; and • evaluate health promotion programmes for leprosy.


29. Tuberculosis: incidence and prevalence

Definition of indicator: The number of new and old cases of tuberculosis recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator : (lncidencel Number of new cases of tuberculosis recorded during 1 year or a given period of time x 100000. (Prevalence) Number of existing (new + old) cases of tuberculosis recorded during 1 year or a given period of time x 100000.


Use: Measurement of tuberculosis status can be used to:

• identify high-risk districts or communities; • evaluate immunization effectiveness and sanitation in high-risk districts and

communities; • assess treatment effectiveness; and • evaluate tuberculosis programmes.


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30. Sexually transmitted disease (STD): incidence and prevalence

Definition of indicator: The number of new and old cases of STDs recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator: (Incidence) Number of new cases of STDs recorded during 1 year or a given period of time x 100000. (Prevalence) Number of existing (new + old) cases of STDs recorded during 1 year or a given period of time x 100000.


Use: Measurement of STD status can be used to:

• identify high-risk districts or communities; • evaluate health behaviours of women and men among districts and communities;

and • evaluate health promotion and education programmes at national or local level.


31. HIV/AIDS: incidence and prevalence

Definition of indicator: Number of new and old cases of HIV recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population (male, female or pregnant women or both by age) and the year to which the data refer.

Numerator: (Incidence) Number of new cases of HIV recorded during 1 year or a given period of time x 100 000. (Prevalence) Number of existing (new + old) cases of HIV recorded during 1 year or a given period of time x 100000.

Denominator: Total population risk in the same area and during the same period of time.

Use: Measurement of HIV status can be used to:

• identify high-risk districts or communities; • evaluate human risk behaviour; • evaluate health education and promotion programmes at country, district and

community level, and within different age and gender groups; and • evaluate maternal and child health care.


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32. Cancer: incidence and prevalence

Definition of indicator: The number of new and old cases of cancer recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator: (Incidence) Number of new cases of cancer recorded during 1 year or a given period of time x 100 000. (Prevalence) Number of existing (new + old) cases of cancer recorded during 1 year or a given period of time x 100000.


Use: Measurement of cancer status can be used to:

• identify high-risk districts or communities; • evaluate risk factors for cancer in high-risk areas and populations; and • evaluate health education and promotion programmes.


33. Hypertension: incidence and prevalence

Definition of indicator: The number of new and old cases of hypertension recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator: (Incidence) Number of new cases of hypertension recorded during 1 year or a given period of time x 100 000. (Prevalence) Number of existing (new + old) cases of hypertension recorded during 1 year or a given period of time x 100000.


Use: Measurement of hypertension status can be used to:

• identify high-risk districts or communities; and • evaluate health education and promotion programmes at national or local level.


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34. Diabetes mellitus: incidence and prevalence

Definition of indicator: The number of new and old cases of diabetes mellitus recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to wh ich the data refer.

Numerator: (Incidence) Number of new cases of diabetes mellitus recorded during 1 year or a given period of time x 100000. (Prevalence) Number of existing (new + old) cases of diabetes mellitus recorded during 1 year or a given period of time x 100 000.


Use: Measurement of diabetes mellitus status may be used to evaluate health education and promotion programmes for diabetes mellitus at national or local level.


35. Impaired glucose tolerance: incidence and prevalence

Definition of indicator: The number of new and old cases of impaired glucose tolerance recorded during one year or a given period of time for which valid statistics are available. It is necessary to indicate the size of the at-risk population and the year to which the data refer.

Numerator: (Incidence) Number of new cases of impaired glucose tolerance recorded during 1 year or a given period of time x 100 000. (Prevalence) Number of existing (new + old) cases of impaired glucose tolerance recorded during 1 year or a given period of time x 100000.


Use: Measurement of impaired glucose tolerance status may be used to evaluate health education and promotion programmes at national or local level.


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36. Percentage of newborn infants weighing at least 2500g at birth

Definition of indicator: The percentage of newborn infants whose birth weight is equal or greater than 2500g, the measurement being taken preferably within the first hours of life, before significant postnatal weight loss has occurred.

Numerator: Number of live births with weight at birth equal or greater than 2500g in a specific area and during 1 year x 100.

Denominator: Number of live births who are weighed at birth in the same area and during the same period of time.

Use: Data on the percentage of newborn infants weighting at least 2500g at birth are used to:

• evaluate national health education especially nutrition programmes, for women and their families; and

• measure the supply of national or local maternal and child health services.

Common data sources: Birth records in health facilities.

37. Percentage of infants exclusively breast-fed for four to six months after birth

Definition of indicator: The percentage of infants below four months of age who were exclusively breast-fed in the last 24 hours in the same area and during a given period oftime.

Numerator: Number of infants below 4 months of age who were exclusively breast-fed in the last 24 hours during a given period of time x 100.

Denominator: Number of infants below 4 months of age during the same period of time.

Use: This indicator can be used to:

• evaluate national or local health education programmes for mothers and their families;

• measure the supply of national or local maternal and child health services; and • evaluate nutritional status and diseases among children.

Common data sources: National health surveys; household health surveys.


Exclusive breast-feeding means the infant has received only breast milk from the mother or a wet nurse, or expressed breast milk and no other liquids or solids with the exception of drops or syrups consisting of vitamins, mineral supplements or medicines.

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38. Percentage of children with weight and height for age acceptable* by national standards

Definition of indicator: The percentage of children below five years of age whose weight-for-age or height-far-age is between either 80% and 120% of the reference value of the country, or +/- 2 standard deviations from this value. A national (or international) reference population should be used to calculate indicators on weight-for-age and height-far-age. A WHO working group has recommended that the best available data are those established by the United States National Center for Health Statistics (NCHS). They may be used for children up to five years of age, since the influence of ethnic or genetic factors on young children is considered insignificant.

* Acceptable refers to children whose nutritional status falls within the range of 80 % to 120 % or +/- 2 standard deviations of the national reference population.

Numerator: Number of children below 5 years of age with acceptable weight-for-age and/or height-far-age during the surveyed time x 100.

Denominator: Number of children below 5 years of age weighed/measured in the same area and during the same period of time.

Use: Measurement of weight and height among children can be used to:

• evaluate children's nutritional status; and • evaluate health promotion programmes in communities and schools.

Common data sources: National health surveys; regular examination records.

39. Percentage of children six months to six years of age with adequate Vitamin A status in suspected high-risk areas, based on clinical symptoms

Definition of indicator: The percentage of children six months to six years of age with adequate Vitamin A status based on clinical symptoms in suspected high-risk areas during a given period of time.

Numerator: Number of children 6 months to 6 years of age with adequate Vitamin A status based on clinical symptoms during a given period of time x 100.

Denominator: Number of children 6 months to 6 years of age in the same area and during the same period of time.

Use: Measurement of Vitamin A status among children can be used to:

• evaluate children's nutritional status and Vitamin A deficiency in high-risk areas; • evaluate health promotion and education programmes in these areas; and • evaluate health services supplied by health facilities.

Common data sources: National health statistics; health surveys.

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40. Percentage of pregnant women with anaemia

Definition of indicator: The number of pregnant women with haemoglobin levels below 110 gil of blood among the total number of pregnant women during a given period of time.

Numerator : Number of pregnant women with haemoglobin levels below 110 gil of blood during a given period of time x 100.

Denominator: Number of pregnant women examined in the same area and during the same period of time.

Use: Measurement of maternal health status and services supplied can be used to.

• evaluate pregnant women's nutritional status; • evaluate health promotion and education programmes for pregnant women; and • analyse the relationship between pregnant women with anaemia and low birth

weight, obstetrical haemorrhage and maternal death.

Common data sources: National health surveys; household surveys.

41. Percentage of women of child-bearing age with anaemia

Definition of indicator: The percentage of women 15 to, 49 years of age with haemoglobin levels below 120 gil of blood for non-pregnant women, and 110 gil of blood for pregnant women, during a given period of time.

Numerator: Number of women with haemoglobin levels below 120 gil of blood for non-pregnant women and 110 gil of blood for pregnant women during a given period of time x 100.

Denominator: Number of women 15 to 49 years of age surveyed in the same area and during the same period of time,

Use: Measurement of women's health status and health services supplied can be used to:

• evaluate the nutritional status among women of child-bearing age; and • evaluate health promotion and education programmes for women of child-bearing

age.


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42. Percentage of women of child-bearing age with clinical evidence of iodine deficiency disorders

Definition of indicator: The number of women of child-bearing age with clinical evidence of iodine deficiency disorders per 1000 women in the same age group during the surveyed time.

Numerator Number of women of child-bearing age with clinical evidence of iodine deficiency disorders during the surveyed time x 100.

Denominator: Number of women of child-bearing age in the same area and during the same period of time.

Use: Measurement of iodine deficiency disorders among women of child-bearing age can be used to:

• identify high-risk areas; • evaluate supply of iodized salt at national or local level; • evaluate health care services supplied for women; and • evaluate national or local health education and promotion programmes.



Iodine deficiency disorders (lDD): A term given to a spectrum of diseases associated with iodine defiCiencies, ranging from endemic goitre to cretinism, including hypothyroidism, impairment of intellectual and reproductive functions, and increased rates of abortion, stillbirth, and neonatal, infant and young child mortality.

43. Percentage of persons with a daily salt intake in excess of 7g.

Definition of indicator: The number of persons with a daily salt intake in excess of 7g. per 100 population surveyed during a given period of time.

Numerator: Number of persons with a daily salt intake in excess of 7g. during a given period of time x 100.

Denominator: Total population surveyed in the same area and during the same period of time.

Use: Measurement of daily salt intake at national or local level can be used to:

• evaluate national or local health education and promotion programmes; and • analyse the relationship between daily salt intake and specific diseases.

Common data sources: Household surveys; national health surveys.

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44. Percentage of overweight or obese (body mass index) persons by gender and by ten-year age groups

Definition of indicator: The number of persons overweight or obese (8MI) by gender and ten-year age groups per 100 in the same age group and during a given period of ti me.

Numerator: Number of persons overweight and obese (8MI) by gender and ten-year age groups during a given period of ti me x 100.

Denominator: Total population by same gender and age groups during the same period of time.

Use: Measurement of overweight and obesity can be used:

• to identify high-risk groups and areas; • to evaluate national or local health education and promotion programmes; and • for national or local health education planning.



Body mass index (8MI): The ratio of weight (kg) to the square of height (m"). It is a good indicator of variability in energy reserves in individuals with a sedentary lifestyle.

45. Percentage of persons with hyperlipidaemia

Definition of indicator: The number of persons with hyperlipidaemia per 100 population examined during a given period of time.

Numerator Number of persons with hyperlipidaemia during a given period of time x 100.

Denominator: Total population examined during the same period of time.

Use: Measurement of hyperlipidaemia can be used.

• to evaluate national or local health education and promotion programmes; • to identify high-risk populations at national or local level; and • for national or local health planning.

Common data sources: Household surveys; national health surveys.

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46. Total fertility rate (TFR)

Definition of indicator: Sum of all the age-specific fertility rates for each year of age from 15 to 49 multiplied by the interval into which the ages are grouped for a particular period (usually one year). It is the average number of children that a synthetic cohort of women would have at the end of the reproductive period, if there were no mortality among the women.

Formula: TFR = 5 x Lfx fx: fertility rate for women of specific five-year age groups (15-19, 20-24,25-29, 30-34,35-39,40-44,45-49)

For example: f (15-19) ~ total number of children in the 15-19 age group! total number of women of same age group in the same area and during the same period of time.

Use: Measurement of women's reproductive health status may be used as a standardized' index for the overall fertility level. It overcomes the limitations of the crude birth rate and general fertility rate and can be used to:

• evaluate national or local health education and promotion programmes; • evaluate national or local family planning programmes; and • estimate rate of population increase in the future.

Common data sources:

47. Crude birth rate

Definition of indicator: population.

National census; national health surveys.

The number of live births in a year per 1000 mid-year

Numerator Number of live births during 1 year x 1000.

Denominator: Total mid-year population during the same period of time.

Use: Measurement of population status can be used to:

• esti mate the natural increase rate of the population; and • evaluate health education and promotional programmes.

Common data sources: National census; national heath surveys.

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48. Crude death rate

Definition of indicator: population.

The number of deaths in a year per 1000 mid-year

Numerator Number of deaths during 1 year x 1000.

Denominator: Total mid-year population during the same period of time.

Use: Measurement of crude death rate can be used to:

• measure the natural increase rate in total population; and • evaluate health education and promotion programmes.


49. Rate of natural increase of population

Definition of indicator: Relative change in population size brought about solely by the balance between births and deaths. It is obtained from the difference between crude birth rate and crude death rates in a year.

Rate of natural increase = Crude Birth Rate ('¥o) - Crude Death Rate ('¥o) of population ('¥o)

Use: Measurement of population change can be used to:

• evaluate health education and promotion programmes; • evaluate national population policy; and • measure natural increase in population.


50. WHOQOl 100·

This is an instrument developed by the Mental Health Division of WHO and contains 100 questions that cover a number of indicators.

Use: Measurement improves comprehension and analysis of health status.

Common data sources: National heath surveys.

'This indicator will be further developed.

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II INDICATORS THAT MEASURE HEALTH SERVICES AND QUALITY

51. Percentage of infants fully immunized with BCG, DPT3, OPV3, measles and hepatitis B

Definition of indicator: This includes the immunization of children against diphtheria, pertussis, tetanus (DPn); measles; poliomyelitis (OPV3); tuberculosis (BCG); and hepatitis B before their first birthday.

Numerator: Number of children given BCG, DPB, OPV3, and measles and hepatitis B immunization before their first birthday in a specific area and during 1 year x 100.

Denominator: Number of live births in the same area and during the same period of time.

Use: Measurement of national immunization levels can be used to:

• evaluate health immunization programmes; and • compare the relationship between these diseases and their immunization coverage.

Common data source: surveys.

Immunization registration and surveys; demographic

52. Percentage of diarrhoeal cases in children below five years of age managed according to UNICEF diarrhoeal case management methods

Definition of indicator: Total number of diarrhoeal cases managed according to UNICEF diarrhoeal case management methods per 100 diarrhoeal cases among children below five years of age during a given period of time.

Numerator: Number of diarrhoeal cases managed according to UNICEF diarrhoeal case management methods among children below 5 years of age during a given period of time x 100.

Denominator: Number of diarrhoeal cases among children below 5 years of age in the same area and during the same period of time.

Use: Measurement of the number of diarrhoeal cases among children below five years age can be used to:

• evaluate and monitor diarrhoeal case management programmes; • evaluate health education programmes regarding prevention of diarrhoea for

mothers who have children below five years of age; and • improve national or local health planning to prevent, treat and manage diarrhoeal

disease.

Common data sources: Hospital treatment records and registrations; case reports.

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Df'finition of important tf'rm:

DiarrhoN: Three or more loose or watery stools in a 24-hour period, a loose stool being one that would take the shape of the container; or local definition of diarrhoea.

53. Cure rate of smear-positive tuberculosis or tuberculosis cure rate

Definition of indicator: Proportion of new sputum smear-positive cases, in a given period of time, who completed treatment and had at least two negative sputum smear results, including one at completion of treatment, out of the total of new smear-positive cases registered for treatment during the same period of time.

Numerator: Number of new sputum smear-positive cases, in a given period of time, who completed treatment and had at least two negative sputum smear results, including 1 at completion of treatment, during a given period of time x 100.

Denominator: Number of new smear-positive cases registered for treatment during the same period of time.

Use: Measurement of the effectiveness of tuberculosis case management and treatments can be used to:

• evaluate the management of tuberculosis control programmes; and • improve national or local health planning to control tuberculosis.

Common data sources: Special treatment follow-up and treatment monitoring system; health facility patient records; health facility reports.


New case: A patient who has never had treatment for tuberculosis or has taken anti-tuberculosis drugs for less than four weeks.

Curro: Initially smear-positive patient who completed treatment and had negative sputum smear results on at least two occasions, including one at completion of treatment.

Treatment complf'ted: Sputum smear-positive cases who completed treatment, with negative smears at the end of the initial phase and none at the end of treatment.

Pulmonary tuberculosis: Classification of all pulmonary cases should be based on sputum smear examination. Ideally, sputum should also be examined for cases of suspected extra-pulmonary tuberculosis.

Pulmonary tuberculosis, smear positive (PTB +): Tuberculosis in a patient with at least two initial sputum smear examinations (direct smear microscopy) positive for acid fast bacilli (AFB +); or tuberculosis in a patient with one sputum examination positive for AFB and radiographic abnormalities consistent with active pulmonary tuberculosis as determined by the treating medical officer; or tuberculosis in a patient with one sputum specimen positive for AFB and culture positive for AFB.

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Pulmonary tuberculosis, smear negative (PTB-): Tuberculosis in a patient with symptoms suggestive of tuberculosis and at least three initial sputum smear examinations negative for AFB, and with radiographic abnormalities consistent with active pulmonary tuberculosis determined by a medical officer followed by a decision to treat the patient with a full course of anti-tuberculosis therapy; or diagnosis based on positive culture but negative AFB sputum examinations.

Extra-pulmonary tuberculosis: Tuberculosis of organs other than the lungs: Tuberculosis of the pleura (tuberculosis pleurisy), of peripheral lymph nodes, abdomen, genito-urinary tract, skin, joints and bones, tubercular meningitis. Diagnosis should be based on one culture positive specimen from an extra-pulmonary site, or histological or strong clinical evidence consistent with active extra-pulmonary tuberculosis followed by a decision by a medical officer to treat with a full course of anti-tuberculosis therapy. Pleurisy is classified as extra-pulmonary tuberculosis. Any patient diagnosed with both pulmonary and extra-pulmonary tuberculosis should be classified as a case of pulmonary tuberculosis.

54. Percentage of population with adequate health care facilities (including essential drugs) within a reasonable distance from their residence

Definition of indicator: The number of persons with adequate health care facilities (including essential drugs) within a reasonable distance from their residence per 100 population during a given period of time.

Numerator: Number of persons with adequate health care facilities (including essential drugs) within a reasonable distance from their residence during a given period of Ii me x 1 00.

Denominator: Total population in the same area and during the same period of time.

Use: Measurement of health care facilities distribution can be used:

• to evaluate health resources distribution; and • for national or local health planning.

Common data sources: National health statistics reports; health surveys.

55. Availability of quality of care instruments and their use in hospital services

Definition of indicator: The quality of care supplied by health facilities, and utilization of human resources for hospital services.

Use: To measure health services quality and utilization of human resources in order to improve health services and increase utilization of human resources for health.

Common data sources: Health sampling surveys.

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56. Availability of screening programmes for common country-specific illnesses

Definition of indicator: The quality and cost-benefit ratio for screening programmes for common country-specific illnesses.

Use: Measurement of health screening programmes for common country specific illnesses can be used in national or local health planning.

Common data sources: National evaluation surveys.

57. Availability of screening programmes for common cancers

Definition of indicator: for common cancers.

The quality and cost-benefit ratio for screening programmes

Use: Health screening programmes for cancers are used in national or local health planning.

Common data sources: National evaluation surveys.

58. Percentage of pregnant women cared for by trained personnel during the antenatal period

Definition of indicator: The number of pregnant women who have had at least one consultation with trained personnel during their antenatal period per 100 live births during one year.

Numerator: Number of pregnant women who have had at least 1 consultation with trained personnel during their antenatal period during 1 year x 100.


Use: Measurement of maternal and child health care at national or local level can be used:

• to evaluate antenatal health care supplied by health facilities; and • for monitoring, supervising and evaluating maternal health care.

Common data sources: national health surveys.

Pregnancy health care registries; annual health statistics;

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59. Percentage of pregnant women having at least three antenatal care consultations with trained personnel during the antenatal period

Definition of indicator: The number of pregnant women who have had at least three antenatal care consultations, including first antenatal consultation during the first trimester (1-11 weeks' gestation), second antenatal consultation during the second trimester (12-24 weeks' gestation), and third antenatal consultation after 25 weeks' gestation, with trained personnel, during their antenatal period per 100 live births during one year.

Numerator: Number of pregnant women who have had at least three health care visits by trained personnel during their antenatal period x 100.


Use: Measurement of the quality of health care for pregnant women at national or local level can be used:

• to measure the quality of antenatal care supplied by health facilities; • for monitoring, supervising and evaluating maternal health care; and • to evaluate national or local maternal and child health programmes.

Common data sources: Annual health statistics report; national health surveys.

fiO. Percentage of pregnant women cared for by trained personnel during delivery

Definition of indicator: The number of pregnant women who were attended by trained personnel during their delivery per 100 live births during one year.

Numerator: Number of pregnant women who were attended by trained personnel during their delivery during 1 year x 100.


Use: Measurement of quality of health services supplied by health facilities can be used to:

• evaluate health services management in national or local health facilities; and • evaluate, monitor and supervise maternal health care.

Common data sources: Vital registration; birth records; annual health statistics records; national health surveys.

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& 1. Percentage of pregnant women cared for by trained personal during the postnatal period

Definition of indicator: The number of pregnant women who have had at least one postnatal health consultation with trained personnel during their postpartum period per 100 live births during one year.

Numerator: Number of pregnant women who have had at least 1 postnatal health visit by trained personnel during their postpartum period during 1 year x 100.


Use: Measurement of maternal and child health care at country level can be used:

• to measure postnatal health care services supplied by health facilities during the postpartum period;

• to evaluate maternal and child health care services supplied at national or local level; and

• for monitoring, supervising and evaluating programmes for maternal health care at national level.

Common data sources: Health services registrations; birth records; health surveys.

&2. Percentage of complicated obstetric cases managed at health centres and district hospitals that provide essential obstetric care (EOO

Definition of indicator: The number of complicated obstetric cases managed at health centres and district hospitals that provide essential obstetric care per 100 complicated obstetric cases at all health centres or district hospitals during one year.

Numerator : Number of complicated obstetric cases managed at health centres and district hospital that provide essential obstetric care during 1 year x 100.

Denominator: Number of complicated obstetric cases at all health centres and district hospitals during the same period of time.

Use: Measurement of EOC services supplied by health facilities at local level can be used:

• to evaluate EOC services supplied by health centres or district hospitals; • for national or local health planning, and allocation of health resources; and • for monitoring, supervising and evaluating maternal health care.

Common data sources: Hospital surveys.

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63. Percentage of caesarean sections

Definition of indicator: Percentage of pregnant women undergoing caesarean section in the same area and during one year.

Numerator Number of pregnant women undergoing caesarean section during 1 year x 100.


Use: Measurement of health care services supplied by health facilities at each level can be used to:

• evaluate qual ity of health services for maternal health care; • evaluate maternal health care supplied by health facilities at each level; and • for health education programmes and health planning at national or local level.

Common data sources: Hospital registrations; birth records; annual reports.

64. Percentage of women immunized with tetanus toxoid (TT2) during pregnancy

Definition of indicator: A pregnant women is considered adequately immunized against tetanus when she has received at least two doses of tetanus toxoid during pregnancy. Since the number of pregnant women is generally not available, the number of live births or estimated newborn infants may be used as the denominator. This indicator is of limited value in countries where a substantial number of women are already immunized when becoming pregnant.

Numerator: Number of pregnant women given at least 2 doses of TT in a specific area and during 1 year x 100.

Denominator: Number of live births or estimated number of newborn infants in the same area and during the same period of time.

Use: Measurement of immunization with TI2 tor pregnant women can be used:

• to evaluate TI2 immunization programme tor women at national or local level; and

• to compare the relationship between TI2 coverage rates tor women and neonatal tetanus incidence in infants.

Common data sources; Immunization registrations; women's health surveys.

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65. Percentage of patients with access to rehabilitation services

Definition of indicator: The percentage of patients who have various forms of access to rehabilitation services during a given period of time.

Numerator: Number of patients having access to rehabilitation services during a given period of time x 100.

Denominator: Number of patients requiring rehabilitation services during the same period of ti me.

Use: Measurement of rehabilitation services supplied by health facilities at each level can be used:

• to evaluate rehabilitation services supplied at national or local level; • to evaluate health programmes for rehabilitation services; and • for health planning.


66. Availability and type of community facilities for the elderly

Definition of indicator: Physical travel time to community health care facilities for the elderly should not be more than two hours.

Use: Measurement of the availability of community health facilities for the elderly can be used:

• for planning for the elderly; and • to evaluate health supply capability in community health facilities for the elderly.

Common data sources: National health surveys.

67. Hospital bed occupancy rates in public hospitals

Definition of indicator: The occupied bed-days to the available bed-{jays as determined by bed capacity in public hospitals during a given period of time.

Numerator: Actual number of occupied bed-{jays in public hospitals during a given period of time x 100.

Denominator: Total available bed-days during the same period of time.

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Use: Measurement of bed occupancy rates in public hospitals can be used:

• to evaluate hospital management; • to evaluate utilization of hospital beds in public hospitals; and • for national or local health planning.

Common data sources: National health statistics; public hospital surveys.

68. Hospital bed occupancy rates in private hospitals

Definition of indicator: The occupied bed-days to the available bed-days as determined by bed capacity in private hospitals during a given period of time.

Numerator: Actual number of occupied bed-days in private hospitals during a given period of time x 100.

Denominator: Total available bed-days during the same period of time.

Use: Measurement of hospital bed occupancy rates in private hospitals can be used:

• to evaluate hospital management and health services supplied; • to evaluate utilization of hospital beds in private hospitals; and • for health planning in private hospitals.

Common data sources: National health statistics; private hospital surveys.

69. Net death rates in public hospitals

Definition of indicator: The number of deaths occurring 48 hours or more after admission in public hospitals per 100 patient separations during a given period of time.

Numerator: Number of deaths occurring 48 hours or more after admission in public hospitals during a given period of time x 100.

Denominator: Number of separations (minus deaths occurring less than 48 hours after admission) during the same period of time.

Use: Measurement of death rates in public hospitals can be used to:

• evaluate quality of hospital management; and • evaluate hospital treatment capability.

Common data sources: Hospital records.

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Separation: The termination of the occupation of a health facility bed by a patient either through discharge, transfer to another health care institution or death.

This is a good indicator of the quality of patient care in a health facility. A 48-hour period is regarded as sufficient for a health facility to diagnose a patient's illness and start curative measures. If this rate is higher than expected (according to the standards of the country), then the records of all deaths should be studied in detail.

70. Net death rates in private hospitals

Definition of indicator: The number of deaths o

a selection of important - wpro iris · 2015. 9. 27. · introduction health indicators measure...

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