mortality & morbidity indicators of health .pptx

INDICATORS OF HEALTH
By
Dr. Madhusudan Swarnkar
Assistant professor
Dept. of Preventive and Social Medicine
Jhalawar Medical College, Jhalawar

HEALTH:
 Health is defined as “ a state of complete physical,
mental & social wellbeing, and not merely an absence
of disease or infirmity” (WHO)
 Health cannot be measured in exact measurable forms
 Hence measurement have been framed in terms of
illness (or lack of health), consequences of ill-health
(morbidity, mortality) & economic, occupation &
domestic factors that promote ill health

INDICATORS OF HEALTH:
 Indicator also termed as Index or Variable is only an
indication of a given situation or a reflection of that
situation
 Health Indicator is a variable, which help to measure
changes and over time they indicate direction and
speed of changes
 On direct measurement, they reflects the state of
health of persons in a community.

USE OF INDICATORS
Indicators are required
 to measure health status of community
 Also to compare health status of one country with
that of another
 For assessment of health care needs
 For allocation of scarce resources
 Monitoring and evaluation of health services,
activities and programs
 To measure the extent to which the objectives and
targets of program achieved

CHARACTERISTICS OF INDICATORS: FOR IDEAL
INDICATORS
 Should be valid, they should actually measure what they are
supposed to measure,
 Should be reliable and objective, the answer should be the
same if measured by different people in different situation,
 Should be sensitive, they should be sensitive to changes in
the situation concerned,
 Should be specific, they should reflect changes only in the
situation concerned,
 Should be feasible, they should have the ability to obtain the
data needed and;
 Should be relevant, they should contribute to the
understanding of the phenomenon of interest.

CLASSIFICATION :
 Mortality indicators
 Morbidity indicators
 Disability rates
 Nutritional status indicators
 Health care delivery indicators
 Utilization rates
 Indicators of social and mental health
 Environmental indicators
 Socio economic indicators
 Health policy indicators
 Indicators of quality of life
 Other indicators

MORTALITY INDICATORS
 Crude death rate:
 Expectation of life:
 Infant mortality rate
 Child mortality rate:
 Under-5 proportionate rate:
 Maternal (puerperal) mortality rate:
 Disease specific mortality:
 Proportional mortality rate

MORTALITY INDICATORS-CRUDE DEATH RATE:
 Number of deaths per 1000 population per yr. in a given
community,
 It indicates the rate at which people are dying.
 It provides a good tool for accessing the overall health
improvement in a population.
 Usefulness of CDR is restricted b/c it is influenced by the
age sex composition of the population.
 A decrees in death rate indicates towards overall health
improvement of community.
CDR =
Total no. of deaths in an area during a given year
Mid year population in the same area and year
x1000

MATERNAL MORTALITY RATE
 “The death of a women while from pregnant or within 42 days
of termination of pregnancy, irrespective of the duration and
site of pregnancy, from any cause related to or aggravated by
the pregnancy or its management but not from accident or
incidental causes.”
 Expressed as a rate per 1000 females in reproductive age
group.
MMR =
Total no. of female deaths due to complication of pregnancy,
childbirth or within 42 days of delivery from puerperal causes
in an area during a given year
Total no. of females in reproductive age group in the same
area and year
X 1000

MORTALITY INDICATORS- MMR……
 MMR strongly reflects the overall effectiveness of health
system.
 The low status of women in the society coupled with their low
literacy levels prevents the women from taking antenatal care
even if services are available
 There is inverse relationship b/w life time risk of maternal
death and the availability of the trained health worker during
pregnancy and at the time of delivery.
 Enhancing women’s access to family planning, adequate
nutrition and affordable basic health care would ↓ rate further.
 11-17 % maternal deaths occur during child birth while 50-
70% in postpartum period. About 45% of postpartum maternal
deaths occur during the 1st 24 hrs.

PERINATAL MORTALITY RATE
 No. of foetal deaths of > 28 weeks gestation plus infant
deaths of < 7 days age in a defined area in one year per
1000 live births > 28 weeks gestation in the same area and
in the same year.
 PMR is a combination of stillbirths and neonatal deaths.
 It is good indication of the extent of pregnancy wastage as
well as quality and quantity of health care available to the
mother and the newborn.
 PMR in India for the year 2011 was 31/1000 live births.
PMR =
Late foetal deaths(28 weeks gestation and more or 1000gm. or more
weight at birth) + early neonatal deaths (1st week) in an area during
a given year
Total no. of live births (weighing over 1000 gm. At birth) in the same
area and year
x1000

NEONATAL MORTALITY RATE
 Neonatal deaths are deaths of newborn commencing at birth
and upto 28 completed days after birth.
 Early neonatal deaths (upto 7 days after birth)
 Late neonatal deaths ( from 7days after birth to 28days after
birth)
 Neonatal mortality is directly related to birth weight and
gestational age.
 Main causes of neonatal mortality are intrinsically associated
with the health of mother and cares she receives before, during
and immediately after birth.
NMR =
Total no. deaths of children under 28 days of age in an area during
a given year
Total no. of live births in the same area and year
x1000

INFANT MORTALITY RATE….
 Infant mortality rate: it is ratio of deaths under 1 yr of age
in a given yr to the total no. of live births in same yr;
expressed as a rate per thousand live birth.
 It is a sensitive indicator of the availability, utilization and
effectiveness of health care, particularly perinatal care.
 It is universally accepted indicator of health status not only
infants, but also of the whole population and of the
socioeconomic conditions under which they live.
 India still among high IMR countries, 40/1000 LBs. in 2013
(while 47/ 1000 LBs. in world).
 Madhya Pradesh, Orissa and UP still having IMR above 70
(while in Rajasthan and Assam it is 67).

CHILD MORTALITY RATE
 Child mortality rate: no. of deaths at ages 1-4 yrs in a
given yr, per 1000 children in that age group at mid-yr. it
excludes infant mortality.
 It is related to inadequate MCH services, insufficient
nutrition, low coverage by immunization and adverse
environmental exposure and other exogenous agents.
 Infectious diseases of childhood like measls, whooping
cough, diphtheria, diarrhoea, and ac.resp. inf. Affect mostly
this age group and lead to high mortality (particularly in
malnourished).
 >8% of total deaths in Rajasthan, Bihar and U.P.

UNDER-5 PROPORTIONATE RATE, AND
UNDER 5 MORTALITY RATE
 Under-5 proportionate rate: proportion of total deaths
occurring in the ↓5 age group.
 High rate reflects high birth rates, high child mortality
rates and shorter life expectancy.
 In communities with poor hygiene the proportion may
exceed 60%.
 Under 5 mortality rate: annual no. of deaths children ↓
5 yr of age, per 1000 live births.
 It measures the probability of dying b/w birth and exact 5
yrs of age.
 It is best single indicator of social development rather
than GNP per capita.

DISEASE SPECIFIC MORTALITY
 When mortality rate were computed for specific diseases.
 It shows burden on community b/c of particular disease.
 It is total no. of deaths by a specified disease in a year and
in particular area.
 Examples: deaths from cancer, accidents, cardiovascular
diseases, diabetes, etc

PROPORTIONAL MORTALITY RATE
 Simplest measure of estimating the burden of a disease in
the community.
 Proportion of all deaths attributed due to diabetes/ MI/
Stroke/ cancer/ accidents etc
 Proportional mortality rate for communicable diseases
indicates the magnitude of preventable mortality.

MORBIDITY INDICATORS
 Incidence and prevalence
 Notification rates
 Attendance rates at out-patient department,
health centers etc.
 Admission, readmission and discharge rates
 Duration of stay in hospital and
 Spells of sickness or absence from work or
school

HEALTH CARE DELIVERY INDICATORS
 a. Doctor-population ratio
 b. Doctor-nurse ratio
 c. Population-bed ratio
 d. Population per health/subcentre
 e. Population per traditional birth attendant
 These indicators reflect the equity of distribution of health
resources in different parts of the country and provision of
health care.

UTILIZATION RATES
 Utilization of services/use of heath services or actual
coverage expressed as the proportion of people in need of
a service who actually receive it in a given period.(a yr.)
 Health care utilization is affected by factor such as
availability and accessibility of health services and the
attitude of an individual towards his health and the health
care system.
 A relationship exists between utilization of health care
services and health needs and status of population.

UTILIZATION RATES
1. Proportion of pregnant women who receive antenatal
care, or have their delivery supervised by a trained birth
attendant.
2. Proportion of infants who are fully immunized against the
6 vaccine preventable diseases.
3. Percentage of population using various methods of family
planning.
4. Bed occupancy rate ( average daily in patients/average
number of beds).
5. Average length of stay(days of care rendered/discharge).
6. Bed turn over ratio(discharges/average beds)

NUTRITIONAL STATUS INDICATORS
 Nutritional status is a positive health indicator.
 Three nutritional status indicators important as
indicators of health status:
1. Anthropometric measurements of preschool
children:- weight, height and mid arm
circumference;
2. Height( and sometimes weight) of children at
school entry and
3. Prevalence of low birth weight (<2.5 kg.)

INDICATORS OF SOCIAL AND MENTAL HEALTH
 These include
 suicide, homicide, act of violence and crime,
 road traffic accidents,
 juvenile delinquency,
 alcohol and drug abuse, smoking, obesity,
 battered baby and battered wife syndromes;
 neglected and abandoned youth in the neighborhood.
 These social indicators provide a guide to social
action for improving the health of the people.

ENVIRONMENTAL INDICATORS
 These reflect the quality of physical and biological
environment in which diseases occur and I which people live.
These are pollution of water and air, radiation, solid waste,
noise, exposure to toxic substances in food and drinks.
 Most useful indicators are those measuring the proportion of
population having access to safe water and sanitation,
(percentage of households with safe water in the home or
within 15 min. walking distance, adequate sanitary facilities in
the home or immediate vicinity)

SOCIO ECONOMIC INDICATORS
 Rate of population increase
 Per capita GNP
 Level of unemployment
 Dependency ratio
 Literacy rate, especially female literacy rates
 Family size
 Housing: no. of persons per room
 Per capita calorie availability

HEALTH POLICY INDICATORS
 The relevant indicators are
 proportion of GNP spent on health services
 proportion of GNP spent on health related
activities (including water supply and sanitation,
housing and nutrition, community development)
 proportion of total health resources devoted to
primary health care

DISABILITY RATES
 Event type indicators:
 Number of days of restricted activity
 Bed disability days
 Work loss days (or school loss days) within a specified period
 Person type indicators:
 Limitation of mobility: eg. Confined to bed/house, Limitation of
activity: eg. limitation to perform the basic activities of daily living-
(eating, washing, dressing, going to toilet, moving about), limitation
in major activity (ability to work at job, ability to housework)

DISABILITY RATES
 Sullivan’s index (expectation of life free of disability):
computed by subtracting from the life expectancy the
probable duration of bed disability and inability to perform
major activities.
 HALE (Health -Adjusted Life Expectancy) : measure
healthy life expectancy, based on life expectancy at birth but
includes an adjustment for time spent in poor health.
 DALY (Disability - Adjusted Life Year): measure of burden
of disease in a defined population and the effectiveness of
the interventions. DALYs express years of life lost to
premature death and years lived with disability adjusted for
the severity of the disability.

OTHER INDICATORS
 Social indicators: Population; Family formation, family and
households; Learning and educational services; Earning
activities; Distribution of income, consumption and
accumulation; Social security and welfare services; Health
services and nutrition; Housing and it’s environment; Public
order and safety; Time use ; Leisure and culture; Social
stratification and mobility
 Basic needs indicators: calorie consumption, access to water,
life expectancy, deaths due to disease, literacy, doctors and
nurses per population, GNP per capita
 Health for all indicators:
 Millennium development goal indicators:

 . Four categories of indicator given by WHO
 Health policy indicators
 Political commitment to heath for all
 Resource allocation
 The degree of equity of distribution of health services
 Community involvement
 Organizational framework and managerial process
 Social and economic indicators related to health
 Rate of population increase
 GNP or GDP
 Income distribution
 Work conditions
 Adult literacy rate
 Housing
 Food availability
 Indicators for the provision of health care
 Availability
 Accessibility
 Utilization
 Quality of care
 Health status indicators
 Low birth weight (%)
 Nutritional status and psychological development of children
 Infant mortality rate
 Child mortality rate(1-4)
 Life expectancy at birth
 Maternal mortality rate
 Disease specific mortality
 Morbidity – incidence and prevalence
 Disability prevalence

 Goal: 1. Eradication of extreme poverty and hunger
 Indicator :4. Prevalence of underweight children under five yrs. of age
Indicator:5. Proportion of population below minimum level of dietary energy consumption
 Goal: 4. Reduce child mortality
 Indicator :13. Under five mortality rate
Indicator:14. Infant mortality rate
Indicator:15. Proportion of 1 yr. old children immunized against measles
 Goal: 5. Improve maternal health
 Indicator:16. Maternal mortality rate
Indicator:17. Proportion of births attended by skilled health personal
 Goal: 6. Combat HIV/AIDS, malaria and other diseases
 Indicator:18. HIV prevalence among young people aged 15 to 24 years
Indicator:19. Condom use rate of the contraceptive prevalence rate
Indicator:20. No. of children orphaned by HIV/AIDS
Indicator:21 Prevalence and death rates associated with malaria
Indicator:22. Proportion of population in malaria risk areas using effective malaria prevention and
treatment measures.
Indicator:23. Prevalence and death rates associated with tuberculosis
Indicator:24. Proportion of tuberculosis cases detected and cured under DOTS
 Goal: 7. Ensure environmental sustainability
 Indicator:29. Proportion of population using solid fuel
 Indicator:30. Proportion of population with sustainable access to an improved water source, urban and
rural
 Indicator:31. Proportion of urban population with access to improved sanitation
 Goal: 8. Develop a global partnership for development
 Indicator:46. Proportion of population with access to affordable essential drugs on a sustainable basis

Indicator Data(year)
Population(in million) 1028.61(2001)
Population male 532.16
Population female 496.46
Sex ratio (females/1000 males) 933(2001)
Literacy rate in >7 yrs. total 65.49
Population below poverty line(%) 25.9(2005-06)
Crude birth rate(1000 MY Population) 23.1(SRS 2007)
Crude death rate(1000 MY Population)
Infant mortality rate (per 1000 live births)
7 (SRS 2013)
40 (SRS 2013)
MMR (per 1 lakh live births) 178 (SRS 2006)
Expectancy of life at birth(Yrs) total 64.8
No. of Doctors ((per 1 lakh Population) 70 (2005)
Health expenditure as % of GDP 0.91
Gross national product (in Crores) 2812758 (2005-06)

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