Health Indicators, Demography, and Population Estimation Flashcards
Tools used to measures objectively a specific health concept of interest
Usually numerical measures which help compare the targeted or expected results of health programs
Health Indicators
Way to know if goals and objectives were able to be achieved by a health program
Health Indicators
It can also serve as a proxy/ gives you an idea for a condition or phenomenon which is difficult to measure
Health Indicators
An indicator may provide a direct estimate of the underlying condition of interest
Ex: health status, accessibility, coverage, utilization of health services
Uses of Health Indicators:
___public health problems at a particular point of time.
___changes over time in the level of health of an individual or a population.
___ the extent to which the objectives of a program are being reached.
____, educate and empower people about health issues.
Define
Indicate
Assess
Inform
Characteristics of Indicators:
measures what is supposed to be measured; Original
Valid
Characteristics of Indicators:
have the same value even if it is measured by other people at different times under similar conditions; Consistency is important
Reliable
Characteristics of Indicators:
able to detect small changes in the phenomenon being measured in a significant way; immediately see the changes
Sensitive
Characteristics of Indicators:
reflects changes only in the situation concerned
Specific
Characteristics of Indicators:
collection of data to determine its value if technically, financially and operationally possible; If it is easy or convenient to do
Feasible
A if only the first statement is correct
B if only the second statement is correct
C if both statements are correct
D if both statements are correct
Determining the Anemia Status of pregnant women.
Which of the following is a reliable indicator?
-Pallor of conjunctiva
-Hemoglobin level
B
A if only the first statement is correct
B if only the second statement is correct
C if both statements are correct
D if both statements are correct
Determining the Anemia Status of pregnant women.
Which of the following is a feasible indicator?
-Pallor of conjunctiva
-Hemoglobin level
A
A if only the first statement is correct
B if only the second statement is correct
C if both statements are correct
D if both statements are correct
Determining the maturity of people in Barangay X.
Which of the following is a specific indicator?
-Age
-Hair color
A
A if only the first statement is correct
B if only the second statement is correct
C if both statements are correct
D if both statements are correct
Determining the nutritional level of children in Sitio Kalusugan.
Which of the following is a sensitive indicator?
-Height
-Weight
B
A if only the first statement is correct
B if only the second statement is correct
C if both statements are correct
D if both statements are correct
Identifying the paternity of the Gutierrez twins.
Which of the following is a reliable indicator?
-DNA test
-Mother’s testimony
A
A if only the first statement is correct
B if only the second statement is correct
C if both statements are correct
D if both statements are correct
Identifying the paternity of the Gutierrez twins.
Which of the following is a feasible indicator?
-DNA test
-Mother’s testimony
B
Sources of Data for Health Indicators:
Complete count of the population of a given place
Census of the country’s population
(First recorded value of the population of PH documented by Fr. Buzeta in 1799 - 1,502,574
First known Philippine - 1877 with a count of 5,984,727
The most recent census - 2015 with a count of 100,979,303)
Sources of Data for Health Indicators:
Requires basic and compulsory registration of all births, deaths and marriages occurring in the country
Vital Registration System (VRS)
PSA is in-charge (It was legally instituted in the country on February 27, 1931
Main problem: under-resignation of births and deaths)
Sources of Data for Health Indicators:
Sub-organizations under National Health Information System (NHIS) :
Enhanced surveillance system that monitors notifiable diseases and other health-related events of public health importance
Philippine Integrated Disease Surveillance and Response (PIDSR)
Category 1: 10 diseases: measles, human avian influenza, anthrax, neonatal tetanus, rabies and SARS among others
Immediately notifiable w/in 24hrs
Category 2 : 17 diseases: acute bloody diarrhea, cholera, dengue, leptospirosis, malaria, typhoid and paratyphoid fever, and pertussis among others
Weekly notifications
Sources of Data for Health Indicators:
Sub-organizations under National Health Information System (NHIS) :
Intended to address the short-term needs of DOH and LGU staff with managerial or supervisory functions in facilities and program areas
Field Health Service Information System (FHSIS)
Provides summary on health service delivery and selected program accomplishment indicators
Sources of Data for Health Indicators:
Sub-organizations under National Health Information System (NHIS) :
Computer based system developed by DOH with the objective of supporting the hospital management for effective and quality health care
Hospital Operation and Management Information System (HOMIS)
To systematically collect, process, store, present and share information in support of hospital functions
Sources of Data for Health Indicators:
Event/ condition-specific information and surveillance systems
Specialized Information Systems within the Health Sector
(Surveillance in post-extreme emergencies and disasters (SPEED)
Online National Electronic Injury Surveillance System (ONEISS)
Phil. Malaria Information System (PhilMIS))
Cancer Registry and HIV/ AIDS Registry
Disease Registry
Sample Surveys:
Collecting accurate and nationally representative data on health, population and nutrition in developing countries
National Demographic and Health Survey (NDHS)
(Important in policy making, program planning, monitoring and evaluation of programs; on-going)
Funded by USAID
Sample Surveys:
Series of household surveys conducted by UNICEF covering important indicators describing the situation of women and children
Multiple Indicator Cluster Surveys (MICS)
Sample Surveys:
Series of national surveys on Filipino youth aged 15-24
One of primary sources on sexual and non-sexual risk behaviors and its determinants in the Philippines.
Young Adult Fertility and Sexuality Study (YAFS)
Types of Health Indicators according to Aspect of health being measured:
measure health outcomes and/ or their risk factors
Personal, environmental, or occupational
Health status indicators
Types of Health Indicators according to Aspect of health being measured:
measure aspects of the performance of health services or public health programs
Utilization, accessibility, quality, and cost
Health service performance indicators
Types of Health Indicators according to Group referred to:
describes the total population (being measured) which is used as the denominator in the computation
Denominator: total population being measured
Crude rates
e.g. Crude Death Rate (CDR)
Types of Health Indicators according to Group referred to:
describes only a specific sub-group of the total population being considered
Specific rates
e.g. Age-Specific Death Rate (ASDR)
Types of Health Indicators according to Group referred to:
half of deaths or births have occurred; June or July
Midyear population
Types of Health Indicators according to Time covered by the events:
occurred during the specific point in time being considered
Usually a day, useful in monitoring incidents of diseases during outbreak or epidemic
Point in time
e.g. Prevalence: old + new cases (period of time)
Incidence: new cases only (point in time)
Types of Health Indicators according to Time covered by the events:
occurred over a period of time
Prevalence of diseases during January to March
Period of time
e.g. Prevalence: old + new cases (period of time)
Incidence: new cases only (point in time)
Types of Health Indicators according to Components of the evaluation framework:
resources needed to deliver the essential services to the population or to achieve project objectives
Ex: Number of posters and brochures on family planning
Input indicators
e.g. Number of community volunteers trained to conduct health education
Funds, work force, fliers, materials/ equipments, facilitators, resources, and infrastructure
Types of Health Indicators according to Components of the evaluation framework:
direct products of project activities.
Generally in the form of activities and processes undertaken
Described in terms by size and scope
Ex:Number of couples who have seen or received the posters
Output indicators
e.g. Number of health education classes conducted
Types of Health Indicators according to Components of the evaluation framework:
immediate result of the services or activities implemented
Changes, easily achievable, can be seen immediately/ right after the implementation
Ex: % increase in the level of knowledge among couples on family planning
Outcome indicators
e.g. % increase in number of family planning acceptors
Types of Health Indicators according to Components of the evaluation framework:
intended or unintended long-term organizational/ community changes
Usually reflects rates of diseases or deaths, needs time to be seen
Ex: Decrease in the average number of children per family
Impact indicators
e.g. Decrease in the population growth rate
morbidity, mortality, fertility
Conventional Health Status Indicators
Conventional Health Status Indicators:
disease frequency and association
Measures of Morbidity
- Measures of Disease Frequency
- Measures of Association
Measures of Morbidity:
Magnitude of the disease in a given population
Measures of Disease Frequency
Incidence or Prevalence? New cases How many people developed the disease? Number of new cases of a disease Acute Disease etiology/ causation
Incidence
Incidence or Prevalence? Old + new How many people have the disease? Number of existing cases of a disease Chronic Service delivery
Prevalence
Types of Incidence Measures:
The proportion of disease-free individuals who contract the disease within a specified period of time
Measures the average risk of developing the disease
Incidence Proportion (IP) or Cumulative Incidence (CI): IP/CI (Called “attack rate” for infection when the implicit reference period is the duration of the outbreak)
Types of Incidence Measures:
Measures the rate at which new cases occur
Deals w/ dynamic population: uses total person time as its denominator
Incidence Rate (IR) or Incidence Density (ID): IR/ ID (Person time: a function of the size of the population followed-up and the duration of the follow-up time)
Types of Prevalence Measures:
Measures the proportion of existing cases of a disease in the population at a particular point in time.
Point Prevalence (Useful in describing the magnitude of chronic conditions existing in a population at a point in time. Does not measure the risk of developing the disease)
Types of Prevalence Measures:
Equal to the prevalence at the beginning of the period + the new cases and recurrences during the said period
Period Prevalence
Useful for quantifying diseases frequency
Other Morbidity Measures
takes into account not only the # of persons sick of a given disease but also the effects of the disability and premature mortality from the disease
Burden of disease
Measures of Morbidity:
Quantifies the strength of the relationship between the disease/ condition of interest and the corresponding exposure/ risk factors being assessed
Measures of Association
- Measures of Mortality
- Measures of Fertility
A risk of dying is measured by the crude and specific death rates Crude death rate Specific mortality rate Cause-of-death rate Infant mortality rate Neonatal mortality rate Post-neonatal mortality rate Maternal mortality rate Proportional mortality rate Case-fatality rate
Measures of Mortality
Measures of Mortality:
Measures how fast mortality occurs in a given population
Affected by age-sex composition, adverse environmental and occupational conditions, peace and order conditions
Crude Death Rate
Measures of Mortality:
Measures the force of mortality in specific subgroups of the population
Specific Mortality Rate
Measures of Mortality:
Used in determining the leading cause of mortality
Mortality rate from specific diseases or conditions
Cause of Death Rate
Measures of Mortality:
Useful indicator of a country’s level of health development
Component of Physical Quality Life Index
Can be artificially lowered by improving birth registration
Infant Mortality Rate
2 Types IMR:
include deaths in the first 28 days of life
Neonatal mortality ratio
2 Types IMR:
include deaths in the after 28 days of life but less than 1 year
Post-neonatal mortality ratio
Measures of Mortality:
Measures occurrence of maternal deaths
“Death while pregnant or within 42 days of termination of pregnancy” – WHO
Reflects level of obstetric risk in a population
Maternal Mortality Ratio
Measures of Mortality:
Measures the proportion of the total deaths occurring in a particular population group or from a particular case
Proportionate Mortality Ratio
Difference with specific mortality ratio is:
Denominator used is the total number of deaths and NOT midyear population
Measures of Mortality:
when this indicator has a high number, it means a disease is fatal
Case Fatality Rate
Measures of Mortality:
Risk of a child born in a specific year or period dying before reaching the age of five
Under-five Mortality Ratio
Measures of Mortality:
Ave. no. of years that the newborn is expected to live if the current mortality rates continue to apply
How long will the individual live in a certain country
Life Expectancy at Birth
Measures of Fertility:
Measures number of children born per 1000 population in a given place and time
Crude Birth Rate (CBR)
Measures of Fertility:
Measures number of children born per 1000 women in the reproductive age groups in a given place during a particular time
General Fertility Rate (GFR)
Measures of Fertility:
Measures number of children born per 1000 women in a particular age group
Measures fertility level of each sub-group of women according to age
Age-Specific Fertility Rate (ASFR)
Measures of Fertility:
Measures number of children who will be born per woman if she pass through the childbearing years bearing children
Total Fertility Rate (TFR)
absolute numbers, ratios, proportions, rates
Computing Indicators
Computing Indicators:
Simple count of the number of persons, houses or events being considered
Easy to understand but difficult to interpret especially when making comparisons among groups with different sizes/ total population
Absolute numbers
Computing Indicators:
Result of dividing one number by another
Reserved for measures wherein the numerator is not part of the denominator
Ratios
Computing Indicators:
Special kind of ratio wherein the numerator is part of the denominator
When multiplied by 100 = percentage
Proportions
Computing Indicators:
Measures how fast an event occurs over time or space
Expressed in terms of the frequency of occurrence of events
Common example in health is the incidence rate of a disease.
Rates
dynamic
scientific study of human populations
Demography
“Study of the size, territorial distribution, and composition of the population, changes therein, and the components of such changes” - Hauser and Duncan (1959: 2)
3 Aspects of Demography
Population size
Population structure/ composition
Population distribution in space
3 Aspects of Demography:
Affected by: natality: birth, mortality: death, migration: emigration (out), immigration (in)
Population Size
2 Methods of Population Allocation:
people are counted or allocated to the area where they were physically present at the time of the census; Philippines uses this method
De Facto Method
2 Methods of Population Allocation:
people are counted or allocated to the place of their usual residence
De Jure Method
3 Aspects of Demography:
Determines the number of percentage of the population according to the categories of important socio-demographic-economic variables
The most basic description of the population composition is according to age and sex
Population Composition
Factors Affecting Population Composition:
- number of births per 1000 population
- of deaths per 1000 population
- number of people leaving a country
- number of people moving to a country
- Birth rate
- Death rate
- Emigration
- Immigration
Describing the Age Composition of Population:
the age below which we have 50% of the population
Median Age
Describing the Age Composition of Population:
indicator of age-induced economic drain on human resources
Computed as the ratio of the dependents to the economically active group (15-64yo) of the population
Age dependency ratio
Dependent: Children (0-14yo) and Elderly (≥65yo)- dependent, no income
Independent: 15-64 yrs old, earning
computed by dividing the number of males by the number of females using a factor of 100
Sex Ratio
Graphical presentation of the age and sex structure of a population
Special type of histogram: male at the left and female at the right
Population Pyramid
Either the actual population count or % of the population can be graphed
(Expansive type: broad base, narrow top, many are born
Stationary type: seen in most developed nations, growth of population is stable)
3 Aspects of Demography:
Description of how people are distributed in a specified space or geographic area
Population Distribution in Space Affected by: Physical: geography Political: peace and order Social/ Cultural Economic: opportunities (work or education)
Indicators of Population Distribution in Space:
(measurement of population per unit area)
Crowding index (number of usual resident in a dwelling ÷ number of rooms in the dwelling)
Population density
Computation of future changes in population numbers, given certain assumptions about future trends in the rates of fertility, mortality, and migration
Population Estimation
Purposes of Population Estimation: \_\_\_\_\_of various trends \_\_\_\_\_ shifts in population \_\_\_\_\_allocation of public funds or political representation in the government \_\_\_\_\_(programs, projects)
Analysis
Measuring
Determining
Planning
Measures of Changes in Population Size:
Natural increase in a specific place and time
Number of births – number of deaths
Natural Increase
Measures of Changes in Population Size:
Rate of natural increase in a specific place and time
Crude birth rate (CBR) – crude death rate (CDR) *both are computed
Rate of Natural Increase
Measures of Changes in Population Size:
Actual difference between 2 census counts expressed in % relative to the population size of the prior census
Relative Increase
Measures of Changes in Population Size:
Measures the average number of people added to the population per year
Absolute increase per year (b)
Measures of Changes in Population Size:
Also utilize results of 2 censuses to quantify the amount of change in population size
Assumes that the population is changing at a constant rate per year
Annual rate of growth (r)
2 Methods of Estimation:
aka Inflow-Outflow or Balancing equation method
Pt = Po + (B – D) + (I – O)
Component Method B: births in the interval 0 and t D: deaths in the interval 0 and t I: immigration between 0 and t O: out-migration between 0 and t
2 Methods of Estimation:
Arithmetic method
Geometric method
Exponential method
Mathematical Method
Mathematical Method of Estimation:
assumes equal change every year
Arithmetic method
Mathematical Method of Estimation:
assumes that the population changes at the same rate over each unit
Geometric method
Mathematical Method of Estimation:
assumes a constant rate of change (r) and population is increasing continuously
Exponential method
Compute for the Rate of Natural of Increase:
In Nicaragua, the crude birth rate is 20/1,000 and the crude death rate is 5/1,000 in 2007.
RNI = 15/1000
In 2007, 15 for every 1000 persons were added to the population of Nicaragua through natural means.
Compute for crude birth rate:
A record from July, 2003 reported Florida’s population to be 1,452,901. According to the Denmark’s Statistics office, 14,633 babies were born in the same year.
CBR = 10.07 or 11
There are 11 births for every 1,000 persons in Florida in 2003.
