Health Indicators, Demography, and Population Estimation Flashcards by Ady Cabalquinto

Q

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

A

Health Indicators

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Q

Way to know if goals and objectives were able to be achieved by a health program

A

Health Indicators

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Q

It can also serve as a proxy/ gives you an idea for a condition or phenomenon which is difficult to measure

A

Health Indicators
An indicator may provide a direct estimate of the underlying condition of interest
Ex: health status, accessibility, coverage, utilization of health services

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Q

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.

A

Define
Indicate
Assess
Inform

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Q

Characteristics of Indicators:

measures what is supposed to be measured; Original

A

Valid

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Q

Characteristics of Indicators:
have the same value even if it is measured by other people at different times under similar conditions; Consistency is important

A

Reliable

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Q

Characteristics of Indicators:

able to detect small changes in the phenomenon being measured in a significant way; immediately see the changes

A

Sensitive

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Q

Characteristics of Indicators:

reflects changes only in the situation concerned

A

Specific

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Q

Characteristics of Indicators:
collection of data to determine its value if technically, financially and operationally possible; If it is easy or convenient to do

A

Feasible

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Q

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

A

B

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Q

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

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Q

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

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Q

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

A

B

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Q

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

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Q

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

A

B

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Q

Sources of Data for Health Indicators:

Complete count of the population of a given place

A

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)

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Q

Sources of Data for Health Indicators:

Requires basic and compulsory registration of all births, deaths and marriages occurring in the country

A

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)

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Q

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

A

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

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Q

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

A

Field Health Service Information System (FHSIS)

Provides summary on health service delivery and selected program accomplishment indicators

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Q

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

A

Hospital Operation and Management Information System (HOMIS)

To systematically collect, process, store, present and share information in support of hospital functions

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Q

Sources of Data for Health Indicators:

Event/ condition-specific information and surveillance systems

A

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))

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Q

Cancer Registry and HIV/ AIDS Registry

A

Disease Registry

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Q

Sample Surveys:

Collecting accurate and nationally representative data on health, population and nutrition in developing countries

A

National Demographic and Health Survey (NDHS)
(Important in policy making, program planning, monitoring and evaluation of programs; on-going)
Funded by USAID

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Q

Sample Surveys:
Series of household surveys conducted by UNICEF covering important indicators describing the situation of women and children

A

Multiple Indicator Cluster Surveys (MICS)

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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: 1. number of births per 1000 population 2. of deaths per 1000 population 3. number of people leaving a country 4. number of people moving to a country

1. Birth rate 2. Death rate 3. Emigration 4. 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.