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Indicators of health

  1. Mortality indicators:
    1. Crude Death rate: Number of deaths per 1000 mid year population per year in a given geographical area. Not a perfect measure of health status, but a useful tool for measuring overall improvement.
    2. Expectation of Life: The average no. of years that will be lived by those born alive into a population if the current age specific mortality persists. LE at birth is most commonly used.
    3. Infant mortality rate: One of the most universally accepted indicators of health status not only for infants, but also of whole population & of socioeconomic conditions under which they live. Sensitive indicator of availability, utilization & effectiveness of health care particularly perinatal care.
    4. Child mortality rate: no longer used now. Replaced by U5MR.
    5. Under 5 proportionate mortality rate: along with IMR, one of the key indicators of health status. UNICEF uses this indicator.
    6. MMR
    7. Disease specific mortality
    8. Proportional mortality rate: indicates magnitude of preventable mortality.
  2. Morbidity Indicators:
    1. Prevalence
      The proportion of persons suffering from a specific disease out of the population normally residing in that area, at a particular point in time, is called the prevalence. It includes both the new cases as well as the old cases occurring in the area at the point in time when the examination was undertaken. It should be seen that the numerator is part of the denominator.
    2. Incidence
      Incidence rate refers to the number of new cases occurring in a population over a specified period of time. The numerator should be part of the denominator as in prevalence rate but unlike as in prevalence rate only new cases are considered. Incidence rate is generally depicted as per 1000 or 100,000.
      1. Relationship between prevalence and incidence
        Prevalence of a disease is the product of incidence and the duration of disease ( P= I xD). Therefore, prevalence of a disease depends not only on the actual number of people who develop a disease but also on the duration of a disease.
        Prevalence is most appropriate in long-standing or chronic diseases as the window period in which a diagnosis can be established is much higher and therefore, cases will not be missed during a survey.
        Incidence is most appropriate in disease of a short duration as such diseases may occur more than once during a reference period and all the episodes may not be captured if the prevalence of the disease were to be measured.
    3. Attendance rate at in & out patient departments
    4. Discharge rate, Readmission rate
    5. Duration of stay in the hospital
  3. Disability indicators:
    1. Sullivan’s index: Expectation of life free from disability, computed by subtracting from life expectancy the probable duration of bed disability & inability to perform major activities according to cross sectional data.
    2. Disability adjusted life years: Measures the burden of disease in the population & years lived with disability adjusted for the severity of the disability. One DALY is “one lost year of healthy life”.
  4. Nutritional Status indicators:
    Weight, height, mid arm circumference, prevalence of low birth weight.
  5. Health care Delivery indicators:
    Doctor population ratio, doctor nurse ratio, population bed ratio, population per health/subcentre, population per TBA.
  6. Socioeconomic status indicators:
    1. Per capita GNP
    2. Per capita calorie availability
    3. Literacy rate
    4. Level of unemployment
    5. Dependency ratio
    6. Housing
    7. Family size

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