Indicators For Monitoring Child Health

Indicators for monitoring child health
Core indicators
Policy goal Indicator and Definition, measure, period and data source
reason for use
Reduce the Type 1 Indicator: Definition & Measure: Proportion of children in
number of Child Status households experiencing the following:
children living in Child poverty • Living in a household that has a household equivalent
poverty. Reasons for use: Child income below R10 189 per annum (2006 value);
poverty is associated • Living in a household without a refrigerator;
with the widest range • Living in a household with neither a TV nor a radio.
of insults to child Sources: Census and other household surveys (Statistics
survival, health and South Africa); provincial poverty data.
development, Period: Every 10 years
including mortality. Notes: This measure is used in the Provincial Indices of
Free download from www.hsrcpress.ac.za

Appropriate for Multiple Deprivation (PIMD) developed by Noble, Babita
national and et al. (2006). See Chapter 3 in this volume.1
international A PIMD for children (PIMDC) will be available once this
reporting: State of the volume is published and should be seriously considered
World’s Children; for these purposes as it will permit description of areas
Millennium below provincial level and will take into account a range of
Development Goals deprivations experienced by children in poverty.
(MDGs).

Accelerate implementation of the National Action Plan for HIV and AIDS

Reduce HIV Type 1 Indicator: Definition & Measure: Proportion of sampled pregnant
prevalence among Child Status women aged 15–24 years attending antenatal clinics who
young people aged HIV prevalence in test positive for HIV.
15–24 years. 15–24-year age group. Source: Annual HIV antenatal seroprevalence survey
Reason for use: (DoH)
Measure of the Period: Annual
prevalence of the
disease in a high-risk
age group.

Type 1 Indicator: Definition & Measure: Number of HIV-positive pregnant
Child Status children (<18 years) per 100 pregnant children.
HIV prevalence in Source: Antenatal HIV seroprevalence survey (DoH)
pregnant children. Period: Annual
Reason for use:
Measure of the
prevalence of the
disease in a high-risk
group.

core indicators for monitoring child health • 379

reason for use
Reduce the Type 1 Indicator: Definition: Children born to HIV-positive women who are
incidence of HIV Child Status polymerase chain reaction (PCR) positive at 6 weeks of
infection in Infant HIV incidence age in a given period.
children. rate Measure: Proportion of children born to HIV-positive
Reasons for use: women who are PCR positive at 6 weeks of age.
Measure of an Source: Provincial Prevention of Mother to Child
important cause of Transmission (PMTCT) Programme
child morbidity. Period: Annual

Expand treatment for infected children and their primary caregivers
Increase the Type 4 Indicator: Definition & Measure: Number of newborns receiving
PMTCT coverage Service Access prophylactic ART per 100 babies born to HIV-positive
(to 95% by 2010). Antiretroviral therapy pregnant mothers.
(ART) cover in Source: PMTCT surveillance (DoH)
eligible newborns. Period: Annual
Reasons for use:

Marker of health
systems’ ability to
prevent new HIV
infections in children.
Increase access to Type 4 Indicator: Definition & Measure: Number of children (aged 0–12
ART for children Service Access and 13–17 years) receiving HAART per 100 children
(to reach 55 000 Highly active anti- eligible for HAART.
children by 2009). retroviral therapy Source: ART roll-out surveillance (DoH)
(HAART) cover in Period: Annual
eligible children aged
0–12 and 13–17 years.
Reasons for use:
Marker of health
manage symptomatic
HIV infection/AIDS
in children.
Increase access to Type 4 Indicator: Definition & Measure: Number of adults (>18 years)
ART for adults – Service Access receiving HAART per 100 adults eligible for HAART
in particular for HAART cover in (stratified by gender and into adults with children as far as
caregivers with eligible adults. possible).
children (to reach Reasons for use: Adult Source: ART roll-out surveillance (DoH)
450 000 by 2009). access to ART will Period: Annual
reduce orphaning.
Marker of health
manage symptomatic
HIV infection/AIDS
in adults.

380 • monitoring child well-being

reason for use
Reduce child mortality
Reduce the Type 1 Indicator: Definition: Deaths <28 days of age per 1 000 live births in
number of infants Child Status same calendar year.
dying in the first Neonatal mortality Measure: Proportion of deaths <28 days of age in same
28 days of life. rate calendar year.
Reason for use: Sources: Stats SA; South African Demographic and Health
Measure of care and Survey (SADHS); Maternal Registry.
support provided to Period: Annual
newborns and young
infants.

Reduce the Type 1 Indicator: Definition: Diarrhoea is defined as 3 or more watery
incidence of Child Status stools in 24 hours, but any episode diagnosed and/or
diarrhoeal disease Proportion of treated as diarrhoea after an interview with the adult
in children under diarrhoea in <5s at accompanying the child should be counted.

5 years. health facilities. Measure: Children <5 years presenting to health facilities
Reason for use: with diarrhoea per 1 000 <5-year-old attendances in a
Measure of an given period.
important cause of Sources: District Health Information System (DHIS);
child morbidity. SADHS.
Period: Monthly

Reduce the Type1 Indicator: Definition & Measure: Children <5 years presenting to
incidence of Child Status health facilities with acute lower respiratory tract
respiratory disease Proportion of acute infections (pneumonia) per 1000 <5-year-old attendances
in children under 5 lower respiratory in a given period.
years. tract infections Sources: DHIS; SADHS.
(pneumonia) in <5s Period: Monthly
at health facilities.
Reason for use:
Measure of
important cause of
child morbidity.
Vaccinate 90% of Type 5 Indicator: Definition: Children <1 year who received measles first
children against Service Quality dose.
measles. Measles 1st dose Measure: Proportion of children <1 year who received
coverage. measles first dose per population of infants eligible for the
Reason for use: vaccine (Denominator: Mid-year estimate of target
Measure of quality of population [<1 year olds]).
health service Source: DHIS
(immunisation). Period: Annual


reason for use
Combat non-communicable diseases

Increase the Type 1 Indicator: Definition: Children at age 6 with no caries.
percentage of Child Status Measure: Proportion of children at age 6 with no caries.
children at age 6 Children at age 6 Source: DHS Oral Health Survey
years who are free with no caries. Period: Annual
of caries (to 50% Reasons for use:
by 2010). Measure of oral
health.
Reduce the mean Type 1 Indicator: Definition: Children with DMFT at 12 years.
number of Child Status Measure: Proportion of children with DMFT at 12 years.
decayed, missing Mean number of Source: DHS Oral Health Survey
and filled teeth DMFT in children Period: Annual
(DMFT) at age at age 12 years.
12 years (to 1 by Reasons for use:
2010). Measure of oral

health.

Improve the nutritional status of children
Reduce the Type 1 Indicator: Definition & Measure: Children under 5 years with more
prevalence of Child Status than 2 standard deviations below the median height for
stunting among Stunting rate age reference value in a defined population of <5s in a
children less than Reasons for use: given period (per 100 children in that population in the
5 years. Measure of same period).
nutritional status of Sources: Provincial and national departments of Health
children. May indicate (DoH); SADHS; Food Consumption Survey; periodic
economic hardship, nutrition surveys.
infection or neglect. Period: Annual
To identify children in
Early Childhood
Development services
to be monitored for
follow-up action.
Appropriate for
national and
international
reporting: State of the
World’s Children;
Convention on the
Rights of the Child;
United Nations
Children’s Fund;
Multiple Indicator
Cluster Survey;
MDGs.


reason for use
Reduce the Type 1 Indicator: Definition & Measure: Proportion of children more than
prevalence of Child Status 2 standard deviations below the median weight for height
wasting among Wasting rate reference value in a defined population of under-5s per
children under Reasons for use: 100 children under the age of 5 years in that population in
5 years. Measure of the same period.
nutritional status of Sources: Provincial and national DoH; SADHS; Food
children. Consumption Survey; periodic nutrition surveys.
Period: Annual

Reduce childhood Type 1 Indicator: Definitions: 1: Overweight: Children with weight for
overweight and Child Status height over 2 standard deviations from the norm
obesity. Overweight and (reference population median).
obesity rates 2: Obesity: Children with a body mass index (body mass
Reasons for use: in kg divided by the square of the height in m) equal to
Measure of or more than 30kg/m2.
nutritional status of Measure: Children at school entry who are overweight or

children. obese per 100 children in the relevant age group in that
population in the same period; optionally also at 10 and
15 years.
Sources: Provincial and national DoH; SADHS; Food
Consumption Survey; periodic nutrition surveys.
Period: Annual

Reduce severe Type 1 Indicator: Definition & Measure: Children aged 0–5 years who weigh
malnutrition in Child Status below 60% expected weight for age (new cases that
children under 5 Severe malnutrition month/year) per 1 000 children in the target age group.
years. rate Source: DHIS
Reasons for use: Period: Annual
Measure of
nutritional status of
children.
Promote Type 1 Indicator: Definition: Exclusive breastfeeding rate: Percentage of
breastfeeding. Child Status living children receiving only breast milk from birth to
Breastfeeding: various ages.
1. Initiation rates Measures: 1. Proportion of newborn children exclusively
2. Exclusive breastfed at hospital discharge or immediately after birth.
breastfeeding rate 2. Proportion of 6-month-old children receiving only
3. Duration of breast milk or expressed breast milk.
breastfeeding 3. Proportion of 12-month-old children receiving
Reasons for use: breastfeeding at 12 months.
Measure of uptake Each of above per 100 live births in the same period.
and success of (Denominator for all: Live births in the same period.)
breastfeeding. Sources: SADHS; periodic nutrition surveys.
Period: Annual


reason for use
Reduce the Type 1 Indicator: Definition & Measure: Number of children <5 years of
prevalence of iron Child Status age with evidence of iron deficiency anaemia in a defined
deficiency among Iron deficiency rate population per 100 children under the age of 5 years in
children under Reasons for use: that population in the same period.
5 years. Measure of Sources: SADHS; periodic nutrition surveys.
nutritional status and Period: Annual
dietary intake.

prevalence of Child Status age with biochemical evidence of vitamin A deficiency in a
vitamin A Vitamin A deficiency defined population and a given period per 100 children
deficiency among rate under the age of 5 years in that population in the same
children under Reasons for use: period.
5 years. Measure of Sources: SADHS; periodic nutrition surveys.
dietary intake.

prevalence of Child Status age with evidence of iodine deficiency in a defined
iodine deficiency Iodine deficiency rate population and a given period per 100 children under the
among children Reasons for use: age of 5 years in that population in the same period.
under 5 years. Measure of Sources: SADHS; periodic nutrition surveys.
dietary intake.

Reduce the Type 1 Indicator: Definition & Measure: Number of children born with a
prevalence of low Child Status birth weight <2.5 kg in a defined population and in a
birth weight Low birth weight rate given period per 100 live births in the same population
(<2.5 kg). Reasons for use: and period.
Indicator of the Sources: Stats SA; Maternal Registry; SADHS; periodic
socio-economic surveys; hospital midwife obstetric unit records; Perinatal
status and health of Problem Identification Programme (PPIP).
the community in Period: Annual
general. Also a
measure of maternal
health during
pregnancy.


reason for use
To improve youth and adolescent health
Reduce proportion Type 1 Indicator: Definition & Measure: Proportion of all live births during
of births Child Status a specific year which are to women who are between 15
attributable to girls Teenage birth rate and 20 years of age, irrespective of marital status per 100
aged 15–19 years. Reason for use: births among women of all ages.
Teenage pregnancy Source: SADHS; Maternal Registry.
disrupts the life of a Period: Annual
child and her
offspring.
Reduce the Type 1 Indicator: Definition: Women aged 13–19 who are mothers or who
number of teenage Child Status have ever been pregnant. The number of women who are
pregnancies. Teenage pregnancy mothers at the time of the survey is a more restrictive
rate definition.
Reason for use: Measure: Number of pregnancies in females aged 13–19

Teenage pregnancy years per 1 000 females aged 13–19 years in the same
disrupts the life of a period.
child and her Source: SADHS
offspring. Period: Annual

Improve clinical management and care at all levels of the healthcare delivery system

Promote Type 5 Indicator: Definition & Measure: Number of accredited baby-
breastfeeding by Service Quality friendly hospitals and maternity facilities per 100 health
accrediting Baby-friendly facilities with maternity beds.
maternity units hospitals and Source: DoH: Baby-friendly hospital initiative assessments
with ‘baby- maternity facilities Period: Annual
friendly’ status Reason for use:
(60% by 2009). Measures ability of
midwife obstetric
units and hospitals to
promote successful
breastfeeding.

Implement the Type 5 Indicator: Definition & Measure: Number of facilities with at least
Integrated Service Quality 60% of their staff who are IMCI trained in a given period
Management of Primary healthcare per 100 primary healthcare facilities.
Childhood Illness facilities equipped to Source: DoH national IMCI co-ordinator statistics
(IMCI) strategy implement IMCI. Period: Annual
(90% of facilities Reason for use: IMCI
are saturated – i.e. is the approach
>60% coverage – chosen by the health
with IMCI trained department to deliver
healthcare primary care to
providers by 2009). children <5.


reason for use
Improve the use of Type 5 Indicator: Definition & Measure: Number of children correctly
drugs in children Service Quality managed by primary health-care nurses in spot
aged under 5 years Sick children assessments at selected primary health-care clinics in a
in primary care receiving drug given period per 100 nurses evaluated for prescribing
facilities. management that practices during the same period.
conforms to IMCI Sources: DoH IMCI health facility survey; supervisory
guidelines. visit reports.
Reason for use: IMCI Period: Annual
is the approach
chosen by the health
department to deliver
primary care to
children <5.

Increase the Type 5 Indicator: Definition & Measure: Number of clinics which are youth
number of PHC Service Quality friendly per 100 clinics.

clinics offering Youth-friendly clinic Source: DoH provincial reports
youth-friendly cover Period: Annual
services (to 100% Reason for use:
by 2009). Youth-friendly clinics
have been established
to promote access to,
and utilisation by,
youth of appropriate
health services.
Increase Type 4 Indicator: Definition & Measure: Number of designated facilities
availability of Service Access providing TOP in the public sector per 100 designated
termination of TOP facility cover TOP facilities.
pregnancy (TOP) Reason for use: Source: DoH TOP statistics
services at While facilities have Period: Annual
community health TOP-designated
centres (to 50% of status, they often do
all centres by not provide this
2009). service.

Increase the Type 5 Indicator: Definition & Measure: Percentage of districts rendering a
proportion of Service Quality basic genetic service as part of the comprehensive primary
districts with at Genetics services healthcare service.
least one cover Source: DoH provincial reports
genetically trained Reason for use: Period: Annual
healthcare provider Genetically trained
(to 70% of districts staff required to
by 2009). provide basic genetic
services.


reason for use
Increase the Type 5 Indicator: Definition: Sites are required to report on Neural Tube
proportion of Service Quality Defects, Albinism, Down Syndrome and cleft lip and
districts Compliance with palate birth defects.
implementing the birth defect Measure: Proportion of sites that report birth defects.
new standardised surveillance policy. Source: DoH Birth Defects Surveillance System
birth defects data Reason for use: Period: Annual
collection tool (to Measure of success of
50% by 2009). the surveillance
system.
Note:
1 See also <http://www.statssa.gov.za/census01/html/C2001Deprivation.asp>.

Additional indicators

reason for use
Reduce child mortality
Reduce the Type 1 Indicator: Definition & Measure: The infant mortality rate is the
number of infants Child Status number of deaths of infants <1 year of age, in a given
dying in the first Infant mortality rate period of time, per 1 000 live births in the same period.
year of life. Reasons for use: Sources: Stats SA; Health and Demographic Surveillance
Important System. Presently available at national and provincial level
determinants of only.
infant mortality are Period: Annual
access to safe water, Notes on data collection: Unless the birth registration
sanitation, nutrition system is complete, infant deaths in particular may not be
and the level of registered, which may seriously bias the result.
mothers’ education. Retrospective questions about the survival of children ever
Determining factors born included in censuses and surveys, and analysed using
within the health indirect estimation procedures, are considered to be
system include the reliable sources.
quality of maternal Surveys using maternity histories, in which women are
care, availability of asked to give the date of birth and age of death (if
vaccines given in the applicable) of each live-born child, are used in many
first year of life, and household surveys, but care must be taken to avoid age
effective referral misreporting and to be sure that there is a complete report
systems. of infant deaths.
Proxy measure of
determinants of
survival, including
socio-economic and
health service status
of a country.

additional indicators for monitoring child health • 387

reason for use
Reduce the Type 1 Indicator: Definition: The number of perinatal deaths per 1 000
number of Child Status births.
stillbirths and early Perinatal mortality Measure: Sum of stillbirths (≥28 weeks gestation or 1 000g
neonatal deaths. rate or more) + early neonatal deaths (≤7 days of age) per
Reason for use: 1 000 live births + stillbirths in same calendar year.
Measure of antenatal Note: Current World Health Organisation definition of
care as well as perinatal mortality rate is different from the definition
neonatal services. used in South Africa, being the number of deaths from
24 weeks gestation/500g to 28 days neonatal life.
Sources: Stats SA; SADHS; DHIS; hospital data; PPIP;
Maternal Registry. Presently available at national and
provincial level only.
Period: Annual


reason for use
Reduce the Type 1 Indicator: Definition: The <5 mortality rate is the probability of
number of Child Status children dying between birth and their fifth birthday,
children dying Under-5 mortality expressed per 1 000 children born alive.
in the first 5 years rate (U5MR) Measure: Number of deaths between birth and exactly
of life. Reasons for use: 5 years of age per 1 000 live births in same calendar year.
Principal indicator of Sources: Stats SA; SADHS. Presently available at national
human and economic and provincial level only.
progress used by Period: Annual
UNICEF. U5MR Notes on data collection: Complete vital registration
measures an end systems, sample registration systems and demographic
result of the surveillance systems, where available, provide good
development process estimates of child mortality.
rather than an ‘input’ Retrospective questions about the survival of previous
such as per capita children from censuses and surveys, analysed using
calorie availability. indirect estimation techniques, are considered reliable
U5MR reflects a wide sources.

variety of inputs: the Demographic surveys using maternity histories, in which
nutritional health and women are asked to give the date of birth and age of death
the health knowledge (if applicable) of each live-born child, are used in many
of mothers; the level household surveys.
of immunisation and The preceding birth technique can be used in antenatal
ORT use; the clinics, maternity clinics, and at the time of immunisation,
availability of to provide a useful recent estimate of the probability of
maternal and child dying by age 2 years at a local level.
health services
(including prenatal
care); income and
food availability in the
family; the availability
of clean water and
sanitation; and the
overall safety of the
child’s environment.
The U5MR is less
susceptible to
averages, it is more
difficult for a wealthy
minority to affect a
nation’s U5MR, and it
therefore presents a
more accurate picture
of the health status of
the majority of
children.


reason for use
Reduce the Type 1 Indicator: Definition: Mortality from a specific cause in children
number of Child Status aged <5 years.
children dying of Cause-specific Measure: Dependent on the specific cause, but similar to
preventable causes mortality rates <5 mortality rate.
in the first 5 years Reasons for use: Sources: Stats SA; SADHS. Presently available at national
of life. Measurement of and provincial level only.
cause-specific Period: Annual
mortality is needed:
• To establish the
relative public
health importance
of the different
causes of death;
• To evaluate trends
over time,
especially as a

method of
evaluating the
probable impact
of intervention
programmes;
• To investigate the
circumstances
surrounding the
deaths of children
for devising
effective actions to
decrease mortality;
• To investigate
reasons for
differing rates of
infant and child
mortality among
geographic areas,
and to evaluate the
effectiveness of
specific public
health
interventions in
controlled settings.


reason for use
Combat communicable diseases and reduce mortality and morbidity
Eradicate polio (by Type 1 Indicator: Definition & Measure: Number of confirmed cases of
2008). Child Status polio in given period..
Declared polio free. Sources: DoH disease notification system; polio
Reason for use: surveillance system; National Health Laboratory service.
Confirmation of Period: Quarterly
eradication of polio.

Eliminate measles Type 1 Indicator: Definition & Measure: Number of confirmed cases of
(by 2008). Child Status measles in given period.
Annual confirmed Sources: DoH disease notification system; measles
cases of measles. surveillance system; National Health Laboratory service.
Reason for use: Period: Quarterly
Confirmation of
eradication of
measles.

Eliminate neonatal Type 1 Indicator: Definition & Measure: Number of confirmed cases of
tetanus. Child Status tetanus during the first 28 days of life in a given period
Annual confirmed and defined population.
cases of neonatal Source: DoH disease notification system
tetanus. Period: Quarterly
Reason for use:
Confirmation of
eradication of
tetanus.
Improve the nutritional status of children
Reduce the Type 1 Indicator: Definition & Measure: Number of children more than 2
prevalence of Child Status standard deviations below the median weight for age
underweight Underweight rate. reference value per 100 children under the age of 5 years
among children Reason for use: in that population in the same period.
less than 5 years Measure of Sources: SADHS; DHIS; periodic nutrition surveys.
(to <4.7% by nutritional status of Period: Annual
2015). children. MDG
target.


reason for use
Improve clinical management and care at all levels of the healthcare delivery system
Increase the Type 4 & 5 Definition: Fully immunised children have received all the
number of health Indicators: Service Expanded Programme of Immunisation (EPI) vaccines by
districts with more Access and Service the age of 5 years.
than 90% full Quality Measure: The number of children 0–5 years inclusive who
immunisation Proportion of are fully immunised, divided by the population <5 years
coverage (to 95% children <5 years (based on mid-year estimates of number of children
of districts by who have been fully <5 years and number of required doses for each vaccine).
2009). vaccinated. Source: DHIS
Reason for use: Period: Monthly; annual.
Measure of coverage
and success of
immunisation
programme and of
health system

functioning.


Indicators For Monitoring Child Health

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Similar a Indicators For Monitoring Child Health

Similar a Indicators For Monitoring Child Health (20)

Más de Thomas Müller

Más de Thomas Müller (20)

Indicators For Monitoring Child Health