Definition of Indicator

Transcription

1 Prepared by Rationale Definition of Indicator Under five Mortality Rate by Sex (37 CSMDG/ 13 MDG) Caribbean Community Secretariat The indicator is a measure of child survival. It also reflects the level of child health and overall development. Child survival is important as they grow up to move into adulthood and working age population. Because data on the incidences and prevalence of diseases (morbidity data) frequently are unavailable, mortality rates are often used to identify vulnerable populations. The under-five mortality rate (U5MR) is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before reaching the age of five if subject to current age-specific mortality rates. Under-5 mortality rate, is strictly speaking, not a rate (i.e. the number of deaths divided by the number of population at risk during a certain period of time) but a probability of death derived from a life table and expressed as rate per 1,000 live births. A live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles whether or not the umbilical cord has been cut or the placenta is attached. Each product of such a birth is considered a live birth. Computation The methods used to calculate the under-five mortality rate (U5MR) depend on the type of data available. Age-specific mortality rates among children and infants are calculated from birth and death data derived from vital registration, national population censuses and/or household surveys. Vital registration: When data collected via vital registration systems is of good quality, the U5MR can be directly estimated by observing the survival status of different cohorts along time and to specific ages since the moment of birth. The number of deaths by age and numbers of births and children in each age group are used to calculate age specific rates. This system provides annual data. Additionally, U5MR can be derived from household survey data using direct or indirect methods. The Direct Method uses data collected on birth histories of women of childbearing age and produces the probability of dying before age five for children born alive, during five year periods before the survey (0-4, 5-9, etc.). Direct methods require each child s date of birth, survival status, and date or age at death. This information is typically found in vital registration systems and in household surveys that collect complete birth histories from women of childbearing age. Birth histories include a series of detailed questions on each child a woman has given birth to during her lifetime, including the date the child was born, whether or not the child is still alive, and if the child has died, the age at death. To reduce sampling errors, the estimates are generally presented as

2 Under five Mortality Rate by Sex (37 CSMDG/ 13 MDG) period rates, for five or 10 years preceding the survey. The Indirect Method uses the Brass method, named after its original developer, William Brass, which converts the proportion of dead children ever born reported by women in age groups 15-19, 20-24, into estimates of probability of dying before attaining certain exact childhood ages. Brass s method assumes that the age of the mother can serve as a proxy for the age of her children and thus for how long they have been exposed to the risk of dying. The formula is then to take the average parity for 5 year age groups of women and the proportions of these children who are dead for 5 year groups of women and convert these into probabilities of dying taking into account the mortality risk to which children are exposed as well as their length of exposure to the risk of dying and assuming a particular model age pattern of mortality. (This model is usually the Coale and Demeny West Model for Caribbean countries) The Trussell Version of Brass Technique (used in MICS) Step 1: Calculation of Average Parity per woman (mean # of CEB) for 5 year groups of women P(i) = CEB(i)/FP(i) where CEB (i) is Children Ever Born to mothers in the age range(i) and FP(i) is women in the age range (i) Step 2: Calculation of Proportion of Children Dead for each group of women D(i) = CD(i)/CEB(i) Where CD(i) is the number of children dead to mothers in the age range (i) Step 3: Calculation of Multipliers using Coefficients for Estimation of Child Mortality Multipliers (Trussel Variant) when Data Classified by Age of Mother (Using data from West Model) 1. where K(i) = a(i) + b(i)p(1)/p(2) + c(i)p(2)/p(3) a(i), b(i) and c(i) are given depending on the model being used for estimation. See UN Manual X for more information. Step 4: Calculation of probabilities of dying and of surviving q(x) = K(i)D(i) l(x) = 1 q(x) Step 5: Calculation of Reference Period (Using the same Model as in step 3 above and therefore the same coefficients from the model) t(x) = a(i) + b(i)p(i)/p(2) + c(i)p2)/p(3) Note: When mortality is changing smoothly, the reference period, t(x) is an estimate of the number of years before the survey date to which the child mortality estimates, q(x) refers. Unit of Expression Data Sources Number per 1000 live births Vital statistics registration system one covering at least 90 per cent of vital events in the population, sample surveys or derived by applying direct and indirect estimation techniques to registration, census or survey data, household 1 The choice of model is dependent on its applicability to the country(ies) being studied.

3 Source of Metadata Links Comments Under five Mortality Rate by Sex (37 CSMDG/ 13 MDG) surveys, including Multiple Indicator Cluster Surveys and Demographic and Health Surveys United Nations Statistical Division, UNSD and World Health Organization (WHO) and The under-five mortality rate captures more than 90 per cent of global mortality among children under the age of 18. Vital registration systems are the preferred source of data on under-five mortality because they collect information prospectively and cover the entire population. However, many developing countries lack fully functioning vital registration systems that accurately record all births and deaths. Thus, household surveys, such as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), have become the primary source of data on child mortality in developing countries; but there are some limits to their quality such as coverage and content errors.

4 Prepared by Rationale Definition of Indicator Computation Infant mortality rate by sex;(38 CSMDGs), (14 MDG) Caribbean Community Secretariat Infant mortality represents an important component of under-five mortality. Infant mortality rates measure child survival. They also reflect the social, economic and environmental conditions in which children (and others in society) live, including health care systems. The infant mortality rate is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before reaching the age of one year if subject to current age-specific mortality rates. The methods used to calculate the infant mortality rate (IMR) depend on the type of data available. In practice, data can be obtained from vital registration systems, sample registration systems, national population censuses, and/or household surveys. When data collected via vital registration systems is of good quality, the IMR can be directly estimated by observing the survival status of different cohorts along time and to specific ages since the moment of birth. IMR can be derived from household survey data using direct or indirect methods. The direct method: Same information for U5MR except only infants are included The indirect method uses the Brass method, (SEE ABOVE): Same information for U5MR except only infants are included The conventional method is defined as the number of infant deaths per year per 1000 live births. This is NOT a true probability as not all infant deaths in year X are related to births occurring in the same year. Note: if the number of births does not fluctuate much from year to year, then the conventional method represents well the probability of an infant dying during the year. However, if there are sharp fluctuations in the number of births from year to year, then, the conventional method will produce a distorted picture of the level and trend of mortality. In this case it is desirable to adjust the conventional rate to allow for the true population exposed to risk. (Siegel and Swanson 2004, p283). Conventional IMR = number of deaths of infants (under one year of age) in the indicated year 1,000 live births in the same year Unit of Expression Data Sources Source of Metadata Links Comments Three Adjusted Methods proposed by Siegel and Swanson will be added later. Number per 1000 live births Vital statistics registration system, Sample surveys, census, survey data, Multiple Indicator Cluster Surveys and Demographic and Health Surveys. United Nations Statistical Division, UNSD; The Methods and Materials of Demography Jacob Siegel and David Swanson Indirect methods require less detailed information that is available in censuses and general surveys, including the total number of children a woman has ever

5 Infant mortality rate by sex;(38 CSMDGs), (14 MDG) borne, the number who survive and the woman s age (or the number of years since she first gave birth). However, indirect methods require model life tables to adjust the data for the age pattern of mortality in the general population. Finding an appropriate model life table can be challenging, since the Coale and Demeny model life tables are derived largely from the European experience. However the West Model is usually the one that is usually used to represent Caribbean experience.

6 Prepared by Rationale Definition of Indicator Computa-tion Proportion of children 1-4 years of age who have received complete immunisation coverage (BCG, 3 doses DPT, oral polio and measles); (39) Caribbean Community Secretariat The indicator provides a measure of the coverage and the quality of the child health-care system in the country. Immunization is an essential component for reducing under-five mortality. Governments in developing countries usually finance immunization against measles and diphtheria, pertussis (whooping cough) and tetanus (DPT) as part of the basic health package. Among these vaccine-preventable diseases of childhood, measles is the leading cause of child mortality. Health and other programmes targeted at those specific causes are one practical means of reducing child mortality. The indicator is a measure of the proportion of children 1-4 who are fully vaccinated in a timely manner. Proportion of 1-4 year old children who have received complete immunization coverage is the percentage of children between ages 1-4 who have received at least one dose of BCG before 1 st birthday, 3 doses of DPT, 3 doses of OPV and 1 dose of Measles, Mumps, Rubella vaccine. Estimates of immunization coverage are generally based on two sources of empirical data: national level reports of vaccinations performed by service providers (administrative data) and household surveys containing information on children s vaccination history (coverage surveys). For estimates based on administrative data immunization coverage is generally computed as follows: Proportion of 1-4 yearolds immunized = Number of dosage of BCG administered before age 1 (12 months) among 1-4 year olds who have received BCG (before age 1), 3 doses D PT, 3 doses of OPV and 1 dose of MMR Number of children (1-4 yrs old) *1 The numerator and denominator are drawn from administrative data and checked against other sources, if available. When determining the coverage rate, credence is given to the administrative and official country reports unless there is a reason to believe they are inaccurate (such as internal inconsistency or reliable survey data). Unit of Expression Data Sources Percentage Reports of vaccinations performed by service providers (administrative data) and household surveys containing information on children s vaccination history (coverage surveys).the principle types of surveys used as sources of information on immunization coverage are Expanded Programme on Immunization (EPI) 30 cluster surveys, Multiple Indicator Cluster Surveys and Demographic and Health Surveys. Routine data are compiled by national EPI programme managers.

7 Proportion of children 1-4 years of age who have received complete immunisation coverage (BCG, 3 doses DPT, oral polio and measles); (39) Source of Metadata Caribbean Community Secretariat, National Statistical Offices; adapted from UN metadata on Proportion of 1 year olds children immunized against measles. Links / Comments Recommendations Use the full five years as (everyone 1-4 years should have received all vaccines listed within this period) for each cohort together and not separate the various immunization coverage

8 Prepared by Rationale Definition of Indicator Computation Unit of Expression Data Sources Source of Metadata Links Comments Number of deaths of children through violence per 1,000 population under 5, by sex Caribbean Community Secretariat Number of deaths to children under 5 years (by sex) due to violence. The Convention on the Rights of the Child defines violence as all forms of physical or mental violence, injury and abuse, neglect or negligent treatment, maltreatment or exploitation including sexual abuse and the WHO defines violence as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation." The definition should be understood to include physical, sexual and psychological abuse (such as the significant abuse of power arising from a dependent relationship, threats, intimidation and neglect). This indicator can be calculated by dividing the total number of violent deaths to children under 5 years for female / male, by the total mid year U5 population multiplied by number of children under 5 years killed by an act of violence * 1000 Total midyear U5 Population The indicator may be computed separately for males and females. Number per 1000 under 5 population Court statistics, police statistics, census, hospital statistics, vital births and deaths registers, other social studies WHO, Caribbean Community Secretariat, National Statistical Offices / According to the WHO, the general definition of violence may be divided into three sub-types according to the victim-perpetrator relationship. Self-directed violence refers to violence in which the perpetrator and the victim are the same individual and is subdivided into self-abuse and suicide. Interpersonal violence refers to violence between individuals, and is subdivided into family and intimate partner violence and community violence. The former category includes child maltreatment; intimate partner violence; and elder abuse, while the latter is broken down into acquaintance and stranger violence and includes youth violence; assault by strangers; violence related to property crimes; and violence in workplaces and other institutions. For example, violence in public places can include intimidation, threats, and physical or sexual assaults, between friends or strangers. Child abuse in the home can include psychological, physical and sexual abuse and neglect.

9 Number of deaths of children through violence per 1,000 population under 5, by sex Collective violence refers to violence committed by larger groups of individuals and can be subdivided into social, political and economic violence. Recommendation Because this number is expected to be small, it is recommended that the multiplier be

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11 40(a) Prepared by Rationale Definition of Indicator Computation Average age of children under 5 who died through violence, by sex Caribbean Community Secretariat Provides an indication of the impact of violence on the very young The mean age at which violence affect the under five population This indicator can be calculated by dividing the sum of the ages of children under 5 years, by sex who died as a result of violence by the total number of children who died violent deaths. sum of the ages of children under 5 years, (by sex) who died as a result of violence Total number of children who died violent deaths under five. Unit of Expression Data Sources Source of Metadata Links Comments Number Court statistics, police statistics, census, hospitals statistics, births and deaths registers, other social studies Caribbean Community Secretariat, National Statistical Offices The number of children under 5 who die from violence may be very small, and therefore there will be little variance in the average age of children under 5 who die from violence.

12 Number of perpetrators responsible for the death of children under 5, by sex Prepared by Caribbean Community Secretariat Rationale Provides an indication of the impact of violence on the very young and the attitudes toward the very young population Definition of Indicator Number of persons (by sex) who have been convicted for the deaths of children < 5 years related to the year the death occurred and not the year of conviction. Computation This indicator may be calculated by totalling the number of convicted perpetrators (those held responsible for the deaths of children under 5 years) related to the year of the death. Unit of Expression Data Sources Source of Metadata Links Comments Recommendations Number Courts statistics, hospitals statistics, census, births and deaths registers, other social studies / surveys. Caribbean Community Secretariat, National Statistical Offices Change indicator name to read the number of perpetrators convicted It is recommended that this indicator be reported in context to reveal how the number of perpetrators relates to the number of solved cases.

13 Average age of perpetrators responsible for the deaths of children under 5, by sex (40c) Prepared by Caribbean Community Secretariat Rationale This indicator points to the need to address correctly the necessary interventions needed for perpetrators which may be age specific. Definition of Indicator Average age of perpetrators at the time crime was committed (by sex), who are responsible for the violent deaths (including neglect) of children under 5 years Computation Unit of Expression Number Data Sources Crime Surveys, Courts statistics, hospitals statistics, census, births and deaths registers, other social studies/ surveys Source of Metadata Caribbean Community Secretariat, National Statistical Offices Links Limitations This indicator MUST be interpreted with caution. It should be noted that not all perpetrators are reported, not all reported are convicted, and not all persons found guilty of the violent death of the child, have actually perpetrated the crime. Therefore the average age of the perpetrator may not be very reliable if relying on say court statistics. Additionally, with the length of time it takes for persons to be convicted, the average age might be skewed if the age is collected after conviction. In that, if it takes approximately 5 years for a conviction, this will not be reflected in this indicator if we collect the age after conviction. Therefore it is recommended that if court statistics are being used, after the person is being convicted, age data obtained should be at the time of arrest of the convicted person. Furthermore, the limitations inherent in averages may skew the data, causing pertinent information (outliers-those extreme values) to be lost. Because of the need to match ages with the time of death, good record keeping is important to the reliability of this indicator. Recommendation The indicator name should read convicted, rather than responsible CASE STUDY To deal with some of the challenges mentioned in the limitations above, Crime Surveys should be the preferred source of data collection for this indicator. It is imperative that the death of the child and the average age of the perpetrator pertain to the same year.

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