Introduction

Patterns of health and disease must be understood in the context of the community and region, taking into consideration the size, structure and growth of the population. In addition to key demographic information and other standard health status indicators, many useful indices exist which specifically pertain to the health of children. Frequently asked questions have included:


• What is the proportion of children in each region?
• What is the birth (fertility) rate?
• What is the death (mortality) rate?

Answers to these and other key questions give a better understanding of the effects of context, non-medical determinants of health and differing program structures. Sharing these statistics may aid in facilitating the best practice models for improving maternal, child and adolescent health.

The indicators described in this concept are taken directly from the deliverable Assessing the Health of Children in Manitoba: A Population-Based Study by Brownell et al. (2001).

NOTE: This concept is related to two other Child Health Indicator concepts contained in the MCHP Concept Dictionary. This concept represents the indicators that were used in the 2001 Deliverable mentioned above. The other two Child Health Indicator-related concepts are:


• Child Health Indicators (2008) based on the information in the MCHP Deliverable Manitoba Child Health Atlas Update (2008); and
  
• Child Health Indicators (2012) based on the information in the MCHP Deliverable How are Manitoba's Children Doing? (2012).
  
  These two concept list some of the same indicators used in the 2001 Deliverable, but are organized differently than the current information.

Premature Mortality Rate (PMR)

Premature mortality rate (see the Health Status Indicators) concept) measures the rate of premature deaths (i.e. death before 75 years of age)

• Gender and age adjusted
  
• Considered the best single measure to reflect the healthiness of a group of people and their need for health care services.
  
• Populations with a high PMR are more likely to report poor health, greater number of symptoms, and more illness both at the subjective self-reported level and the objective illness level.
  
• The lower the PMR, the healthier the region's population
• PMR is usually based upon a five-year average to ensure stability of the measure.
  
• The graphs in the Child Health deliverable are ordered by PMR at both the RHA level and the sub-regional level

Socioeconomic Risk Index / Socioeconomic Factor Index

The Socio-Economic Risk Index (SERI) has been modified to produce the Socio-Economic Factor Index (SEFI) .

• Socio-economic factors are essential in the understanding of the healthiness of regions. Thus, SEFI is one way of indicating the non-medical determinants of health and the need for health care
  
• A low score indicates more favourable socio-economic conditions within a region
  
• The overall Manitoba score is set to "0".
  
  • A negative SEFI score indicates less risk (more favourable socioeconomic conditions)
    
  • A positive score indicates higher risk compared to the Manitoba average.

Describing the Population and Growth: Demographics and Birth Rate

• A region's age structure has implications for planning health care services.
  
• Five-year age brackets (0-4, 5-9, 10-14, and 15-19 years old) are frequently used to note declining or increasing percentages of children. The total percentage children 0-19 years old (inclusive) within a region is also a helpful measure.
  
• General Fertility Rate - the number of births per 1000 women age 15 to 44 years old. Urban and rural regions typically have significantly differing rates.
  
• Total Fertility Rate - interpreted as the number of children who would be born to an average woman who experiences each of the age-specific fertility rates of a population in a given year as she progresses through her reproductive lifetime.
  
  • Trends over time indicate a significant decline in fertility rate in Manitoba. This also reflects the Canadian experience overall, where there was a reported 5% drop in the number of births reported from 1996 to 1997.

Mortality Rates of Children

• Infant Mortality - the number of infant deaths under one year old per 1000 live births per year.
  • Useful indicator of the level of health within a community.
  • Further separated into neonatal (under 28 days - more sensitive to medical care) and post-neonatal (28 days to age 1 year - more sensitive to socioeconomic conditions).
  • Sudden Infant Death Syndrome (SIDS) was the leading cause of post-neonatal deaths at 26%, followed by birth defects at 23%, in 1996 ( Health Canada, 1999 ).
  • Infant mortality rates may be reported:
    • as all infant deaths
    • including only infant deaths of babies weighing 500 g or more, or of 20 weeks or more gestational age.
    
    Note : Bias is likely to be introduced by inclusion of the less than 500g babies if one does not adjust the rate accordingly; different regions, provinces, as well as countries may have very different proportions of less than 500g infants. The Canadian Perinatal Surveillance System committee also recommends adjustment for birth weight, although obtaining necessary data is sometimes difficult.

• Stillbirth Rate - the number of stillborn babies (a fetus weighing 500 g or more, or of gestational age 20 weeks or more) showing no signs of life after birth. This is a rare event with widely fluctuating rates.
  
  
• Child Mortality - rates are normally calculated for the four age groups of 1-4, 5-9, 10-14, and 15-19 year olds.
  
  
  • Child death (or "under five") rate - number of deaths for children aged 1 to 4 years in a given year per 1000 children in this age group.
    
    • Worldwide measure of mortality
      
    • Considered a useful measure of the burden of preventable communicable diseases in the child population.
    
    
  • Age-specific mortality for 1-19 year olds may be presented by age category, gender, and geographical location.
    
    
  • Because child death is a rare event, child mortality rates are presented by larger geographical regions.

MORE INFORMATION:

• Canadian Perinatal Surveillance System (Health Canada,1999)