Introduction

Measuring health is a very complex issue -- there is no quick and easy way to say whether a group of children are healthy. So, in our Manitoba Child Health Atlas Update (Brownell et al. 2008) we used measures that are thought to indicate "healthiness", according to published studies and the opinion of members of our expert working group.

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 2008 Deliverable mentioned above. The other two Child Health Indicator-related concepts are:


• Child Health Status Indicators (2001) based on the information in the MCHP Deliverable Assessing the Health of Children in Manitoba: A Population-Based Study (2001), 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 2008 Deliverable, but are organized differently than the current information.

Child Health Indicator Categories

The health indicators developed for the Child Health Atlas Update are divided into nine broad categories:


1. Perinatal Health
   
2. Health Care Utilization
   
3. Use of Prescription Medications
   
4. Infant and Child Mortality
   
5. Education
   
6. Nutrition and Physical Activity
   
7. Childhood Chronic Conditions
   
8. Community and Social Services
   
9. Adolescent Health and Reproductive Health

Specific indicators are listed under each broad category, with either a brief description of what was calculated, or with a link to a glossary term describing how the rate was calculated. Most indicators were calculated using a population-based approach. This means that the rates or the prevalence shown in the Atlas are based upon virtually every child from 0 to 19 years of age living in Manitoba. Some exceptions to this are the Nutrition and Physical Activity and Adolescent Health and Reproductive Health categories, which both use data from the Canadian Community Health Survey (CCHS) conducted by Statistics Canada. In addition, some measures use a specific age range in calculations. These exceptions are noted for each indicator.

Links at the end of each category provide access to the corresponding chapter in the on-line Manitoba Child Health Atlas Update report and to the related "Data Extras" (graphs, figures and tables) that are available on our web site.

1. Perinatal Health

• Teen Pregnancy - see Teen Pregnancy Rate
  
• Teen Birth - see Teen Birth Rate
  
• Caesarean Sections - see Caesarean Section (C-Section) Rate
  
• Vaginal Birth after Caesarean Section Rate
  
• Preterm Birth - see Preterm Birth Rate
  
• Small for Gestational Age (SGA) - rates for SGA were calculated by taking all live-born small for preterm, small for term and small for postterm births and dividing by the total number of live-born deliveries.
  
• Large for Gestational Age (LGA) - rates for LGA were calculated by taking all live-born large for preterm, large for term and large for postterm births and dividing by the total number of live-born deliveries.
  
• Breastfeeding Initiation - see Breastfeeding Initiation Rate
  
• Breastfeeding Duration - see Breastfeeding Duration Rate
  
• Prenatal and Family Risk Factors - crude rates were developed for six prenatal and family risk factors.
  
• Congenital Anomalies - crude rates for the selected congenital anomalies were calculated for all infants less than one year old.
  
• Newborn Readmissions - see Newborn Readmission Rate

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Perinatal Health
  
• Perinatal Health Data Extras

2. Health Care Utilization

• Immunizations - see Childhood Immunization Rates
  
• Vaccine Preventable Infections - rates of inpatient hospitalization for vaccine-preventable infections
  
• Hospital Episode - rates of inpatient hospital utilization based on hospital episodes
  
• Injury Hospitalization - rates of inpatient hospitalization for injury
  
• Lower Respiratory Tract Infections (LRTI) - rates of hospitalization for Lower Respiratory Tract Infections for children less than 5 years of age
  
• Tonsillectomy/Adenoidectomy - rates of Tonsillectomy/Adenoidectomy for children 0 to 14 years of age
  
• Dental Extractions - rates of pediatric (from birth to 5 years of age) dental extractions performed in hospital under general anesthesia.
  
• Physician Visits -see Ambulatory Visits - Physician - rates of visits to general practitioners (GPs), Paediatricians, and "other" practitioners, which included Psychiatrists, Obstetricians and Gynaecologists, Medical Specialists, General Surgeons, Surgical Specialists, and Technical Specialists
  
• Continuity of Care - see Continuity of Care (COC) (Ambulatory) ) - rates of continuity of care were calculated when at least half of a child's physician visits were to the same practitioner in a two-year period

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Health Care Utilization
  
• Health Care Utilization Data Extras

3. Use of Prescription Medications

• Any Prescription - prescription rates for children aged 0 to 19 years with at least one prescription for any type of medication
  
• Antibiotic Prescriptions - see Antibiotic Use - investigated two different ways: 1). prescriptions rates for children with at least one antibiotic prescription per 1,000 children; and 2). the average number of antibiotic prescriptions per 1,000 children who were prescribed these medications
  
• Antidepressants - prescription rates for antidepressants (including Selective Serotonin Reuptake Inhibitors (SSRIs) ) for children 0 to 19 years of age, as well as prescription rates for SSRIs in Manitoba youths 10 to 19 years of age
  
• Psychostimulants - prescription rates for children aged 5 to 19 years with at least one prescription for a psychostimulant
  
• Narcotic Analgesics - prescription rates for children with at least one prescription for narcotic analgesics
  
• Non-steroidal anti-inflammatory drugs (NSAIDS) - prescription rates for children 0 to 19 years of age with at least one prescription for an NSAID
  
• Anxiolytics - prescription rates for children with at least one prescription for anxiolytic medication
  
• Antipsychotics (children) - prescription rates for children aged 0 to 19 years of age with at least one prescription for antipsychotic medication

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Use of Prescription Medications
  
• Use of Prescription Medications Data Extras

4. Infant and Child Mortality

• Infant Mortality - see Infant Mortality Rate - calculated both with and without fragile infants
  
• Stillbirths - crude rate calculated by taking the number of stillbirths per 1,000 total births (which included live births and stillbirths).
  
• Child Mortality - see Child Mortality Rate - expressed per 100,000 children
  
• Injury Mortality - see Injury Mortality Rate - rates were calculated by dividing the total number of injury deaths by the total population in the same time period, and expressed per 100,000 children

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Infant and Child Mortality
  
• Infant and Child Mortality Data Extras

5. Education

• Retention - rates are based on students in kindergarten through grade 8, who were retained at least once
  
• School Mobility - see School Transfers / School Changes - rates are expressed as the percentage of students with no school transfers / school changes. Two cohorts of students in grade 3 were followed for four years to determine how many school transfers / changes they experienced over that time period
  
• Grade 12 Provincial Exam Performance - rates were calculated to measure not only the percent of the cohort that passed or failed these tests "on time", but also the percent who were absent or did not complete the test, who were in Grade 11 or lower (i.e., retained at least one year) and who had withdrawn from school.
  
• High School Completion - rates are expressed as the percentage of students who completed high school. Two cohorts of students in grade 9 were followed for six years to determine what percentage of students completed high school

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Education
  
• Education Data Extras

6. Nutrition and Physical Activity

• Nutrition - fruit and vegetable consumption - rates are based on the percent of respondents who consumed five or more fruit and/or vegetable servings daily.
  
• Physical Activity - rates are based on the percent of respondents who were considered active, moderately active or inactive
  
• Body Mass Index (BMI) and Obesity/Overweight - rates for obesity, obese or overweight, overweight (but not obese), normal BMI or lower, and crude child BMI ratings are calculated for children aged 12 to 19 years of age
  
• Exposure to Second-Hand Smoke - rates for exposure to second-hand smoke in the home are calculated for children aged 12 to 19 years of age

• Information on nutrition and physical activity comes from the Canadian Community Health Survey (CCHS) which sampled children 12 to 19 years of age. Children living in First Nations communities are not part of this survey.

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Nutrition and Physical Activity
  
• Nutrition and Physical Activity Data Extras

7. Childhood Chronic Conditions

• Asthma - prevalence was calculated for children aged 5 to 19 years of age, based on hospitalization, physician visits, or through asthma prescription medications
  
• Diabetes - prevalence was calculated for children aged 5 to 19 years of age, based on using three years of hospital discharge, physician visit and prescription data.
  
• Attention-Deficit Hyperactivity Disorder (ADHD) - prevalence was calculated for children aged 5 to 19 years of age, based on one or more diagnoses for ADHD, either from physician visit records or hospital discharge claims. Also included as "diagnosed with ADHD" were any children with at least one prescription for a psychostimulant medication and an ADHD diagnosis in the previous three years or children with two or more psychostimulant prescriptions in one fiscal year.
  
• Autism Spectrum Disorders (ASD) - prevalence of ASD are reported for children aged 5 to 9 years of age, as well as for children aged 0 to 19 years of age
  
• Disabilities - see Children with Disabilities - crude rates for children aged 6 to 17 years are reported

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Childhood Chronic Conditions
  
• Childhood Chronic Conditions Data Extras

8. Community and Social Services

• Licensed Child Care Spaces - crude rate was calculated on the number of licensed child care spaces per 1000 children 0 to 12 years of age
  
• Receipt of Income Assistance - investigated two different ways: 1). rates of children (0 to 17 years of age) in families receiving income assistance; and 2). rates of young adults (18 to 19 years of age) receiving income assistance
  
• Children in Care - prevalence was calculated for children 0 to 17 years of age
  
• Children in Families Receiving Protection/Support Services - see Receipt of Protective or Support Services - prevalence of children 0 to 17 years of age receiving services from Child and Family Services (CFS)

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Community and Social Services
  
• Community and Social Services Data Extras

9. Adolescent Health and Reproductive Health

• Adolescent Smoking - rates of children aged 12 to 19 categorized as "smokers" or "non-smokers". For those categorized as "smokers", the average age at first whole cigarette was calculated
  
• Adolescent Drinking - see Adolescent Alcohol Consumption - rates are based on two different age groups and whether or not they had consumed alcohol in the past 12 months, and for the older age group, the volume of alcohol consumption
  
• Adolescent Sexual Activity - rates are based on children aged 15 to 19 years of age. For those who answered "yes", the average age of first sexual intercourse was calculated
  
• Condom Use - see Contraceptive Use - rates are based on children aged 15 to 19 who reported having sexual intercourse in the past 12 months and whether they used a condom the last time they had sex
  
• Birth Control Pill Use - see Contraceptive Use - rates are based on females aged 15 to 19 who reported having sexual intercourse in the past 12 months, and also responded "birth control pill" and/or "birth control injection"

• Information on adolescent and reproductive health comes from the Canadian Community Health Survey (CCHS) which sampled children 12 to 19 years of age. Children living in First Nations communities are not part of this survey.

LINKS:
• Manitoba Child Health Atlas Update report (pdf document): - Adolescent Health and Reproductive Health
  
• Adolescent Health and Reproductive Health Data Extras