cring data compilation process examples from mics reports
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CRING data compilation processExamples from MICS reports
Maternal and Reproductive Health indicators
Statistics and Monitoring Section UNICEF HQMarch 2013
– Contraceptive prevalence rate– Antenatal care
• At least one visit (skilled provider)
• At least 4 visits (any provider)– Delivery care
• Skilled attendant at birth• C-Section • Institutional deliveries
– Early child bearing• Births by age 18
Maternal health indicators in CRING
MDG 5 – Improve maternal healthGoal 5: Improve maternal health Indicators – all in MICS
Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
5.1 Maternal mortality ratio (CRING)
5.2 Proportion of births attended by skilled health personnel (CRING)
Target 5.B: Achieve, by 2015, universal access to reproductive health
5.3 Contraceptive prevalence rate (CRING)
5.4 Adolescent birth rate
5.5 Antenatal care coverage (at least one visit and at least four visits) (CRING)
5.6 Unmet need for family planning
MICS4 Survey Design Workshop
– Contraceptive prevalence rate– Antenatal care
• At least one visit (skilled provider)• At least 4 visits (any provider)
– Delivery care• Skilled attendant at birth• C-Section • Institutional deliveries
– Early child bearing• Births by age 18
Maternal health indicators in CRING
Contraceptive prevalence rate
• Contraceptive use has contributed to improvements in maternal and infant health by serving to prevent unintended or closely spaced pregnancies.
MDG report 2012
Contraceptive prevalence rate
Numerator Denominator
Number of women age 15-49 years currently married or in union who are using (or whose partner is using) any (modern or traditional) contraceptive method
Total number of women age 15-49 years who are currently married or in union
Contraceptive prevalence rate
Table RH.4: Use of contraceptionPercentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Country, Year
Not using any
method
Percent of women (currently married or in union) who are using: Number of
women currently married
or in union
Fe-male sterili-zation
Male sterili-zation IUD
Injectables
Im-plants Pill
Male con-dom
Fe-male con-dom
Dia-phragm/
Foam/Jelly LAM
Periodic abstin-ence
With-drawal Other
Any modern method
Any tradi-tional
methodAny
method1
Any method is an MDG indicator
Modern Traditional Modern and traditional
– Contraceptive prevalence rate– Antenatal care
• At least one visit (skilled provider)• At least 4 visits (any provider)
– Delivery care• Skilled attendant at birth• C-Section • Institutional deliveries
– Early child bearing• Births by age 18
Maternal health indicators in CRING
Antenatal care
• Antenatal care is also among the interventions that can reduce maternal mortality and morbidity.
• The antenatal period is critically important for reaching women with interventions and information that promote health, wellbeing and survival of mothers as well as their babies.
MDG report 2012
Antenatal care: At least one visit with skilled provider (ANC1)
Numerator Denominator
Number of women age 15-49 years who were attended during pregnancy:• at least once by skilled personnel
(doctor, nurse or midwife)
Total number of women age 15-49 years with a live birth in the 2 years preceding the survey
Antenatal care: At least one visit with skilled provider (ANC1)
Table RH.6: Antenatal care coveragePercent distribution of women age 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Country, Year
Person providing antenatal care No antenatal
care received Total
Any skilled personnel
Number of women who gave birth in the preceding two
yearsMedical doctor
Nurse/ Midwife
Auxiliary midwife
Traditional birth
attendant
Community health worker Other
MDG 5 indicator: Antenatal care, at least one visit
Personnel categories • Should have been modified in country• MICS4 standard -- Skilled health personnel includes doctors, nurses,
midwives (auxiliary midwives in some countries).
– Contraceptive prevalence rate– Antenatal care
• At least one visit (skilled provider)• At least 4 visits (any provider)
– Delivery care• Skilled attendant at birth• C-Section • Institutional deliveries
– Early child bearing• Births by age 18
Maternal health indicators in CRING
Antenatal care: Four or more visits with any provider (ANC4)
• The World Health Organization (WHO) recommends a minimum of four visits for antenatal care, including, at a minimum, screening and treatment for infections and identification of warning signs during pregnancy. (MDG report 2012)
• Given measurement challenges, it is not possible to measure that all 4 visits were done with skilled providers, although it might be ideal.
• The ANC4 indicator does not look at the content of the visits but rather at the number of visits.
Antenatal care: Four or more visits with any provider (ANC4)
Numerator Denominator
Number of women age 15-49 years who were attended during pregnancy:• at least four times by any provider
Total number of women age 15-49 years with a live birth in the 2 years preceding the survey
Antenatal care: Four or more visits with any provider (ANC4)Table RH.7: Number of antenatal care visitsPercent distribution of women who had a live birth during the two years preceding the survey by number of antenatal care visits by any provider, Country, Year Percent distribution of women who had: Number of women
who had a live birth in the preceding two
years
No ante-natal care
visits One visit Two visitsThree visits
4 or more visits1 Total
Region Urban-rural Mother's age at birth Education Wealth index quintile Religion/Language/Ethnicity of household head
Total 100.0
1 MICS indicator 5.5b; MDG indicator 5.5
MDG 5 indicator: Antenatal care, 4 or more visitsWatch out for…
• Indicator definition (any provider)
– Contraceptive prevalence rate– Antenatal care
• At least one visit (skilled provider)• At least 4 visits (any provider)
– Delivery Care• Skilled attendant at birth• C-Section • Institutional deliveries
– Early child bearing• Births by age 18
Maternal health indicators in CRING
Delivery CareSkilled attendant at birth
• Having a skilled health professional (doctor, nurse or midwife) is a life saving intervention, both for mothers and babies.
• Skilled birth attendants can administer interventions to prevent and manage life-threatening complications such as heavy bleeding, or refer the patient to a higher level of care when needed.
MDG report 2012
Delivery CareSkilled attendant at birth
Numerator Denominator
Number of women age 15-49 years with a live birth in the 2 years preceding the survey who were:• attended during childbirth by skilled
health personnel (doctor, nurse or midwife)
Total number of women age 15-49 years with a live birth in the 2 years preceding the survey
• Beyond doctor, nurse and midwife, skilled categories may vary by country. • The reporting needs to be customized according to the health cadre in the
country. • This can be confirmed with MoHs at the country level and customized accordingly
for data collection and reporting.
Delivery Care: Skilled attendant at birthTable RH.9: Assistance during deliveryPercent distribution of women age 15-49 who had a live birth in the two years preceding the survey by person assisting at delivery and percentage of births delivered by C-section, Country, Year
Person assisting at delivery
No attend-
ant Total
Delivery assisted by any skilled attendant
Percent delivered by
C-sectionMedical doctor
Nurse/ Midwife
Auxiliary midwife
Traditional birth attend-
ant
Com-munity health worker
Relative/Friend Other
MDG 5 indicator: Skilled attendant at delivery
MICS 4 standard -- Skilled health personnel includes doctors, nurses, midwives (auxiliary midwives in some countries)
– Contraceptive prevalence rate– Antenatal care
• At least one visit (skilled provider)• At least 4 visits (any provider)
– Delivery Care• Skilled attendant at birth• C-Section • Institutional deliveries
– Early child bearing• Births by age 18
Maternal health indicators in CRING
Delivery CareCaesarean section (C-section)
• Caesarean sections are one component of comprehensive emergency obstetric care, which also includes blood transfusions and other interventions to manage life-threatening complications of pregnancy and childbirth.
• Rates below 5% signal a lack of access to emergency obstetric care, and rates above 15% suggest overuse, which may increase poor maternal and neonatal health outcomes (WHO)
Countdown to 2015 – The 2012 report
Delivery CareC-Section
Numerator Denominator
Number of last live births in the 2 years preceding the survey who were delivered by caesarean section
Total number of last live births in the 2 years preceding the survey
Delivery Care: Skilled attendant at birth and C-Section
Table RH.9: Assistance during deliveryPercent distribution of women age 15-49 who had a live birth in the two years preceding the survey by person assisting at delivery and percentage of births delivered by C-section, Country, Year
Person assisting at delivery
No attend-
ant Total
Delivery assisted by any skilled attendant
Percent delivered by
C-sectionMedical doctor
Nurse/ Midwife
Auxiliary midwife
Traditional birth attend-
ant
Com-munity health worker
Relative/Friend Other
– Contraceptive prevalence rate– Antenatal care
• At least one visit (skilled provider)• At least 4 visits (any provider)
– Delivery care• Skilled attendant at birth• C-Section • Institutional deliveries
– Early child bearing• Births by age 18
Maternal health indicators in CRING
Delivery CareInstitutional deliveries
• In addition to professional attention during birth by a skilled birth attendant, it is important that mothers deliver their babies in an appropriate setting, where life saving equipment and hygienic conditions can also help reduce the risk of complications that may cause death or illness to mother and child.
Delivery CareInstitutional deliveries
Numerator Denominator
Number of women age 15-49 years with a live birth in the 2 years preceding the survey who delivered in a health facility
Total number of women age 15-49 years with a live birth in the 2 years preceding the survey
Delivery Care: Institutional deliveries
Table RH.10: Place of deliveryPercent distribution of women age 15-49 who had a live birth in two years preceding the survey by place of delivery, Country, Year
Place of delivery
Total
Delivered in health facility1
Number of women who had a live birth
in preceding two years
Public sector health facility
Private sector health facility Home Other
Region Urban-rural Mother's age at birth Number of antenatal care visits Education Wealth index quintiles Religion/Language/Ethnicity of household head Total 100.0
1 MICS indicator 5.8
• Place of delivery categories varies per country• Public and private, as long as it refers to health facilities• Common - administrative reports on this indicator
– Contraceptive prevalence rate– Antenatal care
• At least one visit (skilled provider)• At least 4 visits (any provider)
– Delivery care• Skilled attendant at birth• C-Section • Institutional deliveries
– Early child bearing• Births by age 18
Maternal health indicators in CRING
Early childbearingBirths by age 18
• One measure of early childbearing is the percentage of young women aged 20–24
• Early childbearing often results from child marriage.• Negative consequences of child marriage abound,
particularly for girls. They may be cut off from their families, their formal education left behind. Their development – and the fulfillment of their human rights – may be compromised. There are also health concerns associated with child marriage, which often leads to adolescent childbearing.
Early childbearingBirths by age 18
Numerator Denominator
Number of women age 20-24 years who had at least one live birth before age 18
Total number of women age 20-24 years
Table RH.2: Early childbearingPercentage of women age 15-19 who have had a live birth or who are pregnant with the first child; percentage of women age 15-19 who have begun childbearing before age 15, and the percentage of women age 20-24 who have had a live birth before age 18, Country, 2010
Number of women age 15-19
Number of women age
15-19
Percentage of women age 20-24 who have had a live
birth before age 18 [1]
Number of women age
20-24Have had a
live birthAre pregnant with first child
Have begun childbearing
Have had a live birth
before age 15Area Urban 2.9 .8 3.7 .2 753 10.3 882
Rural 11.8 3.5 15.3 .7 1299 18.0 1620Education None 20.3 4.8 25.1 1.4 548 24.0 1158
Primary 11.6 4.1 15.7 .9 304 22.7 340Secondary + 2.4 1.0 3.4 .0 1201 2.7 1004
Wealth index quintiles Poorest 15.8 2.5 18.3 1.6 316 21.1 402Second 17.0 4.2 21.2 .1 323 17.7 413Middle 13.2 5.4 18.6 1.5 339 16.8 499Fourth 4.6 1.4 6.0 .0 441 17.1 614Richest .8 .8 1.5 .0 633 6.3 574
Total 8.5 2.5 11.0 .5 2052 15.3 2502[1] MICS indicator 5.2
Early childbearingBirths by age 18
Sum of the first two columns
Childinfo – Delivery care
• http://www.childinfo.org/delivery_care.html
Childinfo – Antenatal care
• http://www.childinfo.org/antenatal_care.html
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