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Care and caring capacity[14]


The indicators corresponding to caring for infants (essentially those relating to feeding practices, a critical issue at this age), those relating to women in general, and finally to other members of the family or group, are considered separately.

A certain number of health indicators (access to care, etc.) would also fall under this heading, but are not included here since they are considered in the section on health and demography (Tables 13 to 17). They may be systematically broken down by sex in order to show more specifically the attention paid to the nutrition of girls and women.

A point to bear in mind is that validation of a number of new indicators in this field is a matter of debate on account of their qualitative nature, and the fact that they are based on observation or interview. Their level of standardization depends greatly on the cultural context in which they are applied. This field is evolving constantly; we have limited ourselves to indicators for which there is a minimum consensus and whose use can be generalized.

TABLE 10
Care for infants and young children

INDICATORS


USED BY

Breastfeeding and complementary feeding[15]

  • % of children who have never received breastmilk
  • children <3 or 5 years

  • Rate of exclusive breastfeeding (breastmilk alone without other liquids or foods)
  • infants 0-4 months (or 0-6 months)

FIVIMS

  • Rate of predominant breastfeeding (breastmilk and other water-based liquids)
  • infants 0-4 months

  • Rate of timely complementary feeding (solid/semisolid complementary foods given in addition to breastmilk)
  • infants 6-9 months

  • Rate of continued breastfeeding at 1 year
  • children 12-15 months

  • Rate of continued breastfeeding at 2 years
  • children 20-23 months

  • Average duration of breastfeeding or mean age at weaning

FIVIMS

  • Bottle-feeding rate
  • children 0-11 months

  • Rate of timely initiation of breastfeeding (% of infants who are breastfed within one hour or within 8 hours of birth)
  • children <24 months

  • Number of maternity hospitals designated as ‘Baby Friendly’ according to the criteria of the Baby Friendly Hospital Initiative[16]


  • Number of meals per day eaten by young children


  • Frequency of changes in infant’s diet in case of illness


  • % of children for whom breastfeeding was discontinued because of diarrhea
  • children breastfed or <24 months

  • % of children continuing to be fed during diarrhea
  • children 0-59 months

Breastfeeding and complementary feeding

  • % of children who have had diarrhea during the last 2 weeks, who have received more liquids and whose feeding was maintained during the episode
  • children 0-59 months

Other caring practices

  • % of preschool children whose birth has been registered with the registry office

  • % of persons caring for children and/or preparing their meals who wash their hands properly

  • % of preschool children with acute respiratory infection during the last 2 weeks who have been taken to an appropriate health care centre

  • % of preschool children taking part in some kind of organised education programme for young children

  • % of people caring for preschool children who know at least two of the signs requiring immediate referral to health care (inability to drink or breastfeed, sudden deterioration in health, fever, rapid breathing, difficulty in breathing, blood in stools, insufficient intake of liquids)

  • % of children 0-59 months who are underweight (see Table 1)

MDG1
FIVIMS
CFS

TABLE 11
Care for women

INDICATORS

USED BY

Health/nutritional status

  • % of newborns with low birthweight (see Table 1)

FIVIMS

  • % of thin women (see Table 1)

  • Prevalence of anemia (see Table 5)

  • HIV prevalence among pregnant women ages 15 to 24 years

MDG6

  • Fertility rate (see Table 15)

  • Average number of pregnancies per woman (see Table 15)

  • % of births attended by skilled health personnel

MDG5

  • % of women who have had at least one prenatal visit in their last pregnancy

Health/nutritional status

  • Fertility rate of women aged 15-19 years (annual number of live births of women aged 15-19 per thousand women of that age)

  • Use of contraception (% of women aged 15-19 who are practising, or whose sexual partners are practising, any form of contraception; total or disaggregated married/unmarried women)

MDG6

  • Average age of mothers at first birth

Education[17]

  • Adult literacy/illiteracy rate

FIVIMS

  • Female literacy rate (>15 years)

FIVIMS

  • Literacy rate of 15-24 year-olds

  • Ratio of literate women to men ages 15-24 years

MDG3

  • Girl net enrolment rate in primary school

FIVIMS

  • Ratio of girls to boys in primary, secondary, and tertiary education

MDG3

  • Level of education of women aged 15-29 years

  • % of women aged 15-29 who have completed their primary studies

Socio-economic role

  • % of woman headed households

  • % of households with no adult male

  • Proportion of seats held by women in national parliaments

MDG3

  • Proportion of women in wage employment in the non-agricultural sector

MDG3

  • % of women with access to wage employment (as % of total women of working age, or as % of total men and women of working age)

  • Average wage of women as % of that of men

  • Ratio adult men/adult women per household

  • % of mothers working outside the home (per formal/informal sector)

  • Control by women of household resources as % of women or as % of households

  • % of women responsible, wholly or partly, for various production activities (food crops; food purchase, processing, preparation or distribution) as a proportion of family members concerned, or as a proportion of households concerned

  • % of women with access to various services (extension, education, vocational training, credit, social security, day care)

TABLE 12
Care for other household members

INDICATORS

USED BY

  • Average household size (number of persons)

FIVIMS

  • Ratio number of adults/number of children per household

  • Average interval between births, in months

  • % of households in which school age children (7-12 years) are in charge of younger children (care, food)

  • % of orphaned children

  • % of orphaned children (0-14 years) fostered by a family

  • % of children entrusted to persons other than their biological parents

  • Ratio of school attendance of orphans to school attendance on non-orphans ages 10-14

MDG6

  • % of physically and/or mentally disabled (children and adolescents <15 years, adults, elderly) and % in care

  • Ratio of dependants to wage-earners in average households

FIVIMS

  • Number of persons per room in dwellings or average area per person

  • % of children aged 5-14 years who are working

  • % of households where at least one member has a regular job

Health and demography

These are standard indicators which have been regularly recommended since the 1980s by WHO and were recently revised (WHO, 1996a; WHO, 2002).

TABLE 13
Mortality

INDICATORS

USED BY

  • Infant mortality rate (number of deaths in infants under one year/number of live births in a specified year, in ‰)

MDG4
FIVIMS

  • Underfive mortality rate (number of deaths in a specified year of children between birth and 5 years/total number of children 0-5 years at mid-year, as ‰)

MDG4
FIVIMS
CFS

  • Infant mortality by sex

  • Underfive mortality by sex

  • Maternal mortality ratio (number of deaths from any cause related to or aggravated by pregnancy and childbirth or within 42 days of termination of pregnancy/total number of live births over a specified year, per 100 000)

MDG5
FIVIMS

  • Proportional mortality (% of deaths in children aged 1-4 or in those <5 years over all deaths)

  • Life expectancy at birth

FIVIMS
CFS

  • Life expectancy of women as % of that of men

  • Prevalence and mortality rates associated with infectious diseases (by sex and age if appropriate) as % of all deaths and, in particular:

- Malaria
- Tuberculosis
- Childhood diseases (measles, pertussis, diphtheria, tetanus, poliomyelitis)
- Diarrheal diseases
- Acute respiratory infections
- HIV/AIDS

MDG6

  • Prevalence and mortality rates associated with non-communicable diseases (by age) as % of all deaths and, in particular:

- Diabetes mellitus
- Nutritional and endocrine disorders
- Cardiovascular diseases Malignant tumours


  • Prevalence and mortality rate attributable to risk factors for chronic diseases (overweight, high blood pressure, physical inactivity, high cholesterol, tobacco, alcohol, etc.) (see Table 14 for cut-off values adopted)

  • Healthy life expectancy (HLE) or disability-adjusted life years (DALY) at birth (or at age 60), by sex
  • Age-specific classification of main causes of mortality

  • Number of children orphaned as a result of HIV/AIDS

MDG6

TABLE 14
Morbidity

INDICATORS

USED BY

  • Incidence, prevalence, severity, duration (possibly disaggregated by sex and age) of infectious diseases, in particular:

- Acute respiratory infections (ARI)
- Diarrhea
- HIV
- Malaria
- Tuberculosis
- Cholera

FIVIMS
MDG6

  • Classification of major causes of infectious diseases (malaria, measles, ARI, diarrhea)

  • Immunization rate of children (under one year and by age group):

- % of children immunized against each disease, among target age group

- % of 1 year old children (or <7 years) fully immunized (adequate number of doses during the first year of life) against infectious diseases (tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, measles)


  • Prevalence of anemia in women (see Table 5)

  • Incidence of measles in children

  • % of children <36 months who had diarrhea during the last 2 weeks (diarrhea defined as more than 3 liquid stools per day)

  • Use of contraception that prevents transmission of AIDS

MDG6

  • Rate of chronic non-communicable diseases (for specific age groups and by sex, as applicable), specifically:

- Diabetes mellitus
- Nutritional and endocrine disorders
- Cardiovascular diseases Malignant tumours


  • Recognized risk factors for chronic non-communicable diseases, in particular:

- Number and % of persons with hypertension (systolic blood pressure ³140 mm Hg and/or diastolic pressure ³90 mmHg) or average systolic pressure

- Number and % of persons with hyperglycaemia (fasting blood glucose ³6.1 mmol/L or 110 mg/dL of whole blood)

- Number and % of persons with hypercholesterolemia (total cholesterol ³6.5 mmol/L) or average cholesterolemia (mmol/L)

- % of sedentary subjects

- Average fruit and vegetable intake (g/day)

- Prevalence of overweight (BMI ³25.0 kg/m2)

- % of alcohol consumers

- Tobacco consumption


TABLE 15
Fertility

INDICATORS

USED BY

  • Total fertility rate (‰)[18]

FIVIMS

  • Use of contraception (% of women aged 15-49 who are practising, or whose sexual partners are practising, any form of contraception. Total or disaggregated as married/unmarried women)

  • Average number of pregnancies per woman

TABLE 16
Water and sanitation

INDICATORS

USED BY

Water

  • % of population (or of households) with sustainable access to an improved water source (piped water, public tap, borehole with a pump, protected well, protected spring or rainwater) (by urban/rural residence where appropriate)

MDG7
FIVIMS

  • Volume of water (litres) per person and per day consumed at household level (drinking, cooking, washing, home cleaning)

  • % of population (or of households) per type of water supply (in a rural environment and in a dry/wet season; pond, dam, river, spring, rainwater, well; in an urban environment: private, communal or both)

  • % of households with available washing facilities (private, communal, none)

  • % of recurring costs of water supply services paid by the community using these services

  • % of water supply installations whose maintenance is carried out by the beneficiary community.

Sanitation

  • % of population (or of households) with access to adequate sanitation (toilets, latrines) (disaggregated by urban/rural residence)

MDG7
FIVIMS

  • % of population using adequate sanitation facilities (toilets, latrines)

  • % of households per type of sanitation facility (rural environment: main sewer, septic tank, pit, bucket, none; urban environment: private, communal access, pit, other)

Household characteristics

  • Number of persons per room

  • % of dwellings without an adequate ventilation system

TABLE 17
Availability and access to health services

INDICATORS

USED BY

Availability

  • Number of facilities providing basic (or extended) essential obstetric care per 500 000 persons as defined in UNICEF/WHO/UNFPA (1997)

  • Number of persons per health personnel (doctors, nurses)

  • % of villages (municipalities or communities) with a health service

Availability

  • % of communities with a community health organization

  • Qualitative indicators of services provided by the health care system (timetables, number, gender and qualifications of staff, languages spoken, cost of services and travel, availability of essential drugs, quality of reception)

Access

  • % of population with access to primary health care services (health centre, hospital, dispensary, public or private; local means of transport in less than 1 hour, or maximum 1 hour walking distance, or roughly 5 km; less than 2 hours drive to hospital)

FIVIMS

  • % of couples with access to a family planning service

  • Prenatal care coverage (number of pregnant women attended by skilled personnel at least once during their pregnancy per 1000 live births)

  • % of births attended by skilled health personnel

MDG5

  • % of one-year - old children immunized against measles

MDG4
FIVIMS

  • Immunization rate of children (under one year and by age group) (see Table 14)

  • Rate of use of oral rehydration in children under 5 years (% of children 0-59 months who had diarrhea in the last 2 weeks and were treated with oral rehydration salts or an appropriate home-based solution)

  • Coverage of children <5 years (or by one-year age group) by health services, namely growth monitoring and promotion

  • % of children covered by a growth promotion programme who have gained weight during the last 3 months

  • % of children <5 years with permanent access to child health care services (no more than half an hour away)

  • % of population in malaria-affected areas using effective malaria prevention and treatment measures

MDG6

  • % of tuberculosis cases detected and treated with DOTS (directly observed short treatment strategy)

MDG6

  • % of population with access to affordable, essential drugs on a sustainable basis

MDG8

Basic socio-economic indicators

Although these are of only general value, they can be used to measure progress in a country’s general socio-economic situation and standard of living. They correspond to the basic causes of malnutrition in the conceptual framework shown previously (see Figure) as an example. These indicators should be analyzed together with indicators of the nutritional situation, in order to have a complete picture of the reasons for change (or lack of change) observed.

Most of these basic indicators are widely available centrally, even if their updating is sometimes slow (a census, for example, takes place every 10 years, but adjustments can be made at regular intervals). It is important to clearly identify their reference period.

TABLE 18
Demography

INDICATORS

USED BY

  • Annual population growth rate

FIVIMS

  • Distribution of population by age group, in particular: % of population under 15 years % of population 65 years

FIVIMS

  • Total dependency rate at national level, as % (number of persons <15 years and 65/number of persons between 15 and 64)

  • % of households according to economic dependency rate

  • Population density (number of persons/km2, per region)

  • Rate of urbanization (capital and other towns)

FIVIMS

  • Rate of migration of persons >15 years

  • Average age of women at marriage

TABLE 19
Economy

INDICATORS

USED BY

  • Gross National Product (GNP) and Gross Domestic Product (GDP) in US$ per capita

  • Average annual growth in GDP

FIVIMS

  • Average annual growth in GDP per capita

FIVIMS
CFS

  • Rate of inflation

  • Level of international prices (commodities exported and imported)

  • Growth of imports and exports

  • Share of agriculture in GNP and GDP

FIVIMS

  • Food aid dependency rate (proportion of food needs covered by external food aid)

  • % of official development assistance for basic social services (basic education, primary health care, nutrition, safe water, and sanitation)

MDG8

  • % of official development assistance that is not tied to purchase of goods and services approved by donors

MDG8

  • Share of food imports in total imports

  • Debt service as % of GNP

  • Debt service as a % of exports of goods and services

MDG8

  • Ratio of debt service/exports of goods and services

  • Amount of external assistance as % of GNP

  • Amount of external assistance per person

  • % of expenditure for housing and public amenities

  • % of expenditure for transport and communications

  • % annual growth of the road network (highways, motorways and secondary roads)

  • % annual growth of the railway network

  • Consumer price index

FIVIMS

  • Ratio of farmgate price index/consumer price index

  • Food price index by area

TABLE 20
Employment and services

INDICATORS

USED BY

  • % of population by occupational category

  • % of population engaged in farming

  • % of civil servants

  • Employment in the informal sector, as % of total employment

  • % unemployed

  • Unemployment rate of 15 to 24-year-olds (male, female and total)

MDG8

  • % of population engaged in non-agricultural activities in rural areas

  • % of economically active persons with more than one job

Number of (retail and wholesale) businesses per capita or per 1000 homes


Number of telephone lines per 1000 inhabitants

MDG8

Number of personal computers per 1000 inhabitants

MDG8

TABLE 21
Education

INDICATORS

USED BY

Adults

  • Adult literacy rate (% of men and women 15 years and over, able to read and write in any language)

FIVIMS

  • Literacy rate of 15-24 year-olds

MDG2

  • % of adults >15 years who have completed primary education

  • Average level of education of adults aged 15-29 years (by sex)

  • % of households with no literate member

Children

  • Gross enrollment rate of children (by sex) in primary and secondary education (% of children registered regardless of age, in relation to total number of children in age group corresponding to each level)

  • Net enrollment rate of children (by sex) in primary education (% of children registered belonging to the age group corresponding to primary level in relation to the total number of children in this age group)

MDG2
FIVIMS

  • Net attendance rate of children (by sex) in primary education (% of children belonging to the age group corresponding to primary level actually attending primary school in relation to the total number of children in this age group)

MDG2
FIVIMS

  • Ratio total number of school-age children/number of teachers (primary and secondary)

  • Ratio of number of pupils/number of teachers (primary and secondary)

  • Average salary of a primary school teacher as % of minimum wage

  • % of pupils starting grade 1 who reach grade 5

MDG2

  • Repetition rate of classes (or grades) in primary education in urban and rural areas

  • % of children aged 10-14 years not attending school

  • Average distance between school (primary and secondary) and home

  • % of households with physical access to school (e.g. less than 2 km or half an hours walk)

  • Government expenditure per pupil

TABLE 22
Investment in public health

INDICATORS

USED BY

  • % of doctors practising in rural/urban areas

  • Health expenditure of as % of GNP

  • Government expenditure per person on health

  • Health expenditure as % of total government expenditure

  • % of villages or towns with a health service

  • Intra-sectoral distribution of resources allocated to health (as % for hospitals/primary health care centres, doctors/nurses)

  • Distribution of government expenditure between preventive and curative care (%)

Basic agro-ecological and sustainable environment indicators

These are given as examples. There are of course many others which would obviously need to be adapted to the specific context of the country or region under consideration.

TABLE 23
Agro-ecology and sustainable environment

INDICATORS

USED BY

Physical environment

  • Arable land per person (in hectares)

FIVIMS

  • Ratio of total population (or agricultural population)/arable land

  • Cultivated area as % of arable land

FIVIMS

  • Carrying capacity of arable land

FIVIMS

  • National monthly rainfall index, and annual rainfall

FIVIMS

  • Number of months of drought per year

  • % of population affected by drought and natural disasters

FIVIMS

  • Deforested areas as % of total land area

MDG7

  • Mangrove areas

Environmental management

  • Change in land use

FIVIMS

  • % of change in forested land areas in the past 10 years

  • Rate of deforestation

FIVIMS

  • Tree density outside forest

FIVIMS

  • Degree of soil erosion

  • Severely degraded land as % of arable land

FIVIMS

  • Protected land area as % of arable land

  • Total human induced soil degradation

FIVIMS
CFS

  • Degree of overgrazing

  • Area protected to maintain biodiversity

MDG7

  • Energy use in agriculture

FIVIMS

  • Intensity of freshwater use from renewable internal sources

FIVIMS

  • GDP per unit of energy use (in kg of oil equivalent)

MDG7

  • Carbon dioxide emission per person

MDG7

  • Urban air pollution



[14] For a more exhaustive presentation of indicators of this type and their use, see: UNICEF, 1997.
[15] See the references: WHO, 1991, and WHO & UNICEF, 1993. An extensive study has recently been carried out by a research group (see IFPRI, 2003) regarding potential indicators of complementary feeding of infants; some of them are presented in this chapter.
[16] See http://www.unicef.org/programme/breastfeeding/baby.htm
[17] See the UNESCO (www.unesco.org) and OECD (www.oecd.org/statsportal/) websites.
[18] Average number of live births a woman would have had at age 50 years if she had been subjected to the current level of fertility throughout her fertile life.

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