Table 4 List of recommended core indicators and their definitions
Indicator name | Indicator definition | Indicator classification | Service level for measurement | Numerator | Denominator | Proposed disaggregation | Proposed data source | Proposed measurement method | Proposed measurement frequency |
|---|---|---|---|---|---|---|---|---|---|
1.Institutional Child Mortality Rate | # of pre-discharge child deaths per 1000 children who visited the health facility | Impact | Inpatient | # of children who died in the health facility before discharge (Includes deaths in the emergency ward but does not include children who died upon arrival at the hospital, child deaths during outpatient visits, and institutional neonatal deaths) | # of children who visited the health facility for medical care during reporting period | •Major causes of death •Sex •Types of inpatient facilities •Age groups (0–7 days, 8–27, 28–59 days, 60 days- < 1 year, 1- < 5 y, 5- < 10, 10- < 15 y) •Death within and after 24 h of admission | Routine HMISa | Review of paediatric ward register or patient medical records, paediatric death audit and triangulation of information if possible | Monthly |
2.In-hospital paediatric case fatality rate (by common paediatric conditions) | % of children who were diagnosed with Sepsis, Pneumonia, Malaria, Meningitis or Severe Acute Malnutrition (SAM) and died in the health facility | Outcome & impact | Inpatient | % of children who were diagnosed with Sepsis, Pneumonia, Malaria, Meningitis or SAM and died in the health facility (Includes deaths in the emergency ward but does not include children who died upon arrival at the hospital, child deaths during outpatient visits, and institutional neonatal deaths) | # of children who visited the health facility and were diagnosed with Sepsis, Pneumonia, Malaria, Meningitis or SAM during reporting period | •Conditions •Levels of health facilities (e.g. secondary level) •Age groups (0–7 days, 8–27, 28–59 days, 60 days- < 1 year, 1- < 5 y, 5- < 10, 10- < 15 y) •Death within and after 24 h of admission to the facility •Sex | Routine HMIS | Review of paediatric ward register or patient medical records, paediatric death audit and triangulation of information if possible | Monthly |
3.Essential IMNCIb assessment for the sick child | % of sick < 5 children who were assessed in the health facility based on key IMNCI assessment criteria | Process / Output | Inpatient & Outpatient | # of sick < 5 children who were assessed based on key IMNCI assessment criteriac | # of sick < 5 children who visited the health facility during the reporting period | •Facility type (e.g. health center) •IMNCI assessment components •Sex •Age (0—< 2 month, 2 month—< 5 years) | Patient medical records | Review of medical records, periodic health facility assessments, quality-of-care assessments, etc | Monthly |
4.Treatment of PSBId at outpatient level | % of young infants classified as having PSBI or signs of PSBI, or very severe disease or sepsis—who were prescribed appropriate antibiotics according to WHO guidelines | Process / Output | Outpatient | # of young infants (< 2 months of age) classified as having PSBI or any child with related signs or very severe disease or sepsis, who were prescribed appropriate antibiotics according to WHO guidelines | # of sick young infants (< 2 months of age) classified as having PSBI or any child with related signs or very severe disease or sepsis who visited health facility during reporting period | •Sex •Weight cutoffs (< 2000 g, ≥ 2000 g) | Patient medical records | Review of medical records, periodic health facility assessments, quality-of-care assessments, etc | Monthly |
5.KMCe initiation for infants weighing 2000 g or less | % of infants initiated on KMC | Process / Output | Inpatient & Outpatient | # of infants weighing 2000 g or less who were initiated on KMC | # of infants weighing 2000 g or less who were born in or presented to the health facility during the reporting period | •Facility type (e.g. health center) •Sex •Weight (≤ 1500 g and 1500—< 2000 g) •Immediate/non-immediate | Routine HMIS | Review of ward registers or patient medical records | Monthly |
6.Pneumonia treatment with 1st choice antibiotic | % of children aged between 7 days and 5 years who were prescribed amoxicillin for treatment of pneumonia | Process / Output | Inpatient & Outpatient | # of children aged between 7 days and 5 years who were diagnosed with pneumonia or showed signs of fast breathing and/or chest indrawing and were prescribed oral amoxicillin | # of children aged between 7 days and 5 years seen in the same health facility and period with pneumonia or fast breathing and/or chest indrawing who visited the health facility during the reporting period | •Sex •Facility type •Age (7–59 days, 2 month—< 5 years) | Routine HMIS | Review of ward registers or patient medical records | Monthly |
7.Management of acute watery diarrhea among children < 5 years old | % of children < 5 years diagnosed with acute watery diarrhea in a health facility who received appropriate treatment for diarrhea | Process / Output | Inpatient & Outpatient | # of children < 5 years who were diagnosed with acute watery diarrhea and received ORS and Zinc supplementation (if 2 months- < 5 years) | # of children < 5 years old with diagnosis of acute watery diarrhea who visited health facility during the reporting period | •Age (0–59 days, 2 months- < 5 years) •Sex •Facility type | Routine HMIS | Review of ward registers or patient medical records | Monthly |
8.Paediatric malaria diagnostic testing rate in malaria endemic areasf | % of children < 15 years old in malaria endemic areas who presented to the health facility with fever and their malaria test results are available | Process / Output | Inpatient & Outpatient | # of children < 15 years old in malaria endemic areas who presented to the health facility with fever for whom malaria test results are available (results from microscopy or malaria Rapid Diagnostic Test) | # of children < 15 years old in malaria endemic areas who visited health facility with fever during reporting period | •Facility type •Sex •Diagnosis •Age (< 5 years old, 5- < 10 years old, 10—< 15 years old) | Routine HMIS | Review of ward registers or patient medical records | Monthly |
9.Treatment of uncomplicated SAMg | % of children aged between 6 months and 5 years with uncomplicated SAM who were treated according to WHO guidelines | Process / Output | Outpatient | # of children aged between 6 month and 5 years with uncomplicated SAM who received oral amoxicillin and RUTFh | # of children aged between 6 month and 5 years diagnosed with uncomplicated SAM who visited health facility during reporting period | •Sex | Routine HMIS | Review of ward registers or patient medical records | Monthly |
10.Management of anemia | % of children aged between 2 months up to 15 years with anemia who were treated according to WHO guidelines | Process / Output | Inpatient & Outpatient | # of children aged between 2 months and 15 years diagnosed with who received the correct prescription for anemia according to WHO guidelinesi | # of children aged between 2 months and 15 years diagnosed with anemia who visited health facility during reporting period | •Sex •Age groups (< 1 year, 1—< 5, 5—< 15) | Routine HMIS | Review of ward registers or patient medical records | Monthly |
11.HIV testing for the mother and/or the child (in high HIV prevalence settings) | % of children < 2 years old for whom the HIV status of the mother and/or the child are known | Process / Output | Inpatient & Outpatient | # of children < 2 years old for whom the HIV status of the mother and/or the child are known (positive or negative) | # of children < 2 years old who visited the health facility during reporting period | •Sex of the child •Mother or child | Routine HMIS | Review of ward registers or patient medical records | Monthly |
12.TB evaluation for children with presumptive TB | % of children < 15 years eligible for TB screening, who were referred or further assessed for TB | Process / Output | Inpatient & Outpatient | # of children who reported a cough duration > 14 days or were diagnosed with SAM or had confirmed HIV infection, who were referred or further assessed for TB | # of children with SAM or confirmed HIV infection or cough duration > 14 days who visited health facility during reporting period | •Sex •Age groups (< 1 year, 1—< 5, 5—< 15) | Routine HMIS | Review of ward registers or patient medical records | Monthly |
13.Missed-Opportunity for vaccination (MOV) | % of children < 2 years of age eligible for DTP-Hep-B-HIB, IPV, RTV, PCV or Measles-containing vaccine, who were administered all catch up immunization during medical visits | Process / Output | Inpatient & Outpatient | # of children < 2 years of age eligible for DTP-Hep-B-HIB, IPV, RTV, PCV and Measles-containing vaccine (unvaccinated or partially vaccinated with these vaccines according to their age and national immunization schedule) who were administered all catch up immunization with DTP-Hep-B-HIB, IPV or Measles-containing vaccines during medical visits | # of children < 2 years of age eligible for DTP-Hep-B-HIB, IPV, RTV, PCV and Measles-containing vaccine (unvaccinated or partially vaccinated with these vaccines according to their age and national immunization schedule) who received medical care in the health facility during reporting period | •Sex •Age (< 1 year, 1- < 2 years) •By antigens | Routine HMIS | RHIS, facility registry, medical record review, caregiver exit interview or observation with concurrent review of child’s vaccination card | Monthly |
14.Inappropriate use of antibiotic for cough or cold | % of children with only cough or cold to whom an antibiotic was prescribed | Process | Inpatient & Outpatient | # of children in a health facility with only cough or cold or any of the following unspecified RTI diagnosis (No pneumonia, RTI, URTI) and no comorbidity requiring antibiotic treatment (E.g., Pneumonia, Severe Pneumonia, SAM, Very Severe Disease, Sepsis, Meningitis, Dysentery, Cholera, HIV +) to whom an antibiotic was prescribed | # of children with only cough or cold or any of the following unspecified RTI diagnosis (No pneumonia, RTI, URTI) and no comorbidity requiring antibiotic treatment (E.g., Pneumonia, Severe Pneumonia, SAM, Very Severe Disease, Sepsis, Meningitis, Dysentery, Cholera, HIV +) who visited health facility during reporting period | •Facility types •Sex •Diagnosis | Routine HMIS | Review of ward registers or patient medical records | Monthly |
15.Completion of medical documentation | % of medical records of children who received care in the health facility during the reporting period with complete key patient information | Input | Inpatient & Outpatient | # of paediatric medical records (or registry entries) with complete key patient information (patient demographics (age, sex), assessment findings, classification / diagnosis, treatment, counselling, and care outcomes) | # of paediatric medical records (or registry entries) of children < 15 years who visited health facility during reporting period | •Service level (inpatient, outpatient) | Facility registry or medical records | Facility registry or medical record review | Monthly |
16.Paediatric QoC indicator review | % of health facilities that have conducted monthly paediatric QoC indicator data review during the last 3 months | Process / Output | Inpatient & Outpatient | # of health facilities that have conducted monthly QoC indicator data review during the last 3 months | # of facilities assessed during the reporting period | •Type of health facilities | Survey | Periodic health facility survey: review of facility documentation | Quarterly |
17.Patient knowledge and understanding of their condition and treatment plan | % of children < 15 years old (or their caregivers) who can describe the child’s condition and how to take the treatment at home | Process / Output | Inpatient & Outpatient | # of children < 15 years old (or their caregivers) who can describe the child’s condition and how to take the treatment at home | # of children (or their caregivers) who were discharged from the health facility and were interviewed during reporting period | •Child vs caregiver •Service level (inpatient, outpatient) •Type of health facility | Survey or interview records | Client Exit interview | Quarterly |
18.Satisfaction with decision-making process for care | % of children < 15 years old (or their caregivers) who are satisfied with the decision-making process for care | Outcome (patient-reported) | Inpatient & Outpatient | # of children < 15 years old (or their caregivers) who reported being satisfied with the decision-making process for care | # of children < 15 years old who received care or their caregivers who were interviewed in health facility during reporting period | •Type of health facilities •Child vs caregiver •Age of child •Health condition | Survey or interview records | Facility Survey, of client exit interviews | Quarterly |
19.Pre-discharge counselling on danger signs and feeding during illness | % of caregivers of children < 5 years who are aware of the danger signs for pediatric illness, when to seek care and how to feed their children during the illness | Process / Output | Inpatient & Outpatient | # of caregivers of children < 5 years who reported being aware of the danger signs of their children, when to seek care and how to feed their children during the illness (e.g. giving extra fluids and continue feeding) | # of caregivers of children < 5 years who received care and were interviewed in health facility during reporting period | •Type of health facility | Facility Survey, of client exit interviews | Periodic health facility survey: review of facility documentation | Quarterly |
20.Awareness of child rights during health care | % of children < 15 years old (or their caregivers) who reported being adequately informed about their rights to care | Process / Output | Inpatient & Outpatient | # of children < 15 years old (or their caregivers) who reported being adequately informed about their rights to care (e.g. free treatment, medication, food, bedding, room-in etc.) | # of children < 15 years old (or their caregivers) who received care and were interviewed in health facility during reporting period | •Age < 2 months, 2- < 5 years, 5- < 15 years, •Type of health facility | Facility Survey, of client exit interviews | Periodic health facility survey: review of facility documentation | Quarterly |
21.Disrespectful care for the child or caregiver | % of children < 15 years old (or their caregivers) who reported being mistreated during care | Outcome (patient-reported) | Inpatient & Outpatient | # of children < 15 years old (or their caregivers) who reported being mistreated during care (Includes those who felt that they were being yelled at or screamed at (verbal abuse), or were hit, or pinched (physical abuse) | # of children < 15 years old (or their caregivers) who received care and were interviewed in health facility during reporting period | •Age < 5 years, 5- < 15 years •Type of health facility •Type of mistreatment •Child vs caregiver | Survey or interview records | Facility Survey, of client exit interviews | Quarterly |
22.Accompaniment during care | % of children < 15 years old whose caregivers were able to stay with them during minor medical procedures | Process/ output | Inpatient & Outpatient | # of children < 15 years old whose caregivers were able to stay with them during medical procedures | # of children < 15 years old (or their caregivers) who received care and were interviewed in health facility during reporting period | •Type of health facility | Survey or interview records | Periodic health facility survey: | Quarterly |
23.Access to play and educational material during hospitalization | % of childrenj (or their caregivers) who reported that the child was able to play and access educational materials during hospitalization | Input | Inpatient | # of children (or their caregivers) who reported that the child was able to play and access educational material during hospitalization | # of children treated as inpatient or their caregiver who were interviewed in health facility during reporting period | •Age 5- < 10, 10- < 15 years •Type of health facility | Survey or interview records | Periodic health facility survey | Quarterly |
24.Clinical mentorship or training | % of health workers providing care for children who received clinical mentorship or training in the past 6 months | Input | Inpatient & Outpatient | # of childcare providers who had reported interactions with professional mentors or participated in continuous professional development to ensure clinical competence and improve performance in the past 6 months | # of childcare providers working in the health facility who were interviewed during reporting period | •Provider cadre, •Facility type | Provider interviews | Facility Survey: Provider interviews | Quarterly |
25.Stock out of essential child health medicines | # of days in the past 3 months when there were stock outs of at least 3 essential children medicines | Input | Inpatient & Outpatient | Total number of days with stock outs of at least threek or more essential medicines. For outpatient facilities, essential medicines include: 19 medications; for inpatient facilities, essential medications include 9 additional essential medications | N/A | •Types of medications, •Inpatient/outpatient | Inventory review or facility-in charge interview | Inventory | Quarterly |