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Denominators : Comparisons using implied rates

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The video discusses the importance of validating health data by comparing indicators that contain multiple denominators, such as the crude birth rate and infant mortality rate, against other reliable sources. Since these metrics are calculated using components like live births and total population, which are also used in separate equations, cross-referencing them with external datasets provides a crucial check on data accuracy. For instance, comparing domestic routine data from systems like DHIS2 with publicly available census figures or United Nations estimates allows analysts to assess the reliability of their own inputs. When these different sources yield values that are closely aligned, it significantly boosts confidence in the underlying data, whereas large discrepancies might suggest issues with specific components or warrant a closer investigation into potential errors. Beyond static comparisons, the presenter emphasizes the value of analyzing trends over time by aligning local data with global estimates to ensure logical consistency. A prime example provided is Laos, where significant improvements in health services should logically result in a steady decline in crude birth rates over an extended period. If local data shows sudden increases or erratic fluctuations that contradict these broader global patterns and the known trajectory of service delivery, it may indicate data quality issues unless there are specific contextual factors like war or migration affecting the population. This approach helps distinguish between genuine demographic shifts caused by external factors and anomalies in the reporting system, ensuring that health systems accurately reflect the reality of service delivery. The discussion also extends to calculating annual growth rates specifically from a health perspective, focusing on changes in live births rather than total population dynamics influenced by immigration or emigration. The video explains how to compute this rate by taking the difference between consecutive years' birth counts and dividing by the previous year's figure, noting that a negative result simply indicates fewer births in the current year compared to the last. It is important to understand that such negative growth rates do not necessarily imply an error in the data; rather, they reflect scenarios where the number of live births has decreased, which could be due to various demographic reasons. By examining these annual changes, health officials can identify whether their data shows stable trends or erratic spikes and drops that require further scrutiny. In conclusion, the core message is that comparing implied rates within complex indicators against external benchmarks and global trends serves as a powerful tool for data validation. Whether checking if infant mortality rates are decreasing in line with system improvements or verifying that birth growth rates do not exhibit unexplained volatility, these comparisons help build a robust foundation for further analysis. The video illustrates that while minor differences between sources are expected and acceptable, significant deviations should prompt a review of the data collection methods or an understanding of specific local circumstances like conflict or migration. Ultimately, this rigorous cross-checking process ensures that health statistics remain accurate, reliable, and reflective of the true status of public health services in a given region.
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Okay, another example is comparing the crude birth rate with other sources. So, um in that same portal I showed you that crude birth rate was possible to obtain. You can do the same thing. Now the reason these types of of comparisons are useful is that it things like infant mortality rate um and um crude birth rate they combine multiple denominators in the indicator itself. Okay. So as an example here crude birth rate is calculated by taking the number of live births divided by our estimated population our total population right and these denominators well well this indicator consists of essentially two denominators that we would use in other equations right in other indicators a live burst is often used in many other indicators we might also use our total population in many other indicators as well okay so this can be an interesting comparison comparison to take these indicators that are made up of other denominators and compare them with other sources as well. And when you see that they are close together um once again same thing it gives you more confidence essentially um with the data that you have um when you're seeing large differences in this case we we give a bit more leeway about 20%. Okay. Uh difference I just have an example table here where we have some some values from the LAO demo. Um this is the the real population data is um that's publicly available. Um and then we have the UN data as well. Okay, that we've taken for the same periods and we can see they're very close. Okay. Um there's very little difference between them. There's some but they're very minor, right? And this gives us a lot more confidence when we think about our live birth and when we think about our estimated population um for our country, right? And and we can give this different weightings in our mind, right? Depending on what we think of the source we're comparing to um but uh you know given that we have one method where we've calculated data using our own method, our live births are from our routine data in this case, right? the data that would be inside of DHIS2 and our estimated population um would be from our census, right? And the UN estimates are completely different, right? They're just estimates of of things. Um they don't have any necessarily or as much raw data to work with necessarily depending on the country, right? But we see the values are very close and this gives us a lot more confidence um in these denominators to use in in further um analyses later on. Okay. Um, another thing we can do is compare the overall trend of your rates with just global rates that you see or globally calculated rates. So, our demo is Lao, okay? And the Lao Ministry has graciously kind of given us their their geography to use in our demos. Okay. Um, but you can see here in Lao there's been a a very steep decrease in crude birth rates over time, right? the the services are improving significantly. So, we wouldn't want to see in our own crew birth rates uh some type of increase all of a sudden, right? That's not reflected um in in the global estimate at all. And that's not maybe a reflection of the services um that are being delivered, right? We know if we zoom out, maybe there are small hiccups here or there, but if we zoom out over an extended period of time, we know that the services are significantly improving. Um so uh we wouldn't want to see a a a different trend necessarily in our own data. Now there are of course places where this is not the case unfortunately um you know places where there has uh you know things like war etc have have affected these services um and then you would maybe want to see the data closely more closely aligned um to those findings. Okay. But the whole idea is that when you're observing these global trends and you're thinking about your own services um just kind of logically you know ideally some of these implied rates should match um with these uh kind of global um global service uh global estimates to some extent. Okay. [clears throat] And and knowledge of course about your own services and how they're being delivered. Um infant mortality uh rate is another u one you could compare. um uh infant mortality rate is taken by uh taking the live births minus your surviving infants um that are less than one and dividing them by your live bursts. Now surviving infants I mentioned was a possible uh denominator for some of your indicators right it's not always used the way it should be um but uh it can be a very useful indicator to use um in many cases okay and these are the number of infants that are surviving um over a certain one-year period that are less than one right um and this could be different than your live birth as as some of those children may unfortunately um die right so so the idea here is once again to make these comparisons and it's the same kind of thought process as your crew birth rate, right? And same kind of thing. If you see that your infant mortality rate is decreasing over time, generally speaking, okay, um then this should align with with what you see in your system. Um another thing we can look at is the annual growth rate. Okay? And what we can do from a health perspective is look at the annual growth rate as a result of births. Um there's other factors that affect the growth rate, right? And we're not asking you to necessarily take those into account. So you could have immigration, people coming in, immigration, people leaving. Um you know, there are other factors here as well. We're we're purely focused on the growth rate from a kind of health perspective, health systems perspective, which is therefore looking at the bursts in this case because we would have access to live bursts for every year, right? And what we would want to see is based on this growth rate, um you know, is it erratic? Is it changing too much? Right? Are the differences in bursts from year to year causing uh large spikes or increases or large decreases? Okay? and what's the overall trend here? Um, and then I'll go through some examples of how we calculate this essentially. Okay, but the whole idea is once again you're looking for erratic kind of differences, large differences, whether they're increases or decreases. Um, couple notes on growth rate. You can have a negative growth rate, right? And what this means is you have less less births in the next year compared to the previous year. This means that just as a result of bursts at least um your population would be decreasing. But there could be other factors um where the that that mean your population is not decreasing necessarily. Um of course people coming into the country through other means um as well could increase could increase that rate. Okay. But uh a negative growth rate is not incorrect necessarily. Okay. It just means that uh your your um population is decreasing based on Barcelona. Okay, here's an example and we'll walk through uh an example um of how to calculate this. So if I wanted to calculate in this example the growth rate for 2024, okay, I would take the number of live births in 2024. I would minus the number of live births in 2023. I would divide this by the live births in 2023, okay, and times it by 100%. In this case, I have a negative growth rate. You can see here my number of live births is less in 2024 when compared to 2023. And that's why I have a negative rate. Okay? Doesn't mean it's wrong. It just is the scenario um in the country. Okay?