chp400: community health program - li mohamed m. b. alnoor kjbkbkljbklb

CHP400:Community Health Program - lI

Mohamed M. B. Alnoor

KJBKBKLJBKLB

D E M O G R A P H Y

Definition

Demography is the science that studies human population.

Demography: The study of populations, especially with reference to size and density, fertility, mortality, growth, age distribution, migration, and vital statistics, and the interaction of all these with social and economic conditions. (Oxford Dictionary)

D E M O G R A P H Y

Three main elements :1- Size of population (census) 2- Composition 3- Distribution

Elements of Demography:

D E M O G R A P H Y

Size of population

Census Estimated population

Number of all persons in the community.


D E M O G R A P H Y

CensusA process of enumeration of all persons in the community.

• Time: 10 Years

• Procedures: Enumeration Demographic Socioeconomic

• Inter-census years: Estimation


D E M O G R A P H Y

CensusTypes

1- De Jure Counting individuals at their legal

residence regardless of their physical presence.

• Factual• Expensive


D E M O G R A P H Y

Census

• Easier• Economic

2- De Facto Counting individuals wherever they

actually are on day of census. regardless of their physical presence.

Types


D E M O G R A P H Y

EstimationMethods

1- Natural increase

(Number of live births – Number of deaths) added to last census population.

(No migration in or out.)


D E M O G R A P H Y

EstimationMethods

2- Arithmetic mean

Two consecutive censusesMean annual increaseExample:1410: 30000, 1420: 40000 Annual increase = 10000/10 =1000

(9 X 1000)

1429 = 4900040000

+


D E M O G R A P H Y

EstimationMethods

3- Geometric method

Most accurateSpecial equation


(compound interest formula)

D E M O G R A P H Y


Compound Interest Formula

P = principal amount (the initial amount you borrow or deposit)

r = annual rate of interest (as a decimal)t = number of years the amount is deposited or borrowed for.A = amount of money accumulated after n years, including interest. n = number of times the interest is compounded per

year

EstimationMethods

3- Geometric method

Methods

Methods

D E M O G R A P H Y

Population (total) 27,163,977

Saudi 18.707.576

Males 9,527,173 (50.9%)

Females 9,180,403 (49.1%)

Non-Saudi 8,429,401

Males 5,932,974 (70.4%)

Females 2,496,427 (29.6%)

Last Saudi Census data (2010/1431

)

D E M O G R A P H Y

THE AGE-SEX COMPOSTION OF POPULATIONS

Saudi Population Pyramid ( 2006)

Age and sex distribution for the year 2000:

D E M O G R A P H Y

Population pyramid is the graphical presentation of the

age and sex composition of a population of an area

or country at a point in time.

The shape of the pyramid reflects the major influences

of births and deaths, in addition to any changes due

to migration.

Population Pyramid

D E M O G R A P H Y

Sex Males are shown on the left side of the pyramid Females on the right

Age young persons at the bottom, and the elderly at the top.

The pyramid consists of a series of bars, each drawn proportionately to represent the percentage contribution of each age - sex group

(often in five-year groupings) to the total population The total area of the bars represents 100 per cent of the

population.

Population Pyramid

D E M O G R A P H Y


1.Sex ratio: Percentage of males and females.

2.Age structure: Base denotes births (broad or narrow base) Apex denotes elderly

3.Mortality and emigration:

Shape of sides (sloping or steep).

4.Life expectancy: (Average number of years that a newborn is expected to live if current mortality rates continue to apply)

Height of the pyramid and shape of the apex.

The importance of the population pyramids

D E M O G R A P H Y


5.Median Age: (lower or higher)

The point in the vertical axis of age through which passes

the horizontal line that divides the surface area of the

pyramid into two equal parts (50%) younger and 50%

older).

The position of this defined point is inversely related to the

width of the base.

The wider the base, (i.e. the higher the birth rate), the lower

the median age and vice versa.

Population Pyramid The importance of the population pyramids

D E M O G R A P H Y


6.Dependency Ratio

The dependency ratio describes the relation between

the potentially self-supporting portion of the

population and

the dependent portions at the extreme of age (below

15 and above 65).


D E M O G R A P H Y

THE AGE-SEX COMPOSTION OF POPULATIONSTypes of Dependency Ratio

Young dependency: Proportion of population below 15 years of age.

Old dependency: Proportion of population above 65 years of age.

Total dependency: Proportion of population below 15 years of age plus the proportion of population above 65 years of age.


D E M O G R A P H Y

Population 15 – 64years

Types of Dependency Ratio

Old dependency ratio

Total dependency ratio

Population above 65 years

Population below 15 yearsYoung dependency ratio =

=

=

X 100

X 100

X 100



Population below 15 years + those above 65 years


D E M O G R A P H Y

How can you calculate the dependency ratio.

Use the figures below to calculate the dependency ratio for Britain in 1990.

0 - 14 = 11.052 million 15 - 64 = 37.690 million 65 + = 9.156 million

Young dep=0.29 Old dep=0.24 Total dep=0.53


D E M O G R A P H Y

Use the figures below to calculate the dependency ratio for Egypt in 1990.

0 - 14 = 22.04 million 15 - 64 = 32.66 million 65 + = 1.99 million

Young dep=0.67 Old dep=0.06 Total dep=0.73


D E M O G R A P H Y

1. List factors affecting Population Dynamics

2. Define and Calculate Fertility rates

3. Define and calculate Mortality Rates

4. Define and mention types of migration

By the end of this lecture you will be able to:

ObjectivesPopulation Dynamics

D E M O G R A P H Y

Factors affecting population Dynamics

Fertility (births),

Mortality (deaths)

Migration.

Population Dynamics

D E M O G R A P H Y

Population DynamicsFactors affecting population Dynamics

Crude Birth Rate (CBR)

General Fertility Rate (GFR)

Age Specific Fertility Rate

Total Fertility Rate (TFR)

Gross Reproduction Rate (GRR)

Fertility (Natality Rates)

D E M O G R A P H Y


Crude Birth Rate (CBR)Fertility (Natality Rates)

Is the simplest indicator of fertility. It is defined as: the number of live births per 1000 mid-

year population in a given year and locality.

CBR=Total number of live births in a certain year and localityEstimated midyear population ( same year and locality)

X 1000

D E M O G R A P H Y


Fertility (Natality Rates)Crude Birth Rate (CBR)

ExampleIn a certain Country in Year 2000,live births: 325,000; population: 13,000,000

Crude birth rate= 325,000/13,000,000 x 1000= 25 live births per 1000 population per

year

=… Live Births/ 1000 population in a year.

CBR=Total number of live births in a certain year and localityEstimated midyear population ( same year and locality)

X 1000

D E M O G R A P H Y


Fertility (Natality Rates)General Fertility Rate (GFR)

= …Live birth/1000 female population aged 15-49.

The number of live births in a calendar year, divided by the number of women in the child bearing ages 15-49 at mid year, multiplied by 1000

GFR=Total number of live births in a certain year and localityMidyear reproductive female population( aged 15 - 49)

X 1000

D E M O G R A P H Y


Fertility (Natality Rates)General Fertility Rate (GFR)

ExampleIn a certain Country in Year 2000, Number of live births: 325,000; Number of women 15 – 49 : 2,600,000

Calculate GFR

General fertility rate= 325,000 /2,600,000 x 1000= 125 live births per 1000 women ages 15-49 per

year

GFR=Total number of live births in a certain year and localityMidyear reproductive female population(aged 15 - 49)

X 1000

D E M O G R A P H Y


Fertility (Natality Rates)Age Specific Fertility Rate

= …Live births/1000 female population in specified age group.

Total number of live births born by mothers in a specific age group in a certain year and locality

Female population in the same specific age group

X 1000 =

D E M O G R A P H Y


Fertility (Natality Rates)Age Specific Fertility Rate

Adolescent fertility rate It is the age-specific fertility rate for women aged 15-19. The annual number of births to women aged 15-19

years per 1,000 women in that age group.

= …Live births/1000 females in 15-19 age group.

Calculation of ASFR is important because early pregnancy is related to higher risks of maternal and infant mortality

Total number of live births born by mothers (15-19) age group in a certain year and

localityFemale population in the (15-19) age group

X 1000 =

D E M O G R A P H Y


Fertility (Natality Rates)Total Fertility Rate (TFR)

TFR represents the average number of births that would be born to a woman throughout her reproductive period.

It is expressed as children per woman. In Saudi Arabia, Total fertility rate (per

woman) 3.5 (2006)• In developing countries the TFR is over

6.0 children per woman. • In most developed countries the TFR is

under 2.0.

D E M O G R A P H Y


Fertility (Natality Rates)Gross Reproduction Rate (GRR) GRR represents the average number of female births that would be born to a woman throughout her reproductive period.

It is expressed as daughters per woman.

It predicts the fertility of the next generation

D E M O G R A P H Y


Mortality Rates

A mortality rate is a measure of the

frequency

of occurrence of death in a defined population

during a specified period of time.

D E M O G R A P H Y


Mortality RatesCrude Death Rate (CDR)

The crude death rate is the mortality rate from all causes of death for an entire population

1000Xlocality)andyear(SamepopulationyearmidEstimated

localityandyearcertainaindeathsofnumberTotal

RateDeathCrude

= … Deaths/1000 individual in the specified year and locality.

D E M O G R A P H Y


Mortality RatesCrude Death Rate (CDR)

Example

In a certain Country in Year 2000,Total population: 13,000,000;Deaths: 65,000Crude Death Rate = 65,000/13,000,000 x

1000= 5 deaths per 1000 per year

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates

An age-specific mortality rate is a mortality rate limited to a particular age group.

• The numerator is the number of deaths in that age group• The denominator is the number of persons in that age group

in the population. Examples of age-specific mortality rates are infant, neonatal,

post-neonatal and under 5-years mortality rates.

1000

area same andyear same in the

group age same in thenumber Total

area andyear certain a and age

certain ain dying persons ofNumber

ratedeath specific Age x

D E M O G R A P H Y



ExampleIn a certain Country in Year 2000,For age group: 25-34 yrs: population = 5,000,000; and

deaths = 20,000 within same age groupAge-specific death rate=20,000/5,000,000 x 1000= 4 deaths per 1000 population of the age group 25-34 per year

1000

area same andyear same in the

group age same in thenumber Total

area andyear certain a and age

certain ain dying persons ofNumber

ratedeath specific Age x

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Infant Mortality Rate (per 1 000 live births)

Infant mortality rate is the probability of a child born in a specific year or period dying before reaching the age of one

• Both sexes 21.0

• Females 20.0 • Males 22.0In Saudi Arabia (2006)

Total number of deaths from zero up to less than one year

during a year in a given localityTotal number of live births

in the same year and locality

Infant Mortality Rate X 1000=

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Infant Mortality Rate

In a certain Country in Year 2000,Number of live births: 325,000; infant deaths: 2,750

Infant Mortality Rate = 2,750/325,000 x 1000= 8.5 infant deaths per 1000 live births per year

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Infant Mortality Rate

Infant deaths per 1000 live births

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Neonatal Mortality Rate (per 1 000 live births)

The number of deaths of neonates (infants <28 days of age) in a calendar year, divided by number of live births in that year, multiplied by 1000.

In Saudi Arabia (2004): Neonatal Mortality Rate =11 /1000 live births

Total number of deaths from zero up to less than 28 days

during a year in a given localityTotal number of live births


Neonatal Mortality Rate X 1000=

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Neonatal Mortality Rate

In a certain Country in Year 2000, Number of deaths at <28 days:2,250; number of live births: 325,000Calculate Neonatal mortality rate?

Neonatal mortality rate= 2,250/325,000x1000= 6.9 neonatal deaths per 1000 live births

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Neonatal Mortality Rate

Causes of Neonatal mortality

Birth defects (the 1st leading cause ) Prematurity / low birth weight (LBW)

(the 2nd leading) Sudden infant death syndrome. Maternal pregnancy complications. Respiratory distress syndrome

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Post - neonatal Mortality Rate (per 1 000 live births)

Post-neonatal mortality rate is the number of deaths

among infants from 28 days up to 1 year of age

during a a year divided by the number of live births

during the same a year multiplied by 1,000

Total number of deaths from 28 days up to less than one year during a year in a given locality

Total number of live births in the same year and locality

Post - neonatal Mortality Rate X 1000=

D E M O G R A P H Y



NeonatalNeonatal Post-NeonatalPost-Neonatal

28 day(0 day) 1yearBirth

I n f a n c yI n f a n c y

NeonatalEarly

NeonatalLate

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Still birth Ratio (per 1 000 live births)

Number of fetal deaths of > 28 weeks

gestation in certain year and locality per

1000 live birthsNumber of foetal deaths from > 28 weeks of gestation in a year and in a given locality

Number of live births in the same year and locality

Still birth Ratio X 1000=

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Still birth Ratio

In a certain Country in Year 2000,Still births: 1,520; live births: 325,000

Still births ratio = 1,520/325,000 x 1000= 4.69 fetal deaths per 1000 live births

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Still birth Rate (per 1 000 total births)

Number of still birth during a year and in a given locality

Total birth (live births + still birth) in the same year and locality

Still birth Rate X 1000=

For international comparison purposes, stillbirths are defined as third trimester fetal deaths (> 1000 grams or > 28 weeks).

Total births : Total births is defined as the sum of live births and still births.

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Still birth Rate (per 1 000 total births)

In a certain Country in Year 2000,Still births: 1,520;live births: 325,000

Still births rate = 1,520 /(325,000+ 1,520) x 1000= 4.66 fetal deaths per 1000 total births

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Causes of Still birth

Placental problems.: Placental abruption due to pre-eclampsia and smokingsmoking.

Defects: between 5 and 10 percent of stillborn babies have chromosomal abnormalities.

Growth restriction: Small for gestational age. Infections. Bacterial infections occur between 24

and 27 weeks of gestation. They are an important cause of fetal deaths.

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Perinatal Mortality Rate (per 1 000 total births)

It is expressed as the sum number of still births and

early neonatal deaths (less than 7 days of life) per

1000 total births (still births plus live births).No. of still birth + No. of early neonatal deaths

in a year and in a given locality

Total birth (live births + still birth) in the same year and locality

PMR = X 1000

It is the best indicator of MCH services

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Perinatal Mortality Rate (per 1 000 total births)

In a certain Country in Year 2000,Still birth (Fetal deaths):1,520; early neonatal deaths: 1,925;live births: 325,000Perinatal mortality rate=(1,520 + 1,925)/(325000+1,520) x 1000

= 10.6 perinatal deaths per 1000 Total births

D E M O G R A P H Y


Mortality RatesAge-specific Mortality Rates Under - 5 Mortality Rate (per 1 000 live births)

Under-five mortality rate is the probability of a child born in a specific year dying before reaching the age of five.

In KSA (2006): deaths per 1 000 live births: • both sexes

26 • female 23 • male 28

Total number of deaths among children under-5 years of age

during a year and in a given localityThe under – 5

mortality Rate X 1000=


D E M O G R A P H Y


Mortality RatesCurrent Situation

Each year nearly 11 million children die before the age of five, 30,000 every day, largely from preventable causes.largely from preventable causes.

41% of these deaths occur in Africa, which has only 10 % of the world’s under-five population.

33% of all child deaths occur in the first month of life.

Under - 5 Mortality

D E M O G R A P H Y


Mortality RatesMaternal Mortality Ratio (per 100 000 live births)

but not from accidental or incidental causes.

The death of a woman while pregnant or

within 42 days of end of

pregnancy

irrespective of the duration or site of pregnancyfrom any

cause • related to • or aggravated by

pregnancy or its management

D E M O G R A P H Y


Mortality RatesMaternal Mortality Ratio (per 100 000 live births) The number of maternal deaths per 100 000 live

births during a specified time period (usually 1 year). In Saudi Arabia (2005) MMR= 18/100 000 live birth

Maternal mortality ratio

Number of Maternal deaths assigned to causes related to pregnancy

in a given year and locality X 100 000=


D E M O G R A P H Y


Mortality RatesMaternal Mortality Ratio (per 100 000 live births)

Abruptio Placenta

Eclampsia

Postpartum Hemorrhage

Retained Place

nta

Hypertension in Pregnancy

Uterine Atony

Puerperal Sepsis

Placenta Previa

Rheumatic Heart Disease Amniotic Fluid Embolism

D E M O G R A P H Y


Mortality RatesMaternal Mortality Ratio (per 100 000 live births) In a certain Country in Year 2000,number of deaths due to maternal causes: 51,Number of live births: 325,000Calculate Maternal mortality ratio

Maternal mortality ratio = 51/325,000 x 100,000= 15.7maternal deaths per 100,000 live births per

year

D E M O G R A P H Y


Mortality RatesCause-specific mortality rate

The number of deaths attributed to a specific

cause divided by the population at the midpoint

of the time period multiply by 100,000.

Deaths of a specific cause in a given year and locality

Estimated mid – year populationin the same year and locality

Cause – specificMortality Rate X 100 000=

D E M O G R A P H Y



Deaths due to tuberculosis (per 100 000 population) In Saudi Arabia (2006) =5.0

No. of deaths of tuberculosisin a given year and locality

Estimated mid – year populationin the same year and locality

Specific death rate

due to tuberculosis

X 100 000=

Example of Cause-specific mortality rates

D E M O G R A P H Y



In a certain Country in Year 2000,Total population: 13,000,000; Deaths due to (cause) accidents: 5,200

Cause-specific death rate= 4,000/5,000,000 x 100,000

= 40 accidental deaths per 100,000 population per year

D E M O G R A P H Y


Mortality RatesProportionate mortality rate

Defined as the number of deaths assigned to a

specific cause in a calendar year, divided by the

total number of deaths in that year, the quotient

multiplied by 100

D E M O G R A P H Y


Mortality RatesProportionate mortality rate In a certain Country in Year 2000,total deaths from all causes: 65 000; deaths from cancer: 29 250

CancerProportionate mortality rate

= 45% of total deaths per year are from cancer

29 250/ 65 000 x 100=

D E M O G R A P H Y


Mortality RatesCase Fatality Rate

(Death to case ratio)

Case Fatality Rate ( CFR )

Total number of deaths froma certain disease

in a year in a given locality

Total number of cases having the same disease


= X 100

It reflects severity (virulence) of It reflects severity (virulence) of diseasesdiseases

D E M O G R A P H Y


Migration

Migration is the movement of populations across a

specified boundary for the purpose of residing.

Migration is the change of residence of a person or

group of persons for better life and higher

standard of living.

D E M O G R A P H Y


Migration The terms immigration and emigration are used

to refer to moves between countries (international

migration).

The parallel terms: in-migration and out-migration

are used for internal movement between

different areas within a country (internal migration).

D E M O G R A P H Y


MigrationTypes of migration Internal migration

It is the movement within the boundaries of a

given country.

Examples of internal migration:

1 - Rural - Urban migration.

2 - Movement of nomads.

3 - Movement of temporary and seasonal nature.

4 - Movement between and within urban areas.

D E M O G R A P H Y


MigrationTypes of migration

a) Permanent migration:

eg. Arabs to the U.S.A., Australia and Canada.

b) Temporary migration:

The intent is return to the motherland after few years.

e.g. Professionals and laborers to Gulf Countries.

In many countries, the effect of migration is minimal when compared to fertility and

mortality.

chp400: community health program - li mohamed m. b. alnoor kjbkbkljbklb

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