Community Health Program - lI

Community Health Program - lI
CHP400: Community Health Program - lI kjbkbkljbklb Mohamed M. B. Alnoor

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)

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

Size of population Number of all persons in the community. Census Estimated population

Census A process of enumeration of all persons in the community. Time: 10 Years Procedures: Enumeration Demographic Socioeconomic Inter-census years: Estimation Census enumeration of a population usually records identity of all persons in every place of residence, with age or birth date, sex, occupation, nationality, religion, marital status, income, educational level (or literacy). Census data is of importance for every country for planning purposes and is usually done every 10 years. The population size in inter-censal years (years between each census) is estimated from births, deaths and net migration.

Census Types 1- De Jure Counting individuals at their legal residence regardless of their physical presence. De Jure Enumeration: A de jure census assigns persons according to their usual place of residence at the time of enumeration. Expensive, more difficult and takes time. Adopted in U.S.A. Factual Expensive

Census Types 2- De Facto Counting individuals wherever they actually are on day of census. regardless of their physical presence. De Facto Enumeration: Counting all people in the locality according to their location at the time of enumeration irrespective of the person’s usual residence. De Facto census is: economic procedure and simple. But, moving people can be counted twice .It is adopted in the majority of countries. Easier Economic

Estimation Methods 1- Natural increase (Number of live births – Number of deaths) added to last census population. (No migration in or out.)

Estimation Methods 2- Arithmetic mean Two consecutive censuses Mean annual increase Example: 1410: , : Annual increase = 10000/10 =1000 1429 (9 X 1000) = 49000

Estimation Methods 3- Geometric method Most accurate Special equation (compound interest formula)

Estimation Methods 3- Geometric method 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 Methods Methods

Saudi population over the years
D E M O G R A P H Y Saudi population over the years

Last Saudi Census data (2010/1431)
D E M O G R A P H Y Last Saudi Census data (2010/1431) Population (total) 27,163,977 Saudi 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%)

THE AGE-SEX COMPOSTION OF POPULATIONS
D E M O G R A P H Y Saudi Population Pyramid ( 2006) THE AGE-SEX COMPOSTION OF POPULATIONS

Age and sex distribution for the year 2000:

D E M O G R A P H Y Population Pyramid 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 Sex Males are shown on the left side of the pyramid
D E M O G R A P H Y Population Pyramid 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.

D E M O G R A P H Y The importance of the population pyramids THE AGE-SEX COMPOSTION OF POPULATIONS 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.

D E M O G R A P H Y Population Pyramid The importance of the population pyramids THE AGE-SEX COMPOSTION OF POPULATIONS 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.

D E M O G R A P H Y Population Pyramid The importance of the population pyramids THE AGE-SEX COMPOSTION OF POPULATIONS 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 Population Pyramid The importance of the population pyramids THE AGE-SEX COMPOSTION OF POPULATIONS Types 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.

Population Pyramid The importance of the population pyramids
D E M O G R A P H Y Population Pyramid The importance of the population pyramids Types of Dependency Ratio Population below 15 years Young dependency ratio = X 100 Population 15 – 64years Population above 65 years Old dependency ratio X 100 = Population 15 – 64years Total dependency ratio Population below 15 years + those above 65 years = X 100 Population 15 – 64years

D E M O G R A P H Y Population Pyramid The importance of the population pyramids How can you calculate the dependency ratio. Use the figures below to calculate the dependency ratio for Britain in 1990. = million = million = million Young dep=0.29 Old dep=0.24 Total dep=0.53

D E M O G R A P H Y Population Pyramid The importance of the population pyramids Use the figures below to calculate the dependency ratio for Egypt in 1990. = million = million = 1.99 million Young dep=0.67 Old dep=0.06 Total dep=0.73

Population Pyramid Age structure
D E M O G R A P H Y Population Pyramid The importance of the population pyramids Age structure 0-14 years: 38.1% (male 5,469,641/female 5,258,508) 15-64 years: 59.5% (male 9,467,325/female 7,284,077) 65 years and over: 2.4% (male 355,173/female 326,693) (2008 est.)

Population Pyramid Median age total: 21.5 years male: 22.9 years
D E M O G R A P H Y Population Pyramid The importance of the population pyramids Median age total: 21.5 years male: 22.9 years female: 19.7 years (2008 est.)

Population Pyramid The importance of the population pyramids Sex ratio
D E M O G R A P H Y Population Pyramid The importance of the population pyramids Sex ratio at birth: 1.05 male(s)/female under 15 years: 1.04 male(s)/female 15-64 years: 1.3 male(s)/female 65 years and over: 1.09 male(s)/female total population: 1.19 male(s)/female (2008 est.)

Population Pyramid Life expectancy at birth
D E M O G R A P H Y Population Pyramid The importance of the population pyramids Life expectancy at birth total population: years male: years female: years (2008 est.)

Population Dynamics Objectives
D E M O G R A P H Y Population Dynamics Objectives By the end of this lecture you will be able to: List factors affecting Population Dynamics Define and Calculate Fertility rates Define and calculate Mortality Rates Define and mention types of migration

Factors affecting population Dynamics
D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Fertility (births), Mortality (deaths) Migration.

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Fertility (Natality Rates) Crude Birth Rate (CBR) General Fertility Rate (GFR) Age Specific Fertility Rate Total Fertility Rate (TFR) Gross Reproduction Rate (GRR)

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Fertility (Natality Rates) Crude Birth Rate (CBR) 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 locality X 1000 Estimated midyear population ( same year and locality)

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Fertility (Natality Rates) Crude Birth Rate (CBR) Example In a certain Country in Year 2000, live births: 325,000; population: 13,000,000 CBR= Total number of live births in a certain year and locality X 1000 Mid-year population: It is important to use the population size at the midpoint of the time interval as an estimate of the average population at risk especially if a denominator population is growing or shrinking during the period of time for which a rate is to be computed. e.g. If a birth/death rate is to be calculated for the year 2000, then the population of July 1, 2000 is used for the denominator. Estimated midyear population ( same year and locality) =… Live Births/ 1000 population in a year. Crude birth rate= 325,000/13,000,000 x 1000 = 25 live births per 1000 population per year

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Fertility (Natality Rates) General Fertility Rate (GFR) The number of live births in a calendar year, divided by the number of women in the child bearing ages at mid year, multiplied by 1000 GFR= Total number of live births in a certain year and locality X 1000 Midyear reproductive female population( aged ) = …Live birth/1000 female population aged

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Fertility (Natality Rates) General Fertility Rate (GFR) Example In a certain Country in Year 2000, Number of live births: 325,000; Number of women 15 – 49 : 2,600,000 Calculate GFR GFR= Total number of live births in a certain year and locality X 1000 Midyear reproductive female population(aged ) General fertility rate= 325,000 /2,600, x 1000 = 125 live births per 1000 women ages per year

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Fertility (Natality Rates) Age Specific Fertility Rate Total number of live births born by mothers in a specific age group in a certain year and locality = X 1000 Female population in the same specific age group = …Live births/1000 female population in specified age group.

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Fertility (Natality Rates) Age Specific Fertility Rate Adolescent fertility rate It is the age-specific fertility rate for women aged The annual number of births to women aged years per 1,000 women in that age group. Total number of live births born by mothers (15-19) age group in a certain year and locality = X 1000 Female population in the (15-19) age group = …Live births/1000 females in age group. Calculation of ASFR is important because early pregnancy is related to higher risks of maternal and infant mortality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics 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 Population Dynamics Factors affecting population Dynamics 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 Population Dynamics Factors affecting population Dynamics 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 Population Dynamics Factors affecting population Dynamics Mortality Rates Crude Death Rate (CDR) The crude death rate is the mortality rate from all causes of death for an entire population = … Deaths/1000 individual in the specified year and locality.

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Crude Death Rate (CDR) Example In a certain Country in Year 2000, Total population: 13,000,000; Deaths: 65,000 Crude 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 Population Dynamics Factors affecting population Dynamics Mortality Rates Age-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.

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Example In a certain Country in Year 2000, For age group: yrs: population = 5,000,000; and deaths = 20,000 within same age group Age-specific death rate= 20,000/5,000,000 x 1000 = 4 deaths per 1000 population of the age group per year

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Infant Mortality Rate (per 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 In Saudi Arabia (2006) Both sexes 21.0 Females 20.0 Males 22.0 Total number of deaths from zero up to less than one year during a year in a given locality Infant Mortality Rate = X 1000 Total number of live births in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-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 Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Infant Mortality Rate Infant deaths per 1000 live births

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Neonatal Mortality Rate (per 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 locality Neonatal Mortality Rate = X 1000 Total number of live births in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-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: 325,000 Calculate 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 Population Dynamics Factors affecting population Dynamics Mortality Rates Age-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 Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Post - neonatal Mortality Rate (per 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 Post - neonatal Mortality Rate = X 1000 Total number of live births in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Early Late Neonatal Neonatal Neonatal Post-Neonatal 28 day 1year Birth (0 day) I n f a n c y

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Still birth Ratio (per live births) Number of fetal deaths of > 28 weeks gestation in certain year and locality per 1000 live births Number of foetal deaths from > 28 weeks of gestation in a year and in a given locality Still birth Ratio = X 1000 Number of live births in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-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 Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Still birth Rate (per total births) 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. Number of still birth during a year and in a given locality Still birth Rate = X 1000 Total birth (live births + still birth) in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Still birth Rate (per 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 Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Causes of Still birth Placental problems.: Placental abruption due to pre- eclampsia and smoking. 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 Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Perinatal Mortality Rate (per 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 PMR = X 1000 Total birth (live births + still birth) in the same year and locality It is the best indicator of MCH services

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Perinatal Mortality Rate (per total births) In a certain Country in Year 2000, Still birth (Fetal deaths):1,520; early neonatal deaths: 1,925; live births: 325,000 Perinatal mortality rate= (1, ,925)/( ,520) x 1000 = 10.6 perinatal deaths per 1000 Total births

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Leading causes of death in children (developing cntries)

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Under - 5 Mortality Rate (per 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 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 locality The under – 5 mortality Rate = X 1000 Total number of live births in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Current Situation Under - 5 Mortality Each year nearly 11 million children die before the age of five, 30,000 every day, 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.

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Under - 5 Mortality Rate (per live births)

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Adult Mortality Rate (per population) Probability that a 15 year old person will die before reaching his/her 60th birthday. In Saudi Arabia (2006) both sexes 178 female 136 male 205 Total number of persons dying between age 15 – 60 during a year and in a given locality Adult mortality Rate = X 1000 Total number of population between 15 – 60 in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Age-specific Mortality Rates Adult Mortality Rate (per population)

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Maternal Mortality Ratio (per live births) The death of a woman while pregnant or irrespective of the duration or site of pregnancy within 42 days of end of pregnancy from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes.

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Maternal Mortality Ratio (per live births) The number of maternal deaths per live births during a specified time period (usually 1 year). In Saudi Arabia (2005) MMR= 18/ live birth Number of Maternal deaths assigned to causes related to pregnancy in a given year and locality Maternal mortality ratio = X Total number of live births in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Maternal Mortality Ratio (per live births) Abruptio Placenta Rheumatic Heart Disease Amniotic Fluid Embolism Placenta Previa Puerperal Sepsis Uterine Atony Eclampsia Hypertension in Pregnancy Postpartum Hemorrhage Retained Placenta

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Maternal Mortality Ratio (per live births) In a certain Country in Year 2000, number of deaths due to maternal causes: 51, Number of live births: 325,000 Calculate 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 Population Dynamics Factors affecting population Dynamics Mortality Rates Cause-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 Cause – specific Mortality Rate = X Estimated mid – year population in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Cause-specific mortality rate Example of Cause-specific mortality rates Deaths due to tuberculosis (per population) In Saudi Arabia (2006) =5.0 No. of deaths of tuberculosis in a given year and locality Specific death rate due to tuberculosis = X Estimated mid – year population in the same year and locality

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates Cause-specific mortality rate 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 Population Dynamics Factors affecting population Dynamics Mortality Rates Proportionate 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 Population Dynamics Factors affecting population Dynamics Mortality Rates Proportionate mortality rate In a certain Country in Year 2000, total deaths from all causes: ; deaths from cancer: Cancer Proportionate mortality rate = 29 250/ x 100 = 45% of total deaths per year are from cancer

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics Mortality Rates (Death to case ratio) Case Fatality Rate Total number of deaths from a certain disease in a year in a given locality Case Fatality Rate ( CFR ) = X 100 Total number of cases having the same disease in the same year and locality It reflects severity (virulence) of diseases

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics

D E M O G R A P H Y Population Dynamics Factors affecting population Dynamics 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 Population Dynamics Factors affecting population Dynamics The terms immigration and emigration are used to refer to moves between countries (international migration). 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 Population Dynamics Factors affecting population Dynamics Migration Types 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 Population Dynamics Factors affecting population Dynamics Migration Types 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.

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