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PERFACE
The reason that caused to input an effort to prepare this book; is well illustrated
books designed to learn short period, which is explained easily way of
understanding and has simple Lessons, because to give knowledge as free for every
knowledge seeker.

So as a teacher I strong-willed to prepared this lecture note which contains seven

Units those are essential for the understanding of Demographic for health as easy
readable as possible for students, it is suitable for all departments of health
science.

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 TABLE OF CONTENTS

PERFACE...............................................................................................................IV

CHAPTER 01............................................................................................................1

INTRODUCTION DEMOGRAPHIC HEALTH......................................................1

CHAPTER 02..........................................................................................................16

TOOLS FOR DEMOGRAPHIC MEASURES;......................................................16

CHAPTER 03 POPULATION MEASUREMENT RATES....................................22

CHAPTER THREE GROWTH OF POPUALTIONS............................................36

CHAPTER 05 WORLD POPULATION GROWTH AND CURRENT TRENDS.50

CHAPTER 06..........................................................................................................59

HEALTH DEMOGRAPHY....................................................................................59

CHAPTER 07..........................................................................................................69

EDUCATIONAL AND ECONOMIC CHARACTERISTICS...............................69

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 CHAPTER 01
INTRODUCTION DEMOGRAPHIC HEALTH
DEFINITION: DEMOGRAPHY

In language “Demos” means people and graph means shape or description. So

demography is the science that studies human population from different
aspects. Demography is very important for health planning, recruitment and
allocation of resources.

STATISTICAL DEFINITION:

Demography is the scientific study of the human population including its

size , distribution , composition and factors that determine changes in its
size distribution and its composition.

OTHER DEFINITION

The study of populations, especially with reference to size and density,

fertility, mortality, growth, age distribution, migration, and vital statistics
and the integration of all these with social and economic conditions (Last)

Introduction and Basic Definitions

From definition demography focuses on five aspects :

1. Size of population ( number of persons in given area at given time ) .
2. Distribution of population ( way of population dispersed in geographic
area at given time ) .
3. Composition ( number of persons in sex , age and other demographic
categories ).
4. population dynamics (way of population change increase or decrease )
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 5. Socioeconomics determinants and consequences of population change.

TYPES OF DEMOGRAPHY

Demography is the study of a population in its static and dynamic aspects

1. Static aspects include characteristics at a point in time such as composition

by: Age ,Sex ,Race ,Marital status and Economic characteristics.
2. Dynamic aspects are: Fertility ,Mortality ,Nuptiality ,Migration and
Growth.

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DEMOGRAPHIC CHARACTERISTICS

- Ascribed characteristics: characteristics that do not essentially change ( or

change in predictable way ) in the life time of individual. Example: Age,
sex, race, year and place of birth.
- Achieved characteristics: characteristics that can be change in the life time
of individual. These characteristics fall into long list of social economic
characteristics including nativity, religion , citizenship, marital status,
educational level, school enrolment, income, labor force status and so on….

BASIC SOURCES OF DEMOGRAPHIC DATA

Demographic statistics may be viewed as failing into two main categories :

primary and secondary.

Primary statistics are most commonly gathered or aggregated at the national

level. A country may have central statistical office for that purpose. The
advantage of primary data that they are timely and may be created to meet
very specific data needed

Secondary statistics : secondary statistics may be either official or unofficial

and include wide variety of textbooks, yearbooks, periodical journals
research reports , internet work sheets and so on. The benefit of this data is
that they generally save time, efforts and cost.

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BASIC SOURCES OF DEMAGRAPHIC DATA

Demographic
Data

Vital Statistics &

Census Civil Surveys
Registration

BASIC SOURCES OF DEMOGRAPHIC DATA.

1) Census.

Census—The total process of collecting, compiling, evaluating ,analyzing,

and publishing or otherwise disseminating demographic, economic, and
social data pertaining to all persons in a country or in a well-delineated part
of a country at a specified time ( United Nation definition1998)

Essential Characteristics

 Individual enumeration
 Universal
 Simultaneous
 Periodic

Content and Types:

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 A census contains:
 Demographic data (at least age and sex)
 Economic data (e.g., occupation and income)
 Social data (e.g., education and housing)

TYPES OF CENSUS

A census can be conducted according these two basis :

1. De jure:Legal or customary attachment to an area (you are registered where

you usually reside)
2. De facto:Physical residence (you are registered where you are currently
staying/residing at the time of the census)

Censuses are universal, simultaneous and require individual enumeration, A

census can be conducted dejure, defacto or some combination

Advantages of Dejure Technique:

• It gives permanent picture of a community.

• It provides more realistic and useful statistics.

Disadvantages of Dejure Technique:

o Some persons may be omitted from the count. A household member who is
temporarily away from home may be missed from being counted unless the
enumerator makes sure that nobody is missing.
o Some may be counted twice.
o Information collected regarding persons away from home is often
incomplete or incorrect.

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Advantages of Defacto Technique :

• There is less chance for the omission of persons from the count.

Disadvantages of Defacto Technique :

o Difficult to obtain information regarding persons in transit. These are

persons who are, for example travelling and have left their area of
permanent residence but haven’t reached the area of destination during the
census day.
o It provides incorrect picture of the population in a community.
o Preparing a census is a meticulous process including many steps
o Censuses should give small area data, although coverage is not always
certain

Data Collection Procedures

Establish administrative tree (census officers, supervisors, enumerators)

a. Develop questionnaire(s)
b. Cartography
c. Define enumeration areas
d. Pretest enumeration processes
e. Design data processing system
f. Enumeration (postal with follow-up, general canvas)

Census errors

No census is perfect.

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A) Coverage error:

Errors occur when some people are inadvertently counted for more than once
and when some other people are not counted at all.

B)Error of content:

 Possible reasons of misreporting:

 Ignorance (Informants do not know requested information.)
 Vanity (Informants want to look better than reality.)
 Reluctance (None of the government’s business.)
 Special customs (as expressed, for example, in the common phenomenon
known among demographers as age heaping, or the tendency of people to
round their reported ages to even years, the nearest five years, or even the
nearest ten years.)

Census Evaluation

 Estimation of undercounts

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 Post-enumeration survey
 Demographic evaluation

Cost

 Estimates$10 per head in the U.S.

 Hence (10*300million)=?
 $1 per head in most developing countries

The cost is high, but not having the information may be more costly

Advantages

 Universal, hence small area data available

 National effort
 Provides frame for later sample surveys
 Provides population denominators

Disadvantages

 Size limits content and quality control efforts

 Cost limits frequency
 Delay between field work and results
 Sometimes politicized

2) VITAL STATISTICS / CIVIL REGISTRATION

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Vital Statistics a

Definition& purpose

Vital statistics is a legal registration, statistical recording and reporting

of the occurrence” of the Vital events” To collect data on the vital
events happening in a population (generally concerned with live
births, deaths, marriages and divorces), Help understand demographic
characteristics of different populations at different points in time

Essential characteristics

 Universality
 Continuity

Definitions and content

 Live birth
 Death
 Marriage
 Divorce

Live Birth

Live birth—Complete expulsion or extraction from its mother of a product of

conception, irrespective of the duration of pregnancy, which after such
separation, breathes or shows any other evidence of life such as beating of
the heart, pulsation of the umbilical cord, or definite movement of voluntary
muscles, whether or not the umbilical cord has been cut or the placenta is
attached; each product of such a birth is considered live-born

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All live-born infants should be registered and counted as such irrespective of
gestational age or whether alive or dead at time of registration, and if they
die at any time following birth they should also be registered and counted as
deaths. (Source: WHO)

Live Birth Registration

The United Nations recommends that the following be collected at a minimum

for live birth registration:

Data on event

 Date of occurrence
 Date of registration
 Place of occurrence
 Type of birth/delivery
 Attendance at birth

Data on infant:

 Sex
 Legitimacy status
 Weight at birth

Data on mother:

 Age or date of birth

 Number of previous children born alive
 Date of marriage or duration of marriage
 Place of usual residence

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DEATH REGISTRATION

Death—Permanent disappearance of all evidence of life at any time after live

birth has taken place (post-natal cessation of vital functions without
capability of resuscitation). This definition excludes fetal deaths

Fetal Death

Fetal Death—Death prior to the complete expulsion or extraction from its

mother of a product of conception, irrespective of the duration of pregnancy

The death is indicated by the fact that after such separation the fetus does not
breathe or show any other evidence of life, such as beating of the heart,
pulsation of the umbilical cord, or definite movement of voluntary muscles

Fetal Death Categories

Three major categories of fetal deaths recommended by WHO:

 Early fetal death: < 20 completed weeks of gestation (Miscarriage)

 Intermediate fetal death: ≥ 20 but < 28 weeks (Abortion)
 Late fetal death: ≥ 28 weeks (Still Birth)

Stillbirth

Stillbirth—Late fetal death

To be used only if essential for national purposes

Death Registration

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The United Nations recommends that the following be collected at the
minimum for death registration

Data on event:

 Date of occurrence
 Date of registration
 Place of occurrence
 Cause of death
 Certifier

Data on decedent:

 Age or date of birth

 Sex
 Marital status
 Occupation
 Place of usual residence

MARRIAGE REGISTRATION

Marriage—Ceremony or process by which the legal relationship of husband

and wife is constituted, The legality of the union may be established by
civil, religious, or other means as recognized by the laws of each country.
(Source: United Nations). The United Nations recommends that the
following be collected at a minimum for marriage registration:

Data on event

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 Date of occurrence
 Date of registration
 Place of occurrence
 Type of marriage—civil, religious, customary

Data on bride and groom

 Age or date of birth

 Previous marital status
 Place of usual residence

Divorce Registration

Divorce—Final legal dissolution of a marriage, that is, that separation of

husband and wife which confers on the parties the right to remarriage under
civil, religious and/or other provisions, according to the laws of each
country.

Civil Registration

Civil registration is continuous and universal (it should give small area data)

The cost is high, but not having the information may be more costly

There are advantages and disadvantages to the system and its completeness
varies widely between countries and continents

- Notes: Registration is said to be virtually complete when at least 90 percent

of the events occurring each year are recorded.

Number of Countries with Virtually Complete Civil Registration by Vital

Event and by Continent.
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 Continents Frequency
Africa 37
Asia 23
North America 35
South America 13
Europe 37
Total 165

Advantages

 Continuous monitoring of vital rates

 Small area data available
 Base for testing the accuracy of censuses and surveys

Disadvantages

 Uncertain coverage: Difficult to ensure registration of all the events

 Limited background information
 Information may come from third party
 Easily disrupted by political/economic events
 Costly

SAMPLE SURVEYS

A sample survey is another source of demographic data carried out in a

scientifically selected area which covers only a section or portion (sample)
of the population under consideration.

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As countries have began increasingly to formulate population policies as part
of their development programs, especially since 1970; so they have required
more data about their populations.

Demographic surveys have become increasingly Important as a comparatively

rapid method of obtaining such information.

It was recognized that the quality of demographic data available for the
developing world was poor and the need for better data both for scientific
study and for policy application is also recognized.

EXERCISE

1. What is Demography?

2. Name and explain the different sources of demographic data?

3. State the steps that should be followed to undertake a population census.

4. Explain the advantages and limitations of sample surveys.

5. What are advantages and disadvantages of the census Techniques..?

CHAPTER 02
TOOLS FOR DEMOGRAPHIC MEASURES

TOOLS OF DEMOGRAPHY

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1. Count.

The absolute number of a population or any demographic event occurring in

a specified time period (for example, 1,228,000 live births in Japan in 1990).

The raw quantities of demographic events are the basis of all other statistical

refinements and analyses.

2. Rates.

The frequency of demographic events in a population in a specified time

period (for example, birth rate: 17.6 live births per 1,000 population in Cuba

in 1989). Rates tell how frequently an event is occurring -- how common it

is. Crude rates are rates computed for an entire population. 

Specific rates are rates computed for a specific subgroup, usually the

population at risk of having the event occur (for example, general fertility

rate; births per 1,000 women ages 15-49 years). Thus, rates can be age-

specific, sex-specific, race-specific, occupation-specific, and so on.

3. Ratio. The relation of one population subgroup to another subgroup in the

same population; that is, one subgroup divided by another (for example, sex

ratio: 102 males per 100 females in Turkey in 1989).

4. Proportion. The relation of a population subgroup to the entire population;

that is, a population subgroup divided by the entire population (for example,

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 the proportion urban: 26.7 percent of the population of India was classified

as urban in 1989).

5. Constant. An unchanging, arbitrary number (for example, 100 or 1,000 or

100,000) by which rates, ratios, or proportions can be multiplied to express

these measures in more understandable fashion. For example, 0.0176 live

births per person occurred in Cuba in 1989. Multiplying this rate by a

constant (1,000) gives the same statistic in terms of 1,000 people. This is a

clearer way of expressing the same thing: There were 17.6 births per 1,000

population. Most rates are expressed "per 1,000 population." In the

demographic formulas, "K" means constant.

6. Cohort Measures. Statistics that measure events occurring to a cohort -- a

group of people sharing a common demographic experience who are

observed through time. The most commonly used cohort is the birth cohort

-- people born in the same year or period. Other kinds of cohorts include

marriage cohorts and school class cohorts.

7. Period Measures. Statistics that measure events occurring to all or part of a

population during one period of time -- "taking a snapshot" of a population,

in effect (for example, the death rate of the entire Canadian population in

1990).

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1. RATE

Number of events of a specific type in a given time period divided by number of

people at risk. Occurrence / Exposure

Population at risk : population that could potentially experience that type of event
in the given time period.

The population at risk is approximated by ‘person years of exposure’ or most

conviently ‘mid year population’

When a rate is applied to a certain time period(duration):

When an interval is greater than one year, we evaluate exposure in terms of person
years of risk

Time should always be included.

Person years

Persons at risk * # of years spent in interval; example.10 people at risk for 1 year
= 10 person years of risk (5 people × 5 years = 25 person years)

PY is rarely directly observed /counted & normally use mid-year population

TYPES OF DEMOGRAPHIC RATES

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Types of rates: The rates can be Crude rates and Specific rates

Crude Rates are actually observed rates based on the entire population and are
not reflective of any specific population group such as only females or any
specific age group. Example: Crude Birth Rates and Crude Death Rates.

Specific Rates: Specific Rates are actual observed rates based on specific
population group such as sex wise groups, age wise groups and disease wise
groups or specific time periods Example: Annual Rates, Monthly Rates and
Weekly Rates.

OTHER TYPES OF CRUDE RATE

 Crude Birth Rate (CBR)

 Crude Death Rate (CDR)
 crude r (rate of growth of a population)
 Crude net migration rate 

Other specific Rate

 Age Specific Death Rates (ASDRs)

 Infant Mortality Rate (IMR)
 Neonatal Mortality Rate (NNMR)
 Cause - specific mortality rates
 Specific Fertility Rates
 Children ever born (CEB)
 Age Specific Fertility Rate (ASFR)

RATIO

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When the population at risk is unavailable, we use a ratio than a rate, Expresses the
relation of one population subgroup to another subgroup.

Ratio: x / y, Ex. Sex ratio at birth - number of male births per 100 female births

Proportion

Proportion: is type of ratio showing the relation of a population subgroup to the

entire population

x / (x + y)

PROBABILITY

A probability expresses the chance that an event will occur within a defined time
period, Is more meaningful in a cohort analysis and for a specific age or time
interval

Is similar to a rate, but their important difference is;

o The denominator is composed of all those persons in the population at

the beginning of the period of observation
o Probabilities are based on initial population

Probability

Ex. the probability of dying at age 50 in a cohort is based on the number of people
who celebrated their 50th birth day.

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Probability of getting a 2nd child among women with one child:

EXERCISE

1. What are ratios, proportions and rates? Explain their differences.

2. Distinguish the difference between Types of rate?

3. List and define the important difference between probability and rate?

CHAPTER 03
POPULATION MEASUREMENT RATES
MEASURES OF MORTALITY (DEATH)

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Mortality refers to deaths that occur within a population (reduction of population).
The incidence of death can reveal much about the living standard, the health status
of a population and the availability of health services.

Mortality (Death) rates have three essential elements:

 A population group exposed to the risk of death (denominator)

 The number of deaths occurring in that population group (numerator)
 A time period.

CRUDE RATES

A crude rate is used to describe the frequency of a demographic event across the
total population, without regard to age or sex.

The standard reference period is one year. Because the population is usually not the
same at the beginning and end of the year,

 The denominator for crude rates is the average of the population at the
beginning and end of the one year period.
 The numerator is the number of vital events (e.g., births, deaths)
observed for the total population in the specified calendar year.

CRUDE BIRTH RATE (CBR):

Crude Birth Rate (CBR): # of births per 1,000 persons in a population over a given
period of time (i.e. 1 year).

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This rate is most often used when looking at fertility, though the crude measure
does not account for important variations in population fertility such as sex ratios,
age distributions, postponement “delay” or acceleration of marriage age, all of
which can alter the way that the crude rate should be interpreted.

Example: In the town of Kolikouro, Mali, there were 5663 births. The total
population was 149,442.

The CBR is: 5663/149,442 * 1000 = 37.9

Ranges of CBR:

 Least Developed: 40.4

 Developing: 23.1
 More Developed: 11.2

CRUDE DEATH RATE (CDR)

Crude Death Rate (CDR) : # of deaths per 1,000 persons in a population over a
given period of time (i.e. 1 year). CDR is calculated in the same way as for CBR,
but with deaths instead of births as the numerator.

CDR = Total number of deaths in a year/Mid-year population X 1000

Ranges of CDR:

 Least Developed: 14.9

 Developing: 7.8
 More Developed: 10.2

SPECIFIC RATES

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Specific Rates: As noted above, population events, particularly vital events such as
births or deaths, do not affect people in all age groups in the same way.

The numerators for specific rates are the numbers of events observed in a one year
period for the denominator population, namely the total population in the requisite
five year age group at the beginning of the observation year.

SPECIFIC MORTALITY RATES

Specific Mortality Rates – Mortality rates that distinguish between different age
groups help to inform public health practitioners about different kinds of health
concerns. Very high death rates among children under 1 year of age may require a
very different intervention than would very high death rates among adults over 70
years of age.

If unfavorable changes in the crude mortality rate alone is used to gauge the health
of a population, than important differentiations and programmatic responses would
be impossible.

AGE SPECIFIC DEATH RATES (ASDRS)

Age Specific Death Rates (ASDRs)- In describing population phenomenon like

mortality, rates are often calculated for specific age groups of the population to
gain a more sophisticated picture of how the population is changing over time.

This is especially important for gauging the efficacy of health interventions that are
targeted at specific segments of the population such as children or the elderly. They
are usually expressed per 1000 persons.

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Age Specific Death Rates are the number of deaths experienced in a single year by
the specific age and sex group at risk for those deaths. The population at risk is
assessed as the mid-year population. The formula is as follows:

D i, j /  P i, j * 1000  where

 D = deaths
 P = population
 i = age group
 j = sex

Example: In 1997-99, in a neighborhood in Dar es Salaam, Tanzania, there were

an average of 29 deaths for males 5-9 years of age and 39 for females 5-9 years of
age. At this time there were 11,525 males and 11,657 females. The ASDR for the
5-9 year old cohort are calculated as follows:

ASDR 5-9, M = 29/11525 * 1000 = 2.5

ASDR 5-9, F = 39/11657 * 1000 = 3.3

Examples of Age Specific Death Rates:

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INFANT MORTALITY RATE (IMR):

Infant Mortality Rate (IMR): Infant mortality is the annual number of infant deaths
among infants under the age of 1 year divided by the mid-year population of all
infants under the age of 1 year. However, because mid-year population is only
available in certain countries and only for those years in which a census takes
place, the most commonly used formula is as follows:

[# deaths of infants <1 yr. in the current year] /[# live births in the previous year] *
1,000

Example: In 1995, Niger had 548,000 births. In 1996 the country registered
74,528 deaths to children under age 1. The IMR is estimated as:

(74,528/548,000) * 1000 = 136.

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The IMR is the most widely used indicators of population health. Because an
infant’s death is reflective of the mother’s well-being and nutritional status during
pregnancy, the child’s nutritional status after birth and the child’s lack of protection
against preventable, infectious diseases, a high IMR is an indirect measure of poor
overall health and poor levels of living.

Range of IMR:

 Least Developed: 102

 Developing: 56
 More Developed: 8

Neonatal Mortality Rate (NNMR):

Neonatal Mortality Rate (NNMR): Neonatal mortality is defined as the annual

number of neonatal deaths among infants under the age of 28 days divided by the
mid-year population of all infants under the age of 28 days. However, because mid-

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year population is only available in certain countries and only for those years in
which a census takes place,

The most commonly used formula is as follows:

NNMR is very often underestimated, as neonatal deaths may go unreported,

particularly if the birth was never reported or the death occurs in the period before
the child’s naming or baptism.

Range of NNMR:

Developing:

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  Very low Birth weight (<1500 g): 500-900 if <1000g, 120-500 if
1000-1500g
 Low Birth weight (1500-2500g): 20 – 150
 Normal (>2500 g) : 2 – 10
 More Developed (US): 4.7
 White 3.8
 Black 9.4
 Hispanic 3.8
 Very low Birth weight (<1500 g : 300 if <1000 g, 20-60 if 1000-
1500g
 Low Birth weight (1500-2500g): 10-35
 Normal (>2500 g): 3-18

CAUSE - SPECIFIC MORTALITY RATES

Cause - specific mortality rates are the number of deaths attributable to a specific
disease in a given population over a given time period (usually expressed per
100,000 persons per year).

For example, if among a population of 100 people, 3 people died of measles, the
cause specific mortality would be as follows:

3 measles deaths/ 100 population * 100,000 or 300 measles deaths per

100,000 population

This rate is most frequently used to study the relative mortality effects of specific
diseases/causes of death among a population of interest.

MEASURE OF FERTILITY

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Fertility is the reproductive performance of an individual, a couple, a group or a
population. It is meant the actual bearing of children. Some demographers prefer to
use natality in place of fertility.

Fertility leads to increase of population. It differs from fecundity – which refers to

the physiological capability of a woman to reproduce. A woman’s reproductive
period is roughly 15 – 49 years of age.

Total Fertility Rate (TFR)

Total Fertility Rate (TFR)- The total fertility rate of a population is a synthetic

fertility rate, indicating the total number of children a woman is expected to bear
during her reproductive lifetime. It is calculated by adding together the age specific
fertility rates for women of each age from 15-44.

If using five year age groups for the ASFRs, the TFR is calculated by multiplying
the sum by 5, to factor in the five years of exposure in each age group.

TFR = ∑i ASFR * 5. 

Where i = 5 year age cohort, for ages 15-44.

TFR = Sum of all Age specific fertility rates multiplied by age Interval (Usually
5).

Ranges will be:

 More Developed Countries = 1.5 children per woman

 Less developed countries = 3.1 Children per woman
 Africa = 5.2. Children per woman
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  Sub – Sahara Africa = 5.6 Children per woman

GENERAL FERTILITY RATE (GFR)

The General Fertility Rate is the number of live births per 1000 females aged 15-
49 years (fertile age group) in a given year.

The GFR in more sensitive measure of fertility than the CBR, since it refers to the
age and sex group capable of giving birth (females 15-49 years of age).

GFR = Number of live births in a year/Number of females 15-49 years of age X

1000

GROSS REPRODUCTION RATE (GRR)

The Gross Reproduction Rate is the average number of daughters that would be
born to a woman throughout her lifetime or child bearing age (15-49 years), if she
were to pass through all her child bearing age.

This rate is like the TFR except that it counts only daughters and literally measures
“reproduction”; a woman reproducing herself by having a daughter.

The GRR is calculated by multiplying the TFR by the proportion of female births
(Sex Ratio at birth).

GRR = TFR X Female births/Male + Female births.

Example: - The sex ratio at birth of Ethiopia (2001) = 100.6 (i.e 100.6 males for
every 100 females) and the TFR (2001) = 5.9 (5.9 children per women)

 GRR = TFR X proportion of female births

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  GRR = 5.9 X 100 /200.6 = 2.94
 = 2.9 daughters /woman

CRUDE R (RATE OF GROWTH OF A POPULATION)

Crude r (rate of growth of a population) – Among locales where an estimate of the

total population is available each year, estimating the growth of a population
requires little more than dividing the change in population at the end of the year by
the population at the beginning of the year.

However, for most settings, vital statistics are collected during censuses only every
few years.

For these cases, we can estimate the average yearly population growth using the
following formula, and solving for r.

Pt = P0 * ert

Where:

Pt: is the population # at the last year for which there is data

P0: is the population # at the first year for which there is data

e: is the natural logarithmic constant

r is the unknown annual rate of growth

t is the number of years between Pt and P0

Example: In 1950, the population in thousands for the Dominican Republic was
2,353. In 2000 (50 years later), it was 8,353. The rate of growth is estimated as
follows:
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 8353 = 2353*e **r(50)

8353/2353 = e** r(50)

Take logs and re-arrange, to:

(ln 8353 – ln 2353 ) /50 = r

r = 2.54

Ranges of r:

 Least Developed: 2.50%

 Developing: 1.48%
 More Developed: 0.30%

CRUDE NET MIGRATION RATE

Crude net migration rate – This rate illustrates the change in the population as it is
affected by people moving in and out of a country or other specified locale.

To calculate this rate, one would need to know both the number of people that
immigrated to (moved into) a country or the designated district/subnational area
and the number of people that emigrated from (moved out of) a country or the
designated district/subnational area.

Then the crude net migration rate can be calculated using the following formula:

Crude net migration rate = I – E / P * 1,000

where:

 I is the number of immigrants or in-migrants

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  E is the number of emigrants or out-migrants
 P is the total midyear population of the country or designated area.

Example: In 2002, a central African nation had 8,320 immigrants and 7249
emigrants, according to their international arrivals and departure statistics. The
total population (June 2002) was estimated as 1,258,000.

The NMR is (8,320-7249)/1258000 * 1000 = 0.85

Accurate and complete data on immigrants and emigrants is very difficult to

obtain. Immigrants may be incompletely observed because countries may keep
track of airplane arrivals, but seldom of all arrivals. Further, they may only note
permanent resident visas, and not the conversion of visitors to residents. Forced
immigrants may only include those requesting asylum, and not all forced migrants.

There also are problems with the reporting of emigrants. Few governments know
when people have left permanently, and they may only track departures by mode of
transport (air, bus, car).

Interpretation of the NMR is also problematic, as a low figure can result from low
levels of movement or from high counterbalanced in and out flows. For this reason,
it is generally preferred to calculate two separate crude migration rates:

 Crude In-migration rate (I/P * 1000) and

 Crude Out-Migration rate (E/P * 1000).

Ranges of NMR:

 Least Developed: 0.2

 Developing: -0.5
 More Developed: 1.8
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EXERCISE

1. Distinguish the difference between natality, fertility and fecundity?

2. List and define the important demographic measures of fertility and
mortality?
3. Exercise on Fertility & Mortality
- A survey was conducted in town “X” in September 2003. It revealed a total
population of 389,000 (196,500 males and 192,500 females). Total number
of children born alive during the previous year was 16,400. The survey has
also recorded a total of 5835 deaths (3200 meals and 2635 females) during
the same year. The survey has also identified the following deaths among the
population.
 􀂾 Children < 1 month = 370
 􀂾 Children 1 month - 11 months =1100
 􀂾 Children 1 year – 4 years = 1865
 􀂾 Children 5 – 4 years = 800
 􀂾 Persons 15 – 49 years = 700
 􀂾 Previous 50 years and above = 1000
 􀂾 Death of mothers during pregnancy and child birth =130
Questions

- Based on the above data provided and tables 1and2, calculate the following
measures of fertility and mortality. If there no date available to calculate any
one of the following measures of fertility or mortality your answer has to be
“Data no avaible”.
1. Crude Birth Rate

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 2. Crude Death Rate
3. General Fertility Rate
4. Infant Mortality Rate
5. Neonatal Morality Rate
6. Post Neonatal Rate
7. Sex Ratio at Birth
8. Under five morality Rate
9. Sex Specific Mortality Rate for Females
10.Sex specific Mortality Rate for Males
11.Maternal Mortality Rate
12.Total Fertility Rate
13.Gross Reproductive Rate

CHAPTER THREE
GROWTH OF POPUALTIONS
INTRODUCTION

If we assume that the number of individuals entering a population (immigration),

equals the number of leaving (emigration), population growth is the result of the
increase of births over deaths. This relationship is summarized by a formula known
as the balancing equation. It is expressed as:

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 P2 = P1 + ( B – D) + ( I + E)

Where:-

 P2 = Size of population for the year under consideration

 P1 = Size of population in the preceding year
 B = Number of births between the two dates
 D = Number of deaths between the two date.
 I = Number of immigrants in the time under consideration (between
P2 and P1)
 E = Number of emigrants in the time under consideration (between P2
and P1)

The differences between births and deaths in a population produces the Natural
Increase (or Decrease) of a population. The rate of Natural Population increase
is the rate at which a population is increasing (or decreasing) in a given year due to
excess (or deficit) of births over deaths expressed as percentage of the base
population.

RNI = Births – Deaths/Total Population X 100

OR

Birth Rate - Death Rats/10

Net Migration: is the difference between the numbers of persons entering a

geographic area (Immigrants) and those leaving the area (emigrants).

TOTAL POPULATION GROWTH RATE

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It is the rate at which a population is increasing (or decreasing) in a given year due
to natural increase and net migration expressed as a percentage of the base
population.

1. REASONS FOR POPULATION GROWTH

Thomas Malthus, (1766-1834), English clergyman and economist in his “essay,

“The Principles of Population”, hypothesised that there is relationship between
economic development and population growth. He claimed that population was
increasing faster than food production, and he feared eventual global starvation.

Malthus was criticized that he could not foresee how modern technology would
increase food production, and that he considered people only as consumers, but
they are also producers, since “with every mouth God sends a pair of hands”.
However, his observations how populations increase and his arguments are
important when there are fixed resources such as land, energy resources, etc.

He suggested that populations tend to grow in geometric progression

(Exponential), doubling in size every 'n' years depending on the population growth
rate; while food supplies can at best grow in arithmetic progression.

- Geometric Progression:- A series of ordered numbers is said to be in

geometric progression if the proportion of any two adjacent numbers is the
same. e.g. 3, 9, 27, 81 ……………..; or 1, 2, 4, 8, ……….. etc.

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Population size over a period of years is said to follow a geometrical pattern of
growth, if the change within a particular year is proportional to the population size
at the beginning of that year.

- Arithmetic progression:- a series of figures is said to be in arithmetic

progression, when the difference between any two adjacent figures is the
same.

e.g. 3, 5, 7, 9, 11,…………; or 1. 2, 3, 4, …….. etc.

Population size over a period of years is said to be in arithmetic progression, if the

size changes by a constant amount each year.

- The doubling time of a population is the number of years it would take for
a population to double in size if the present rate of growth remained
unchanged. Its purpose has been to emphasize how quickly populations can
grow, doubling their numbers geometrically. Doubling time cannot be used
to project future population size because it assumes a constant growth rate
over decades, where as growth rates do change over time.

To calculate doubling time, divide the number 70 (actually 69.3 for better
accuracy) by the population growth rate expressed in percent.

Doubling Time = _______70_________

Population Growth Rate

Malthus said that if the growth of population exceeds that of food, preventive
checks such as continence (self resistance in refraining from sexual intercourse)
and delayed marriage must be introduced; or Positive Checks, such as starvation
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or famine, disease and war will plague the society. He grouped these checks under
the heading of "Misery “sadness” and vices".

2. POPULATION GROWTH FORMS

Populations have characteristic patterns of increase which are called Population

Growth Forms. There are two patterns of population growth forms.

A. EXPONENTIAL GROWTH FORM (J - SHAPED GROWTH CURVE)

In this growth form density increases rapidly in exponential or compound interest

fashion, when there is no environmental restrictions; and then stops abruptly as
environmental resistance or other limits of resources become effective more or less
suddenly. This resistance is the carrying capacity, the upper level beyond which
no major increase can occur (K).

B. Sigmoid Growth Form (S - Shaped)

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In this growth form the population increases slowly at first (establishment or
positive acceleration), then increases more rapidly (perhaps approaching a
logarithmic phase), but soon it slows down gradually as the environmental
resistance increases percentage wise (the negative acceleration phase), until a
more or less equilibrium level is reached and maintained that is the carrying
capacity, showing more or less an S – shaped curve.

Carrying Capacity
Population

Growth

Time

Fig. 3.2: Sigmoid Growth Curve (S- shaped)

3. POPULATION DYNAMICS

Definition: Population dynamics is the study of the changes in population size and
structure over time

MAJOR FACTORS IN POPULATION DYNAMICS

Three major factors or variables determine the population of a defined area and its
growth over time. There are:

1. Births (Fertility)
2. Deaths (Mortality)
3. Migration

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 i. immigration (in migration)
ii. emigration (out migration)

The balance among these three factors determines whether a population increases,
remains stationary, or decreases in number. The relation between births and deaths
is referred to as Natural Population Increase (Natural Population Growth).

When the net effect of migration is added to natural increase, this is referred to as
Total Increase (Total Growth).

4. POPULATION STRUCTURE (COMPOSITION)

Aside from the total size, the most important demographic characteristic of a
population is its population structure.

Population structure refers to the composition of the population in terms of Age,

sex, occupation, religion, educational status, geographical distribution, socio–
economic status etc. The structure of a population is influenced or affected by
births, deaths and migration and their predisposing factors.

The age – sex structure determines potential for future growth of specific age
groups, as well as the total population. For these reasons the age structure has
significant government policy implications. A population of young people needs a
sufficient number of schools and later, enough jobs to accommodate “put up”
them.

Countries with a large proportion of older people must develop retirement systems
and medical facilities to serve them. Therefore, as a population ages needs change
from child care schools and jobs to jobs, housing, and medical care.

5. POPULATION PYRAMID
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The age–sex structure of a country can be studied through population pyramids.
Population pyramids show pictorially (graphically) the effects of the three factors
that influence population. The overall shape of the pyramid indicates the potential
for future growth.

Population pyramids present the population of an area or country interms of its

composition by age and sex at a point in time. The series of horizontal bars in a
pyramid represent the percentage contribution of each age and sex groups (often of
five years age group interval) in the population.

One can easily see whether a population is young or old. By convention males are
shown on the left and females on the right of the pyramid. Young persons at the
bottom and the elderly at the top.

The ratio or percentage of the various age groups in a population determines the
current reproductive status of the population and indicate what may be expected in
the future.

The shape of the pyramid reflects the major influences on births and deaths, plus
any change due to migration over three or four generations proceeding the date of
the pyramid.

The following four representations of population age – sex structure provide an

overall example of what a pyramid for different levels of population growth would
look like – rapid growth, slow growth, zero growth and negative growth (Fig
3.3).

a. A pyramid with a Broad Base

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This indicates a high percentage of young population. Rapid population growth.
The low survivorship and high natality of human population in many developing
countries result in a pyramidal stable age - structure, in which most of the
population is young.

b. A Bell shaped Polygon:- This indicates a moderate proportion of young to old

Population. Slow population growth.

c. A Rectangular Polygon:- In a more developed countries high survivorship and

low natality produce populations with an almost rectangular, stable age structure in
which all age groups are equally abundant. Zero population growth.

d. An Urn - shaped Figure: This type of shape indicates a low percentage of

young Population, which is characteristic of a declining Population. Negative
population growth.

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6. THE ECOLOGICAL AGES

The ecological age include:

- Pre - reproductive - Population less than 15 year old

- Reproductive - Reproductive age groups (15 – 49 years)
- Post reproductive - Elderly people (> 49 years - females)

A stationary population will have a more even distribution of all age classes. A
rapidly expanding population will usually contain large proportion of young

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individuals. A declining population will contain a large proportion of old
individuals and a small proportion of young individuals.

7. TYPE OF POPULATIONS

Population s may be categorized into four major groups depending on their state of
expansion:

a. TYPE I - EXPANSIVE

This is characteristic of traditional poor countries indicated by:-

i. High Fertility

ii. High Morality

iii. High proportion of children (young age)

iv. Moderate Growth Rate.

b. TYPE II - EXPANSIVE

Includes modern, less developed countries characterised by:-

i. High Fertility

ii. Declining Mortality

iii. High Growth Rate

iv. Very young population

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c. TYPE III - STATIONARY

This includes contemporary developed countries characterised by:-

i. Declining Fertility

ii. Declining Mortality

iii. Moderate Growth Rate

iv. Aging population

d. TYPE IV - CONSTRICTIVE

These are future developed countries characterised by:-

i. Low fertility

ii. Low Mortality

iii. Ceasing Growth Rate

iv. Very old Population

8. THEORY OF DEMOGRAPHIC TRANSITION

Demographic transition is the historical shift of birth and death rates from high to
low levels in a population; a term used to describe the major demographic trends of
the past centuries.

The change in populations basically consists of a shift from an equilibrium

condition of high birth and death rates, characteristic of agrarian societies to a
newer equilibrium in which both birth and death rates are at much lower level.

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The period of transition, at least in Western Europe, was initiated by a drop in
death rates that was followed some years later by a fall in birth rates.

The intermediate period was one of a rapid population growth (population

explosion). The period of transition is described by four major stages.

STAGE ONE

Agrarian civilizations (primitive stage) are characterised by stable or slowly

growing populations with crude birth rates greater than 45 per 1000 and crude
death rates greater than 35 per 1000 births.

Agricultural existence favours large families. However high birth rates are
balanced by high death rates from diseases famine, war etc resulting in very low
population growth.

STAGE TWO

Advances in sanitation and improved availability and quality of food, water, and
shelter lead to fall in death rate and an increase in life expectancy. This has usually
occurred without an immediate change in birth rate;

however, the improved conditions of life may favour an increase in fertility. During
this period, a marked excess of births over deaths developed leading to a rapid
expansion of population.

STAGE THREE

Characterized by falling growth Rates. After a time, birth rates tend to fall,
largely as a reflection of industrialisation and consequent urbanisation. With
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industrialization people tend to migrate from rural to urban areas. Urban living not
only breaks the traditional patterns but also creates incentives for having small
families. Living quarters are cramped, children being a financial liability rather
than asset.

There is a grater need for cash, since food and clothing can no longer be produced
at home. For these reasons husbands and wives are encouraged to seek work
outside the home for wages.

These various factors increase the likelihood that contraceptive practices will be
adopted. In some places abortion has been included in the measures available for
the control of fertility.

This stage is a situation in which birth rates and death rates are again essentially in
balance, but at a lower level as compared with those of the primitive first stage,
when both

crude birth rate and crude death rate are in the surrounding area of less than 20 per
1000 and 10 per thousand respectively.

STAGE FOUR

This stage is reached in highly developed societies when both birth and death rates
are low and population growth rates are zero or even negative.

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EXERCISE

1. Define the following demographic terms Natural population increase,

Progression, Population doubling time, Population Dynamics.

2. Discuss the hypothesis of Thomas Malthus on Population Growth.

3. Explain the differences between the Exponential Growth Form and the sigmoid
Growth Form of populations.

4. What is the demographic transition and why was population growth so slow
during the first stages of the transition.

5. How can the Age-sex structure of a population determine the needs of that
population?

6. What does it mean to have a “young” or “old” population?

7. A population structure of District “A” is indicated in table

3.1. Draw a population pyramid of District “A” based on the table and identify
what type of pyramid it is.

8. Figure 3.5. Shows population growth through Natural Increase, 1775–2000.

a. What were the levels of birth and death rates in less developed countries and in
more developed countries in 1775?

b. Describe how the birth and death rates in the less developed and more developed
countries changed from 1775 to 1995?

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 CHAPTER 05
WORLD POPULATION GROWTH
AND CURRENT TRENDS
INTRODUCTION

Anthropologists believe, that human species dates back at least 3 million years. For
most of our history these distant ancestors lived a precarious existence as hunters
and gatherers. This way of life kept their total numbers small probably less than 10
million. However, as agriculture was introduced, communities evolved that could
support more people.

World population expanded to about 300 million by A.D. 1 and continued to grow
at a moderate rate. But after the start of the Industrial Revolution in the 18th
century, living standards rose and widespread famines and epidemics diminished in
some regions. Population growth accelerated.

The population climbed to about 760 million in 1750, reached 1 billion around
1800, and 6 billion by the end of the twentieth century

World population accelerated after world war II, when the population of less
developed countries began to increase dramatically.

After million of years of extremely slow growth, the human population indeed
grew explosively, doubling again and again; a billion people were added between
1960 and 1975; another billion were added between 1975 and 1987.

Throughout the 20th century each additional billion has been obtained in a shorter
period of time. July 11, 1987 was designated as the day on which world population
reached 5000 million- ‘a day to celebrate’, ‘a day to contemplate’. October 12 ,
1999 was also celebrated in which the population reached 6000 million.

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It is estimated that population numbers had grown to 1000 million around 1800,
and by 1900 the total was 1,700 million. By the end of the 1st half of the 20th
century the figure was 2500 mill, and less than 40 years later had reached 5000
million, a huge figure in the context of the history of the world population growth.

By 2000 the number has grown to 6,100 million. Human population entered the
20th century with 1.6 billion people and left the century with 6.1 billion people.

The history of the world population growth can be divided into 2 periods. For most
of the time that human beings have inhabited the planet, population has grown very
slowly indeed.

The pace of growth began to increase from around the beginning of the 18th
century, accelerating to the very rapid rates characteristic of the 2nd half of the
20th century.

WORLD POPULATION DISTRIBUTION & REGIONAL GROWTH

RATES

The rapid growth of world population, especially in the 2nd half of the 20th
century, had been accompanied by a shift of population away from the developed
regions of the world towards the developing world.

During the last two centuries most of the world’s people lived in Asia, while
relatively few lived in Latin America, North America and Oceania. Europe ranks
second to Asia, but it share is decreasing while Africa’s share is increasing.

Prior to 1800 Asia’s population represented roughly two thirds of the world total.
Europe and Africa fluctuated, each usually holding between 15% and 20% of the
world population. The remaining few people were scattered in Latin America,
North America and Oceania with Latin America having the largest number.

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By 1800, the Industrial Revolution began in Europe and its share of global
population increased. Asia maintained two thirds of the world’s people and Africa’s
share declined. Less than 5% resided in the Americas and Oceania combined.

By 1900, Asia’s share of the world population declined to about one half, while
Europe North America and Latin America grew rapidly.

In 2000, Asia’s population rose again to account for 60% of the world total.
Africa’s share increased to be equal to Europe’s portion. It current trends continue,
Asia will remain at 60% of the world total in 2050. Africa’s share will rise to about
20% and Europe’s share will drop below Latin America’s-less than 10%.

The more developed countries in Europe and North America, as well as Japan,
Australia, and New Zealand, are growing by less than one percent annually.
Population growth rates are negative in many European countries, including Russia
(-0.6%), Estonia (-0.5%), Hungary (-04%), and Ukraine (-0.4%).

If the growth rates of these countries continue to fall below zero, population size
would slowly decline.

The largest absolute growth in the world was taking place in South Asia. Up to the
year 2000, South Asia was expected to add about 33 million people a year to world
population, and then about 30 million a year to 2025. Its share of world population
will increase from 32 % in 1980 to 34 % by 2025, even though its growth rate will
have declined from 2.3. % in 1980 to 1.5 % by 2000-5 and 0.9 % by 2020-25.

On the other hand, East Asia (which includes China) experienced the largest
decline of growth rate in the 1970’s from 2.1 % in 1970 -75 to 1.2 % in 1980-85 ,
largely as a result of the dramatic decline in fertility that took place in China during
this period. This sharp decline in the growth rate in China is expected to continue

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to the end of the century and beyond, reaching to 0.1 % by 2025 in China and 0.5
% in the region.

At the other end of the spectrum, Europe is the lowest growing region of the
world. Its rate of growth has declined from 0.9 % per annum in 1960-65 to 0.3 %
in 1980-85, and is expected to fall further to 0.2 % in 2000- 5, finally achieving
near 0 growth rates of 0.04 % by 2020-25.

Africa had the highest average annual growth rate at around 3.0% in 1985-90. This
had decreased to about 2.4% by 2000, and there will be a slow decline to 1.9% by
2020-25. The population of Africa grew from 479 million in 1980 to 872 million
by 2000 and 1617 million in 2025, when it will comprise 20% of the world’s
population compared with only 9.0% in 1950 and 11.0% in 1980.

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2. Trends of Fertility

There has never been as a wide variation in child bearing patterns as exists in the
world today. Fertility (Total fertility rate) ranges from 1.2 in a number of
industrialized countries to 8.0 in Niger and 5.9 in Ethiopia (2003).

In general, fertility has increased in importance in determining population growth

as mortality has fallen to low levels, and future trends in world population growth
will be determined largely by levels of fertility.

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2.1. Ranges in Birth Rates

The wide range of birth rates within the world and the contrasts that exist within
the developing world (20 in Cuba and Singapore; 50 in sub-Saharan Africa) and
between the developing world (average birth rate of 33) and the developed world
(average rate of 16) is testimony to the variety of factors that impinge on birth
rates.

Fertility levels have traditionally been seen as closely related to development, (as
assumed in the demographic transition model), but today in the developing world
the relationship between fertility and development is less close than it was even 20-
30 years ago.

In some African countries for example, rising fertility has been observed recently
and is related to a variety of factors including changes of breast feeding and the
reduction in traditional sexual abstinence after childbearing.

2.2. Low Fertility in Developed Countries

In nearly all of Europe and some parts of East Asia and other regions, couples have
fewer than two children too few to replace themselves when they die.

If sustained overtime, such low fertility leads to population aging and population
decline. Both of these phenomena have profound economic, social and political
consequences.

2.3. Fertility Decline in the Developing World.

In the developing world, fertility has also fallen nearly everywhere, but the pace of
decline has varied greatly from one country to another. Even where fertility

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declines, populations continue to grow because large numbers of young people
(from previous decades of high fertility) move into their reproductive years.

A variety of factors affect fertility including demographic factors such as age

structure, age and type of marriage (polygamous or monogamous), infant and child
mortality rates and socio-economic factors such as education, women’s status and
employment, rural or urban residence, social development, health factors, breast
feeding, contraceptive use and abortion prevalence.

2.4. Marital fertility Decline

Fertility is declining in the developing world although there is still a wide spread of
birth -rates. The immediate reasons for the decline include increased age at
marriage, more contraception and more induced abortion.

On the other hand, changes in the age structure of the population of developing
countries as more adults survive, have tended to retard declines in the crude birth
rate.

Age of marriage, traditionally at a young age (often the early teens) in the
developing world compared with Europe, has been increasing in the past and has
changed most in Asia and least in Africa.

3. Migration

Migration is the movement of individuals or groups from one place to another

which involves permanent or semi permanent change of usual residence.

Migration is the most volatile of the basic demographic variables- quickly

reflecting changing social, economic and political circumstances; both at the
national and international level. Internal and international migration are essentially

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geared by the same forces and the majority of migrants in the world to- day are
rural dwelres moving to the towns and cities either of their own or another country.

Most people move for economic reasons, but some migrate to escape political or
religious persecution or simply to fulfil a personal dream. Some people divide the
reasons for migration into Push factors and Pull factors.

• Push factors include, widespread unemployment lack of farm land, famine

or war at home. In the 1980’s and 1990’s hundreds of thousands of Africans
were pushed out of their homelands to neighbouring countries because of
famine and civil war.

• Factors that attract migrants, pull factors, include booming economy,

favourable immigration laws, or free agricultural land in the area to which
the migrant is moving.

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 CHAPTER 06
HEALTH DEMOGRAPHY

INTRODUCTION

Health is a leading characteristic of the members of a population, akin to other

demographic and socioeconomic characteristics. It is an important correlate of
other demographic and socioeconomic characteristics as well. For example, health
statistics are often used in interpreting trends in mortality and in designing
assumptions for making projections of mortality. Moreover, health has often been
the subject of inquiry in population surveys and censuses.
Summary measures of population health are important because of the various types
of potential applications:
1. Comparing the health of one population with the health of another
population
2. Comparing the health of the same population at different points in time
3. Identifying and quantifying health inequalities within populations
4. Providing appropriate and balanced attention to the effects of nonfatal health
conditions on overall population health
5. Informing debates on priorities for health service delivery and planning
6. Informing debates on priorities for research and development in the health
sector
7. Improving professional training curricula in public health
8. Analysing the benefits of health interventions for use in cost-effectiveness
analyses.

HEALTH CONDITIONS

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Several general terms are employed to indicate a lack of good health, such as:
 Disease,
 Illness
 Health condition,
 Morbid condition.
 Disability
 Disease refers to the biophysical state of ill health, whereas
 Illness is the social experience of being sick or diseased.
 Morbidity is a broad term for any health condition.
 Disability refers to an acute or chronic condition that affects an
individual’s ability to function and carry out his or her activities.

SOURCES OF DATA FOR HEALTH STUDIES AND QUALITY OF

HEALTH STATISTICS

Health data can be obtained both from:

1- General sources for demographic data, such as censuses, vital statistics
registrations, and general sample surveys.
2- Specialized sources, such as sample surveys on health, administrative
records on health (e.g., disease registries), epidemiological studies, and
clinical trials.

CENSUSES
Periodically, population censuses have obtained information regarding conditions
that we now term sensory, physical, and mental impairments.
Does this person have any of the following long-lasting conditions?
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 a. Blindness, deafness, or a severe vision or hearing impairment?
b. A condition that substantially limits one or more basic physical activities
such as walking, climbing stairs, reaching, lifting, or carrying?
Because of a physical, mental, or emotional condition lasting 6 months or more,
does this person have any difficulty in doing any of the following activities?
a. Learning, remembering, or concentrating?
b. Dressing, bathing, or getting around inside the home?
c. (Answer if this person is 16 years old or over.)
d. Going outside the home alone to shop or visit a doctor’s office?
e. (Answer if this person is 16 years old or over.)
Working at a job or business?

VITAL STATISTICS AND ADMINISTRATIVE RECORDS

The various registration systems constituting the total vital registration system for a
country produce several sets of data directly or indirectly related to health,
including data on births and deaths, and possibly fatal losses, induced terminations
of pregnancy, the health conditions associated with these events, marriages, and
divorces.

GENERAL SAMPLE SURVEYS AND NATIONAL HEALTH SURVEYS

General sample surveys not specifically designed as health surveys, such as the
Current Population Survey and the Survey of Income and Program Participation in
the country, occasionally carry questions on health, such as;
 On work disability or functional status, to accompany the Principal
questions on labour force participation and income.

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SAMPLE SURVEYS ON HEALTH
National and local health departments, and public and private research
organizations; maintain or and preserve files on:
 Communicable, infectious and opportunistic diseases
 selected chronic conditions
 selected acute conditions
ADMINISTRATIVE RECORDS
Administrative records may be maintained as a surveillance device for health
conditions or use of health care services. Such records include
 disease registries
 health care utilization records

EPIDEMIOLOGICAL STUDIES
Epidemiological studies are concerned with the distribution of diseases, injuries,
and impairments in human populations and the possible risk factors associated with
them.
The goal is to identify the determinants of the diseases and to devise programs of
disease prevention and control. Epidemiological studies are a principal tool of
community or population medicine, which has the community as its primary object
of concern.

CLINICAL TRIALS
The purpose of clinical trials is to evaluate the efficacy of a treatment protocol for
humans compared with no treatment or an alternative treatment. Clinical trials
accompany the practice of clinical medicine, which deals with the medical care of
individuals.

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PROBLEMS WITH HEALTH DATA SOURCES
Census data, as is true of all survey data, are subject to errors of coverage and
errors of classification. The undercounting of certain groups, such as particular age
groups, some racial minorities, economically disadvantaged persons, and certain
types of households particularly affect census data.
Similarly, vital statistics and administrative records may sometimes be seriously
incomplete and inadequate in other ways, particularly in less developed countries.
Epidemiological studies have important limitations or potential limitations. They
cannot definitively prove a cause effect relation between so-called risk factors and
the disease; at best, they show a probable cause-effect relation. Risk assessment in
epidemiological studies is more likely to be valid if the association is strong (e.g.,
smoking and lung cancer) than when it is weak.

MEASURES OF HEALTH STATUS, FUNCTIONING, AND USE OF

HEALTH SERVICES

MEASURES OF HEALTH STATUS

Measures of health may be based on either subjective information on health

conditions or objective information.
For example, the percentage of respondents assessing their health as poor, fair,
good, or excellent is a commonly used subjective measure. However, many health
measures are based on respondents’ self-reports of actual health conditions, after a
diagnosis by a health professional.

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Prevalence Ratios and Incidence Rates
The measures differ also as to whether they refer to the health status of a
population group at some date or to health events occurring to an exposed
population over a year or similar period. The former are called measures of
prevalence, and the latter are called measures of incidence.
Formula: prevalence = incidence * Duration time

MEASURES OF HEALTH FUNCTIONING

There are numerous measures of health that focus on what one cannot do have
difficulty doing because of health conditions. As noted previously, a health
condition that limits functioning is termed a disability. Early measures of disability
were based on questions about limitations in performing one’s “major activity” due
to health reasons in surveys such as National Health Interview Survey.
A selected list, with only limited explication, is given here:
 Number of days of restricted activity associated with acute conditions per
100 persons per year
 Average number of days of restricted activity per episode of acute condition
in a year
 Number of days of restricted activity associated with chronic conditions per
100 persons with chronic conditions per year
 Average number of days of restricted activity associated with chronic
conditions per chronic condition in a year.

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MEASURES OF USE OF HEALTH SERVICES AND AVAILABILITY OF
SUPPORT
There are several commonly used measures of the use of health services that
provide formal support to ill persons and of kinship networks that provide informal
support to them:
 Number of physician visits per 100 persons in a year
 Number of dental visits per 100 persons in a year
 Number of hospital stays (discharges) per 100 persons in a year
 Percentage of persons aged 65 years and over who have living children
 Percentage of persons aged 50 years and over who have living parents 65
years and over
 Number of days of care delivered per week by caregivers per 100 dependent
persons
 Average number of days of care delivered per week by each caregiver
OTHER HEALTH STATUS MEASUREMENTS…….
MEASUREMENT OF REPRODUCTIVE HEALTH
Reproductive health is concerned with the health correlates of reproductive events
(i.e., conception, pregnancy, birth, and the postpartum period) and the ability to
bear healthy children and avoid pregnancy loss, to regulate fertility, and to engage
in satisfying sexual behaviour without fear of disease or unwanted pregnancy.
Reproductive health is measured by a combination of:
 Self-reports
 clinical examinations
 Laboratory analyses.
Respondents’ perceptions of what is healthy and unhealthy affect the nature and
consistency of the measures when a condition is reported.

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MEASUREMENT OF MATERNAL HEALTH
Maternal mortality is conventionally measured by the maternal mortality ratio,
representing the risk of a woman’s dying from complications of pregnancy,
childbirth, or the puerperium.
The maternal mortality ratio is now generally defined as the number of deaths due
to puerperal causes per 100,000 births. The formula is MMR = D÷B*100,000.

MEASUREMENT OF PREGNANCY LOSSES AND FETAL LOSSES

Fatal losses may be measured by the fatal loss ratio or the fatal loss rate. The fatal
loss ratio is defined as the number of fatal losses reported in a year per 1000 live
births in the same year.
FLR = L÷B*1000

MEASURES OF CONTRACEPTIVE PRACTICE

Effectiveness of contraception may be considered in three dimensions:
 Clinical effectiveness; refers to the effectiveness of a contraceptive method
under ideal conditions (i.e., when the method is used consistently and as
instructed).
 Use effectiveness; refers to the actual experience of couples using a method
in terms of periods of protection provided.
 Demographic effectiveness; refers to the effect on population growth of the
use of the method in terms of births averted. Demographic effectiveness is
more difficult to measure than use effectiveness.
Both measures of prevalence and measures of incidence figure among the many
measures of contraceptive practice.
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The more commonly used measures are noted, and then we call attention to the use
of multiple-decrement life tables for this purpose. Several measures of prevalence
are based on the number of patients served annually by the national family
planning program (i.e., covering all family planning clinics in a country).

MEASURES LINKING MORTALITY AND MORBIDITY

The initial assumptions regarding mortality and morbidity trends have been that the
two were closely related and therefore followed close trajectories over time. Thus,
if mortality declines, then morbidity also declines.
The incidence, prevalence, and duration of morbid conditions, case-fatality rates,
and the disabling effects of morbid conditions are increasingly important concerns
in the examination of population health.

MEASURES OF OVERALL HEALTH STATUS

Calculating the average of a variety of physiological biomarkers and measures of
performance at each age, such as 25 to 34, taken as standard. Because of the great
variability in the biomarkers and in the performance of individuals at given ages,
this approach has been considered futile. It should be useful, however, in showing
the general shift in health over the age scale, even if it cannot serve as a standard
for individuals.

MEASURES OF HEALTH-RELATED QUALITY OF LIFE

These measures may include such aspects of health as;
 Mental health
 Cognitive functioning
 Social functioning

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  Intimacy “Familiarity”
 Productivity
 Physical health
 Contacts with health providers
 Self-assessed health
 Self-perceived health.

HEALTH PROJECTION MODELS

Demographic factors are usually treated as exogenous, while health conditions are
generally treated as endogenous. Because health is most commonly compromised
and most costly at the older ages, it is important to carry out the computations in
considerable age detail and cover a wide range of ages.
There are a variety of models of projection procedures, not always distinguishable.
It is enumerated the following types:
1- actuarial models; tend to project selected populations (e.g., those to be
insured)
2- demographic forecasts; tend to be general-purpose projections
3- economic forecasts; a system of simultaneous linear equations links health
changes and relevant factors, and a least-squares solution is used to establish
the relationship and project health changes.
4- Epidemiological forecasts; use prevalence ratios for diseases and data from
epidemiological investigations to estimate the population impact of a disease
or health condition. Forecasts are based on longitudinal data on the
physiological status of individuals.

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 5- Health and functional forecasts; health states are antecedent to and
determine the projections of mortality. Disease risks are described as a
multivariate process of physiological change.

CHAPTER 07
EDUCATIONAL AND ECONOMIC CHARACTERISTICS

INTRODUCTION
Educational and economic characteristics are often one of the focuses of
demographic studies. The standard topics for demographers and demographic
organizations are:
 Causes and consequences of differential educational attainment
 Poverty status of the population

The demography of educational and economic characteristics is fundamentally

linked to public policy. For example policy makers rely on such demographic
information in the:

 Formation and evaluation of civil rights policies,

 Gender equity efforts
 antipoverty programs.

1- EDUCATIONAL CHARACTERISTICS

School Enrolment

Perhaps the most fundamental educational characteristic is whether an individual is

enrolled in an educational institution.

The share of individuals, especially those in younger age groups, enrolled in school
is a key indicator of a society’s level of socioeconomic advancement. In more

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developed societies, most young people are in school, while a much smaller share
of children and youth in less developed countries are enrolled in school.

Measures

Measures of school enrolment usually relate to an exact date or a very short period
of time. They may depend on either census or survey data alone or on a
combination of these data with statistics from educational systems.

Crude and General Enrolment Ratios

The first measure, the crude enrolment ratio (often mislabelled a rate), may be
expressed symbolically as

Where E = Total enrolment at all levels and ages, P = Total population

Uses and Limitations

Data on school enrolment are used to measure the extent of participation of an

area’s population in the school system, as well as the relative participation of
different segments of the population. Those involved in educational planning
utilize enrolment statistics to measure the current (or projected) trend in school
participation in both absolute and relative terms. Most uses focus on changes over
time, comparisons across groups, or comparisons across geographic units.

Quality of Data

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Enrolment data from school systems vary in quality depending on the attention
given to statistical collection and reporting systems in the country (or in some
cases, the school district) and the adequacy of the number and skills of personnel
assigned to amass the data.

Educational Progression

Measures of educational progression reflect how students move through the

educational system.

1. from preschool to elementary school

2. from elementary school to middle school
3. from middle school to high school
4. from high school to college
5. from undergraduate school to graduate school (or professional school)

2- ECONOMIC CHARACTERISTICS

Economic Activity and Employment

Economic activity is vital to every society. How people organize themselves

around productive activity and the stratification processes that are associated with
differentiation of labour are fundamental characteristics of a society.

Although all persons consume goods and services, only part of the population of a
country is engaged in producing such goods and services. Most obviously, the
youngest, the oldest, and the physically or mentally incapacitated do not engage in
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such economic activity because of an inability to do so. The manpower of a nation,
then, is the totality of persons who could produce the goods and services if there
were a demand for their labors and they desired to participate in such activity. The
economically active (sometimes also called the labor force or workforce) is that
part of the manpower that actually is working or looking for work.

The United Nations (1998) has recommended the following classification:

 Economically active population

 Employed
 Unemployed
 Not economically active population
 Students
 Homemakers
 Pension or capital income recipients

The crude economic activity ratio (conventionally called a “rate”) represents the
number of economically active persons as a percentage of the total population. It is
also referred to as the crude labor force participation ratio (“rate”) in countries
where the labor force concept is applicable.

The crude economic activity ratio is formulated as follows:

Measures

Economic measures relate to the

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  economically active population,
 the labour force, or gainful workers

Standards

1. Agriculture, Forestry, Fishing, and Hunting

2. Mining
3. Utilities
4. Construction
5. Manufacturing
6. Wholesale Trade
7. Retail Trade
8. Transportation and Warehousing
9. Information
10. Finance and Insurance
11. Real Estate and Leasing
12. Professional, Scientific, and Technical Services
13. Management of Companies and Enterprises
14. Administrative and Support and Waste Management and Remediation
Services
15. Educational Services
16. Health Care and Social Assistance
17. Arts, Entertainment, and Recreation
18. Accommodation and Food Services
19. Other Services (except Public Administration)
20. Public Administration

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