DEMOGRAPHY

INTRODUCTION
The population on the planet earth is increasing very fast because of
declining death rate and high birth rate. The fast increasing population is
creating problems of imbalance in the ecosystem affecting socio economic
aspects and quality life. Population data are integral to the burden of disease
estimation for both denominators and consistency check. In a national
setting, a recent census is useful for providing accurate population counts by
age and sex. Demography highlights the implications and consequences of
global increase in population growth

MEANING
Demography is the scientific study of human population. It focuses its
attention on three readily observable human phenomena,
a) Changes in population size (growth or decline)
b) The composition of the population
c) The distribution of population in space

It deals with five demographic “processes” namely fertility, mortality,

marriage, migration and social mobility. These five processes are
continuously at work within a population determining size, composition and
distribution.

DEFINITION
Demography is defined as the scientific study of human population which
includes the study of changes in population size, its composition and
distribution.

Gulani .K.K, 2005

Demography is the study of human population with respect to size, type,
composition pattern and distribution.
( Prabhakara. G.N)

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DEMOGRAPHIC CONCEPTS
Stages
The worldwide history of population growth depicts changing trends in the
population size and composition due to increase / decrease in number of
births and deaths. It suggests definite stages of its growth which are as under,
1. High stationary stage: - In this stage there is no change in the size of the
population due to high birth rate & high death rate which nullify each other’s
effect. Until the middle of seventeenth century the world’s population was in
the stage. Up to 1920, India’s population was also in the stage.
2. Early expansion stage: - In this stage there is some increase in
population because death rate begins to decrease but the birth rate remains
the same. The world’s population was in this stage from middle of
seventeenth to middle of nineteenth century. Whereas India’s population was
in the stage from 1921 to 1950. Many countries in South Asia and Africa are
still in the stage. In some of these countries there is some increase in birth
rate due to improvement in health conditions and facilities.
3. Late expansion: - In this stage the birth rate begins to decline and
death rate further decreases. A number of developing countries including
India are in this stage. There is tremendous nature increase in population.
4. Low stationary: - In this stage both birth and death rates are low and
negate the effect of each other on population change. Most of the developed
and industrialized countries like UK, Sweden, Denmark, Australia, and
Belgium are in this stage.
5. Declining stage: - In this stage the birth rate is lower than the death
rate. There is negative growth in the population. Currently Germany and
Hungry are in this stage.

Factors Influencing Population Increase

There are two major factors which influence population increase. These are
decrease in deaths resulting in longevity and sustained high birth rate. It
takes about 70yrs for a nation to double its population when death rate is 10
and birth rate is 20 per annum. Its takes much more time (75 to 100yrs) to
double its population when death rate is 8 and birth rate is less than 20.
The contributing factors for increased survival at birth and longevity are
improved environmental sanitation, regular and complete immunization,
health and medical care facilities, effective pharmaceuticals, better nutrition,
occupational health, better living standard, etc.

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 The sustained high birth rate by itself is not enough for population
increase. The population increase will depend upon the survival of female
children into and trough child bearing age. It is this increased number of
female children who will increase the possibility of more children.
In addition, there are number of socio – cultural forces and incentives
which are responsible for sustained high birth rate. These factors vary in
each society but prevail in some form or the other in all societies. Bearing
children is considered as a pride and God gift, the maleness in men and
womanliness’ and sense of fulfillment in women.
In many societies like in India, male child has a very significant status and
role. Family name continues with the male member in the family. Sons are
considered parents assets in house hold management and old age security.
With the result a number of children are borne by a woman. At times in
order to have a son or more than one son, a number of unwanted daughters
are born. But with education of women and their involvement in socio-
economic developments of their families and society there is bound to be a
change in their attitude and attitude of their families and society towards
small family norms because to bring up large family is unmanageable. This
phenomenon is experienced in developed and industrialized countries and
urban areas of developing countries.

SCOPE
Demography plays a significant role in nursing. It is very important for
community health nurses to know demographic aspects of community health
nurses to know demographic aspects of their community. Population
information both static and population dynamic.
1. Information regarding population static
It will help nurses to plan and manage need based health care services for
the community at large. The following demographic information need to be
identified by them.
a. Total population: - this will help to determine the bulk of services and
the work load which health workers are going to have.
b. Age and sex composition: - this will help to analyze health needs,
mortality and morbidity pattern, utilization of health care services and
accordingly plan and manage health care services.
c. Median age and dependency ratio: - this will help to know about the
ratio of young and elderly population (dependent population) and adult

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population (productive population). This will help nurses to determine
economic burden.
d. Socio – economic characteristics: - these characteristics include
education, marital status, occupations, income, etc. This will help not only to
identify socio-economic status but also morbidity and mortality pattern and
fertility behavior. Such analysis will help nurses in effective and efficient
planning and management of health and nursing care of people at large.
e. Family size: - information regarding family size will help the nurses to
determine socio-economic burden on the family and family welfare needs of
the family. Accordingly nurses will be able to plan and manage family
welfare services.
f. Life expectancy: - Information regarding life expectancy will help her
understand and appreciate the impact of health care services on morbidity
and mortality among the people.
g. Distribution and concentration: - Distribution and concentration of
population in the community will help to identify areas where services are
needed most.

2. Information regarding population dynamic

It will help nurses to understand the changes that are taking place in the
population under the influence of fertility, mortality and migration pattern in
the community. It is there very important for nurses to find out.
a. Crude mortality rate, birth rate: - These rates will help nurses to know
natural increase in population and compute growth rate. This information
will help to appreciate the need for family welfare services.
b. Specific mortality rates: - These include age, sex, cause specific rates,
case fatality and proportional mortality rates. These specific death rates will
help them identify population growth at risk, specific causes of deaths, etc.
This information will help them plan and implement preventive and control
measures.
c. Age specific fertility rates: - this information will help nurses identify
specific age group at risk of child bearing. On the basis of this information
they can plan family welfare services for specific age groups on priority
basis.

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METHODS OF DATA COLLECTION

PURPOSES OF COLLECTION

To measure population level

To know the birth statistics
To know the death statistics
To measure the health status
To design a solution to the health problem
To assess the effectiveness of the medical and health interventions
To measure the health status of the people from time to time.

METHODS
 Census
 Registration of vital events
 Sample registration system
 Notification of diseases
 Hospital records
 Epidemiological surveillance
 Other services records
 Population survey

CENSUS: - the census contains not only demographic but also social
and economical characteristics of the people. In India census is taken in
once in 10 years. The census is usually conducted at the end of 1 quarter
of first year in each decade. The legal basis of census is provided by
census Act 1948. Census commissioner for India is responsible for this
activity.

REGISTRATION OF VITAL EVENTS: - the registration of birth and

death is legalized by as central Act 1968 and state Governments enacted
various rules under central Act for implementation. During recent time,
the registration of births and deaths has been improved in many states,
especially in urban areas. Encouraged the village health workers to
register the birth and death in their areas.

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SAMPLE REGISTRATION SYSTEM: - since the registration of births
and deaths is deficient in many places, a sample registration system was
initiated in the mid 1960s to provide reliable estimate. In SRS the births
& deaths are recorded by an “enumerator” in the sample area and it is
checked by a survey by an investigator supervisor. SRS now covers the
entire country and it is a reliable source of information system.

NOTIFICATION OF DISEASE: - the list of notifiable disease varies

from country to country. In India there are legal Acts in many states. In
Tamil Nadu, Madras public health Act 1930 provides necessary
regulation to notify the diseases. The village head man (VAO) has the
responsibility, however now at village level, health workers have this
responsibility. Since the notification cover only a small part of the total
sickness of community, its usefulness is very limited.

HOSPITAL RECORDS: - this is a record of patients, which give the

morbidity of persons who actively demand medicates at institutional
level. Inspect of the limitations, hospital limitations, hospital records
provide certain useful information like pattern of morbidity, geographic
distribution of morbidity, the peak period of morbidity etc.,

EPIDEMIOLOGICAL SURVEILLANCE: - many of the National

programmes (malaria, T.B, Leprosy etc) the surveillance activity is
instituted only with service components. So, on account of surveillance
system, the incidence & prevalence rate of the diseases have been
monitored from time to time.

OTHER HEALTH SERVICE RECORDS: - other records from PHC,

S.C PRIVATE CLINICS and instructions provide some information on
‘morbidity’.

POPULATION SURVEY: - various times, the health survey is

conducted for various purposes on the basis of random survey. It may
be cross sectional or longitudinal survey. It may be conducted by means
of interview, questionnaire or record survey. The size of the sample
necessary for a household survey depends upon the measurement being

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 taken and the degree of accuracy needed. Many national samples
typically cover 5000 to 10,000 house hold survey.

HEALTH STATISTICS: - health statistics is related to various

epidemiological factors including service components, besides vital
statistics . However to discuss each every one if it, is beyond the scope
of this book. Hence under the following four are discussed;
 Fertility statistics
 Morbidity statistics
 Mortality statistics
 Natality statistics

RATES AND RATIOS IN DEMOGRAPHY

The important rates and ratios used in demography are,
Birth rate
Death rate
Growth rate
Specific death rate
Infant mortality rate
Neonatal mortality rate
Maternal mortality rate
Perinatal mortality rate
General fertility rate
Under five mortality rate
Sex ratio
Dependency ratio
Birth rate
The birth rate is defined as the number of live births during a year
per 1,000 estimated midyear populations. It is given by the formula,

Birth rate = number of live births during the year x1,000

Estimated midyear population
In India the birth rate is 24/1000.In most of the world, the birth rate is
falling and a global trend towards small family.

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Death rate
The death rate is defined as the number of deaths per 1,000
estimated midyear population in one year. It is given by the formula,
Death rate =Number of deaths during the year x 1,000
Estimated midyear population
Currently the death rate in India is 9/1000 population. Death rate has also
declined worldwide.

Growth rate
When the crude death rate is subtracted from the crude birth rate,
the net residual is the current annual growth rate.
The growth rate is not uniform in the world. There are many
countries in the world (eg.European countries) it is 0.5%per year. Where
the growth rate are excessive. It is around 2.8 per year in developing
countries.
Specific death rate
The death rate due to
1) Specific causes eg.cholera
2) Specific group, age, sex, occupation, social class, and
3) Specific period, annual, weekly, monthly.
1. Specific death rate due to cholera
= No of death from cholera during the yea
Midyear population.
2. Specific death rate for males=No of deaths among males in the year
Midyear population
3. Death rate in 1985 = No of deaths in 1985 x 1,000
Midyear population
Infant mortality rate
It is the number of infant deaths less than one year of age per
1,000 live births in one year .It is given by the formula,
IMR= No of deaths under one year of age x 1,000
Total live births in the year
Infant mortality rate is regarded as a most sensitive index of the health of
the community.

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Neonatal mortality rate
Death occurring within 28 days of birth is called neonatal death
Neonatal mortality rate = No of deaths under 28 days of age x 1,000
Total live births

Maternal mortality rate

It is the no of deaths from puerperal causes per 1,000 live births.
M.M.R=No of death directly due to pregnancy or child birth x 1,000
Total live births in the year

Perinatal mortality rate

It is the mortality of infants occurring during the period from the
th
28 week of pregnancy to 7 days after birth per 1,000 total live births. It
includes still birth +death under 1 week.
General fertility rate.
This is defined as the number of live births during a year per 1,000
women in the reproductive age group 15-45 years.
General fertility rate = No of live births x 1000
No of females in the age group 15 -45 years
Under5 mortality rate
It is the annual no of death of children less than 5 years express as a
rate per 1000 live births
=No of death of children <5 years of age in a given year x 1000
No of live birth in the same year
Sex ratio
Sex ratio is defined as the number of females per 1000 males.
The sex ratio in India has been generally adverse to women;
ie.the no of women per 1,000 men has generally been less than 1,000.
Dependency ratio
The population of persons above 65 years of age and children below 15
years of age are considered to be dependent on the economically
productive age group.(15-64 )
The ratio of the combined age group 0- 14 years +65 years and
above to the 15 -65 year age group is referred to as the societal
dependency ratio.
The dependency ratio sub divided into young age and old age dependency
ratio.

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ANALYSIS OF DEMOGRAPHIC DATA

Calculation of vital & Health indices

Vital & morbidity indices are calculated as rates (or) ratio
There are three methods

 Natural increase method

This is done by adding the increase due to birth & immigration to the last
census population & subtracting from it the loss due deaths & emigration
 Arithmetic progression method:

It is assumed that population increases equally in each year of the intranasal

period.
It is found by the formula
Pn=Pc1+a (Pc2-Pc1)/10
Pc1&Pc2 – Population of the last two censuses
Pn – midyear population
Geometric progression method
Here it is assumed that population increases like compound interest & the rate
of growth is geometric & not arithmetic. If Pc is the population of the census
year r is the rate of increase per year, per person in the intercensal years, then
midyear population at the year will be P(1+r)n
Rates & Ratio
The rates are usually calculated from the total events occurring in a
geographical area over a period of a calendar year. they are hence anneal
rates & are of two types, crude & specific crude is based on total population
while a specific rate is based on the population group specified on the basis
of age, sex, occupation, etc..,
Total No. of events that occurred
in a given geographical area
during given period
Crude rate = x 1000
Mid year population

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 No. of events which occurred
among a specific group of
population
Specific rate per 1000 = x 1000
Mid year population

Birth rates:
No. of live birth which occurred
in the population of a given
during on give year

Crude birth rate = x 1000

Mid year total population

Marriage rate
Total No. of marriage during
a calendar year

Crude marriage rate = x 1000

Total midyear population

Total No. of marriages

during the year

General marriage rate = x

1000 Total No. of UN married
person aged 15-49 years

Death rates & ratio

No. of deaths which occurred in
the population in during given year

Crude death rate = x 1000

Mid- year population

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Specific death rates

No. of deaths in a
particular age group
1. Age specific death rate = x 1000
Midyear population of
that age group
2. Sex specify death rate
Male deaths
Male death rate = x 1000
Midyear population
of males

3. Age & sex specific death rate

Female death at
specified age

Age & sex specific death rate = x 1000

Female population

INTERPRETAION OF DATA
Based conclusions due to defects is registration collection, compilation are
very likely. When the records are not reliable it is better to carry out sample
survey.

Birth & fertility rates

High crude birth & fertility rate indicate rapid increase in population, which
calls for birth control measures. If the birth control measures are effective,
there should be a fall in birth & infertility rate.

Children under 5yrs

a. Child women ratio =
Women aged 15-49
b. Percentage of the births of higher odor such as 4 & more it is low, it means
family planning is effective.
c. Average interval between births – longer in travel indicates fall in birth rate

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 Pregnancies to women
of child bearing age

d. Pregnancy rate = x 100

Total year of exposure

Death rates
 Direct standardization
 Indirect standardization
Direct standardization
In this method the age specific death rates in the community under the study
are applied to various are groups in the standard population. Their total gives
the standardized mortality rate for the population under study. The reference
of population is usually the population of the whole country
Indirect standardization
The direct method necessitates the knowledge of age specific death roes in
the population studied before one result can be standardized. Sometimes this
information may not be available. at other times, the population size may be
too small, especially in certain age groups, with the result that age-specific
death rates may fluted ate widely with slight variation in the member of
deaths in particular category, in such situation the indirect methods of
standardizations used.

(a) Calculation of Index rate

No. of deaths estimated occur in the study

population using the age specific death rate
of the standard population
Index rate =
Population of the study area

(b) Calculation of the standardizing factor

Overall rate for the standard

population

Standardizing factor =
Index rate for the
study population
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(c) Calculation of standardized rate for the study population

Standardized rate – observed rate * Standardizing factor

Sex ratio:
This is the ratio of females to males. It is expressed as the number of females
per 1000 males in a population. Ordinarily speaking sex ratio should be more
than-1.

CONCLUSION
The science of demography includes the study of five demographic
processes, Viz., marriage, fertility, mortality, migration and social mobility.
In general, demography may be said to be synonymous with population
analysis.

BIBLIOGRAPHY
Basavanthappa B.T (2008) “Community health nursing”2nd,Jaypee,
New Delhi,
Gupta & Mohanjan (2005) “Text book of preventive and social medicine”
Jaypee brothers, New Delhi, 399- 406
Kasthuri sundar Rao (2006) “An introduction to community health
nursing” 4 th, B.Ipublication,Chennai,
Keshav swarnkar (2006) ‘‘Community health nursing” N.R brothers,
Indore.
MersonH.Michealet.al,(2005)‘‘International public health-disease,
programs, systems and policies’’Janes &Bartlett, Boston
Park. K (2007) ‘‘Textbook of preventive and social medicines” 19 t , M/S
Bhanarsidas bhanot, Jabalpur,
Stanhope and Lancaster (1996) ‘‘Foundation of nursing in the
community”4th, Mosby Elsevier, china, 65- 85.

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 SYMPOSIUM

ON

DEMOGRAPHY

Submitted to: Submitted by:

Mrs. Sumathi M.sc(N) M.sc (N) I YR

Asso.Professor Community health nursing dept

VMACON,Salem VMACON, Salem

Submitted on: 16.2.09

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