MORTALITY

UN & WHO Definition

• Mortality refers to death

• Death is the permanent disappearance of all evidence of life
after birth has occurred/ taken place.
• Evidence of life include: beating of the heart, voluntary
movement of muscles or pulsation of umbilical cord.
• This definition of death excludes all death prior to birth which is
called foetal death.
• A Foetal death is death prior to the complete expulsion or
extraction from its mother of a product of conception
irrespective of the duration of pregnancy.
 .

• Foetal death in demography embraces the events such

as still birth (late foetal death), miscarriages and
abortions.
• The term still birth is usually used synonymously with
late foetal death.
• The term miscarriage is popularly is popularly
employed to refer to spontaneous or accidental
termination of foetal life occurring early in pregnancy.
• The term abortion is popularly used to refer to induced
early foetal death including illegal and legal.
• Technically, abortion and miscarriages can hardly be
distinguished.
 CLASSIFICATION OF DEATH BY UN
Under 1: Infant Mortality (IM)
1,2,3 & 4: Child Mortality (CM)
5+: Adult Mortality
Note:
• IM: Under 1 year mortality (1q0)

• Neonatal Mortality (NM): Probability of dying within the first four

weeks (1 month)
• (1-4 weeks)
• Post Neonatal Mortality (PNM): Mortality after 4 weeks (1 month) but
within the 1st year of life.
• Child Mortality (CM) (5q1): Probability of dying before 5 th birth day but
after 1 year. Death from 1 year and 4 years.
• Perinatal Mortality: Foetal death of 28 weeks of gestation in pregnancy.
 CAUSES OF DEATH
• Endogenous
• Exogenous
 ENDOGENOUS

Arise from the genetic make up of an individual and

circumstances of prenatal life and birth process.
• Degenerated diseases of later life eg. Heart diseases,
cancers (breast, prostate and cervical most common),
diabetis, muscular dystrophy, degenerative spinal lesions
• Diseases peculiarly to birth eg. Birth injuries, complications
due to immaturity
• Hereditary traits of parents eg asthma, sickle cell, cancers
eg goiter, venereal diseases eg syphilis, tuberculosis (TB)
Endogenous mortality has a typical biological character. It is
often resistant to scientific progress.
 EXOGENOUS
Arise from purely environmental and external causes
• Infectious- malaria, TB, measles etc
• Accidents- motor, snake bites, murders, suicides etc.

Exogenous mortality is relatively preventable and treatable

Factors that affect mortality are:

• Social characteristics
• Economic characteristics
• Marital status
• Educational attainment
• Occupation
• Income
• Social class refer to poorest or richest fifth or quarter
 MEASURES OF MORTALITY
• CDR (Crude Death Rate)
• IM (Infant Mortality)
• CM (Child Mortality)
• MM (Maternal Mortality)
• ASDR (Age and Sex specific Death Rate)
• LE (Life Expectancy)
 Crude Death Rate (CDR)

This is the simplest and commonest measure of mortality. It is the number

of death in a year per 1000 of the mid- year population.

• CDR = #D/p *k

• Where # D = number of death

P =mid- year population
K= constant (1000)

• Sometimes an average (annual) crude death rate covering data for 2 or

3 years is computed in order to represent the longer period with a
single figure or to add stability to rates based on small numbers or
intended for use in intensive comparative analysis.
 .

1st procedure
• CDR= 1/3 [D1/P1*1000 +D2/P2*1000+D3/P3*1000]
• It gives equal weight to the rates of three years.

2nd procedure
• Average number of death is divided by the average population.
• CDR= 1/3(D1+D2+D3)
………………….. *1000
1/3 (P1+P2+P3)

3rd procedure
• Average number of death is divided by the mid year population. Most
commonly used. P2 assumed to be average population.

1/3 (D1+D2+D3)
……………………..*1000
P2
 Limitations of CDR

• Mixes together many population groups

whose mortality varies widely ie infants,
middle age groups & old ones.
• Mortality differs according to sex apart from
age
 eg Costa Rica
Year population Death

1963 1,126,000 P1 10,176 D1

1964 1,171,000 P2 10,063 D2

1965 1,225,000 P3 9,726 D3

 CDR for selected countries

1986 1996 2000 2004 2008 2013

Kenya 14/1000 13/1000 14/1000 15/1000 12/1000 9/1000

Uganda 17 19 20 17 16 10

India 13 10 9 8 8 8

Japan 6 7 8 8 9 10

US 11 9 9 8 8 8

UK 10 11 11 10 9 9

Note: Improvement in health care can change the situation. See Costa Rica and Malaysia
 Infant Mortality (IM) (1q0)

• The number of death of children under one

year of age in a particular year per 1000 live
births in that year
 Trends in infant mortality

Region 70-75 75-80 80-85 85-90 90-95 2000 2008 2013

world 92 85 78 71 62 57 49 40

MDCs 22 19 16 14 9 8 6 5

LDCs 104 96 88 79 68 63 54 44

EA 131 126 120 112 106 102 98 73

Uganda - - 120 101 115 87 76 54

 Infant Mortality (IM) (1q0)
• The number of death of children under one year of age in a
particular year per 1000 live births in that year
• IM = D0
---- *k
B
• D0 = number of death among infants in a year
• B = Total number of live births during the same year
• k = constant (1000)

• It is possi ble to estimate Infant mortality for males and females

separately
• IM (m) = D0 IM(f) = D0
…. *k …… *k
B B
 Child Mortality (CM) (4q1)
• CM = #D1-4/ P1-4 *k

• Can calculate for male and female separately

 Maternal Mortality (MM)

• Death of women due to complications of pregnancy,

child birth and puerperal (after child birth) causes. This
is per 10,000 or 100,000

• MM = D
---- *10,000
B

• Ref. State of Uganda Population Report 2005 pp42-44

Making motherhood safer
 MM for Uganda

Year 1991 1995 2000 2002 2010 2014

MM 700 506 504 505 435

MM represents 17% of all death to women aged 15-49. Three women dying in Mubende hospital every month
 Why high MM in Uganda
• Delay to come to deliver in hospital
• Do not come for medical check-up (low antenatal visits) when pregnant
(4 times needed)
• Prefer local birth attendants (cheap, known to the mothers, type of delivery in
hospitals, behavior of midwives in hospitals, do not know when due to deliver)
• Low age at marriage
• Low contraceptive prevalence {All methods 30%, Modern 26% 2013]
(4 toos- too young, too old, too many, too often)
• High rates of abortions yet illegal
• Low education
• Break up of social norms that encouraged virginity and maturity of girls (size of the
thighs)
• Few doctors/ health workers- Quality training of doctors maintained in universities
• Low men’s involvement in birth process by men
• Poorly equipped hospitals
• Low pay of medical workers (study for many years)
• Low innovativeness by doctors/ Start own hospitals
 Age and Sex Specific Death Rates (ASDR)

• The number of death aged x in a given population

divided by the population aged x.

• They may be called central death rates denoted by nMx

nMx = nDx or Das

------ *k ----- *k
nPx nPx

See Huw R.Jones: A population Geography. Pg. 17.

 Age pattern of mortality for LDCs and MDCs

Age MDCs (%) LDCs (%)

Under 1 3.0 49.2

Under 5 3.8 42.2

Under 15 4.7 48.6

15-24 1.5 4.0

25-64 26.2 24.6

65+ 67.6 22.8

 Draw graphs

• HS: Age in years

• VS: Relative percentage of death rates

• J shape for the MDCs

• U (two peaks or bi-modal peak) for the LDCs
 Why differentials in death rates between LDCs and MDCs?

• Child health care through Primary Health Care (PHC)

• Medical facilities/advances
• Amount/percent spent on Health Care (HC)
• Environment
• Education levels
• Food situation and eating habits
• Cultural aspects
• Accidents
• Economic situations
• Political factors- Poor leadership, do not tell truth, egocentric,
retrogressive, opportunists, corrupt
 Primary Health Care (PHC)
In developing countries, although strategies emphasize the eight essential
elements of Primary Health Care (PHC), it is either low or not properly
implemented. Eight essential elements of PHC are:
• Education concerning Prevailing Health Problems
• Promotion of food supply and proper nutrition
• An adequate supply of safe water and basic sanitation
• Maternal and Child health care including Family Planning
• Immunization against the major infectious diseases (six killer diseases
diphtheria, tetanus, whooping cough, measles, poliomyelitis &
tuberculosis) now immunize against pneumonia & cervical cancer for
teenage girls.
• Prevention and control of locally endemic diseases eg guinea worms,
sleeping sickness, river blindness, hepatitis B and E, nodding disease
• Appropriate treatment of common diseases and injuries
• Provision of essential drugs
 Education level affect the following:

• Income
• Decision making
• Use of modern methods of family planning
• Distribution of food refer to Bangladesh
• Food eaten- quantity and quality
• Culture
• Communication and transport
• Demand of children
• Mean age at marriage
• Environment where the child grows and lives
 Culture affects the following:

• Weaning method of infants

• Fear of twins as bad omen eg Nigeria
• Sex preference of boys. Girls killed (infanticide)
• Food eaten eg good food not eaten by women /way food is prepared
• Levirate (widow inheritance)
• Sister-in-law relation
• Low education for girls
• Not using latrines eg karamajong
• Type of houses
• Communal beer drinking
• Wife meant to produce children
 Culture affects the following cont’
• Subordination of women
• Resuming four days after birth
• Using one knife for circumcision
• Female genital mutilation
• Cattle rustling
• Culture of no medical check-up
• Large family size
• Men’s claim: one woman not enough for a man
• Belief in witch craft
• Every body must have a child even with hereditary diseases