Demography and health

Service Statistics
Teshale Fikadu (MPHE, Asst. Prof)
School of Public Health,
Arba Minch University
 Course Objective
At the end of the course the students are

expected to
• Define and understand the concepts of

demographic statistics
• Describe the main types of demographic

measures
• Identify the different methods of data collection

for demographic
2
 Demography - Definition
Demography: comes from 2 Greek words

demos = people graphos -- study.

Demography is the scientific study of human

populations, primarily with respect to size,

distribution, composition, social mobility and its
variation (UN, 1958)
Size
Distribution
Composition
Social mobility
3
 Demography focuses
Demography studies;
 Population size and composition
 Population distribution and movement
 components of population change
(fertility, mortality &migration)
 Patterns and trends of change over time
Determinants & consequences of population
change
Health and morbidity
Family systems and family structure;

4
 Type
Static demography —is the study of anatomy

of communities and their environment in a given

population
science that studies human populations (size,

structure and evolution)

Dynamic demography—it deals with physiology

of communities
science that deals human populations changing

patterns (mortality, fertility and migration)

5
 Major Demographic Data
sources
1. Population census

2. Records of vital statistics

3. Records of health departments

4. Records of health institutions

5. Reports of special surveys

6. Periodic publications
• Health demographic survelliance data
• World Health Organization (WHO)

7. Other sources;
Hospital data
6
Other secondary sources
 Population Census
is an important source of health information

the oldest of the sources

Official count of the entire population at a single point in time

“Total process of collecting, compiling, evaluating, analyzing,

and publishing or otherwise disseminating demographic and

other data pertaining at a specified time to all persons in a
country or a well delimited part of a country”
Even though census is as old as 5 B.C, modern census begun

in 17th and 18th centuries

7
 Population Census
The two approaches of census
1. De jure:- persons legally or customarily attached
to the location at the time of the census. A single
person can be counted twice. e.g. who is usually
living here in the last 6 months?
2. De facto:- persons physically resident in the
location at the time of the census
e.g. who was present in this area/house in the last
night?
Data collected through census helps to determine;
 Population size, distribution &composition
 Population dynamics (fertility, mortality &
migration)
 Economic and social characteristics of a
population
 Used as sampling frame for planning
8
But purposes have changed over time
 Topics covered in census
i. Total population at the time of census.

ii. Age, sex composition and marital status.

iii. Language spoken, education and economic

status.

iv. Fertility, i.e. number of children born alive

between two censuses to all women up to the

date of census.

v. Citizenship, place of birth, urban and rural

populations.
9
Essential Features of census
Four essential features
 Individual enumeration
 Universality
 Simultaneity
 Periodicity

1. Individual Enumeration: Each individual

is counted separately and the
characteristics of each person is recorded

10
 Essential Features of
census
2. Universality
A census covers a precisely defined territory and

includes every person present or residing within its

scope.
Ideally, 100 % coverage of a population.

3. Simultaneity
The population is enumerated with respect to a well

defined point of time, and data are in terms of a well

defined reference period.
- EX. May 9, 1984
- Last 12 months
11
 4. Periodicity
 The census is taken at a regular interval,
usually 10 years.
 Ethiopian census was irregular in
periodicity

1984 1994 2007

12
 Counted Population Size of Ethiopia,
1984-2007

13
 Strength& Limitations of
Census
Strength
High coverage (universality)
Strong geographic detail
Population at risk (denominator information)
Developments overtime

Limitations
Enormous organization
Costly
Not continuous, weak timeliness of data
Moderate topical detail
14 Response errors
 Errors in census data
Types of errors:
 Non-Sampling errors

 coverage error

- under-enumeration(undercount)
- over-enumeration(over count)
 content errors

Sampling error( inbuilt surveys)

15
 under-count ,
implications
Implications
 fewer resources allocated;
less political representation

But, official Census reports are not adjusted

for undercount for political reasons:
- Competition among states for federal
resources &
- political representation

16
 Errors of Census Data
Content error

- Misreporting, (e.g. age heaping, income)

- Data editing and tabulation

Sampling error –

All surveys have sampling error of estimates.

Long Form of Census is a sample survey with

variable sampling frame.
17
 Vital ( Civil) Registration
Legal and continuous registering, recording and reporting of the

occurrences of vital events

- Collection, compilation, analysis, presentation, and distribution of

vital statistics
Major vital events: births, deaths, marriages, divorces &

adoption..etc
Characteristics of each individual are recorded and updated in

different databases (birth, death, marital status, change of address,

etc)

18
 Purposes of Vital
Registration
Statistical: data are analyzed and reported for
administrative, public health and other purposes
- form data for vital statistics
(birth rates, death rates, marriage rates… etc )
Legal (administrative): provides permanent
legal records of events in the lives of citizens
- birth certificate
- death records (death certificates)
- marriage certificates
- other records

19
 Defining vital events
 UN statistical office defines vital events in a standard
format for international comparison of statistics.
Ex. Live birth

The 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 definitive
movement of voluntary muscles, whether or not the
umbilical cord has been cut or the placenta is attached;
20 each product of such birth is considered live-born.
 Live Birth Registration
The UN recommends that the following data be

collected at a minimum for live birth registration:

Data on event,

Date of registration

Date of occurrence

Place of occurrence

Attendance at birth

Type of birth/delivery
21
 Live Birth Registration
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

22
 Death Registration
The UN recommends that the following data be

collected at a minimum for death registration:

Data on event,

Date of registration

Date of occurrence

Place of occurrence

Sex and date of birth or age

Cause of death

23 Certifier, medically qualified or lay person

 Data Collection for Vital
Registration
Events are collected by a local registration office

Registration Office is usually a government

agency
Who reports to registration office?

Individual citizens, local officials, physicians,

hospital employees, etc.

Essential characteristics of Registration;

Universality

Continuity
24
 Vital Registration
Systems
Complete vital registration systems are found in

most developed countries (MDCS).

Such systems are non-existent or seriously

incomplete in developing countries.

Completeness and accuracy depends on:

legal necessity to report

timeliness of reporting

reporting by many different persons who

25 have /no training

 Strengths & Limitations
Strengths
 Continuous

 High coverage

 Long and short time series

 Can be accurate & reliable due to short recall period

 Comparison between countries and regions possible

Limitations
 Completness problem

 Weak topical detail

 No population at risk(lack of denominator

26
information)
 Sample Surveys
Data which cannot be collected in vital registration

or census or when data are deficient in quality.

 mostly research-oriented objectives

Involves Sampling => part of population

Voluntary participation

Not always organised by the government

27
 Advantages & disadvantages
Advantages
- Economical: lower cost, less time
- Adaptablity : strong topical detail
- Accuracy : quality of enumeration and
supervision can be high
- Events + population at risk
Disadvantages
less geographical detail
Sampling error
Errors of coverage and content
Higher technical demands: close supervision
28
 DHS
 DHS are nationally-representative household
surveys with large sample sizes.
 Indicators from DHS are representative for the
whole country, at the urban/rural & regional
level.
 Implementing agencies : Local statistical
agencies & measure DHS
 It provides data for a wide range of monitoring
& impact evaluation indicators in the areas of
Population, Health, and Nutrition in Developing
Countries.
 conducted every 5 years to allow comparisons
over time.
29
 Health service statistics
Health statistics include both empirical data and

estimates related to health, such as mortality, morbidity,

risk factors, health service coverage, and health
systems.
To measure health and disease frequency, one has to

measure them using standard measuring scale and units.

Measuring of health is so difficult, thus we use the
measure of disease frequency and Mortality which
provide the indirect measure of health status
RATIO
PROPORTION
 RATE

30
 Ratio

31
 Proportion

32
 mortality
Mortality: describes the occurrence of deaths in a
population.
Death: "the permanent disappearance of all

evidences of life at any time after birth has taken

place” (WHO).
The definition excludes fetal death

Fetal death – is death prior to birth.

33
 Mortality measures

34
Mortality Measures……

35
 Mortality measures….
Cause Specific death rate (CSDR)
CSDR = total deaths from a given cause *
1000
population at risk

Infant Mortality Rate (IMR)

IMR = No. of deaths of under 1 in a year x

1000
Live births in a year
36
Mortality measures…

Neonatal MR(NMR):
Deaths 1-4 weeks x 1000
Live births

Post Neonatal MR(PNMR) :

Deaths 4-52 weeks x 1000
Live births

37
M.measures

Child Mortality Rate:

CMR = deaths of children in 1-4 years age group*1000
mid-year popn. of children 1-4 years
Eth, 2011 – 31 per 1000
Under five mortality rate : the probability of
dying between birth & age five per 1000 live
births.

U5MR= No. of deaths of under five children* 1000

total live births
Eth, 2011 – 88 per 1000.
38
Mort. measures
Maternal Mortality Ratio (MMR) :
MMR = No. of maternal deaths in a year * 100,000
No. of Live births
 Maternal Mortality Rate :
No. of maternal deaths in a specified period*1000
No. of women of reproductive age

 represents both the obstetric risk and the frequency with which
women are exposed to this risk

 MMRate * GFR = MMRatio

39
 Reading assignment
Admission rate (AR):

Average length of stay (ALS)

Bed-occupancy rate (BOR)

Turnover interval (TI)

Hospital Death Rate (HDR)

Program based death rate

40
 References

 Siegel J. & Swanson D. (2004) The methods & Materials

of Demography, Elsevier Academic Press, USA
 Newell, C. (1988), Methods and models in
Demography,Blackwell, USA
 Preston H., Heuveline P., & Guillot M.,(2001)
Measuring and Modeling Population Processes,
Blackwell, USA
 www.measuredhs.com – measuredhs website
 www.csa.gov.et – Ethiopian central statistical
authority

41