demography community health nursing pptt

CHN

1. Demography, Vital Statistics and Health indicators Prepared by: Deepa Manandhar Lecturer

2. Definition Population - Is a collective group of organisms of the same species living in the same place at the same time. Population density - it is the number of individual per unit in area. https://www.vedantu.com/biology/population-pyramid

3. Population pyramid: The age and sex composition of population can be visualized by its graphic presentation is called as population pyramid . These are described as under: Expansive population pyramid Constrictive population pyramid Stationary population pyramid

4. Expansive population pyramid this pyramid has broad base and a tapering top and is seen in expansive population which has high birth rate and larger number of people in younger ages.

5. Constrictive population pyramid It has narrower base, bulge in the middle. It has smaller number of people in the younger ages.

6. Stationary population pyramid This pyramid has roughly equal numbers in almost all age groups, tapering gradually at the older age group level as seen in developed and industrialized countries.

7. Population pyramid… The fertility rate is the key factor which determines the shape of a pyramid. Mortality rate has less influence on the age distribution. The larger the number of children is born to women, the broader the base of the pyramid.

8. Definition…. Demography - it is the scientific study of human population. It focuses on three phenomenon : change in population, the composition of population and the distribution of population.

9. Definition…. Greek words ‘demos’ meaning people and ‘ graphein ’ meaning record. It is the scientific study of human population. Focuses its attention on three readily observable phenomena: change in population size (growth or decline), the composition of population and the distribution of population in space.

10. MCQ “Demographic Process” does not include: Fertility Morbidity Mortality Social mobility ANS: b

11. Definition…. It deals with five “demographic processes” Fertility, mortality, marriage, migration and social mobility. These five processes are continuously at work within a population determining size, composition and distribution.

12. Demographic Cycle Demographic cycle, or population cycle, refers to the evolution over time of the population profile of a country, region or other defined geographical area. Demographic cycle describe changes in population size and composition due to increase or decrease in number of births and deaths.

13. Demographic Cycle The history of world population since 1650 suggests that there is a demographic cycle of 5 stages through which a nation passes: First Stage Second Stage Third Stage Fourth Stage Fifth Stage

14. Demographic Cycle

15. First stage (High Stationary) It is characterized by high birth rate and high death rate which cancel each other. So the population remains stationary. No country as a whole at present retains the characteristics of stage

16. Second stage (Early Expanding) There is a decline in death rate while the birth rate remains unchanged. So the population expands. Many developing countries of Asia and Africa are in this stage.

17. Third stage (Late Expanding) Death rate declines further and birth rate begins to fall. Yet there is an increase in population since birth exceeds deaths. India appears to have entered this stage. In number of countries birth rates have decline rapidly. (e.g. China, Singapore)

18. Third stage (Late Expanding)… The gap between birth and death rates narrows down There is an increase in population since birth exceeds deaths.

19. Fourth stage (Low Stationary) Is characterized by Low birth rate and low death rate. So the population becomes stationary. Most of the industrialized countries have gone a demographic transition shifting from high birth and death rates to low high birth and death rates. Belgium, Denmark and Switzerland are in this stage.

20. Fourth stage (Low Stationary)… Total population is still high, but it is balanced by a low birth rate and a low death rate. Example : Newly industrialized countries such as South Korea and Taiwan have just entered stage 4. United States, Canada, Argentina, Australia, New Zealand, most of Europe, Bahamas,Brazil, Singapore, Iran, China, Turkey, Thailand and Mauritius

21. Fifth stage (Declining) Low birth rate along with an aging population leads to declining population The population begins to decline because the birth rate is lower than the death rate.

22. Fifth stage (Declining)… Example:   Countries like G ermany, Italy, Japan, Russia  leading to a shrinking population

23. MCQ In demographic cycle low stationary phase corresponds to which stage? First Second Third Fourth ANS: d

24. MCQ Third stage of demography cycle indicates: High birth rate and high death rates While the birth rate remains unchanged Birth rate tends to fall and death rate declines still further Death rate begin to decline ANS: c

25. MCQ Early expanding stage is denoted by: Decreased birth rate and decreased death rate Increased birth rate and increased death rate Decreased birth rate and increased death rate Unchanged birth rate and decreased death rate ANS: d

26. Definition… Statistics , is the science of collecting, analyzing, presenting, and interpreting data and drawing conclusion from such data.  Health statistics  refers to the science of collecting, summarising, and interpreting data on health and disease in populations.

27. Definition… Vital statistic is statistic relating to vital events of life normally birth, death, marriage, migration and divorce that occur in a community or a country.

28. Definition… Vital statistics may be defined as the facts, systematically collected and compiled in numerical form, related to, or derived from record of vital events which are legally registered.

29. Definition… The collection, compilation, presentation, analysis and distribution of statics pertaining to vital events are recorded (e.g. live births, death, marriages, migration that occur in the community).

30. Classification Mortality Morbidity Fertility Population statistics

31. Introduction… Health statistics is relatively a new corner. Now it is called as Health Information System . It measures three aspects State of health(morbidity or mortality) Factors affecting health (housing, social economic and environmental factors) Items of service- Preventive, promotive and curative services.

32. Uses of Vital and Health Statistics It measures the state of health of a community (problem, nature, size, resources) Comparing the present status with that of the (country to another country) For planning and administration of health services. To determine priorities for health programs.

33. Uses… To discover solution for health problems. For prediction of health trends. For estimating the future needs of the community and suitable targets for achievement. Direct and maintain control during execution of programmes.

34. Uses…. To promote health legislation. For evaluating the progress, success or failure of health programs and services already in operation. Demand public support for health work. For research into community health problems.

35. Sources of vital and health statistics Census: is an important source of health information. It is taken in most countries of the world at regular intervals, usually of 10 years. A census is defined by the United State as “ the total process of collecting, compiling and publishing demographic, economic and social data pertaining at a specified time or times, to all persons in a country or delimited territory’

36. Census… It is massive undertaking to contact every population in it given time and collect a variety of information. Use of Census in Health Matters To determines population of an area which forms basis for calculation of health indices such as birth, fertility, death, morbidity, marriage rates etc.

37. Census… All health services are planned and community measures are adopted as per nature and size of the population. Average rate of growth of population per year is computed from the population enumerated in two census years.

38. Census… Knowledge of population distribution helps in planning of the other welfare services such as provision of schools, orphanages, food supplies etc.

39. Sources… Registration of vital events: The United Nations defines a vital events registration as including “legal registration, statistical recording and reporting of the occurrence of, and the collection, compilation, presentation, analysis and distribution of statistics pertaining to vital events, i.e., live, birth, death, fetal deaths, marriages, divorces, adoptions, legitimations, recognitions, annulments, and legal separations.

40. Registration of vital events Registration of vital events has been the foundation of vital statistic. If registration of vital events is complete and accurate, it can serve as a reliable source of health information. Since 1962 AD, Government has forced a law to register vital events in grassroots level (VDC).

41. Sources… 3. Notification of disease- the primary purpose of notification is to effective prevention or control of the disease. Some notifiable diseases are cholera, plague, yellow fever, poliomyelitis, rabies, etc. List of notifiable diseases vary from country to country.

42. Notification of diseases… Notification provides valuable information about fluctuations in disease frequency. It also provides early warning about new occurrences or under breaks of disease.

43. Notification of diseases… The concept of notification has been extended too many non-communicable disease e.g. cancer, congenital malformation, mentally illness, stroke and handicapped persons.

44. Sources… 4. Hospital Records: Primary source of information about disease prevalent in the community . Hospital data only provides information on those patients patients who seek medical care.

45. Hospital Records… Hospital discharge sheets contain much useful information on diagnosis, medical and surgical procedures, complications, length of stay, laboratory data, etc.

46. Sources… 5. Health survey: health survey of demographic health, household populations etc are also used to detect specific health related condition in the community. Besides these morbidity surveys, nutritional survey are some example of health surveys.

47. Sources… Disease Registration: it implies something more than notification. Morbidity registers are a valuable source of information as to the duration of illness, case fatality and survival. These registers allow follow-up of patients and provide a continuous account of the frequency of disease in the community.

48. Disease Registration If the reporting system is effective and the coverage is on a national or representative basis, the register can provide useful data on particular disease, treatment given and disease specific mortality.

49. Sources… Record Linkage : the term record linkage is used to describe the process of bringing together records relating to one individual (or to one family), the records originating in different times or places. It is particularly suitable method of studying associations between diseases.

50. Record Linkage… In practice record linkage has been applied only on a limited scale as large volume of data can accumulate. At the moment, record linkage is beyond the reach of many developing countries.

51. sources… Epidemiological Surveillance : In many countries, where particular diseases are endemic, special control/eradication programmes have been instituted, as for example national disease control programmes against malaria, tuberculosis, leprosy, filariasis, etc.

52. Epidemiological Surveillance… These programmes have yielded considerable morbidity and mortality data for the specific diseases.

53. Introduction… Health is defined as “a state of complete physical, mental & social wellbeing, and not merely an absence of disease or infirmity” (WHO) This statement has been amplified to include the ability to lead a “socially and economically productive life”

54. Introduction…. Health cannot be measured in exact measurable forms Hence measurement have been framed in terms of illness (or lack of health), consequences of ill-health (morbidity, mortality) & economic, occupation & domestic factors that promote ill health- all the antithesis of health.

55. Definition of health indicator Indicator also termed as Index or Variable is only an indication of a given situation or a reflection of that situation. According to WHO, health indicators can be defined as variables which helps to measure changes occurred in the community.

56. definition… Health Indicator is a variable, susceptible to direct measurement, that reflects the state of health of persons in a community. Indicators help to measure the extent to which the objectives and targets of a programme are being attained.

57. definition… Health status indicators measure different aspects of the health of a population. Examples include life expectancy, infant mortality, disability or chronic disease rates.

58. Characteristics of indicators Valid – they should actually measure what they are supposed to measure. Reliable – the results should be the same when measured by different people in similar circumstances. Sensitive – they should provide information about the impending changes.

59. Characteristics of indicators… Specific – they should be focused, concrete and well defined. Feasible – they should have the ability to obtain data when needed. Relevant – they should generate the data that can answer the question of interest.

60. Types of indicators Mortality indicators Morbidity indicators Fertilty indicators Nutritional status indiactors Health care delivery indicators

61. Types of indicators… Utilization rate Indicators of social and mental health Environmental indiators Socio-economic indicators Health policy indicators

62. Types of indicators… 11. Quality of life measurement Disability Adjusted life years Quality Adjusted life years 12. Others: Contraceptive prevalence Life expectancy

63. MCQ Denominator of crude birth rate is: Mid year population Number of living children Number of death children Total number of crude birth ANS: a

64. 1. Mortality indicators Crude death rate (death rate) The number of death per 1000 in a given time period and place divided by the total mid year population. No. of deaths occurred in a year * 1000 Mid-year population

65. CDR… CDR of Nepal is 7/1000 population (The World Bank 2020)

66. Mortality Statistics…. Specific Death Rates Specific cause of disease, e.g. T.B, HIV/AIDS, Cancer, Accidents etc. Related to specific group, i.e. age, sex, and age / sex specific Specific death rate gives accurate picture of mortality rate for male and female of each age.

67. Mortality Statistics…. Case specific death rate due to tuberculosis Number of deaths from tuberculosis year during a calendar year * 1000 Mid year population Proportional Mortality rate It is sometimes useful to know what proportion of total deaths is due to a particular disease or particular age group.

68. Mortality Statistics… Proportional Mortality rate from specific disease: Number of deaths from a specific disease in a year *1000 Total number of deaths during the same period

69. Mortality Statistics… It is a usually computed for a broad disease group and for specific disease of major health importance, such as cancer. Survival rate is the proportion of survivors in a group. Total number of patients alive after 5 years *1000 Total number of patients diagnosed and treated

70. Mortality Statistics… Case fatality rate: it is the percentage of deaths among those attacked by a given disease. Number of deaths *1000 Number of attacks

71. Mortality Statistics…. Maternal Mortality Ratio (MMR): It is the number of deaths from puerperal causes per 100000 live births.(MMR=151;NPHC 2021) Number of deaths directly due to Pregnancy or within 42 days of the delivery *100000 Total live birth

72. Mortality Statistics… Infant mortality Rate (IMR): it is the number of infants deaths under 1 year of age per 1000 live births in any population in one year.(IMR=28;NDHS 2022) Number of deaths under one year of age *1000 Total live birth in the year

73. Mortality Statistics…. Neonatal Mortality Rate: Deaths occurring within 4 weeks or 28 days of birth are called neonatal deaths.(NMR=21;NDHS 2022) No of deaths under 28 days of age *1000 Total live births in the year

74. Mortality Statistics… Under five Mortality Rate: annual number of death of children aged less than 5 year, expressed as a rate per 1000 live births. (U5MR=33;NDHS 2022) No of deaths of children less than 5 years of age in a given year *1000 No. of live births in the same year

75. 2.Morbidity Statistics Incidence Rate: No. of new cases of specific disease during a given time period X 1000 Population at risk

76. Morbidity… Special Incidence Rates Attack rate or case rate Secondary attack rate Hospital admission rate

77. Morbidity… Attack Rate or case rate: No of New cases of a specified disease during a specified time interval *1000 Total population at risk during the same interval

78. Morbidity…. Secondary attack rate: No of exposed persons developing the disease within the range of incubation period *100 Total number of exposed / susceptible contact

79. Morbidity…. Prevalence: Point prevalence: No of current cases of a specified existing at given point of time *100 Estimated population at same point in time

80. Morbidity…. Period prevalence: No of current cases of a specified existing at given period of time *100 Estimated population at same period of time

81. 3. Fertility Statistics Is the actual bearing of children. It depends upon: The age at which females marry. The period during which they live in fertile union, reproductive period is 15-49years, i.e. a period of 34 years.

82. Fertility Statistics…. Measurement of Fertility Crude birth rate General Fertility Rate Age specific Fertility Total fertility rate Gross Reproduction Rate Net Reproduction rate

83. Measurement of Fertility Crude marriage rate Abortion ratio Pregnancy rate Abortion rate Child-woman ratio

84. Crude birth rate It is the number of live births in the year per 1000 population Number of live births in the year x 1000 Mid-year population It is not an appropriate measurement of fertility because the total popualtion is nit exposed to child bearing.

85. Crude birth rate… In Nepal, CBR is 20/1000 population (2022 NDHS)

86. Crude marriage rate It is the number of marriages in the year per 1000 population Number of marriages in the year x 1000 Mid-year population

87. General Fertility Rate It is the "number of live births per 1000 women in the reproductive age-group (15-49 years) in a given year". Number of live births in an area during the year *1000 Midyear female population age(15- 49) in the same area in same year

88. General Fertility Rate In Nepal, GFR is 78/ 1000 women age 15-44 (NDHS 2022)

89. Age specific Fertility A more precise measure of fertility and is defined as the "number of live births in a year to 1000 women in any specified age-group". Number of live births in a particular age group *1000 Midyear female population of the same age group

90. Total fertility rate The average number of children a woman would have if she were to pass through her reproductive years bearing children at the same rates as the women now in each age group. It is computed by summing the age-specific fertility rates for all ages; if 5-year age groups are used, the sum of the rates is multiplied by 5.

91. Total fertility rate… 45-49 TFR= 5 * ∑ASFR 15-19 1000

92. Gross Reproduction Rate Average number of girls that would be born to a woman if she experiences the current fertility pattern throughout her reproductive span (15-49 years), assuming no mortality. No of female births *Total fertility rate Total no of birth

93. Net Reproduction rate Net Reproduction Rate (NRR) is defined as the numbers of daughters a newborn girl will bear during her lifetime assuming fixed age-specific fertility and mortality rates. No of female children born and survived *100 1000 women

94. Abortion ratio This is calculated by dividing the number of abortions performed during a particular time period by the number of live births over the same period.

95. Abortion rate The annual number of all types of abortions usually per 1000 women of child-bearing age (usually defined as age (15-49)

96. Pregnancy rate Is the ratio of number of pregnancies in a year to married women in the ages (15-49) years. The number of pregnancies includes all pregnancies whether these had terminated as live births, still births or abortions or had not yet terminated.

97. Child-woman ratio It is the number of children 0-4 years of age per 1000 women of child-bearing age, usually defined as15-49 years of age. This ratio is used where birth registration statistics either do not exist or are inadequate. It is estimated through data derived from censuses

98. 4. Nutritional status indicators- Nutritional status is a positive health indicator. Three nutritional status indicators are: Anthropometric measurement of preschool children e.g. weight and height, mid arm circumference. Height and sometimes weight of children at school entry Prevalence of low birth weight

99. 5)Health care delivery indicators The frequently used indicators of health care delivery are- a. Doctor-population ratio b. Doctor-nurse ratio c. Population-bed ratio d. Population per health/sub- centre  

100. Health care delivery indicators… These indicators reflect the equity of distribution of health resources in different parts of the country, and of the provision of health care.

101. 6)Utilization rates Health care utilization is also affected by factors such as availability and accessibility of health services and attitude of an individual towards his health and the health care system.

102. Utilization rates…. Some example are a. Proportion of infants who are fully immunized against the 6 EPI disease b. proportion of pregnant women who receive antenatal care, or have their deliveries supervised by a trained birth attendant. c. Percentage of population using the various methods of family planning.

103. 7)Indicators of social and mental health It is necessary to use indirect measure of social and mental pathology. These include suicide, homicide, other acts of violence and other crime, road traffic accident, juvenile delinquency, alcohol and drug abuse, obesity etc.

104. 8)Environmental indicators Environmental indicators reflect the quality of physical and biological environment in which disease occur and in which the people live. They include indicators relating to pollution of air and water, radiation, solid wastes, noise, exposure to toxic substances in food or drink.

105. 9)Socio-economic indicator These indicators do not directly measure health. Nevertheless, they are of great importance in the interpretation of the indicators of health care. These include : a. rate of population increase b. per capita GNP c. level of unemployment

106. Socio-economic indicator… d. dependency ratio e. literacy rates, especially female literacy rates f. family size g. housing: the number of persons per room h. per capita "calorie" availability.

107. 10)Health policy indicators The relevant indicators which measures health policy are: proportion of GNP spent on health services proportion of GNP spent on health-related activities (including water supply and sanitation, housing and nutrition, community development) and

108. Health policy indicators… (iii) proportion of total health resources devoted to primary health care.

109. 11)Indicator of quality of life Quality of life is difficult to define and even more difficult to measure. Physical quality of life index (PQLI) is one such index. It consolidates three indicators, infant mortality, life expectancy at age one and literacy .  

110. 11)Indicator of quality of life… Quality Adjusted Life Years (QALYs) is a measure of both quality and quantity of life lived. It is years of life lived in perfect health . It is used in assessing the value of money of a medical intervention

111. 12.Disability rates It is the percentage of the population, unable to perform the routine expected, daily activities due to injury or illness. E.g. eating, walking, dressing, going to toilet etc. The disability rates are based on the premise or notion that health implies a full range of daily activities.

112. Disability rates… Since death rates have not changed markedly in recent years, despite massive health expenditures, disability rates related to illness and injury have come into use to supplement mortality and morbidity indicators. The commonly used disability rates fall into two groups:

113. Disability rates… Events type indicators i. Number of days of restricted activity ii. Bed disability days iii. Work loss days   person type indicators Limitation of mobility-e.g. confined to bed. Limitation of activity-e.g. limitation to perform the basic activities of daily life.

114. Disability rates…. Sullivan’s index -This index (expectation of life free of disability) It is computed by subtracting the probable duration of bed disability and inability to perform major activities from the life expectancy.

115. Disability rates… DALY(Disability Adjusted life year): DALY is best measure of the burden of disease in a defined population and the effectiveness of the intervention.

116. DALY… DALYS express years of life lost to premature death and years lived with disability adjusted for the severity of the disability. DALY= YLL (Years of Life Lost +YLD (Years Live with Disability) One DALY is “ one lost year of healthy life”.

117. Others Contraceptive prevalence rate : it is defined as the percent of eligible couples effectively protected against childbirth by one or the other approved methods of family planning. CPR= current user of modern FP methods * 100 married women at reproductive age

118. Others… Life expectancy : it is defined as the average number of years which a person of that age may expect to live, according to the mortality pattern prevalent in the country. It is estimated for both sexes separately. An improvement in expectations of life is regarded as an improvement in health status.

119. References 1. K. Park. Park’s textbook of Preventive and Social Medicine. 18th edition. Jabalpur India: M/s Banarsidas Bhanot; p.p 22,53,356. 2005 2. Kamalam S., Essentials in community Health Nursing Practice, first Edition, Jaypee 2005. 3.https:// unstats.un.org / sdgs /indicators/Global%20Indicator%20Framework_A.RES.71.313%20Annex.pdf

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