Concepts and measures 1.ppt

Population and Development
Course Code: PHDP6022
Instructor: Motuma Getachew (Assist. Prof.)
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Chapter I: Concepts and Measures
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CHAPTER OBJECTIVES
After Completing this unit, the students will be able
to:
Define Demography
 Explain the population prospects the
Describe the social, economic and Health indicators
 Explain the concept Sustainability
 Determine demographic measures
 Identify and describe mortality measures
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INTRODUCTION
Definition
 Demography is derived from two Greek Words;
 Demo= people
 Graphy= writing/ study
Demography is writing or study about population
 Thus; Demography can be defined as the study of human
populations including:
 population composition (structure),
 Population distributions in a given geographical area,
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INTRODUCTION CONT’
 Population densities per KM,
 Growth and other characteristics
 As well as the causes and consequences of changes in
these demographic factors
 Contemporarily, demography is understood as the
scientific study of human population and its dynamics
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CONCEPTS IN DEMOGRAPHY
Population Size:
 De jure approach:
 The number of people residing in a specific area at a
specific time
 it comprises all of the people who “belong” to a given
area by virtue of legal residence, usual residence, or
some similar criterion
 De facto approach:
 The number of people actually present in a given
area at a given time.
 |All tourists, business travelers, seasonal residents,
and temporary workers can be included in the count.
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CONCEPTS CONT…
 Population Distribution
 Refers to the geographic location
 Approaches to identify the location
1. Administrative approach : areas are defined
according to administrative or political criteria.
E.g. states, counties, cities, districts, a wide variety
of state and local administrative and political
delineations(e.g., city council, water, and school
districts).
2. Statistically defined: define geographic areas
specifically for purposes of identifying areas that are
economically, socially, and culturally linked.

CONCEPTS CONT…
NB: Geographic boundaries can also be defined according
to other criteria :
 Postal ZIP code areas and
 Data for market areas that are important for
businesses.
 Composition
 The characteristics of the population
 Age (more valuable for a wide variety of planning and
analytical purposes)
 Sex (often used in combination with age to show a
population’s age-sex structure)
 Race and
 Ethnicity widely used demographic
characteristics

CONCEPTS CONT…
 Change
 The difference in population size between two points in
time.
 A point in time can correspond to the date of a census
or to the date of a population estimate.
 Population change can also be measured for various
subgroups of the population, different geographic areas
(e.g., counties, cities), and different time periods.
 Can refer to changes in size, distribution, or
composition, or to any combination of the three

CONCEPTS CONT…
 Components of Population change
 Births (Increment),
 Deaths (Decline), and
 Migration In (Increment)and out (Decline),
 Estimates: refer to the present or the past while
 Estimates are often based on data for corresponding
points in time.
 Projections and forecasts: refer to the future
 E.g. estimates for 2016 made in 2015 can be based on
data (e.g., births, deaths, building permits, school
enrollments, and Health insurance enrollment)
reflecting population growth through 2015.

CONCEPTS CONT…
 The distinction between estimates and forecasts is not
always clear-cut.
 Sometimes no data are available for constructing
population estimates.
 A population projection is the numerical outcome of a
particular set of assumptions regarding future population
trends

 The world’s population is projected to reach 8 billion on 15
November 2022.
 The latest projections by the United Nations = could grow
to around 8.5 billion in 2030, 9.7 billion in 2050 and 10.4
billion in 2100.
 Population growth is caused in part by declining levels of
mortality, as reflected in increased levels of life expectancy
at birth.
Globally, life expectancy reached 72.8 years in 2019, an
increase of almost 9 years since 1990.

 Global life expectancy at birth fell to 71.0 years in 2021,
down from 72.8 in 2019 (COVID-19) pandemic).
 In 2022, the two most populous regions were both in Asia:
 Eastern and South-Eastern Asia with 2.3 billion people
(29 per cent of the global population), and
 Central and Southern Asia with 2.1 billion (26 per cent).
 Further reductions in mortality are projected to result in
an average longevity of around 77.2 years globally in 2050.
 In 2020, the global growth rate fell under 1 per cent per
year for the first time since 1950.

 The world’s population is projected to reach a peak of
around 10.4 billion people during the 2080s and to remain
at that level until 2100.
 More than half of the projected increase in global
population up to 2050 will be concentrated in just eight
countries: the Democratic Republic of the Congo, Egypt,
Ethiopia, India, Nigeria, Pakistan, the Philippines and the
United Republic of Tanzania.
 It took around 37 years since 1950 for human numbers to
double, surpassing 5 billion inhabitants in 1987.

 It is estimated that more than 70 years will be required for
the global population to double again, rising to over 10
billion by 2059.
 1950 to 2050, the world population was growing the fastest
in the period 1962-1965, when it was increasing on average
by 2.1 per cent per year.
 Since then, the pace of population growth has slowed by
more than half owing to reduced levels of fertility.

POPULATION, HEALTH AND
DEVELOPMENT
 POPULATION AND DEVELOPMENT
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
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POPULATION AND
DEVELOPMENT CONT’
 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, Population growth accelerated due to
 Living standards rose and
 Diminished Widespread famines and epidemics in some
regions
 In 1750 climbed to about 760 million
 1800 reached 1 billion
 By the end of twentieth century 6 billion
 Now 8 billion
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POPULATION AND
DEVELOPMENT CONT’
 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; (Population Booming)
 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.
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THE IMPACT OF POPULATION ON
DEVELOPMENT
Population growth, Agricultural Stagnation and
Environmental Degradation
There are multiple and synergistic links between
 Rapid population growth,
 Poor agricultural performance and
 Environmental degradation
 Relationships are difficult to analyze, as multiple factors
affect the relationship:
 The rate of population growth,
 Rate & level of environmental degradation, and
 Peace
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POPULATION AND GROWTH
 Expansive agriculture involves conversion of large areas:
 Forest,
 Wetlands,
 River valley bottoms, and
 Grassland savanna to crop land
 Agricultural expansion + rapid population growth =
accelerates degradation of natural resources
Agricultural stagnation
24

POPULATION AND GROWTH
CONT’
 Rapid increase of population increases the Rapid
population growth led to an erosion and breakdown in
customary laws
 Poor rules of governing sustainable use and management
of land and
 Other common properties, resources = risk of
environmental degradation
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POPULATION AND GROWTH CONT’
Deforestation and Fuelwood
90 % of households in SSA use wood-fuel as the staple
source of energy (forest trees).
 Slow economic growth in the region will hinder the
switch to non-wood fuels ( like electric, other gases).
 Hence the demand for wood-fuel with rapid population
growth would increase the risks of deforestation, drought
& flood.
This has important negative effects on rural women,
health, nutritional patterns and soil conservation.
(Decrease in soil fertility)
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LABOR FORCE AND POPULATION
GROWTH
Labor force:
 Population aged 15-65 years, is actively seeking jobs.
 Growth of the labor force in future will depend upon:
 Age structure of the population: the younger the
population- the faster will be the growth of labor force
population in the near future.
 Aggravated by:
 Current high fertility levels
 Low Development of Technology
 Low Development of Economic sector
27

 High population growth rate and unemployment is more
acute problem among nations with younger population
E.g. In SSA countries, 45% of the population is under
15 years
( huge number of none productive population)
= High dependent population
 Huge proportion of jobless productive forces
 Needs special population and economic policies
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Labor Force cont’

The goal of development is human dignity and well-being,
an essential ingredient of which is health.
 Progress in sustainable social development is
manifested in the health status of the population.
 “Health for all" must become one of the guiding
principles within the larger framework of sustainable
development.
 A healthy, active population is a prerequisite for
economic development, finding more time and energy
and using its human and natural resources for
productive work and care of the environment

 This can ensures an increase in school attendance, thus
enhancing learning, and frees economic resources which
would otherwise be required for treating illness and
disease.
 Health and population
 Second World War
Mortality
 By the end of the 1960s the anticipation of excessive
population growth refocused much attention on
cooperation for health and development.
International Development
efforts

International Conference on Population and Development
to be held in Cairo in 1994 is to challenged to ensure that:
 Population policies are implemented as part of a general
effort to improve the health of individuals, and
 Shift the focus of population policies from a
demographic to a quality-of-life imperative.
 In 1978, the International Conference on Primary Health
Care, held in Alma-Ata, declared that primary health care
is the key to health for all.

Primary health care is based on
 Practical, scientifically sound and socially acceptable
methods and technology.
 Implies that health care is universally accessible to
individuals and families in their community, with their
full participation, at an affordable cost, and on a
continuing basis.
 is given at the first point of contact between individuals
and the national health systems close as possible to
people's homes and work.
 It is the first element in a continuing health care
process and forms an integral part of the country's
health system.

 The health-for-all strategy calls for concerted action in all
sectors and requires the commitment of
 Political,
 Economic and
 Social decision-makers
 Population dynamics contribute to the complexity of
bringing health to all, because population change
constantly modifies the nature of the task.
 Health systems should respond effectively to changes
taking place in the growth, structure and distribution of
the world's population.
Mobilizing
public
support and
involvement

It requires
 The intensification of measures within the primary
health care framework and
 The creation of new responses to global population
changes.
 The challenge to health systems is that they respond
urgently in anticipation of the many different aspects of
population change;
 measures for early identification of emerging health
issues, and
 Timely response in order to avert problems where
possible and manage them where necessary, must be
given greater prominence in national and international
plans.
 Analysis and interpretation of population trends must be
an intrinsic part of health planning

 POPULATION GROWTH AND HEALTH
 Populations vary as a function
 Increases due to fertility,
 Decreases due to mortality, and
 Changes due to migration.
 The pattern of mortality is a measurable demographic
result of the general health status of the population by
region and country.
 More-developed,
 Less-developed and
Discrepancies
 Least-developed regions
 Shift in causes of death from infectious diseases towards
diseases of aging will continue in the less- and least-
developed regions

 The overall patterns and levels of fertility and mortality
(particularly infant mortality) are the most important
factors influencing population growth.
 Reproductive health
 Socio-economic status Health
Development
 Development (determined, specified and planning)
 Four principles determine the effects on health of
population growth:
(1.) Social development reduces fertility and thus slows down
population growth;
(2.) Rapid growth of population requires resources for health to
be increased at least as fast if the health status is to be
maintained, and faster if health is to be improved

(3.) Health must be given higher priority than hitherto in the
overall allocation of resources by governments;
(4.) Any health intervention which can influence population
growth must be firmly based on the highest ethical
standards
 POPULATION SIZE AND HEALTH
 Population size and material and human resources for health
is a crucial determinant of the health strategy of a country.
 Governments should give high priority to more important
measures for health and to the development of strategies
protecting people from adverse health consequences of
inappropriate development.

IMPACTS OF POPULATION ON
DEVELOPMENT AND HEALTH IN
ETHIOPIA
 Population growth trends can impede or hasten
development and development can in turn lead to
reductions in both fertility and mortality.
 E.g. the level of agricultural productivity and yield
can both be the cause and consequence of high or
low population growth.
 Population growth leading to rapid urbanization which
can in turn lead to greater access to contraceptive use
and a decrease in birth rates.
 population-food production nexus (high population
growth rate) Local and national strife and security
challenges disrupt agricultural production
Food shortages and internal displacements observed
repeatedly in Eastern African. 38

Access To clean water (EDHS data)
2005 90% Urban , 13% rural
2011 95% Urban, 42% rural
2016 97% Urban , 57% rural
Food Security
Population size farm sizes
are becoming smaller
difficult to sustain age-old practices
(Subsistence level)
Agricultural Productivity
Complete dependency on rain-fed
agriculture
low rate of fertilizer and nonuse of
improved seeds
land degradation and
deforestation
Sustainability and
Environment
Four Major areas of Past and
ongoing environmental damage
 Soil Erosion
 Deforestation
Biodiversity Loss
 Pollution:
Urbanization
17 percent (15.2 million) in
2012 42.3 million in 2034
Due to the urban growth
rate forecast of 5.4 percent
per year

IMPACTS OF POPULATION CONT’
Access to Health Care:
16,440 health posts
3,547 health centers
 311 hospitals were constructed as part of the Ethiopia’s
Health Transformation Plan [EHTP] EHTP.
Over 38,000 Health Extension Workers (HEWs) have
been trained and deployed to all regions - two HEWs per
Kebele
 Achievements (pro-poor policies and strategies)
MDG related
 Two-thirds drop in under-five mortality rate from 1990
levels
Increase in average life expectancy at birth from 45 in
1990 to 64 in 2014.

 69% decrease in maternal mortality
 Contraceptive Use 3% to 42% 7.7 in the
1990s to 4.6 in 2016 total fertility rate.
 stands out for the “rapid decline” in mother-to-child
transmission of HIV, by 50 percent between 2009 and
2012.
 Significant decrease in hospital admissions of children
under five (down by 81%) and
 Under-five deaths in this age group (73%) have been
achieved.
 Yet,
 Just over a quarter of Ethiopian women have access to
delivery care even though the country improved access
to delivery care five-fold between 2000 and 2016
 Over a third of Ethiopia’s children have had all eight
vaccinations

IMPACTS OF POPULATION
CONT’
 Sustainability and Environment
“Environmental Policy of Ethiopia” lists the two main policy
objectives of the country’s environmental protection program
( )
1) Enhancement of the health and quality of life of all
Ethiopians, and
2) Promotion of sustainable social and economic
development through the sound management and use
of natural, human-made, and cultural resources and
the environment in order to meet the needs of the
current generation without jeopardizing the ability of
future generations to meet their needs.

 Definition: Sustainable development is development that
meets the needs of the present without compromising the
ability of future generations to meet their own needs. It
contains two key concepts within it:
 The concept of 'needs', in particular, the essential needs
of the world's poor, to which overriding priority should
be given; and
The idea of limitations imposed by the state of
technology and social organization on the environment's
ability to meet present and future needs.
 Sustainability is a societal goal that broadly aims for
humans to safely co-exist on planet Earth over a long
time.

 Sustainability is commonly described along the lines of
three dimensions (also called pillars): environmental,
economic and social.
 In everyday usage of the term, sustainability is often
focused mainly on the environmental aspects.
 The most dominant environmental issues since around
2000 have been climate change, loss of biodiversity, loss of
ecosystem services, land degradation, and air and water
pollution.

 Six interdependent capacities are deemed to be necessary
for the successful pursuit of sustainable development.
 Capacities to measure progress towards sustainable
development
 Promote equity within and between generations
 Adapt to shocks and surprises
 Transform the system onto more sustainable
development pathways
 Link knowledge with action for sustainability and
 To devise governance arrangements that allow people
to work together in the exercising of the other capacities

 The Sustainable Development Goals (SDGs) or Global
Goals :
 Are a collection of 17 interlinked global goals designed to
be a "blueprint to achieve a better and more sustainable
future for all".
 The SDGs were set up in 2015 by the United Nations
General Assembly (UN-GA) and are intended to be
achieved by 2030.
 It is colloquially known as Agenda 2030.
developed in the Post-2015 Development Agenda as
the future global development framework to succeed
the Millennium Development Goals which were
ended in 2015.

 Goal 1: End poverty in all its forms everywhere
 Goal 2: End hunger, achieve food security and improved
nutrition and promote sustainable agriculture
 Goal 3: Ensure healthy lives and promote well-being for
all at all ages
 Goal 4: Ensure inclusive and equitable quality
education and promote lifelong learning opportunities
for all
 Goal 5 : Achieve gender equality and empower all
women and girls
 Goal 6: Ensure availability and sustainable
management of water and sanitation for all
 Goal 7: Ensure access to affordable, reliable,
sustainable and modern energy for all

 Goal 8: Promote sustained, inclusive and sustainable
economic growth, full and productive employment and
decent work for all.
 Goal 9: Build resilient infrastructure, promote inclusive
and sustainable industrialization and foster innovation
 Goal 10: Reduce inequality within and among countries
 Goal 11: Make cities and human settlements inclusive,
safe, resilient and sustainable
 Goal 12: Make cities and human settlements inclusive,
safe, resilient and sustainable
 Goal 13: Take urgent action to combat climate change
and its impacts

 Goal 14: Ensure sustainable consumption and
production patterns
 Goal 15: Protect, restore and promote Sustainable use
of terrestrial Ecosystems, sustainably manage Forests,
combat desertification, and Halt and reverse land
degradation And halt biodiversity loss
Goal 16. Promote peaceful and inclusive societies for
sustainable development, provide access to justice for all
and build effective, accountable and inclusive institutions
at all levels
 Goal 17. Strengthen the means of implementation and
revitalize the Global Partnership for Sustainable
Development

Economic Development Indicator :
 Economic development is the increase in the amount of
people in a nation’s population with sustained growth
from a simple, low-income economy to a modern, high-
income economy
 Gross Domestic Product (GDP): Gross domestic product is a
measure of economic activity in a country. It is calculated by
adding the total value of a country’s annual output of goods
and services.
o GDP = private consumption + investment + public
spending + the change in inventories + (exports -
imports).
.

 Gross National Product (GNP) : GNP is calculated by
adding to GDP the income earned by residents from
investments abroad, less the corresponding income sent
home by foreigners who are living in the country.
 National debt: is the total outstanding borrowing of a
country’s government (usually including national and
local government). It is often described as a burden,
although public debt may have economic benefits.
 The national debt is a total of all the money ever raised
by a government that has yet to be paid off;

 Trade balance: The balance of trade (or net exports,
sometimes symbolized as NX) is the difference between the
monetary value of exports and imports of output in an
economy over a certain period.
 Positive : Trade surplus if it consists of exporting more
than is imported
 Negative: unfavorable balance is referred to as a
 trade deficit or, informally, a trade gap
 Credit rating: A credit rating estimates the credit
worthiness of an individual, corporation, or even a country.
 Potential borrower’s ability to repay debt
Distribution of wealth: The distribution of wealth is a comparison
of the wealth of various members or groups in a society.
Wealth = assets − liabilities

 Aggregate measurements of health: Measures of average,
median and proportion.
 Ecological or environmental measurements: Physical
characteristics of the place where people live or work.
E.g. Exposure to air pollution
 Global measurements: attributes of group or place that
are not analogous to the individual level.
e.g. Population density
 Every health indicator is an estimate (a measurement
with some degree of imprecision) of a given health
dimension in a target population.

 Social development: refers to the institutions of societies
through which development is enhanced: the ‘soft’
dimensions of development, often invisible and difficult to
measure.

 Health: “a state of complete physical, mental, and social
well being not merely the absence of disease or infirmity “
(WHO,1947).
 Measuring Health Variables
 Direct individual observation e.g. Measuring blood
pressure
 Observation of population group/location based
observation
E.g : Rate and proportion can be generated
Prevalence of hypertension,
: Averages Average per-capita salt intake in
municipality
: Median Median survival of cancer patients

 Indicator: a measurement that reflect specific situation
 Dynamic
 Specific time linked
 Cultural situations and contexts
 Health indicator: Is a way of measuring specified health
situation of a given population.
 Positive Health indicator: Direct relationship with the
being healthy
 Negative Health indicator: Inverse relationship with
being healthy

USES OF HEALTH INDICATORS
 Description: describe health care need in population or
disease burden in specific group of population
 Forecast or prognosis: anticipate the results of the health
status of population or a group of patients.
 Explanation: understanding why some people are
healthy while others don’t.
 System management and quality improvement:
Feedback to improve decision making in various systems
and sectors.

 Evaluation: The impact of health policy, programs,
services and action.
 Advocacy: Support or oppose ideas or ideologies in
different historical and cultural contexts.
 Accountability: Provide needed information on risks
,disease, mortality patterns and health related trends for
a wider audiences.
 Research: To generate hypothesis and analyze the
situation.

 Measure gender gaps: measure inequalities that can be
attributed to gender norm, role and relation
 WHO Health Inequality indicators
oP Place (Region, province)
oR Race or Ethnicity
oO Occupation
oG Gender
oR Religion
oE Education
oS Socio-economic status
oS Social Capital or resources

 Measurability and feasibility: Availability of data for
measuring
 Validity: measuring what it intends to measure
(Accuracy and method of measurement)
 Timeliness: Need to be compiled and reported at the
proper time (Decision making).
 Replicability: provide the same result when measured by
the different people using the same measurement.

 Sustainability: Usable over the span of time.
 Relevance and importance: Provide information that is
appropriate and useful for programs and policies as well as
decision making.
 Comprehensible: Understood by responsible body who
will take the action/decision making.

 An indicator may be as simple as absolute number of
events or a complex calculation like life expectancy at
birth, fertility rate and description of quality of life.
 Most frequent measurements are
Counts
Ratios
Proportions
Rate
Odds

 Count: gives the number of occurrence of the event(s)
being studied within specified time, and at specific place.
 also Called absolute frequency
refers to magnitude of problem
e.g. 250 person diagnosed with TB in the community
 Ratio: The relationship between two numbers
 Proportions: Numerator is the subset of the denominator
 Expressed in percentage
Observed relative frequency of an event
e.g. Finite number of population observed and 10% of them have
hypertension
 Rate: Absolute number of occurrences of events being studied in
specified time. E.g.

 Odds: The numerator is the Proportion of event of interest
and the denominator is the proportion of non-event.

 Incident: New event or case of disease (death or other
health condition) that occurred in specified time period).
 Incidence rate: Number of new cases or other health
condition divided by the population at risk of disease
(exposed) population in specified place during specified
period of time.

 Prevalence: an event or existing case of diseases (other
conditions ) at specified period of time.
 Prevalence Rate: number of event or existing case of diseases
(other conditions ) divided by the number of population at specified
period of time.
Relationship between incidence and prevalence

 Incidence: essential for analyzing the occurrence of new
events in populations and their related factors.
 Prevalence: essential for planning and organizing existing
resources and services as well as for obtaining additional
support, when necessary.

 Core indicator: An indicator is prioritized as “core” and
included in The Global Reference List if it meets all of the
following criteria:
 The indicator is prominent in the monitoring of major
international declarations to which all member states
have agreed, or has been identified through
international mechanisms such as reference or
interagency groups as a priority indicator in specific
programme areas.
The indicator is scientifically robust, useful, accessible,
understandable as well as specific, measurable,
achievable, relevant and timebound (SMART).
There is a strong track record of extensive
measurement experience with the indicator (preferably
supported by an international database).

 The indicator is being used by countries in the
monitoring of national plans and programmes.
 Additional indicator: An indicator is categorized as
“additional” if it is considered relevant and desirable
but did not meet all the criteria mentioned above.

DEMOGRAPHIC DATA
What is Data?
Data is any quantities, characteristics(variables) or
symbols on which measurements are performed
i.e. data is any variable that we can measure, count ,
categorize or qualify
Data is any information that can be measured
(E.g. Height, weight, distance) Or
Counted (age, number of students in a class) or
Categories (blood type, color, Religion, etc)
76

USES OF DATA
Demographic data are important in providing factual
basis for decision making on matters of public policy
and action concerning social and economic affairs
These data can be used to indicate present information
and future requirements in terms of types and extent
of social needs and services such as:
- health services ,
- education,
- employment opportunities,
- production, etc
77

 Primary Data Sources: Provide direct evidence about the
event.
 Data collection can take forms through the population
census, national or local researches .
 Data source is created to achieve some purpose
 Secondary Data Sources: Originally collected for other
purpose

DEMOGRAPHIC DATA
What are the sources of data?
The major sources of demographic data include:
2.1. Census( complete population count)
2.2. Registration of vital events (Records)
2.3. Sample surveys
2.4. Ad-hoc Demographic studies
80

DEMOGRAPHIC DATA CONT’
Census
 Census is defined as a complete enumeration or count of a
population at a point in time within a specified
geographical area
 A census provides more reliable and accurate data if
properly enumerated as it counts the actual number of the
individuals
e.g. Population and housing census
81

Old Censuses :
• - During the Babylon Era in about 3800 B.C.
E.g. China done it in about 3000 B.C.
- Egypt done it in about 2500 B.C
Modern Censuses
the first modern Census :
• Canada in 1666 A.D.
• USA in 1790 A.D
• Zaire in 1984 A.D
• Ethiopia in 1984 A.D.
83

Techniques of Census
There are two techniques of conducting census,
I.E. Dejure and Defacto techniques
A. DEJURE
This technique is counting people according to their
permanent place of location or residence of individuals
(guests will not be counted)
84

DEMOGRAPHIC DATA
Advantages
 It gives permanent picture of a community
 It provides more realistic and useful population statistics
Disadvantage
household member who is temporarily away from home
may be missed from being counted
 Some people/ individuals may be counted twice
 Information collected regarding persons away from home is
often incomplete or incorrect
85

B. DEFACTO
This technique of census refers to counting
persons where they are present at the time of the census
period (regardless of their permanent residence)
 Advantages
There is less chance for omitting person from the
count/census
86

Disadvantages
 Difficult to obtain information regarding persons in transit
( on the way)
 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
 Less likely to provide picture of the population in a given
community
87

Use of Census
A census is useful for:
• Planning, decision making, policy formulation
• Calculating health indicators and vital indices
Steps in Conducting Census
• The major steps to be followed in a census include:
• Planning and preparation
(e.g. budget, human resource, logistics)
• Collecting information (actual field work)
88

Steps:
 Compilation and analysis ( data presentation using
table, different graphs)
 Dissemination
(publicizing /mass media, publication, workshop, etc)
 Evaluation of the over all performance
89

Qualities of a Census
A census must have the following qualities
 Inclusiveness: include every individual in the area (no
omission or duplication or double count)
 Fixed point in time: Information should relate to a well–
defined point in time
 Regularity: It should be taken at regular intervals; preferably
every 10 years
defined territory: should refer to people inhabiting in a well
defined geographical area
90

DEMOGRAPHIC DATA
Registration of Vital Events (Statistics)
 It is a regular and continuous registration of
vital events
 It is a Civil Registration system, which records
births, deaths, marriages ,divorce, etc (vital
statistics),
 It enables calculating rates of population growth
but are much less adequate than national
censuses
91

DEMOGRAPHIC DATA
 Particularly, In developing countries where illiteracy
rates are high and communications are poor,
 The problems of recording births and deaths are
immense
(Both in in rural and Urban populations )
92

DEMOGRAPHIC DATA
Sample Surveys
 A sample survey is another source of demographic data
 It is carried out in a scientifically selected area following
a systematic and scientific procedures
 It covers only a representative section or portion
(sample) of the population under consideration
 Then the result will be generalized to the general
population
93

DEMOGRAPHIC DATA
Advantage of sample survey
 Less costly
 Results are immediate
Disadvantage
 Relatively less accurate as compared to Census
 Sampling error
94

Principle and determinants of Fertility
Bongaarts Model of the Proximate determinants of
fertility
 Studies of the causes of fertility levels and their
changes often seek to measure directly the impact of
socioeconomic factors on fertility.
 The biological and behavioral factors through which
socioeconomic, cultural, and environmental variables
affect fertility are called intermediate fertility variables.
 The primary characteristic of an intermediate fertility
variable is its direct influence on fertility.

 If an intermediate fertility variable, such as the
prevalence of contraception, changes, then fertility
necessarily changes also (assuming the other
intermediate fertility variables remain constant).
 while this is not necessarily the case for an indirect
determinant such as income or education.
 Consequently, fertility differences among populations
and trends in fertility over time can always be traced to
variations in one or more of the intermediate fertility
variables.

Although these relationships have been recognized since the
pioneering work of Kingsley Davis and Judith Blake in the mid-
1950s,
Efforts to quantify the link between a set of intermediate fertility
variables and fertility have proven difficult and have thus far only
resulted in highly complex reproductive models.'

I. Exposure factors
1. Proportion married
II. Deliberate marital fertility control factors
2. Contraception
3. Induced abortion
III. Natural marital fertility factors
4. Lactational infecundability
5. Frequency of intercourse
6. Sterility
7. Spontaneous intrauterine mortality
8. Duration of the fertile period
NB: the term "natural fertility“; applies to a population in
which couples do not practice deliberate fertility control
dependent on the number of children they have.

1. Proportions married: measure the proportion of women
of reproductive age that engages in sexual intercourse
regularly.
 All women living in sexual unions should theoretically
be included,
 For convenience, the term "marriage" is used to refer
childbearing of women living in stable sexual unions,
such as formal marriages and consensual unions
2. Contraception: Any deliberate parity-dependent
practice-including abstention and sterilization-undertaken
to reduce the risk of conception is considered
contraception.
 absence of contraception and induced abortion implies
the existence of natural fertility

3. Induced abortion: This variable includes any practice
that deliberately interrupts the normal course of gestation.
4. Lactational infecundability: Following a pregnancy a
woman remains infecundable (i.e., unable to conceive) until
the normal pattern of ovulation and menstruation is
restored.
 The duration of the period of infecundity is a function of the
duration and intensity of lactation.
5. Frequency of intercourse: This variable measures
normal variations in the rate of intercourse, including
those due to temporary separation or illness.
 Excluded is the effect of voluntary abstinence-total or
periodic to avoid pregnancy.

6. Sterility: Women are sterile before menarche, the
beginning of the menstrual function, and after menopause,
 But a couple may become sterile before the woman
reaches menopause for reasons other than contraceptive
sterilization.
7. Spontaneous intrauterine mortality: A proportion of all
conceptions does not result in a live birth because some
pregnancies end in a spontaneous abortion or stillbirth.
8. Duration of the fertile period: A woman is able to
conceive for only a short period of approximately two days
in the middle of the menstrual cycle when ovulation takes
place.
 The duration of this fertile period is a function of the
duration of the viability of the sperm and ovum.

 Marriage
Cm = index of proportion married.
 TFR total fertility rate= equal to the number of births a woman
would have at the end of the reproductive years if she were to bear
children at prevailing age-specific fertility rates while living
throughout the reproductive period (excluding illegitimate births
but based on all women of reproductive age whether married or
not);
 TM total marital fertility rate= equal to the number of births a
woman would have at the end of the reproductive years if she were
to bear children at prevailing age-specific marital fertility rates and
to remain married during the entire reproductive period (based on
the fertility of married women aged 15-45);
 Cm= TFR/TM

Contraceptive
 To estimate the effect of contraception on marital
fertility
 TM = Cc x TNM
 TM- total marital fertility rate;
 TNM = total natural marital fertility rate, equal to TM
in the absence of contraception and induced abortion;
 Cc - index of non-contraception.
 With the value of Cc depending on the prevalence of
contraception, that is, the extent of use and the
effectiveness of contraception (induced abortion is
assumed absent for the moment).
 if all couples who practice contraception are assumed

 Cc = 1- 1.8ue
 where
 u = average proportion of married women currently using
contraception (average of age-specific use rates);
 e = average contraceptive effectiveness (average of use-
effectiveness levels by age and method)
When no contra-ception is practiced, Cc equals 1.0; when
all nonsterile women in the reproductive years are
protected by 100 percent effective contraception, Cc = 0
and TM = 0.
 Induced Abortion: Estimates of the number of births
averted by induced abortion are largely based on numerical
exercises using mathematical reproductive models.

 In the absence of contraception, an induced abortion
averts about 0.4 births, while about 0.8 births are
averted when moderately effective contraception is
practiced.
 b= 0.4 (1 + u)
 To be exact, u should equal the proportion protected
by contraception among women who have had an
induced abortion.
 Since this information is almost never available, the
variable u in equation is taken to equal the
proportion of all married women who are currently
using contraception.

 Lactational Infecundability
A birth interval can be divided into four components
1. An infecundable interval immediately following a
birth. In the absence of lactation, this segment
averages about 1.5 months, while prolonged lactation
results in infecundable periods of up to two years.
2. Waiting time to conception, which starts at the first
ovulation following birth and ends with a conception
 5 months to high values that only rarely exceed 10
months, with typical values around 7.5 months
3. Time added by spontaneous intrauterine mortality. In
cases where a conception does not end in a live birth, the
duration of a shortened pregnancy and another waiting
time to conception are added to the birth interval.

On average the time added by intrauterine mortality
equals about 2 months per birth interval
4. A nine-months gestation period ending in a live birth.
 Without lactation, a typical average birth interval can
therefore be estimated to equal 1.5 + 7.5 + 2 + 9 - 20
months.
 with lactation it equals the average total duration of the
infecundable period plus 18.5.
The ratio of the average birth intervals without and with
lactation will be called the index of lactational
infecundability
C = 20/ 18.5 + i
Where C- index of lactational infecundability;
i- average duration (in months) of infecundability from
birth to the first postpartum ovulation (menses).

 Frequency of Intercourse
 The level of the total fecundity rate is influenced by
coital frequency,
 Because reliable coital frequency data exist for very few
countries, it is difficult to analyze this relationship by
comparing individual populations.
 If the typical mean birth interval in the absence of
lactation equals 20 months, then, on average, 15 such
birth intervals can be fitted into a 25-year span.
 If one further accepts the previously proposed range of
5-10 months for the mean waiting time to conception,
then the mean birth interval in the absence of lactation
would range from 17.5 to 22.5 months.

 Intrauterine Mortality, Sterility, and the Duration of the
Fertile Period
 Little is known about the genetic factors, but two
environmental factors, health and nutrition, are often
considered significant determinants of fertility.
Nutrition and health may affect infant mortality, which
is considered one of the determinants of desired family
size.
Nutrition and health can affect adult mortality and
therefore the risk of widowhood. The risk of widowhood
in turn influences the proportion married

Well-nourished women have periods of lactational
infecundability that are slightly shorter than those of
poorly nourished women.
 It is not clear whether this is due to difference in
lactation behavior, ability to lactate, or other physiological
characteristics influencing lactational infecundability.

MEASUREMENT OF FERTILITY
Crude Birth Rate ( denoted as CBR)
 The crude birth rate indicates the number of live births
(children born alive) per 1000 mid–year population in a
given year
CBR = Number of live births in a year X 1000
Total mid – year population
 CBR varies widely from population to population based on
socio-economic status of a country Developing countries have
high CBR while Developed countries have low CBR
111

MEASUREMENT OF FERTILITY
CONT’
 Fertility may be grossly termed as:
 High
 Medium or
 Low based on CBR values as follows:
 High fertility Rate = > 30 births/1000
 Medium fertility rate = 20-30 births/1000
 Low fertility rate = < 20 births/1000
112

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 is more sensitive measure of fertility than the
CBR,
Because, it refers to the age and sex group capable of
giving birth (females 15-49 years of age)
It eliminates distortions that might arise due to different
age and sex distributions among the total population
113

GENERAL FERTILITY RATE
(GFR)
 The major limitation of GFR is that not all women in the
denominator are exposed to the risk of child birth
( as there are many infertile women included in the
denominator)
= under estimates the birth/1000
GFR = Number of live births in a year X 1000
Number of females 15-49 years of age
114

 The Age specific fertility rate is defined as the number
of children born alive to females in a specific age group
per 1000 females in that specific age group
e.g of age category(5-year category):
(15-19), (20-24) (25-29),(30-34),….. (45-49) years of age (5
years interval in each category)
115

ASFR = No. of live births to females in a specific
age group in a year X 1000
Mid-year population of females of the same age group
For example, ASFR for women 20 – 24 years of age is
expressed as:
ASFR (20-24) = Live births to women 20- 24 yrs of age X
1000
Total No. of females in 20 – 24 years of
age
116

 The total Fertility Rate is the average number of children
that would be born to a woman throughout her
reproductive life time or child bearing age (15-49 years),
 if she were to pass through all her child bearing years at
the same rates as the women now in each age group
 The TFR sums up in a single the number of the Age
Specific Fertility ( it is the sum of ASFR)
117

 If 5 – year age groups interval is used, the sum of the rates is
multiplied by 5
 This measure gives the approximate magnitude of “completed
family size”
The TFR is one of most useful indicators of fertility, because it
gives the best picture of how many children the women are
having currently
 TFR = Sum of all Age specific fertility rates multiplied by age
interval (usually 5)
118

E.G
Age group
of mothers
Number of
Women(a)
No. of live births to
the age group (b)
Age specific
birth rates
15-19 years 1,237,721 117,583
20-24 978,136 268,987
25-29 979,623 283,111
30-34 989,693 254,351
35-39 814,243 162,034
40-44 548,882 57,633
45-49 406,540 22,766
Total 5,954,838 1,166,465
119
------ children per woman in her reproductive
life

Age group
of mothers
Number of
Women(a)
No. of live births
to the age group
(b)
Age specific
birth rates
15-19 years 1,237,721 117,583 0.095
20-24 978,136 268,987 0.275
25-29 979,623 283,111 0.289
30-34 989,693 254,351 0.257
35-39 814,243 162,034 0.199
40-44 548,882 57,633 0.105
45-49 406,540 22,766 0.056
Total 5,954,838 1,166,465 1.276
120
TFR= 5x1.276= 6.38 children per woman in her
reproductive life
(TFR= 5xASFR)

TFR also varies widely between populations in the world.
It is higher for developing countries than developed ones.
 According to World Population Data Sheet of the population
Bureau the TFR for 2003 was:
World = 2.8 children per woman
More Developed Countries = 1.5 children per woman
 Ethiopia 1994 = 6.5 Children per woman
 Currently it is estimated to be 4.1 (2014)
121

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 the
daughters
 Literally it 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
122

Example:
The sex ratio at birth for Ethiopia (2001) was 100.6 (i.e. 100.6
females for every 100 males) and the TFR (2001) = 5.9 (5.9 children
per women)
GRR = TFR X proportion of female births
GRR = 5.9 X 100.6 = 2.94
200.6
= 2.9 daughters /woman
123

CHILD – WOMAN RATIO (CWR)
 Child woman ratio is defined as the number of children 0 – 4
years of age per 1000 women of child bearing age, (15 -
49years).
 This ratio is used where birth registration statistics do not exist
or are inadequate
 It is estimated through data derived from censuses
 CWR = No of children (0 – 4 years of age) X 1000
Total No of women 15 – 49 years age
124

Eg.
 If the number of children under 5 years of age in an area is 2,000,
and the number of women 15 – 49 years of age is 8,000,
 The CWR = 2,000 X 1000 = 250 / 1000
8,000
 That is 250 children 0 – 4 years of age (under five) per 1000 women of the
reproductive age
125

MEASURES OF MORTALITY
(DEATH)
 Mortality refers to deaths that occur within a population
(leading to reduction of population)
 The incidence of death can much related to the living
standard, the health status of a population and the
availability of health services
 Mortality (Death) rates have three essential elements:
1. A population group exposed to the risk of
death(denominator)
2. The number of deaths occurring in that
population group (numerator)
3. A time period (given period of time)
126

MEASURES OF MORTALITY CONT’
Measures of mortality
Crude Death Rate (CDR)
 The crude death rate is the number of deaths per 1000
population in a given year
CDR = Total number of deaths in a year X 1000
Mid-year population
 As its name implies the CDR is not a sensitive
measure
 It is affected by particularly the age structure of the
population 127

AGE SPECIFIC MORTALITY
RATES
 Death Rates can be calculated for specific age groups, in
order to compare mortality at different ages. E.g. for
infants (< one year of age), children 1-4 yeas of age,
children under five years, etc.
ASMR = Number of deaths in a specific age group X1000
Mid-year population of the same age group
Infant Mortality Rate (IMR)
 Infant Mortality Rate is the number of deaths of infants
under one year of age (0-11 months of age) per 1000 live
births in a given year
128

AGE SPECIFIC MORTALITY
RATES
IMR = No. of death of children < 1 yr of age in a yr X 1000
Total live births during that year
 Infant (children under one year of age) are at highest
risk of death than any other age group
 The infant mortality rate is considered to be a sensitive
indicator of the health status of a community, because it
reflects the socio-economic condition of the population; i.e.
 The level of education, environmental sanitation,
adequate and safe water supply, communicable diseases,
provision of health services etc
 As they are highly prone to infectious diseases
129

INFANT MORTALITY RATE
(IMR)
 Infant Mortality Rate is the number of deaths of infants
under one year of age (0-11 months of age) per 1000 live
births in a given year.
 Infant (children under one year of age) are at highest
risk of death than any other age group.
IMR = Number of death of children < 1 year of age in a
year X 1000
Total live births during that year
IMR widely varies between countries in the world
130

 These factors mostly affect infants and children under five
years of age.
 Hence, IMR widely varies between countries in the world
Child Mortality Rate (CMR)
 It is the number of deaths of children 1-4 years of age per
1000 children 1-4 years of age.
 It is a sensitive indicators of the health status of a
community.
131

CMR = Number of deaths of children 1-4 year of age in a
year X 1000
Total number of children 1-4 years of age
Under Five Mortality Rate (<5MR)
It is the number of deaths of children under five years of
age in a year (0-4 years of age) per 1000 children under
five years of age (0-4 year).
It is also a very good indicator of the health states of a
community
It can also be calculated as the number of deaths of
children under five years of age in a year per 1000 live
births
5MR = Number of deaths of children <5 yrs in a year X 1000
Total number of children < 5 years of age
132

Or
< 5MR = Number of deaths of children <5years in a year X
1000
Total live births in the same year
Neonatal Mortality Rate (NNMR)
Neonatal period is the first month of age of an infant.
Neonatal mortality (death) is the death of infants under
one
month (<4 weeks). Per 1000 live births.
Neonatal Mortality Rate (NNMR) =
Number of deaths of infants < 1 mouth in a year X 1000
Total number of live births in the same year
133

 Neonatal mortality rate reflects mortality due to:
Maternal factors during pregnancy
Birth injuries
Neonatal infection, etc.
 It is an indicator of the level of prenatal and obstetric
components of maternal and child health care (MCH).
134

Post-Neonatal Mortality Rate (PNNMR)
 The past neonatal age is the period of time between one
month up to one year
 Post – Neonatal mortality (death) is deaths of infants one
month (four weeks) of age up to one year (1 – 11 months
age of) per 1000 live births
PNNMR = Number of deaths of infants 1 month to 1 year of
age in a year X1000
Total Number of live births during the same year
135

 The post-neonatal mortality rate reflects deaths due to
factors related to;
• Environmental sanitation
• Infections (communicable diseases)
• Nutritional problems
• Child care etc.
 It can be used as an indicator to evaluate Maternal and
Child Health Care services and
 socio-economic development of a community or country
136

 Maternal mortality ratio is the number of maternal
deaths related to:
 pregnancy,
 child birth and
 post natal (peurperium) (45 days after delivery)
complications per 1000 live births (usually per
100,000 L.B).
MMR = Number of deaths of women related to
pregnancy child
birth and peurperium in a year X 100,000
Total number of live births in the same year
137

It is a sensitive indicator of health status of a
population
It reflects the socio- economic status of a community
The Maternal Mortality Ratio of Ethiopia is currently
estimated to be 401 deaths per 100,000 live births
(2017, estimation)
138

Sex Specific Death Rate is the number of deaths
among a specific sex group (males or females) per
1000 population of the same sex group
Sex specific Death (Mortality) Rate for males =
Number of deaths among males X 100
Total number of males
Sex specific mortality rate is used to determine
which sex group is at higher risk of death than the
other
139

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