Shraddha Acharya_Demographic transition theory n NDHS


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here are some slides on Demographic Transition Theory and the Nepal Demographic and Health Survey's major indicators!!!...hope it comes out as an informative presentation!!!

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  • Reasons for high birth rate in stage I: children need for farming, children die at early age, No family planning, Social and cultural encouragementReasons for high death rate in stage II: famine, diseases, poor medical knowledge
  • Reasons for changes in Birth and Death rates in Stage III: Improved medical care and diet, use of family planning methods, improved water supply and sanitation, fewer children die
  • Reasons for changes in Birth and Death rates in stage IV: family planning, later marriages, improved women status, good health, longer life expectancy, reliable food supply
  • Reasons for decline in birth and death rates in Stage V: family planning, high standard of living, highly advanced medical services, food supply, longer life expectancy, improved women status, later marriages etc.
  • Though fertility declined in western but the condition under which it declined were diverse.
  • There has been a decline in the use of female sterilization and injectables, while the use of male sterilization has increased slightly. It is also notable that the long-term use of temporary methods such as implants and IUDs has been increasing over the past few years, providing options for women to drift away from permanent methods such as sterilization. Use of traditional methods has also increased over the years.
  • Tetanus toxoid (TT) vaccine is given to women during pregnancy to prevent infant deaths caused by neonataltetanus, which can occur when sterile procedures are not followed in cutting the umbilical cord after delivery.
  • Shraddha Acharya_Demographic transition theory n NDHS

    1. 1. Maharajgunj Medical Campus, IOM (BPH 26th Batch) GROUP V CONTENTS:   DEMOGRAPHIC TRANSITION THEORY NEPAL DEMOGRAPHIC AND HEALTH SURVEY (NDHS) & ITS MAJOR INDICATORS BY: 1. 2. 3. 4. 5. Ravindra Bhandari (451) Ramsagar Thakur (454) Sanjay Sah (457) Shraddha Acharya (460) Yograj Karki (466)
    3. 3. INTRODUCTION  The Demographic Transition Theory refers to the transition from a condition of high mortality and high fertility with consequent slow growth of population to conditions of low mortality and low fertility, once again leading to a slow growth of population; as the country develops from pre-industrial to industrialized economic system.  Unlike other population theories, it is based on the actual demographic experience of Western countries.
    4. 4. BACKGROUND  Earlier demographers such as Landry (in 1909) and Warren Thompson (in 1929) had attempted to construct a typology to describe the transition from conditions of high mortality and high fertility to conditions of low mortality and low fertility.  In 1945, Frank W. Notestein presented the theory of demographic transition in mature form, with explanation for the changes in fertility so he may be credited with expounding the theory of Demographic Transition.  However, in 1947, C.P. Blacker attempted to identify the following five phases of the demographic transition:
    6. 6. 1. HIGH STATIONARY STAGE  Characterized by high birth rates and death rates which are in balance which causes population stationary.  All human populations are believed to have experienced this balance until the late 18th century.  Mostly in pre-industrialized countries.  Because both rates are approximately in balance, population growth is typically very slow in this stage.
    7. 7. 2. EARLY EXPANDING STAGE Death rate begins to decline while the birth rate remains same. Developing countries like countries of South Asia and Africa are in this phase. The death rates drop rapidly as a result of improved health conditions. Example: Egypt, Kenya, India
    8. 8. ….CONTD  The decline in the death rate is due initially to two factors: 1. Improvements in the food supply brought about by advancements in agricultural practices and better transportation prevent death due to starvation and lack of water. Agricultural improvements included crop rotation, selective breeding, and seed drill technology. 2. Significant improvements in public health, reduced mortality, particularly in childhood. Improvements in water supply, sewerage, food handling, and general personal hygiene and knowledge about disease causation.  During the second half of the 20th century less-developed countries entered Stage-2 i.e. Early Expanding Stage, creating the worldwide population explosion.
    9. 9. 3. Late expanding stage  The death rate declines still further and the birth rate tends to fall.  Birth rates fall due to access to contraception, increases in wages, urbanization, an increase in the status and education of women etc.  Due to decline in child death rate and increase in incomes, parents realize that they do not need more child for their comfortable old age.  Population growth begins to level off.  Example: Brazil, Singapore, China
    10. 10. 4. LOW STATIONARY STAGE  There is low birth and low death rate which results in stationary population.  Population is stable or very slow increase in growth.  Many industrialized countries are in this stage.  This is all due to development in socio economic condition, education and all services and facilities concerning well being and quality life of every individual.  Example: USA, Japan, France, UK, Denmark, Belgium
    11. 11. 5. Declining stage The population begins to decline because death rate exceeds birth rate. European and many East Asian countries now have higher death rates than birth rates. Example: Germany, Hungary
    12. 12. Corresponding Population Pyramid of the Phases of Demographic Transition Theory
    13. 13. Notestein characterized 3 types of populations according to their stage of demographic evolution: 1. INCIPIENT DECLINE • Where fertility have fallen below the replacement level. Example: USA, Australia, New Zealand 2. TRANSITIONAL GROWTH • Where birth and death rates are still high and growth is rapid, but the decline of the birth rate is well established. Example: Soviet Union, Japan, some countries of Latin America 3. HIGH GROWTH POTENTIAL • Where mortality is high and variable and is chief determinant of growth, while fertility is high and has thus far shown no evidence of a downward trend. • Rapid growth is expected as soon as technical developments make possible decline in mortality. Example: Asia, Africa, Latin America
    14. 14. CRITICISM OF DEMOGRAPHIC TRANSITION THEORY 1. The critics of this theory point out that the experiences of the various European countries were not uniform, in the sense that the sequences of the stages as described in the theory were not the same. 2. In Spain and in some eastern and southern Europe countries, fertility decline occurred even when mortality was very high. 3. In some countries like USA, the growth rate in the post-transition stage was probably higher than in Stage-II and Stage-III.
    15. 15. CONTD…. 4. Notestein’s claim that fertility declined initially in urban areas is not true for some countries. Example: countries like France, Sweden, Finland, Bulgaria with predominantly rural populations, experienced declines in birth rate to the same extent as did some highly urbanized countries like England and Wales. 5. This theory cannot also explain the phenomenon of “baby boom” in Western countries after economic recovery and Second World War.
    16. 16. CONT…. 6. It does not provide a theoretical explanation of the forces that caused demographic changes, especially fertility which brought demographic transition. 7. Further it took European countries 150 to 200 years to reduce their death rate below 15 but this was done by some developing countries in 15 or 20 years. Thus, it could also not be used to predict the sequences through which the developing countries would pass. 8. It cannot be called a “theory” because it does not also identify crucial variables involved in fertility decline therefore, it also doesn’t fulfill the criterion of a theory. * However, its greatest strength is the prediction that the transition will occur in every society which is experiencing modernization. So, the force of the generalization remains despite many objections, qualifications, and doubts about the demographic transition theory.
    17. 17. APPLICATION IN DEVELOPING NATIONS  As we see later, mortality in Nepal started to decline since the late fifties and the pace of mortality decline has become faster since the 1990s. If one looks at the fertility transition in Nepal one would find that fertility started to decline much later and at much slower speed than mortality. For example, fertility in Nepal was more or less constant till early eighties and started to decline thereafter. Thus it can be argued that Nepal is in the third phase of Demographic transition where both the fertility and mortality are declining.  The developing countries have recently experienced a phenomenal reduction in death rates, as a result of which there has been tremendous increase in rates of population growth. This rapidly increasing population is an obstacle in the path of development programmes for economic developments, industrialization and modernization.  According to this theory, the reduction in the birth rate is an outcome of industrialization and modernization. However, in rapidly growing population, it is not possible to wait for industrialization and modernization to bring about reduction in fertility. Many developing countries have, therefore, adopted family planning programmes directly to influence fertility negatively. Therefore, it is difficult to trust that the Demographic Transition Theory is also applicable to developing countries like Nepal and that what happened in West, in respect to population growth, would be duplicated in developing countries.
    19. 19. INTRODUCTION  Population censuses have been carried out in Nepal since 1911 at decennial intervals. However, detailed information about the size and structure of the population was provided only since the 1952/54 census.  The 2011 Nepal Demographic and Health Survey (NDHS) is the fourth nationally representative comprehensive survey conducted as part of the worldwide Demographic and Health Surveys (DHS) project in the country. It was conducted under the aegis of the Ministry of Health and Population (MOHP).  The survey was implemented by New ERA, a private research firm in Nepal. ICF Macro provided technical assistance through its MEASURE DHS project. Funding for the survey came from the United States Agency for International Development (USAID).  Long-term objective of the survey is to strengthen the technical capacity of local organizations to plan, conduct, process, and analyze data from complex national population and health surveys in Nepal.
    20. 20. Sample Selection • Samples were selected independently in every stratum, through a two-stage selection process. In the first stage, Enumeration Areas (EAs) were selected using a probability proportional-to-size. In order to achieve the target sample size in each domain, the ratio of urban EAs over rural EAs in each domain was roughly 1 to 2, resulting in 93 urban and 196 rural EAs, for a total of 289 EAs. • A complete household listing and mapping was carried out in all selected clusters. In the second stage, 35 households in each urban EA and 40 households in each rural EA were randomly selected. The 2011 NDHS collected demographic and health information from a nationally representative sample of 10,826 households, which yielded completed interviews with 12,674 women age 15-49 in all selected households and with 4,121 men age 15-49 in every second household.
    21. 21. DEMOGRAPHIC INDICATORS Here, is Comparison of selected Demographic Indicators: INDICATORS 1971 1981 1991 2001 2011 POPULATION (MILLIONS) 11.6 15.0 18.5 23.2 26.6 GROWTH RATE 2.1 2.6 2.1 2.2 1.4 DENSITY (POPULATION /Km2) 79 102 126 157 181 LIFE EXPECTANCY : MALE 42 50.9 55 60.1 63.6 FEMALE 40 48.1 53.5 60.7 64.5
    22. 22. NDHS, 2011 The Kathmandu district has the highest population density (4,408) and Manang (3) the lowest. The decennial population growth has been highest in Kathmandu (61 percent) and lowest in Manang (-31 percent) . Currently, 4.5 million people (17 percent) reside in urban areas. The largest percentage of the population is in the Central development region (36 percent) and the smallest in the Far-western region (10 percent). The sex ratio (number of males per 100 females) is estimated at 94.4 in the current census, as compared to 99.8 in the previous census in 2001. Average household size has decreased in 2011 (i.e. 4.7) as compared to 2001 (i.e. 5.4)
    23. 23. FERTILITY • 120 115 110 105 100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 According to the results of the 2011 NDHS, the Total Fertility Rate(TFR) calculated for the three years preceding the survey is 2.6 births per woman age 15-49. The other fertility indicators are as shown below according to NDHS,2011. 102 Total 96 Urban Rural 60 25.5 24.3 16.6 2.6 1.6 TFR 2.8 GFR CBR
    24. 24. Trends in TFR 1996 TFR 2001 2006 2011 4.6 4.1 3.1 2.6 Age Specific Fertility Rate (ASFR) NDHS,2011 Age group Total 15-19 81 20-24 187 *(max) 24-29 126 30-34 71 34-39 36 40-44 14 45-49 5 * (min)
    25. 25. FAMILY PLANNING  Family planning use has remained essentially the same since 2006. Use of female sterilization has dropped slightly, from 18% in 2006 to 15.2% in 2011, while male sterilization has increased, from 6.3% in 2006 to 7.8% in 2011.  One in two currently married women is using a method of contraception, with most women using a modern method (43.2 percent).  Use of traditional methods has also increased, from 4% in 2006 to 7% in 2011, mostly due to an increase in the use of withdrawal.  The 2011 NDHS also reveals that 27% of married women have an unmet need for family planning – 10% for birth spacing and 17% for limiting.
    26. 26. INFANT AND CHILD MORTALITY • • • • • * Neonatal mortality (NN): the probability of dying within the first month of life. Post-neonatal mortality (PNN): the difference between infant and neonatal mortality. Infant mortality (1q0): the probability of dying between birth and the first birthday. Child mortality (4q1): the probability of dying between exact ages one and five. Under-five mortality (5q0): the probability of dying between birth and the fifth birthday. Rates of childhood mortality are expressed as deaths per 1,000 live births, except in the case of child mortality, which is expressed as deaths per 1,000 children surviving to age one. • Neonatal Mortality Rate (NMR/1000 live births) 2001 NMR 2006 2011 39 33 33
    27. 27. • Post-Neonatal Mortality Rate (PNMR/1000 live births) 2001 PNMR 2006 2011 26 15 13 • Infant Mortality Rate (IMR/1000 live births) 2001 IMR 2006 2011 64 48 46 • Child Mortality Rate (CMR/1000 children surviving to age 1) 2001 CMR 2006 2011 29 14 9
    28. 28. • Under 5 Mortality Rate( U5 MR/1000 live births) 2001 2011 91 U5 MR 2006 61 54 • Perinatal Mortality Rate (PMR/1000 live births) 2001 2011 47 PMR 2006 45 37 * Perinatal Mortality rate: death of child from 28 weeks of gestation to 7th day after delivery.
    29. 29. MATERNAL HEALTH • Antenatal Care (ANC) 2001 2006 2011 % ANC by skilled providers (Doctors, nurses, and midwife) 28% 44% 58% % of ANC by Trained Health workers (HA,AHW,VHW,MCHW,FCHV) 11% 28% 36% ANC 1st Coverage 7.8% 8.5% 60.1% ANC 4th Coverage 14% 29% 50.1%
    30. 30. • Tetanus Toxoid (TT) vaccination coverage 2001 2006 2011 TT vaccination 9% 78% 82% TT 2+ coverage 45% 63% 70% 2001 2006 2011 Delivery in Health facilities 9% 18% 35% Home Delivery 89% 81% 63% Delivery assisted by SBA 11% 19% 36% Delivery assisted by HA 2% 4% 4% By FCHV - 2% 3% By TBA 23% 19% 11% By Relatives >50% 50% 40% • Site of Delivery
    31. 31. • Postnatal Care (PNC) Coverage 2006 2011 Women receiving PNC service 33% 45% PNC within 4 hours of Delivery 1 in 5 women 1 in 3 women PNC within 4-23 hours of Delivery 27% 7% PNC within 1-2 days 4% 4%
    32. 32. CHILD HEALTH • Overall Immunization among children(12-23 months) 2001 Overall Immunization coverage 2006 2011 60% 83% 87% •Coverage of individual vaccine among children(12-23 months) 2001 2006 2011 BCG Coverage 83% 93% 97% Measles 64% 85% 88% DPT-1 83% 93% 96% DPT-3 71% 89% 92% Polio-3 90% 91% 93% Children who didn’t receive any vaccines 3% 3% 3% Polio-1
    33. 33. NUTRITION • Malnutrition among Under 5 children Percentage 60 50 57 49 NDHS 2001 43 41 NDHS 2006 39 40 NDHS 2011 29 30 20 11 13 11 10 0 Stunting Wasting Underweight
    34. 34. • Malnutrition among Women 2001 2006 2011 Underweight (BMI<18.5) 27% 24% 18% Overweight (BMI>25) na 9% 14% • Anemia 2006 2011 Anemia among 6-59 months children 48% 46% Anemia among women of 15-49 years 36% 35% • Breast Feeding 2001 2006 2011 Duration of BF 33 months 30 months 31 months Exclusive BF 50% 53% 70% Mean duration of Exclusive BF na 3 months 4.2 months
    35. 35. CONCLUSION • Mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors result in the non-sampling errors in NDHS. • Also the data collected through questionnaires, debriefing are not very authentic. • Moreover, it doesn’t use analytical statistical methods to ascertain the significance of change and causative association between variables. • However, information provided in this report will help to assess the current health- and population-related policies and programs. It will also be useful in planning, implementing, re-focusing, monitoring, and evaluating health programs related to these issues in Nepal.
    36. 36. REFERENCES  Nepal Demographic and Health Survey (NDHS) report      2001,2006 and 2011 Population and studies :Challenges and Opportunities-J.C. CHESNAIS Demographic Transition Theory-DUDLEY KIRKT transition Principles of Population Studies- Asha A. Bhende and Tara Kanitkar (21st Edition) Park’s Textbook of Preventive and Social Medicine(21st edition)- K.Park