The document discusses mortality statistics in Afghanistan based on the 2010 Afghanistan Mortality Survey (AMS). Some key findings from the AMS include an infant mortality rate of 77 per 1000 live births, an under-five mortality rate of 97 per 1000 live births, and a pregnancy-related mortality ratio of 327 per 100,000 live births. The lifetime risk of pregnancy-related death is four times higher in rural versus urban areas. The AMS also estimated life expectancies of approximately 64 years for both sexes in Afghanistan. Causes of death are discussed for females and males of all ages based on AMS data.

1. Mortality Statistics
By: Dr Akhtar Mohammad Totakhail
Jamhoriat Hospital
Kabul January 9, 2013

2. Contents
• Public Health
• Demography
• Mortality
• Mortality Statistics
• Mortality Data sources
• Measures of Mortality
• Afghanistan Mortality Survey
• References
• pictures during AMS Survey

3. • Mortality record monthly based on
prognose survice to country
• Dialysis coordination with medicine
• Monthly report on mortlality
• Reasking for patient to volantaily exailing
patient.
• Protoccol with caregiver
• Reasking for doctor and nurse to volantaily
exailing patient.

4. Public Health
• Health:
WHO 2001: Health is a complete physical,
mental and social well-being state and not
only absence of disease or ailment
• Public health:
• The art and science dealing with the
protection and improvement of community
health by organized community effort
called public health.

5. Cont… pubic health
• Epidemiology
• Is the Greek terminology which Epi mean
upon, Demos mean, people and the Logos
mean study of.
• The study of the distribution and
determinants of health related states or
events in specified human populations and
its application to the control of health
problems

6. DEMOGRAPHY
Scientific study of population
• Births (Fertility)
• Sickness (Morbidity)
• Deaths (Mortality)
• Population movements (Migration)
• Other e.g. abortion rates, divorce rates etc.
• Scholars often focus on subtopics e.g. teenage
fertility, immigrant fertility, Malay fertility, infant
mortality, maternal mortality

7. DEMOGRAPHY
• Composition of population --- ethnic, age,
sex (also, how many are non-citizens)
• Distribution --- % rural, % urban, %
suburban. Also, how many citizens live
overseas
• Growth --- rapid growth, slow growth,
population decline

8. DEMOGRAPHY
Population is affected by fertility, mortality
and migration rates
Final population = Initial population + (Births
– Deaths) + (Immigration – Emigration)

9. Mortality
Why look at mortality?
• index of severity
• Effectiveness of treatment for a disease.
• Attention of authorities and policy makers
• Preventative measures

10. Mortality statistics
• What is Mortality Statistics?
• It is the study of mortality in
mathematically-based techniques used to
collect, organize, analyze, and interpret
quantitative data of mortality.

11. Mortality Data Sources
• Hospital records
• HMIS data
• Mortality survey
• Others???

12. Mortality Data Sources
Maternal Mortality
Mortality of women during pregnancy,
childbirth and the postpartum period.

13. Proportionate Mortality
• The proportion of deaths attributable to a causes
in a specific population over a period of time
• Each cause is expressed as a percentage of all
deaths
• The sum of the causes must add to 100%
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14. • Is a quick look at the major causes of death
• Not a rate –
– Since the denominator is all deaths, NOT the
population in which the deaths occurred
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15. Standardized Mortality Ratio
(SMR)
the age-specific rates of the standard
population to the population of interest to
determine the number of “expected”
deaths

16. SMR
Total number of observed Deaths in
population X 100
Total number of expected Deaths in
population

17. • Calculate expected deaths in the
Panamanian population:
Age Standard Panama Expected
Rate population deaths
0-29 0.0011 741,000 815.1
30-59 0.0036 275,000 990.0
60+ 0.0457 59,000 2696.3
Total expected deaths = 4501.4
Total deaths Panama = 8281.0

18. • Standardised mortality ratio (SMR)
= mortality rate in study population
mortality rate in reference population
= Observed deaths= O
Expected deaths E
SMR Panama (%) =8281 = 184
4501.4

19. SMR
• SMR = 100
– Rates are similar to the standard
population
• SMR < 100
– Fewer deaths occurred than expected
(rates are lower than the standard)
• SMR > 100
– More deaths occurred than expected
(rates are higher than the standard)

20. White Male Miners and Tuberculosis, 1950
Age Miner TB Death Rate Expected Miner
group Population General Pop. Deaths Observed
(100000) Deaths
20-24 74598 12.26 9.14 10
25-29 85077 16.12 13.71 20
30-34 80845 21.54 17.41 22
35-44 148870 33.96 50.55 98
45-54 102649 56.82 58.32 174
55-59 42494 75.23 31.96 112
Totals 534533 181.09 436
SMR (for 20-59-yr-olds) 436
181.1
= 241
=

21. Death rates
Crude:
Rates calculated for the
entire population
–Crude annual
–etc
Specific:
Rates calculated for
specific subpopulations
Age-specific
Gender-specific
etc

22. Crude death rate
Crude death rate = no. of deaths among residents
in an area in a calendar year X1000
average population in that area
in that year
• Crude death rate influenced by:-
– individual probability of dying
– population age distribution

23. Crude rates
Mortality in Sweden
Age Deaths Population Rate per 1000
person years
All ages73,555 7,496,000 9.8
Mortality in Panama
Age Deaths Population Rate per 1000
person years
All ages8,281 1,075,000 7.7

24. Crude rates
• Uses
– International comparisons
• Advantages
– Easy to calculate
– Actual summary rates
• Disadvantages
– Differences difficult to interpret

25. Specific death rates
Age-specific death rate (ages 0 to 29) =
Number of deaths among residents aged
0 to 29 in an area in a calendar year X 1,000
Average population aged 0 to 29 in the
area in that year
Age - specific death rate in Sweden (ages 0 to 29) =
3,523 X 1,000 = 1.1 per 1,000 person years
3,145,000

26. Age-specific mortality rate
• Limited to a particular age group
• Numerator is the number of deaths in that age
group
• Denominator is the number of persons in that
age group in the population
– Mortality rate in 20-45 years adults
– Under-five mortality rate
– etc

27. Specific death rates
Mortality by age-group in Sweden
Age Deaths Population Rate per 1000
person years
All ages73,555 7,496,000 9.8
0-29 3,523 3,145,000 1.1
30-59 10,928 3,057,000 3.6
60+ 59,104 1,294,000 45.7
Mortality by age-group in Panama
Age Deaths Population Rate per 1000
person years
All ages8,281 1,075,000 7.7
0-29 3,904 741,000 5.3 
30-59 1,421 275,000 5.2 
60+ 2,956 59,000 50.1 

28. Infant mortality rate
• Infant mortality rate (deaths of babies under 1
year old)
• Neonatal mortality rate (<28 days after birth)
• Postneonatal mortality rate (between 28 days
and 1 year old)
IMR = Deaths of babies under 1 year X 1,000
Total live births

29. MEASURES OF MORTALITY
• IMR = Neonatal Mortality Rate +
Postneonatal Mortality Rate
• Low Birth Weight (<2.5 kg at birth) greatly
increases the risk of infant mortality

30. Specific death rates
• Uses
– Detailed understanding of disease experience in
different population subsets.
– Age, sex, ethnicity
• Advantages
– Homogeneous subgroups
– Detailed rates
• Disadvantages
– Cumbersome to compute

31. • Calculation:
• =
Total number of deaths
from all causes in an age
group
Number of persons in that age
group in the population at mid-
year
X 1000
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32. Hypothetical Example
• In Afghanistan in 2010, the number of all
deaths in children under the age of five
years were 15,000 and the total mid-year
population of the country was 28,000,000.
– Calculate age-specific death rate for under
fives
– Interpret the results
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33. Case-fatality rate
• Case-fatality rate is a PROPORTION which is
Percent of persons with a disease who die from
that disease.
Case-fatality proportion
= Number of individuals dying during a specified period of
time after disease onset or diagnosis X100%
Number of individuals with the specified disease.
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34. Years of Potential Life Lost
(YPLL):
• measure of premature mortality or early
death.
• A mortality index to gauge the loss of
productive years in a person who dies.
• YPLL individual = end point – age at death

35. Years of Potential Life Lost
(YPLL):
• In the Afghanistan, this predetermined
"standard" age is usually 64 years. a
person dying at 50 years of age has lost
14 years of life
YPLL = 65 – 50 = 14

36. Afghanistan Mortality Survey
AMS-2010
• The AMS 2010 is the first comprehensive
mortality survey in Afghanistan.
• It is a nationally representative survey of
22,351 households, 47,848 women aged 12-
49, and includes verbal autopsies of 3,157
deaths.

37. AMS-2010
• Infant mortality rate 77 per1000 live births
• Under five mortality 97 per 1000 live births
• The pregnancy-related mortality ratio in
Afghanistan is estimated to be 327 per
100,000 live births (ranging between 260
and 394) for the 7 years before the survey

38. AMS-2010
• The lifetime risk of pregnancy-related deaths
is four times as high in rural areas (417) as in
urban areas (95).
• The risk of pregnancy-related mortality is
particularly high for women age 15-19 and
for women age 30-49.
• North = 354; Central = 285; South = 356
(with wide confidence intervals)

39. Causes of Female and Male
Deaths, All Ages
Percentage of female and male deaths in the
three years before the survey

40. AMS-2010
• Life expectancies of approximately 64 years
for each sex.

41. 16.2
10.9
13
2.5
7.3
0.1
3.7
0.3
1.4
14
1.9 1.8
1
0.3
1.5
13.2
7.4
0.2
3.3
0
2
4
6
8
10
12
14
16
18
Mortality
Mortality

42. AMS-2010
Pregnancy-Related Mortality Ratio in
Selected Countries
0
50
100
150
200
250
300
350
Afghanistan Pakistan Nepal Bangladish
2010 2006-07 2006 2010
327
297 281
194
MMR
MMR

43. Causes of Maternal Deaths in
Afghanistan
Percentage of maternal deaths in the
three years before the survey

44. References
1. CDC book, Principles of Epidemiology in Public
Health Practice, (third Edition)
2. OUP. Oxford Text book of Public Health, (4th
Edition). London, Oxford Press.
3. Gordis Leon, 2004 Epidemiology, (Third Edition),
Elsewhere Saunder Publication
4. APHI ,2010 Afghanistan Mortality Survey-2010
Indian Institute of Health management Ressearch

47. References