Demography and Health Service Statistics

By: Nigussie Y(BSc, MPH in Epid & Biost, Assistant Professor)

February 05,2023
Demography: is a science that studies human population with respect to
size, distribution, composition, social mobility and its variation with
respect to all these features

Size: The number of persons in the population at a given time.

Distribution: The arrangement of the population in geographical and

climatic zone.

Composition: The distribution of a population into its various groups

mainly by age and sex.

Change: The increase or decline of the total population or its components.

The components of change are birth, death and migration.

Sources of demographic data:
I. Complete enumerations (census)

II. Vital events registration

III.Sample survey

IV.Health service records

1. Census: A nation-wide periodic counting of population.

De jure: - The enumeration is done according to the usual or legal

place of residence.
• Excludes temporary residents and visitors, but includes
permanent residents who are temporarily away.

De facto: - The enumeration is done according to the actual place of

residence on the day of census.
• Includes temporary residents and visitors, but excludes
permanent residents who are temporarily away on the day of
census.
N.B. For most practical purposes various combinations or
modifications of the two-schemes are used depending upon
national needs and the enumeration plan followed.

Uses of census
• Gives complete and valid picture of population composition

• Serves as a sampling frame

• Provides vital statistics of the population (fertility and mortality).

• Planning the welfare of the people

2. Sample Survey:
• Is a technique based on sampling methods

• Made at a given moment, in a specific territory

• Done sporadically and without periodicity for the deep study of

a problem.

3. Registration of vital events

 Is a system by which all births, deaths, marriages and migrations
occurring nationwide are registered.
 Counting of births and deaths (vital records) is a continuous
process.
4. Health Service Records
• All health institutions report their activities to the ministry of health
through the regional health bureaus.
• The ministry of health compile, analyze and publish it in the health
service directory.
• Therefore it is the major source of health information in Ethiopia.
Advantages:
 Easily obtainable
 Available at low cost
 Continuous system of reporting
 Causes of illness and deaths are available
Demographic Transition
• A term used to describe major demographic changes of the past
two centuries
• Attempts to explain the changes in mortality and fertility in three
different stages.

1. Pre-transitional:- high mortality and fertility with low population

growth (young population).
• Triangular, broad based pattern of population pyramid.

• Seen in primitive societies and is known as expansive (type I).

2. Transitional: - high birth rate and reduced death rate, with high growth
rate (“young population”).
• Triangular pyramid characterizing a developing society

• known as expansive (type II).

3. Post –transitional: - low birth and death rates with stable growth rate.
• Narrow based pyramid and steeper sides.

• Typical of advanced or developed countries

• known as stationary (Type III).

• Life expectancy is higher and a high proportion of the population

survives in to the old age (“old population”).
Population Pyramid
• Is a graphical representation of the age –sex distribution of a
population.
• Males are shown on the left of the pyramid, females on the right

• Young persons at the bottom and elderly at the top.

• Consists of a series of bars each drawn proportionately to represent the

percentage contribution of each age-sex group in five-year interval.
• The total area of the bars represents 100% of the population.

• Shows any gross irregularities due to special past events such as a war,
epidemic or age-selective migration, fluctuations of fertility, etc.
 Population Pyramid
65+

60-64

 Is a graphical representation of the age 55-59

50-54
–sex distribution of a population. 45-49

40-44
 Males are shown on the left of the 35-39

30-34
pyramid, females on the right, young 25-29

people at the bottom and elderly at the 20-24

15-19

top. 10-14

5-9

0-4

20.0 15.0 10.0 5.0 0.0 5.0 10.0 15.0 20.0

 Ratio, Proportion & Rate
Ratio: the magnitude of one occurrence or condition in relation to another.
M
Eg - Sex ratio: SR = F x 100

- Child-Woman-Ratio (CWR):

CWR = P0-4 / Pf15-49 x 1000 per 1000 women in the child bearing
age.
- Dependency Ratio (DR):
P0-14  P65 P014 P 

DR   100   100  65  100

P1564 P P
15  64 15 - 64

- It is useful in economic studies.

 Proportion

 A type of ratio which quantifies occurrences in relation to the

population in which the occurrences take place.

Example: The proportion of malaria cases among inhabitants of

Adola-Wayu town.
 Rate

Is a proportion with a time element

Number of demographic events of interest
Rate  k
Population at risk

where K is a constant mainly a multiple of 10 (100, 1000, 10000, etc.).

Crude rate:
 shows the frequency of a class of events through out the entire population
without regarding to any of the smaller groupings.
Specific rate:
 implies events in a particular category of age, sex, race, particular disease,etc.
 Measures of Fertility
 Crude Birth Rate (CBR):
Total Number of live birth * in a year
CBR  1000
Mid - year population in the same year

Live Birth: The complete expulsion or extraction from its mother as a product of
conception irrespective of the duration of pregnancy, which after such
separation show evidence of life (breathing, pulsation of the heart, etc.)
 General Fertility Rate (GFR):
Total number of live births during a year
GFR  1000
Mid year female population aged 15 - 49 years

– all females in the age group 15-49 are considered with out restricting to
those who have a child (children).
 Measures of Fertility…
 Age Specific Fertility Rate (ASFR):

Total number of live births registered to women of a given age

group during a year
ASFR   1000
Mid year female population of the same age group
during the same year

 ASFR is used to measure the reproductivity performance of a given age.

 Shows variation in fertility by age.

Read other fertility rates; total fertility rate and gross

reproductive rate
 Measures of Mortality
 Crude Death Rate:
Total number of deaths due to all causes occurring in an area in a given year
CDR  1000
Mid year population in the same area in the given year

 Age-Specific Death Rate (ASDR):

Total deaths at age or age group a
ASDR a   1000
Mid year population at age or age group a
 Measures of Mortality…

 Infant Mortality Rate (IMR):

Deaths of children under one year of age

IMR   1000
Total live births

• Read other mortality rates!!

 Population growth and projection

 Rate of population growth (r) = Crude Birth Rate - Crude Death

Rate

– Called rate of natural increase

 Population projection: Based on the rate of natural increase

(r), the population (Pt) of an area with current population size of
(Po) can be projected at some time t (not more than 5 years) using
Pt  Po (1  r) t
the following formula.
 Projection…cont’d

Example: CBR=46, CDR=18 per 1000 population and population

size of 25,460 in 2005
 what will be the population at the year 2010 ?

• Rate of natural increase = 46 - 18 = 28 per 1000 = 2.8 % per year

• The estimated population in 2010 after 5 years, will be:

• P2010 = P2005 (1 + 0.028)t = 25,460(1 + 0.028)5 =

25,460(1.028)5

= 25,460(1.148) = 29,230
 Population doubling time

• The doubling time of a population can be estimated based on

the formula for projecting the population.
• Pt = Po(1+ r) t

• From the above formula, the time at which the current

population Po will be 2 × Po can be found by:

 Calculate the doubling time of the above population

 Health service utilization rates
1. Admission rate (AR): The number of (hospital) admissions
per 1000 of the population per year
Number of Admissions in the year
AR   1000
Total population of the Catchment area

2. Average length of stay (ALS): the average period in hospital

(in days) per patient admitted.

The Annual Number of Hospitalized Patient Days

ALS 
Number of discharges and deaths
 Health service utilization rates…

 Bed-occupancy rate (BOR): the average percentage occupancy

of hospital beds.
The Annual Number of Hospitalized Patient Days 1
BOR  
Total Number of Beds 365

 Turnover interval (TI): the average period in days that a bed

remains empty( the average time elapsing between the discharge
of one patient and the admission of the next).
(365  Number of Beds) - Number of Hospitalized Patient Days
TI 
Number of Discharges and Deaths
 Hospital Death Rate (HDR)

Total Number of Hospital Deaths in a Given Period

HDR   1000
Number of Discharges in the Given Period
 Exercise
a) Calculate the population doubling time of a given country with annual rate of

growth ( r) = 1% .

b) The following summary table was taken from the annual (1988) health profile of district Z.

Year Total population of No of health institutions in the district Total number of

the district hospital beds

Health Station Health Center Hospital

1988 400,000 14 2 1 80

During the same year, there were 14,308 discharges and deaths. The annual number
hospitalized patient days was also recorded as 28,616. Calculate:
1. The health service coverage of the district
2. The average length of stay
3. Bed occupancy rate
4. Turnover interval