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FERTILITY AND MORTALITYFERTILITY AND MORTALITY
CRP II
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FERTILITY
FERTILITY
refers to the number of live births women have
FECUNDITY
refers to the physiological capability ofwomen to reproduce
Fertility is directly determined by a number of factors that,
in turn, are affected by a great many social, cultural,economic, health and other environmental factors
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BIRTH RATE
The Birth Rate = Crude Birth Rate (CBR)
Indicates the number of live births per 1,000 population ina given year
Numberof live births
Mid-yearpopulationx k =
38,868
1,620,086x 1,000 = 24.0
e.g.
There were 24 births per1,000 population in Kuwait in 1984
Around the world BR vary widely
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GENERAL FERTILITY RATE = FERTILITY RATE
GFR is the number of live births per 1,000 women ages15-49 in a given year
GFR is somewhatmore refined measure than the BR,because it relates births to the age-specific group at risk ofgiving birth (women ages 15-49)
#of
live
births 181,268
x 1,000 = 62.0
# women ages 15-49 2,923,344
x k =
There were 62 births per1,000 women ages 15 49 in Equador
in
1995
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AG
E-SPECIFIC FERTILITY RATE (ASFR)
# ofbirths to women ages 20-24 23,694
x k = x 1,000 = 81.4
# ofwomen ages 20-24 290,998
e.g
In Austria in 1994, there were about 81,4 live births forevery
1,000 women ages 20-24.
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Compare the fertility rates for women in Puerto
Rico in the different age group belowAges
Year 20-24 25-29 30-34
1965 257.4 189.6 114.1
1975 154.9 146.1 91.2
1985 146.3 132.0 70.6
1994 133.8 113.5 69.6
In Puerto Rico in 1994, there were 134 live births to women
ages 20-24 per1,000 women in that age group
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TOTAL FERTILITY RATE
TFR is the average number of children that would be
born to a woman by the time she ended childbearing,if she were to pass through all her childbearing yearsconforming to the ASFR of a given year
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Calculate the TFR : A countrys TFR, 1994
Age ofwomen
(1)
# ofwomen
(2)
# of birthsto that age
group
(3)
Birthsrate
(2) : (1)
(4)
ASFR
(3) X 5
15 - 19 244,000 4,474 .018 .090
20 - 24 225,800 28,013 .124 .620
25 29 194,200 36,440 .188 .940
30 34 182,300 27,402 .150 .750
35 39 181,400 14,044 .077 .385
40 44 177,600 3,176 0.18 .090
45 - 49 151,100 182 .001 .005
Sum 2.88
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In some developing countries the TFR is > 5 children
In most developed countries the TFR is < 2
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GROSS REPRODUCTION RATE (GRR)
GRR is the average number of daughter that wouldbe born to a woman (or a group of women) duringher lifetime, if she passed through childbearing
years conforming to the ASFR of a given year
GRR TFR~
daughter measures reproduction
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NET REPRODUCTION RATE (NRR)
NRR is the average number of daughters that wouldbe born to a woman (or group of women) if shepassed through her lifetime from birth conforming
to the ASFR and mortality rates of a given year
NRR GRR~
It is lower because it takes account the fact thatsomewomen will die before completing their childbearing
years
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Country GRR NRR
Burkina Faso 3.50 2.41
U.K. 0.86 0.85
1993
That means that if 1993 fertility levels were to continue, awoman in BF would produce 3,5 daughters, on average,during her lifetime.
In the UK, by contrast a woman would produce < 1daughter on average her lifetime.
In BF: 1 daughter would die, on average before completingher childbearing years.
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MORTALITY
Mortality refers to deaths that occur
within a population
While we all eventually die, the probability of dying duringa given time period linked to many factors, such as age,
sex, race, occupation and social class.The incidence of death can reveal much about populationsstandard of living and health care.
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Mortality data
Limitations of mortality data
Sources of mortality data
Systems
Shortcomings in the system
System improvement
Definitions of mortality rates
1
2
3
4
5
6
7
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(a) Vital Statistics
Data on various vital events of human life,such as :
- births - marriages
- stillbirths - divorces
- deaths - etc.
1 Mortality data
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(b) Mortality statistics
(c) The use of mortality and fatality rates in the
following context:
- comparative assessment of community health
- assessment of health needs of the people andfixing priorities for action in terms of reducing
risks of death
- remodelling and strengthening of health
services
- Evaluation of health programmes
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- measurement of relative importance of specificdiseases/conditions as causes of death
- estimation of average span of life that an
individual of a specified age is likely to attain.
- assessment of the efficacy of a drug or procedure
in a clinical therapeutic trial against a disease/
condition, particularly one for which fatality is high
(such as bubonic or pneumonic plague).
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Use alone, mortality data do not reveal the levels of
health of a group of people who are alive.
Detailed cause-specific mortality data are of limited
use in the absence of reliable statistics on births,
deaths, and demographic aspects aspects, preferably
by geographical and/or social subgroups.
2Limitations of mortality data
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Vital registration system
National sample surveys
Special health surveys
Hospital records
Notification of infectious diseases
Government health institutions
Voluntary health institutions
Revenue agencies
Police
Village/community councils
Reports of national and international organizations
3 Sources of mortality data
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- Systems for recording, reporting and registering
deaths and fetal deaths, covering:
- registration of deaths and stillbirths
- differences in methods used forR-R-R
deaths from country to country
- the various agencies responsible for
registering deaths, according to legal
provisions of the country
- A uniform system of registering deaths is
necessary for national and international
comparisons
4 Systems (R-R-R)
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Shortcomings in the R-R-R of deaths and fetal deathsmay occur through:
- incomplete data;
- lack of uniformity in collection/reporting such data;
- lack of uniformity in definitions and criteria of events and
rates;
- lack of accuracy, particularly in respect ofage at, and
cause of, deaths.
5 Shortcomings in the system
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A number of suggestions for possible improvement in
the system :
- Compulsory registration of deaths;
- Establishment of a uniform system throughout
the country;
- Health education to promote recognition of the
significance and usefulness of such data by the
primary reporting agency;
- Use of special sample surveys to check extent
and accuracy of registration of deaths by
regular agencies;
- Training of persons certifying deaths.
6 System improvement
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(a) Crude death rate (CDR)
Total no.of deaths due to all causes occurring
in a defined area during a defined period
CDR =
Estimated totalpopulation at risk in the same
area during the same period
x k
D
CDR = X 1000
P(est. mid-year population)
7 Definitions of mortality rates
10n
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The merits and demerits of the CDR:
It measures the average risk of death in thepopulation at large
It is easy to compute
Its level reflects not only mortality risks but alsothe age and sex composition of the population.
Hence it can be used to compare relative mortality
in two populations if they have a similar age/sex
composition
It is often used forcomparing relative mortality in a
given area between two periods of time that are not
too far apart
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- It takes no account of the fact that the chance of
dying varies according to age group, sex, race,
occupation, etc.
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(b). Age- and sex-specific death rate (ASDR)
Total no. of deaths occurring in a specific age and sexgroup of the population of a defined area during a
defined period
Estimated total population ofthe same age and sex
group of the population of the same area during thesame period
=x k
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The merits and demerits of the ASDR
- It measures risk of death among persons in a specific
age and sex group
- It is simple to calculate
- It does not summarize total mortality in a single
figure.
- It can be used to compare the mortality of two
populations of the same specific age and sex group,
even when the age and sex compositions of these
populations are different.
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- It takes no account ofdifferences in the population
structure in terms of race, occupation, religion, etc.
-It gives the essential components forconstructing life-tables.
- Comparison of overall mortality conditions in the two
populations is cumbersome, because of the need to
compare rates for all the different age groups and for
males and females.
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(c) Stillbirth rate (Late fetal death rate)
Measures the risk of fetal death occurring
after 28 completed weeks of gestation
No. of stillbirths occurring in a specified area
and period of time
No. of live births and stillbirths occurring in
the same area and period
=x k
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(d) Perinatal Mortality Rate
Measures the risk of death occurring either during
pregnancy after 28 completed weeks of gestation or
within 1 week after delivery
No. of perinatal deaths*) occurring in a
specified area and period of time
No. of live births and stillbirths occurring in
the same area and period
= x k
*) no. of stillbirths + no. of deaths of infants under 1 week of age
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(e). Neonatal Mortality Rate
Measures the risk of dying within 28 days of birth
No. of deaths of infants under 28 days of age occurringIn an area during a given period
No. of live births in the area during the same period
x k=
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(f). Post-Neonatal Mortality Rate
Measures the risk of dying during infancy after the first 4
weeks of life
No. of deaths among infants aged 4 weeks to 1 yearoccurring in a specified area and period
No. of live births in the same area and period
x k=
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(g). Infant Mortality Rate
Measures the risk of dying during infancy
(i.e. the first year of life)
No. of deaths of infants under one year of age occurringIn an area during a given period
No. of live births in the same area during the same period
x k=
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(h). Maternal Mortality Ratio
Measures the risk of women dying from maternal causes
Total no. of maternal deaths due to complications ofpregnancy, childbirth and the puerperium
in an area during a given period
Total no. of live births in the same area and period
x k=
K= 100,000
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(j). Case Fatality Rate (CFR)
Is useful in measuring how fatal a disease/ condition is
Total no. of deaths due to a given disease/conditionOccurring in an area during a given period
Total no. of persons who suffered from the same
disease / condition in the same area during the same period
x k=
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28 weeks
Delivery
1 week
28 days
1 yr
PMR
NMRPNMR
IMR
Gestational
age
SR
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References
1. Population Reference Bureau.Population Handbook,
5 ed., 2004
2. S.K. Lwanga and Cho-Yook Tye (ed.). Teaching Health
Statistics : twenty lesson and seminar outlines. Geneva:
World Health Organization,1986
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