community medicine lecture on demography with some statsistic of pakistan

1. DEMOGRAPHY
DEFINITION: It is a science, which deals with the size, distribution, structure and change of
population. It is also related with other factors like race, mother tongue, marital status, women’s
status, employment status, literacy, occupation, income etc.
POPULATION PYRAMID.
It is a graphical structure showing the age sex distribution of the population of an area.
• Conventionally males are to the left and females to the right.
• Young population is shown at the bottom and old at the top.
• Age interval is to the left and yearly interval to the right.
• X-axis shows the population in percentage & Y- axis shows the age intervals
• Population pyramid of developing countries is conical shaped while that of
developed countries is cylindrical
• There’s narrowing of the pyramid at any point at which there is sudden decrease in population
due to any cause

2. DEMOGRAPHIC TRANSITION.
The shift of population from high fertility and high mortality to low fertility and
low mortality is called demographic transition. It consists of the following stages
Old balance -Increased fertility, increased mortality
Transition -Increased fertility, declining mortality
Unbalance -Increased fertility & decreased mortality
Transition -Declining fertility, decreased mortality
New balance -Decreased fertility, decreased mortality.

3. MOMENTUM OF POPULATION.
The increase in growth rate for coming few years despite slight decrease in
fertility level is called momentum of population.
REPLACEMENT LEVEL FERTILITY.
The production of only two children by each couple who will replace their
parents and hence there will be zero growth rate.
FERTILITY
Fertility is the number of live births, a women actually had.
FECUNDITY
It is the ability of a woman to conceive. Fecundity cannot be known unless
fertility is proved. A women may remain fecund throughout her life, but fertility may be
low.
ELIGIBLE COUPLES
An eligible couples refer to a currently married couple where in the wife is in
reproductive age that is between 15 – 45 years.
TARGET COUPLES
The term target couples is applied to those couples who have 2 – 3 children.
Now the definition has been enlarged to include families with even one child or even
newly married couples.

4. CAUSES OF HIGH FERTILITY
•Early age of marriage & Increase period of fecundity
•Polygamy
•Increased Infant Mortality Rate
•Religious misconceptions
•Desire for more sons
•Pressure of in laws, husband, relatives in joint family system
•Social prestige for a large family
•Economic factors-children are a source of earning in old age
•Lack of education leading to unawareness of the uses of Family Planning.
•Inaccessibility to Family Planning centers
•Unavailability of contraceptive devices
•Fear of side effects of contraceptive devices

5. CAUSES OF DECLINE IN MORTALITY.
 Improved medical techniques and surgical procedures
 Improved agricultural techniques leading to increased availability of food at affordable
rate which in turn leads to increase in host resistance and tolerance.
 Better hygiene leading to prevention of infections.
 Increased education leading to health awareness and early health seeking behavior.
 Better economic condition of the people leading to affordability of treatment
 Better means of communication

6. REASONS FOR INCREASED MORTALITY IN THE PAST
Food shortage leading to lack of immunity and malnutrition
Spread of infections
Poor hygiene
Poor medical and surgical techniques
Economic problems leading to inability to buy good food and medicine
Lack of education and awareness about health
Lack of health outlets

7. FERTILITY DIFFERENTIALS
Fertility differentials means the difference in fertility rate in urban and rural areas. Increased practice
of Family Planning is seen in urban areas because:-
 Increase education level of the community-particularly females
 Correction of differential sex behavior
 Forward looking society in which people don’t feel prestige in large family size, rather
prefer a small family
 Nuclear family system in which couples live independently and are not pressurized by
in-laws
 Economic and social empowerment in relation to decision making
 Proper religious guidance of the public
 Improved socioeconomic conditions of the masses so that they don’t rely on their
children
 Better economic conditions of the public so that they can afford contraceptives
 Late marriage.
 Child spacing
 Better mass media campaign
 Better and easy availability of F.P services
 Decrease in Infant Mortality Rate

8. ADVANTAGES OF POPULATION CONTROL
 Decreased Maternal Mortality Rate (MMR)
Decrease Infant Mortality Rate (IMR)
 Economic benefit
 Social uplift-improved standard of living.
IMPLICATIONS OF HIGH POPULATION GROWTH
 Overcrowding
 Housing problem
Transport problem
 Jobs problem
 Health problems
 Education problem
 Sanitation problem
 Decreased standard of living
 Environmental deterioration

9. POPULATION EXPLOSION
Population explosion means a sudden increase in the population beyond 2.0% growth
rate.
The increase in world population has been as under
1st
billion upto 1800
2nd
billion in next 130 years
3rd
billion in next 30 year
4th
billion in next 15 years
5th
billion in 8 years.
Year Population Growth rate
2000 years ago 250 million
1800 978 million 0.5
1900 1650 million 0.6
1950 2526 million 1.0
1970 3696 million 1.92
1989 5000 million 1.63
2011 6,928,198,253 1.09%
2050 10 billion

10. Relationship of population explosion with growth rate and doubling time of
population as under:-
Doubling time = 70 / growth rate
Growth Rate Doubling time of population
 Slow < 0.5% 140 years
 Moderate 0.5% - 1% 70-140 years
 Rapid 1 - 1.5% 47-70 years
 Very rapid 1.5 - 2% 35-47 years
 Explosive > 2% 28-35 years
(population explosion) -

11. GROWTH RATE =
Crude birth rate – crude death rate + net migration.
Growth rate of Pakistan – 1.6%
Growth rate of the world – 1.09%
CBR = Total Live births during the year x 1000 {24.8/1000}
mid year population
CDR= Total deaths during the year x 1000 {6.9/1000}
mid year population
Growth rate of the world was at it’s peak around 1970 when it was 1.92 %. In 1996 it fell
to 1.7 %.
CBR of the world = 19.15/1000 population
CDR of the world = 8.12/1000 population
Births/min = 252 worldwide
Births/ sec = 4.2 worldwide
95% of the world’s growth is occurring in developing countries.

12. DEPENDENCY Ratio = Dependent population
Independent population
Population below 15 + above 65 x 100
Population 15 – 64
D.R . of Pakistan = 86 %
SEX Ratio = No. of male = 1.07/1.00
No. of females
LIFE EXPECTANCY AT BIRTH
Average No., of years a person can expect to live if he experiences through out his live
the age specific death rates currently prevailing.
Total = 65.99
Male = 64.2
Female = 67.9
Target for 2025 = 74.1 years
LITERACY RATE : The WHO definition is “A person who can write his name and a
simple paragraph about himself”
Total = 49.9%
Male = 63%
Female = 36%

13. GENERAL FERTILITY RATE= No. of Live births in a year x 1000
No. of females between 15 – 49
AGE SPECIFIC FERTILITY RATE
No. of live births in a year to a women of particular age group x 1000
Total No. of women of that age group
Age specific fertility rate between 15 – 19 year = 0.082
Age specific fertility rate between 20 – 29 year = 0.245
Age specific fertility rate between 25 – 29 year = 0.275
Age specific fertility rate between 30 – 34 year = 0.212
Age specific fertility rate between 35 – 39 year = 0.145
Age specific fertility rate between 40 – 44 year = 0.071
Age specific fertility rate between 45 – 49 year = 0.023
Total 1.053
Total fertility rate = sum of ASFR x 5
1.053 x 5 = 5.26
Current = 3.17 children born/woman

14. Age specific death rate =
No. of deaths of people in a specific age group x 1000
Total population of that age
Infant Mortality Rate (IMR) =
No. of deaths of children below 1 year x 1000
Total live birth in a year
Pakistan IMR = 63.26/1000 {male 66.5 female 59.8} Target for 2025 = 20/1000
Under 5 mortality - 86.5/1000 {WB 2011} Target for 2025 = 50/1000
Probability that a child will die before reaching 5 using the current age specific mortality
rates
Neonatal mortality rate =
No. of deaths during 1 month after birth x 1000
Total live births in a year
Pakistan NMR = 54/1000

15. Perinatal mortality rate =
No. of deaths after 28 weeks of pregnancy + 1 week after birth x 1000
Total deaths after 28 weeks + total live births in a year
Maternal Mortality Rate =
Deaths of women due to pregnancy related causes during pregnancy + 40 days after birth X 1000
Total Live birth in a year
Pakistan MMR = 260 / 100,000 Target for 2025 = 110/1000
Case fatality rate
This helps to know the virulence of the disease and the need for its primary prevention
No. of deaths due to a specific cause
Total cases( alive or dead) of that cause
Proportionate mortality rate
This helps to know the contribution of a particular disease in the overall mortality of an
area and hence it’s significance and the need for primary prevention
No. of deaths due to a specific cause
Total deaths due to all causes

16. Human development index = 0.504 ranking145 among 185 countries
Developed in 1990 Pakistani economist Dr. Mehboob ul Haq
{life expectancy at birth + adult literacy + GDP/capita}
Physical Quality of life index = IMR + L.E at 1 year + literacy rate
Gross National Product (GNP) = Total income of the country generated from internal
sources as well as in the form of foreign exchange. In Pakistan it is 550 L
Gross Domestic Product (GDP) = Income generated from within the country or income
per family per year
Poverty Line = Income required to earn 2400 cal/ person / day in urban areas and 2100
cal / day / person in rural areas 24% (2005)
Human Development report of UNDP 2009 = 60% of Pakistanis live on less than 2
USD/day
In Pakistan 1/3rd
of the population is living below the poverty line
Contraceptive prevalence rate = 30 %
% of GDP spent on education = 2.7% (2009)
% of GDP spent on health = 2.6% (2009)
Under 5 children under weight for age = 31.3%

17. Countries in decreasing order of population =
China, India, USA, Indonesia, Brazil, Pakistan,Bangladesh,Nigeria, Russia, Japan.
Pakistan’s population 187,343,000
With an area equal to 0.6 % of the world, Pakistan has 2.3 % of the world
population.
Age structure of Pakistani population
Under 15 = 35.4% 15-64 years = 60.4% Above 65 years = 4.2%
Population having access to clean drinking water
96% urban and 89% rural (WHO& UNICEF Joint Monitoring programme 2004)
But house connections to 49% & 15% respectively
Population having access to improved methods of sanitation
92% urban and 41% rural (WHO& UNICEF Joint Monitoring programme 2004) but
sewerage system is available only to 40% & 6% respectively

18. HEALTH SECTOR TARGETS
2000-01 Target for 2025
•Percentage of children 51 100
below 1 year fully immunized
•Percentage of expectant mothers 40 100
fully immunized against tetanus
•Trained personnel attending 30 100
pregnancy & child health
•Population with access to Health
Services 65 100
•Hospital beds per 1,000 people 0.645 1
•Doctors per 1000 population 0.8 10
•Dental Surgeons per 10,000 people 0.33 1
•Nurses per 10,000 population 2.09 4.5

19. Source: CIA World Fact book July 12 2011