Mortality and Morbidity

• Morbidity refers to sickness or illness in a

population due to disease
• Mortality refers to the case- specific fatality
rate in a population.
– it is the number of persons who die as a result
of natural or accidental causes in a population
 Mortality controls
• Curative methods seek to treat morbidity after it
occurs primarily through medical institutions and
their practitioners
• Preventive measures focus on reducing both
morbidity and case fatality. These include
providing an adequate level of nutrition and
exercise, implementing immunization
programmes, improving public health conditions,
and eliminating unhealthy behaviors.
 What is death?
• Death is the permanent disappearance of all
evidence of life at any time after birth has taken
place. (WHO, 1995)
• it is the post-natal cessation of vital functions
without capability of resuscitation
• Fetal death is defined as death prior to the
complete expulsion or extraction of a product of
conception irrespective of duration of pregnancy
• Life expectancy : the average number of
years a person can be expected to live after
birth. The calculation is based on actual
mortality data
• Life span: the theoretical maximum number
of years that an individual can live under
optimal conditions. It is the age at which .01
% of the population survives, about 120 yrs
 Infant mortality rate

• The rate at which children under one year

old are dying in a population
• Deaths to infants < 1 year X1000
Total live births
 Advantages
• It is used as an indicator of development in
a population
– Tells us how well developed the health sector in
a country is
 Neonatal mortality rate
Deaths to infants 0-days X 1000
total live births in year
Early neonatal mortality rate

Deaths under 1wk X 1000

Total live births
 Late Neonatal mortality rate

• Deaths 1- 4 weeks X1000

Live births
Registration of Births, Stillbirths and Infant Deaths in Jamaica
International Journal of Epidemiology 1996.Vol. 25, No. 4

Affette M Mccaw-Binns, Kristin Fox, Karen E Foster-Williams, Deanna E Ashley and Beryl Irons .
 Registration of Births, Stillbirths and Infant Deaths in Jamaica
International Journal of Epidemiology 1996.Vol. 25, No. 4

Affette M Mccaw-Binns, Kristin Fox, Karen E Foster-Williams, Deanna E Ashley and Beryl Irons .
• The perinatal mortality rate (stillbirths plus early
neonataldeaths) was 40 per 1000 deliveries.
• The neonatal mortality rate was 18.4 per 1000
live births.
• The IMS identified 486 infant deaths in the six
• parishes, 69% of which were neonatal deaths.
• infant mortality rate of 24.4/1000 live births
neonatal mortality rate of 16.7 per 1000 live
births;
• only 26%of maternal deaths being accounted for
in the official
• statistics. Official statistics for 1988, 1989 and
1990
• only report 12, 12 and 7 maternal deaths
respectively
• while deaths in government hospitals numbered at
least
• 34, 37 and 30. T
Registration of Births, Stillbirths and
Infant Deaths in Jamaica

International Journal of Epidemiology

1996.Vol. 25, No. 4
AFFETTE M MCCAW-BINNS,** KRISTIN FOX,"-* KAREN E FOSTER-WILUAMS,'
DEANNA E ASHLEY"
AND BERYL IRONS"

• held or the Coroner rules that no inquest is necessary.

• The inquest or the ruling often occurs a year or more
• after the death. When the death does get registered, the
• statistical data are not updated, resulting in the non
reporting
• of the deaths. Thus, while death certificates
• were found for 56% of maternal deaths between 1981
• and 1983, only 13% of sepsis deaths were registered
• and reported, as these were mo
 Infant and under five mortality rates by background and
demographic characteristics Jamaica 2005.
Multiple Indicator Cluster Survey 2005

Sex Infant Under five

Mortality Rate mortality rate
Sex Male 28 33
Female 24 30
Area Total urban 29 36
KMA 26 33
Urban 33 40
Rural 21 25
Mother’s education Primary, none 51 67
Secondary 22 26
Total 26 31
 Post-neonatal mortality rate

• Deaths 4-52 weeks X1000

Total Live births
 Age specific mortality rates
• deaths to individuals in specific age groups

• Deaths 15-19 X 1000

• _______________
• Population 15-19
 Cause specific death rates

• Number of deaths from a specific cause X 100,000

• Total midyear population
 Proportion dying from a specific
cause

• Death from specific cause (AIDS) x 100

• Total deaths in a given year
 Measuring Maternal Mortality
A maternal death is the death of a woman while pregnant or within 42
days of termination of pregnancy regardless of the site or duration of
pregnancy, from any cause related to or aggravated by the pregnancy
or its management, but not from accidental causes.

• Can be subdivided into direct and indirect deaths.

– Direct maternal deaths are those resulting from complications of pregnancy
occurring either prenatally, during labor or childbirth, or within 42 days
following
termination of the pregnancy. Usually due to one of five major causes:
hemorrhage, sepsis, eclampsia, obstructed labor, or complications of unsafe
abortion
– Indirect maternal deaths are those that result from other diseases that were
aggravated by the physiological effects of pregnancy, such as malaria,
HIV/AIDS
or cardiovascular disease
– Temporal and causal relationship with pregnancy
• skip
 Maternal mortality
• Number of deaths to women due to
pregnancy-related causes, when pregnant or
within 42 days after the termination of
pregnancy per 100,000 live births
 Maternal mortality
• The complications of pregnancy and childbirth are the
leading cause of death and disability among women of
reproductive age in developing countries.
• It is estimated that around 515,000 women die each year
from maternal causes.
• for every woman who dies, approximately 30 more suffer
injuries, infection and disabilities in pregnancy or
childbirth. This means that at least 15 million women a
year incur this type of damage.
• The cumulative total of those affected has been estimated
at 300 million, or more than a quarter of adult women in
the developing world
• The most common fatal complication is post-
partum haemorrhage.
• Sepsis, complications of unsafe abortion,
prolonged or obstructed labour and the
hypertensive disorders of pregnancy, especially
eclampsia, claim further lives.
• These complications, which can occur at any time
during pregnancy and childbirth without
forewarning, require prompt access to quality
obstetric services equipped to provide lifesaving
drugs, antibiotics and transfusions and to perform
the caesarean sections and other surgical
interventions that prevent deaths from obstructed
labour, eclampsia and intractable haemorrhage.
• The foundations for maternal risk are often laid in
girlhood.
• Women whose growth has been stunted by
chronic malnutrition are vulnerable to obstructed
labour.
• Anaemia predisposes to haemorrhage and sepsis
during delivery and has been implicated in at least
20% of post-partum maternal deaths in Africa and
Asia.
• The risk of childbirth is even greater for women
who have undergone female genital mutilation,
with an estimated 2 million girls mutilated every
year.
• . Every year, over half a million women continue
to lose their own lives to the hope of creating life
• Women in Sub-Saharan Africa continue to face a
1 in 13 chance of dying from pregnancy and
childbirth, when the risk for women in the
industrialized world is only 1 in 4,085.
• The factors that cause maternal morbidity and
death also affect the survival chances of the foetus
and newborn, leading to an estimated 8 million
infant deaths a year (over half of them foetal
deaths) occurring just before or during delivery or
in the first week of life.
 maternal mortality ratio by region
and country
• the world figure is estimated to be 400 maternal deaths per 100,000
live births.
• the rate was highest in Sub-Saharan Africa (1,100), followed by South
Asia (430), the Middle East and North Africa (360), Latin America
and the Caribbean (190), East Asia and the Pacific (140), and CEE/CIS
and the Baltic States (55).
• the rate for the industrialized countries is only 12 deaths per 100,000
live births.
The country with the highest estimated number of maternal deaths is
India (110,000), followed by Ethiopia (46,000), Nigeria (45,000),
Indonesia (22,000), Bangladesh (20,000), Democratic Republic of
Congo (20,000), China (13,000), Kenya (13,000), the Sudan (13,000),
Tanzania (13,000), Pakistan (10,000) and Uganda (10,000). These
twelve countries account for 65% of all maternal deaths
• End skip
 Morbidity measures
• Incidence rate

• The number of new persons contracting the

disease in a given period (year) per 100,
1000, 10000 OR100,000 in the population
who are at risk
Total # new persons developing a disease during a given time period x100,000
#persons at risk of developing the disease
during that period(usually1 year).
 Prevalence rate
• Used to describe the existing health status
of a country. The rate includes previously
existing cases as well as new cases
• # persons with a particular disease at a given point in time X 1000

Total number in the population at that same point in time.

• This is refereed to as point prevalence. Takes in consideration all persons with

the disease, irrespective to when they contracted it. Another type is period
prevalence. Here we are measuring the nos. persons who had the disease in a
given year, some are alive and some are dead.
Questions you would ask in a survey
to get at these measures.
• Do you currently have measles- point
prevalence
• Have you had measles in the last (x) years-
period prevalence
• Have you ever had measles- cumulative or
lifetime incidence.
 Case rate
• The number of reported cases of a specific
illness per 100, 000 persons in a population
during a given year
• It differs from the incidence rate in that it is
based on the number of reported cases
rather than the number of persons
contracting the disease.
• John Doe contracts syphilis from Jean
Brown in January 2002. He visits the
doctor and is treated that same year.
• In December of the same year he is
reinfected by Jean Brown after a
passionate encounter. He again visits the
doctor and receives treatment.
• Let us say Jean never sought treatment for
her illness
• We have on our hands,
1 reported incidence
2 reported cases
 Case fatality rate

• The proportion (percentage) of persons

contracting the disease who die of the
disease in a given period
• Number of persons dying from malaria x 100
• Number of persons developing the disease
HIV