Chapter Four

Demography and Health Services Statistics

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Learning Objectives
At the end of this chapter, the students will be able to:
 Define and understand the concepts of demographic statistics .

 Identify the different methods of data collection for demographic studies .

 Understand different ratios used to describe demographic data .

 Understand fertility and mortality measures.

 Understand methods of population projection and computation of

doubling time.

 Understand and compute the different indices relating to hospitals

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 Introduction
Definition
• Demography is a science that studies human
population with respect to size, distribution,
composition, social mobility and its variation with
respect to all the above features and the causes
of such variation and the effect of all these on
health, social, ethical, and economic conditions.
• Size: is the number of persons in the population
at a given time.
• Example: The size of Ethiopian population in 2002
is about 65 million.

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• Distribution: is the arrangement of the population in
the territory of the nation in geographical, residential
area, climatic zone, etc.
• Structure/composition: refers to the distribution of
population by different characteristics such as age, sex,
ethnicity, religion, etc
• Change: refers to the increase or decline of the total
population or its components.
• The components of change are birth, death, and
migration.

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 Demographic statistics
• Is the application of statistics to the study of human
population in relation to the essential demographic
variables and the source of variations of the
population with respect to these variables, such as
fertility, mortality and migration.
• Sources of Demographic Data:- Demographic
information is acquired through two main ways:
• By
• complete enumerations (census) and sample surveys at a
point in time, and
• Through recording vital events as they occur over a
period of time.
 A) THE CENSUS
• The term “census” refers to a nation-wide counting of
population.
• It is obtained by a direct canvass of each person or
household, which is a large and complicated
undertaking.
• are taken by obtaining information concerning every
inhabitant of the area.
• There are two main different schemes for enumerating
a population in a census.
• De jure
• De facto
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 a. de jure:
• De jure: - the enumeration (or count) is done according
to the usual or legal place of residence .
Advantage
• It yields information relatively unaffected by seasonal
and other temporary movements of people (i.e, it gives a
picture of the permanent population).
Disadvantages
• Some persons may be omitted from the count while
some others may be counted twice
• In some situations, it is difficult to be sure just which is a
person’s usual or legal residence. (In places where
mobility is high and no fixed residence is indicated)
• Information collected regarding persons away from
home is often incomplete or incorrect.
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 b. De facto
De facto: - The enumeration is done according to the
actual place of residence on the day of the census.
Advantages
• Offers less chance of double counting
• Gives less chance for the omission of persons from
the count
Disadvantages :
• Population figures may be inflated or deflated by
tourists, travelling salesmen, and other transients.
• In areas with high migration, the registration of
vital events (vital statistics) is subject (liable) to
distortion.
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 Essential features (characteristics) of a census
• Separate enumeration and recording of the
characteristics of each individual .
• It should refer to people inhabiting a well-defined
territory .
• The population should be enumerated with respect
to a well defined point in time .
• It should be taken at regular intervals (usually every
ten years) .
• In most countries the personal data collected in a
census are not used for other than statistical
purposes.
• The compilation and publication of data by
geographic areas and by basic demographic
variables is an integral part of a census.
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 Census Operation
• The entire census operation has 3 parts (stages)
Pre-enumeration →planning and preparatory work
Enumeration → field work ( collection of the data)
Post-enumeration→ editing, coding, compilation,
tabulation, analysis, and publication of the results

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 Uses of a census
Gives complete and valid picture of the
population composition and characteristics .
Serves as a sampling frame
Provides with vital statistics of the population
in terms of fertility and mortality.
Census data are utilized in a number of ways for
planning the welfare of the people .

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 Common errors in census data
– Omission and over enumeration.
– Misreporting of age due to memory lapse, preference
of terminal digits, over/under estimation.
– Overstating of the status within the occupation.
– Under reporting of births due to problem of reference
period and memory lapse.
– Under reporting of deaths due to memory lapse and
tendency not to report on deaths, particularly on
infant deaths.

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 B. Surveys
A survey is a technique based on sampling
methods by means of which we try to obtain
specific information from part of the population
liable to be considered as representative of the
whole.
Surveys are made at a given moment, in a
specific territory; sporadically and without
periodicity for the deep study of a problem.

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 C. Registration of vital events
• Changes in population numbers are taking
place every day.
• Additions are made by births or through new
arrivals from outside the area.
• Reductions take place because of deaths, or
through people leaving the area.
• The taking of a census is merely a snapshot of
an event while the counting of births and
deaths (vital records) is a continuous process.
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The registration of vital events (births, deaths,
marriages, etc) is a system by which all births, deaths,
etc. occurring nationwide are registered, reported to a
central body and compiled centrally.
A certificate is issued for every death and birth. The four
main characteristics of vital registration are
comprehensiveness, compulsory by law, compilation
done centrally and the registration is an ongoing
(continuous) process.
This system is not well developed in Ethiopia and hence
cannot serve as a reliable means of getting information.

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 Population Pyramid
 Population pyramid graphically presents the population
of an area or country in terms of its composition by age
and sex at a point in time.
 The pyramid consists of a series of bars, each drawn
proportionately to represent the relative contribution of
each age-sex group (often in five-year groupings) to the
total population .
 By convention, males are shown on the left of the
pyramid, females on the right, young persons at the
bottom, and the elderly at the top.

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Populations of countries can differ markedly as a result of
past and current patterns of fertility, mortality, and
migration.
However, they all tend to fall into three general profiles of
age-sex composition.
1. Rapid growth is indicated by a pyramid with a large
percentage of people in the younger ages.
2. Slow growth is reflected by a pyramid with a smaller
proportion of the population in the younger ages.
3. Zero growth or decreasing populations are shown
by roughly equal numbers of people in all age
ranges, tapering off gradually at the older ages.

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 The shape of the pyramid also reflects the major influences on
births and deaths, plus any changes due to migration.
1. A triangular(broad-based and narrow apex) pattern of a pyramid
reflects a high birth rate over a long period of time.
 This is Expansive type of structure.

 In Expansive type only a small proportion of persons have survived

into the older age groups and a large percentage of people are in
the younger ages.; as a result the median age is relatively young.
 YOUNG POPULATION: >35% of its people are < 15 years old
 AN OLD POPULATION: > 10% of its people are > 65 years old
 The expansive structure is typically characterized by high fertility
and mortality regime, thus resulting a rapid population growth
rate. It is also characterized by high dependency ratio.
 It is a population structure mostly for Africa and Asia.

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• Population Pyramid – Rapid Population Growth

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 Population pyramid continued….

• The constrictive type has a narrow base & a narrow apex (as
compared to the middle of the population pyramid). It is
characterized by a recent decline in fertility, leading to slow PGR,
high life expectancy &high median ages.
• Population Pyramid – Slow Population Growth

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 Population pyramid continued….

• Stationary type of population structure is characterized

by constant fertility and mortality schedule for a long
period of time.
• Stationary population model assumes a zero growth rate
(i.e., constant and equal numbers of births and deaths
each year and, hence, constant and equal birth and death
rates each year.) or a decreasing population where roughly
equal numbers of people in all ages but tapering of
gradually at the older ages.
•The pyramid is almost of a rectangular shape .

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 Population pyramid continued….
• Population Pyramid – Zero or Declining Growth

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 Creating Population Pyramid
Steps
• 1. Table population by age and sex, in five year age-
groups, from 0-4 up to maximum desired (75+, 85+, 90+
etc.). Compute totals
• 2. Compute each cell as percentage of total
population (all males + all females=100%)
• 3.Lable male percentage values to the left of the
horizontal axis and female percentages to the right with
respect to the vertical symmetric axis.
4.Graph male and female percentage columns against
age groups using horizontal bar chart
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 Israel, Arab Population 2002 (’000)
Source: Annual Abstract of Statistics, No.54, Table 2.18

Age Males Females TOTAL Percentages

TOTAL 633.8 611.9 1245.7 50.9 49.1
0-4 101.3 96.0 197.3 8.1 7.7
5- 9 88.4 83.7 172.1 7.1 6.7
10-14 73.5 70.2 143.7 5.9 5.6
15-19 60.6 58.1 118.7 4.9 4.7
20-24 55.7 54.4 110.1 4.5 4.4
25-29 54.1 52.2 106.3 4.3 4.2
30-34 46.3 44.1 90.4 3.7 3.5
35-39 40.2 38.1 78.3 3.2 3.1
40-44 31.5 30.1 61.6 2.5 2.4
45-49 23.1 22.7 45.8 1.9 1.8
50-54 16.4 16.6 33.0 1.3 1.3
55-59 14.2 14.2 28.4 1.1 1.1
60-64 10.6 10.3 20.9 0.9 0.8
65-69 7.3 8.5 15.8 0.6 0.7
70-74 4.7 6.0 10.7 0.4 0.5
75-79 2.8 3.8 6.6 0.2 0.3
80-84 1.6 1.8 3.4 0.1 0.1
85-89 1.0 0.8 1.8 0.1 0.1
90+ 0.7 0.5 1.2 0.1 0.0
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 Population Pyramid, Israel Arab Population, 2002

90+
Females
80-84
Males
70-74
Age Groups

60-64
50-54
40-44
30-34
20-24
'10-14
0-4
10 5 0 5 10
Percentages

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Population Pyramid, Ethiopia 2005

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 Assignment for presentation
1/ Ratio, Proportion and Rate
2/ Measures of Fertility (CBR,GFR,ASFR,TFR,GRR,NRR)
3/ Measures of Mortality (CDR,ASDR,CSD ratio, CSD rate,
IMR,NMR,PNMR,MMR)
4/ Population Growth and Projection (Population doubling
time)
5/ Health Services Statistics (Hospital statistics) – Indices
relating to the hospital
 Admission rate (AR),Average length of stay(ALS) Bed-occupancy
rate (BOR) Turnover interval (TI) Hospital Death Rate (HDR)

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Thank you!!!

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