VITAL STATISTICS
Must Know Topics*****
• Definition
• Uses & Sources
• Maternal death & causes of MMR
• Infant Mortality Rate & its causes
• Calculation on CBR, CDR, ENMR, LNMR,
PNMR, NMR, IMR, PeriNMRate & Ratio,
SBRate & Ratio & MMR
• Diagram of measures of mortality in early life
Definition
• Means the data collected from going recording or
registration of all “ vital events” births and
adoption, deaths and fetal deaths, marriages,
divorces, separation, and annulments
• Probably the major source of information about the
health of population
• Registration with which health personal are mainly
concerned deaths, birth, and fetal death
• In Myanmar, formal certification – medical doctors,
basic health workers
• Central Statistical Organization ( Vital Statistic
Division) - Compilation and reporting of these
events at the national level
Sources of Vital Statistics***
• Census
• Hospital Records, OPD registers
• Birth & Death Registers
• Immigration & Emigration
• Church Records
• Records of Health Centre/ Sickness Absenteeism
• Health & Morbidity Surveys
• Surveys of Particular Disease
• Notification of Infectious Diseases
Uses of Vital Statistics***
• To use in Public Health Program & Project
(Prevention & Treatment)
• To estimate the population of town & country (E.g
Annual Growth Rate, Population Growth Rate)
• To plan Education, Health & Administration (E.g
Teacher: Student Ratio)
Mortality
Mortality data
• Relatively easy to obtain & reasonably accurate
• Provide the starting point for most epidemiological
researches
• Information of death is mostly obtained through
records on death achieved in different ways
Certification of Death
• Death has to be certificated before the body is
permitted for burial or otherwise
• Death certificate provide information not only
on number of deaths & also the conditions
which let to death
• It is important to be aware of some problems
inherent in obtaining and interpreting
information on cause of death
Validity of cause of death depends on
• The availability of clinical investigation
performed before the person died
• Familiarity of certifyng physician with the
diseased
• Whether or not an autopsy was done
Assignment of cause of death
• Medical doctors, as a rule, is the key personnel who
certify the cause of death
• The decision he must make can best be understood by
viewing the standard certificate of death
• For each death, particular condition must be assigned
as the underlying cause of death
International Form of Death Certificate
ICD
• International Statistical Classification of Diseases ,
Injuries and Cause of Death
• Internationally accepted classification
• Published by WHO and revised every 10years
Limitation of mortality data
A. Incomplete reporting of deaths
B. Lack of accuracy
C. Lack of uniformity
D. Choosing a single cause of death
E. Changing coding system in ICD every 10 years
Measurement of Mortality
Crude Death Rate (CDR)
• 10/1000 population (2021, World Bank data)
Death rate, crude (per 1,000 people) - Myanmar |
Data (worldbank.org)
• The crudest possible type of rate based on data of
registered deaths
• Great advantage in showing the level of mortality
in an entire population
• Easily and quickly computed
Crude Death Rate (CDR)
No. of deaths which occurred among the
population of an area during a year
-------------------------------------------------------- x 1000
Mid- year total population of same area
during the same year (1st July)
Some Limitations
• mix many population groups, as age, occupation,
marital status & race
• particularly dangerous to compare the death
rates of old and young populations (Developed
countries)
Specific Death Rate
• Specific causes Eg. Cholera, Ca stomach
• Specific groups Eg. Age, sex, occupation, social
class
• Specific period Eg. annual, monthly, weekly etc
Standardized Death Rate
• Elimination of irregularity d/t age composition of
place with different population is needed for
mortality data
1. Direct standardization
2. Indirect standardization
1. Direct Standardization
• Age specific rates in population being compared
must be known
• Standard population is identified
• Age specific rates * Standard population= Number
of events that would have occurred
The Total Number of Events
Adjusted Rate= -----------------------------------
Standard Population Chosen
2. Indirect standardization
• Age composition & total number of observed
events (deaths) must be known
• The age specific rates from larger population
is borrowed
• Known population in the specific age group *
borrowed specific rate = the expected number
of events
Standardized Mortality Ratio
Total observed deaths
------------------------------ x 100
Expected deaths
SMR >100 - more deaths occurred than
expected population
- summary rates for total population (fictitious)
- useful for comparison
Proportional Mortality Ratio
No. of deaths due to a
specific cause in a year
---------------------------------------- x1000
Total deaths due to all causes
• expresses what proportion of total deaths is due to
specific cause
• not measure the probability of dying
• E.g. PMR due to cancer, PMR at age 50 & above
Case Fatality Rate
• CFR= No. of deaths assigned to a specific disease
----------------------------------------------------- x1000
Number of cases of a disease
• predicts the risk of dying if the disease is contracted
Years of Potential Life Lost
• a quantitative measure of premature mortality
• reflects the mortality trend of younger age group
• defined by CDC as the number of years of potential
life lost by each death occurring before age of 65
• WHO 2019 data (Life expectancy at birth (years)
(who.int))
• Average life expectancy- M- 65.9 years
F- 72.2 years
Specific Mortality Rates
• Infant Mortality Rate ( IMR)
• Neonatal Mortality Rate ( IMR)
• Fetal Death Rate & Late Fetal Death Rate
• Perinatal Mortality Rate ( IMR)
• Maternal Mortality Rate ( IMR)
Infant mortality Rate ( IMR)
• number of infant deaths (death under one year of
age) per 1000 live birth in one calendar year
IMR
• IMR is given a separate treatment by demographer
because
– is the largest single age category rate
– Deaths at this age are due to particular set of disease
– affected rather quickly and directly by specific health
programmes and may change more rapidly than general
death rate
• most sensitive index of health and level of living of the
population
No. of death of infants under 1 year of age
• IMR = among a population of an area, during a year
-----------------------------------------------------------x 1000
No. of live births registered among the
population of the same area, during the year
Causes of Infant Mortality
1. Medical causes
Neonatal Mortality (0-4 wks): 45%, 1st day : 20-
40%, 1st week: 60%
– Immaturity
– Birth injury/ difficult labour
– Congenital anomalities
– Haemolytic diseases of newborn
– Conditions of placenta and cord
– Diarrhoeal diseases
– Acute Respiratory infections
– Sepsis
• Post Neonatal Mortality (1-12 months):55% of IMR
– Diarrhoeal diseases
– ARI
– Other communicable diseases ( Whooping cough,
influenza, pneumonia)
– Malnutrition
– Congenital abnormalities
– Accidents
2. Biological causes
– Birth weight
– Age of mother
– Birth order
– Interval between births
– Multiple births
– Family size
– High fertility
3. Socio-economic causes
• Bottle feeding • Availability and quality of
• Religious & socio-cultural health care
system • Lack of trained personnel
• Illiteracy • Untrained T.B. A
• Ignorance of child care
• Sex of child
• Illegitimacy
• Brutal habits and customs
• Poverty
• Broken family
Measure of Mortality in early life
Infant Mortality
Post-neonatal Death
Neonatal Death
Late Neonatal
Early Death
Neonatal
Death
Perinatal Death
Still Birth
28 weeks of Birth 7 days 28 days 1 year
gestation
Neonatal mortality rate
• number of deaths of children under 28 days of age,
per 1,000 live births
Postneonatal mortality rate
• number of deaths of children that occur
between 28 days and 365 days after birth,
per 1,000 live births
Post Neonatal Mortality Rate
Deaths of infants between
age of one month and one year
-----------------------------------------x1000
No: of live births in the same
population of the same year
Neonatal mortality
Causes are dominated by ‘Endogenous Factors’
1. Birth Injuries
2. Congenital abnormalities
Post neonatal mortality
• Causes are dominated by Exogenous or
environmental factors
1. Malnutrition
2. Infection
3. Congenital anomalies (especially in
developing countries)
Fetal Death Rate
• Number of fetal death with stated or presumed
gestation of 20 wks or more divides by the sum
of live births plus fetal deaths, per 1,000
Late fetal death rate (Still Birth Rate)
• Number of fetal deaths with stated or presumed
gestation of 28 wks or more divided by the sum of live
births plus late fetal deaths, per 1,000 live births
No: of fetal deaths of 28 wks or
• Still birth = more completed weeks of gestation
Rate ------------------------------------------------------x1000
Total births (live births+ SB)
Perinatal Mortality
• Perinatal Mortality Rate
• Sum of late fetal deaths plus infant deaths within 7
days of birth divided by the sum of live births plus
late fetal deaths, per 1,000 live births plus late fetal
deaths
No of SB+ death under 1 week of age
in a year among a population
PMR= --------------------------------------------------------- x1000
LB+SB in the same population of the same yr
Perinatal Mortality Ratio
No: of still births+ deaths under
PMR = one week of age in a yr among population
----------------------------------------------------------x1000
No. of live births in the population
of the same year
Perinatal Mortality Ratio
• Sensitive indicator, reflecting standards of obstetric
and paediatric care as well as effectiveness of social
measure and public health measure
• Lower limit of viability of fetus- 28 complete weeks of
gestation, & early part of extrauterine life- first 6
days of life
Late fetal deaths (>28 weeks)
• PMR= and deaths under one week
----------------------------------------------x1000
Total births (SB+ LB)
Late fetal deaths
+
PMR = deaths under one week > 1000gms (1kg)
----------------------------------------------------------x1000
Total births weighing over 1000gms at birth
Causes of Perinatal Mortality
1. Antenatal causes
• Maternal diseases; Hypertension, CVS diseases, Diabetes, TB,
anaemia
• Pelvic diseases; Uterine myoma, endometriosis, ovarian
tumour
• Anatomical defects; Uterine anomalies, incompetent cervix
• Endocrine imbalance& inadequate uterine preparation
• Blood incompatibilities
• Malnutrition
• Pregnancy induced hypertension (PIH)
• Antepartum Haemorrhage (APH)
• Congenital defects
• Advanced maternal age
Causes of Perinatal Mortality
2. Intranatal causes
• Birth injuries
• Asphyxia
• Prolong effort time
• Other obstetrics complications
Causes of Perinatal Mortality
3. Post-natal cause
• Prematurity
• Respiratory distress syndrome
• Infections- Respiratory & GI
• Congenital anomalies
4. Others
• Unknown causes
Maternal Mortality Ratio
• Number of deaths from puerperal causes per 1,000
live births
• Puerperal causes are given under the code No: 630-
676 as “complication of pregnancy, childbirth and
puerperium” in International Classification Diseases
9th Division
• Puerperal deaths (within 6 weeks of delivery)
vary from one country to another, or
• Within the same country, we must be cautious
in comparing M.M. R for different places
• MMR is a fine measure of maternity services
• Is a measure of likelihood that a pregnant
woman will die from maternal causes
Maternal Mortality Rate
No. of death due to pregnancy or
Child birth, occur during pregnancy
or within 42 days of delivery
MMR = ---------------------------------------------- x 1000
Total live births in the year
Causes of Maternal Mortality
I. Medical causes
a. Obstetrics
(1) Toxaemia of pregnancy (PIH)
(2) Haemorrhage
(3) Sepsis
(4) Vascular accidents (air/ amniotic fluid embolism)
(5) Anaesthesia
(6) Transfusion reaction
(7) Shocks and accidents
Causes of Maternal Mortality
b. Non- obstetrics
(1) Anaemia
(2) Associated diseases e.g. Cardiac, Renal, Hepatic,
metabolic and infection
(3) Accidents
Causes of Maternal Mortality
II. Social causes
• Age at childbirth
• Parity
• Too close pregnancies
• Family size
• Malnutrition
• Poverty, Illiteracy
• Ignorance Lack of MCH services
• Social customs
• Shortage of manpower
• Poor environment
Fertility Statistics
Crude Birth Rate (CBR)
• Simplest measure of fertility
No. of live births which occurred
among the population
of an area during a year
CBR = ------------------------------------------- x 1000
Mid- year total population of the
same area during the same year
Crude Birth Rate (CBR)
The main defect
• entire population is the denominator whereas all
members of the population do not contribute equally to
births
• Number of births and deaths are supplied by the vital
registration system
• There is a great deal of under-registration of births and
deaths (most countries)
• Population figures are mostly obtained from
census data
General Fertility Rate
• Total number of live births, regardless of age of
mother per 1,000 women of reproductive age,
15-44 years in a given year
No. of live births
GFR= ----------------------------------------------x1000
No. of female in the age group
15-45 years
***The deficiency, is that not all women are
exposed to the risk of childbearing
Total Fertility Rate
• The sum total of the age specific fertility rate * age
interval
• Shows the potential impact of current fertility
patterns on reproduction, i.e , completed family size
• Indicates the average number of births to a
hypothetical cohort of 1,000 women, if they
experienced throughout their childbearing years the
age specific birth rates observed in a given year
Total Fertility Rate
• Because it is based on age-specific birth rates, the
TFR is not affected by changes over time in the age
composition of a population and can be used to
compare populations over time or between different
groups
Gross Reproduction Rate (GRR)
• Represents the average number of daughters born to
hypothetical cohort of 1,000 women, if they
experienced the age-specific birth rates observed in a
given year throughout their childbearing years and
• If none of cohort was to die during her childbearing
year
• The GRR is similar to TFR except that it measure
only female births, since reproduction is largely
dependent on the number of females in a given
population
Net Reproduction Rate (NRR)
• Allowance is made for mortality
• It is closely related to the GRR
• However, unlike the GRR, the NRR incorporates the
effects of mortality
• NRR represents the average number of daughters
who would be born to a hypothetical cohort of 1,000
women, if they passed through their childbearing
years conforming to the age-specific fertility and
mortality rates of a given year
Population Statistics
A. Census
- provides two estimates of the population of
the community as a whole and of local area
(1) Defacto population
(2) Dejure population
(1) Defacto population
• the number of person enumerated in the
area at the census (enumerated population)
(2) Dejure population
• the number of persons ordinarily resident
in each area, regardless of where they
happen to have been enumerated at census
(Resident population)
Uses of census
Two essential contributions to public health workers
(1) Numerical descriptions of the population and its social,
environmental, economic etc, necessary for proper
comprehension of the human community that constitute
the field of application of public health
(2) Statistical denominators that are required for the
calculation of mortality and morbidity rates, so that
number of deaths or illnesses can be measured in
relation to the number of person at risk
Intercensal Movements of population
• Between one census and next, it is necessary to adjust
the census figures annually to allow for population
changes that have been taken place
(1) Natural increase
• excess of birth over deaths during a given period
(2) Net inward or outward balance of migration the
difference between the natural increases and actual
increase of the population, in a given period
Estimation of population
(1) Natural Increase Method
Estimated population
= Census population+( Births- Deaths )+
( Immigrants- Emigrants)
(2) Arithmetic progression
P= Estimated population
p1= Earlier Census
p2= Late Census
n = number of inter censal years
d = years between the estimated years
p1+ p2
P = p + ----------- x d
n
(3) Geometric Progression Method
Log p2 – Log p1
Log p = Log p2 + ----------------------- x d
n
Problems
1. Define Infant Mortality rate (IMR) and Maternal Mortality Rate (MMR).
• Compute MMR for the following data of locality for the year 2016.
• Number of pregnancies = 2500
• Number of abortions = 500
• Number of still births = 200
• Number of live births = 2000
• Death of mothers due to APH = 5
• Death of pregnant mother due to road traffic accident = 2
• Maternal death due to pregnancy induced hypertension =5
• Death of mother with fever 52 days after delivery =3
Problems
2. The demographic data of a town for the year 2016 are shown below:
• Total number of population on 01/01/2016 = 90,000
• Total number of population on 31/12/2016 = 110,000
• Total number of live births during 2006 = 2000
• Total number of deaths during 2006 = 800
• Total number of maternal deaths =10
• Total number of infant deaths = 80
• Total number of neonatal deaths = 30
• Total number of still births = 50
• Total number of deaths within 7 days of life= 15
• Calculate CBR, CDR, IMR, Neonatal and Post neonatal mortality rates,
Still birth rate, perinatal mortality rate and ratio.
Birth for Death
Or
Birth for What?
Thank You!
