health statistics

1. UNIT- I GNM

2.  Vital statistics are the statistics on principal
events in the life of an individual.
 They are usually gathered at the time of an
event, i.e. birth, marriage, death vital
statistics are commonly complied from
records of vital events registered through
offices that are organized as part of vital
registration system.

3.  Birth rate
 Death rate
 Specific death rate
 Infant mortality rate
 Neonatal mortality rate
 Perinatal mortality rate
 Under five mortality rate
 Maternal mortality rate
 Expectation of life
 General fertility rate

4.  “The Birth rate is defined as the number of live
births during a year per 1000 estimated mid-
year population.”
Birth rate= Number of live births during the year x 1000
Estimated mid year population
 Currently the birth rate in India is about 17.5
per 1000 population.
 In the developed countries, the birth rate is
less than 15.
 The aim of the family planning programme in
India is to reduce the birth rate to at least 2.1
by 2025.

5.  “The Death rate is defined as the number of
deaths per 1000 estimated mid-year population
in one year.”
Death rate= Number of deaths during the year x 1000
Estimated mid year population
 Currently the death rate in India is about 8.5
per 1000 population.
 In USA and other developed countries, the
death rate is less than 9.

6.  The Death rate due to:
Specific causes, e.g. Cholera
In specific groups like age, gender,
occupation, social class
Specific periods, annual, weekly, monthly
are called specific death rates.

7. 1. Specific Death rate due to Cholera=
Number of deaths from Cholera during the year x 1000
Mid year population
2. Specific Death rate for males=
Number of deaths among male during the year x 1000
Mid year population
3. Specific Death in 2001=
Number of deaths in 2001 x 1000
Mid year population

8.  “It is the number of deaths under one year of
age per 1000 live births in one year.”
IMR= Number of deaths under one year of age x 1000
Total live births in the year
 Currently the IMR is about 69 per 1000 live
births.
 In developed coutries, it is about 6.
 Infant mortality rate is regarded as a most
sensitive index of the health of the community.

9.  “Deaths occuring within 4 weeks or 28 days of
birth are called neonatal deaths.”
Neonatal Mortality Rate=
Number of deaths under 28 days of age x 1000
Total live births
 The importance of neonatal mortality rate is
beacuase the total infant deaths, nearly 50 %
occur during the first 4 weeks.

10.  The causes of infant mortality are:
Pre maturity
Birth injury and asphyxia
Neonatal infections, i.e. Diarrhea, Broncho-
pneumonia
Congenital abnormalities
Hemorrhagic disease.
In India, the neonatal mortality rate was 30.9
in 2019.

11.  “It is the annual number of deaths of children
aged under 5 years, expressed as a rate per
1000 live births.”
Under Five Mortality Rate=
Number of deaths of children
less than 5 years of age in a given year x 1000
Number of live births in the same year
 Currently the under five mortality rate in India is
about 96 per 1000 live births.
 In developed countries it is less than 7.

12.  Death of a woman who is pregnant or within
42 days of termination of pregnancy
irrespective of the duration and the site of
pregnancy from any cause related to or
aggravated by the pregnancy or its
management but not from accidental or
incidental causes.

13.  The MMR is expressed in terms of such
maternal deaths per 1,00,000 live births.
 In most of the developed countries, the MMR
varies from 4-40 per 1,00,000 live births.
 In the developing countries, it varies from
100-700 with India having about 408 per
1,00,000 live births.

14. DIRECT
INDIRECT BIRTH
NON-OBSTETRIC

15.  Direct obstetric deaths are those resulting
from complication of pregnancy, delivery or
their management such conditions are
abortion, ectopic gestation, pre-eclampsia,
eclampsia, antepartum and post-partum,
hemorrhage and puerperal sepsis.

16.  Conditions present before or developed during
pregnancy but aggravated by the physiological
effects of pregnancy and strain of labour.
 These are anemia, cardiac disease, diabetes,
thyroid disease, etc.
 Of which anemia is the most important single
cause in the developing countries.
 Viral hepatitis when endemic, contributes
significantly to maternal deaths.
 Include accidents, malaria, typhoid and
infectious diseases.

17. AGE
PARITY
SOCIO
ECONOMIC
STRATA
ANTENATAL
CARE
SOCIAL
FACTORS

18.  The optimum reproductive efficiency appears
to be between 20-25 years.
 In the young adolescent pregnancy carries
higher risk due to pre-eclapsia,
cephalopelvic disproportion and uterine
inertia.
 In women aged 35 years or above the risk is
3-4 times higher.

19.  The risk is slightly more in primigravidae but
it is 3 times greater in para 5 or above where
post-partum hemorrhage, malpresentations
and rupture uterus are more common.
 The risk is lowest in the second pregnancy.

20.  Mortality ratio are higher in women
belonging to low socio-economic status as
these women are likely to be less privileged
in the field of nutrition, housing, education
and antenatal care.

21.  The most significant factor affecting maternal
mortality is the availability of antenatal care
and its acceptance by the community.
 Unfortunately, those very groups which have
the highest mortality, like grand multiparae or
the patient's of lower socio-economic status
are the women who least often avail
themselves of this facility.

22.  It is partinent at finding out the circumstances
in which the deaths occur and whether the
particular deaths are avoidable rather than to
know what is the immediate cause of death.
 An avoidable factor is a departure from the
best current clinical practice preceeding a
maternal death.
 Even in the advanced countries where the
death rate had been lowered to an almost
irreducible minimum, about 40-45 % of the
deaths have got avoidable factors.

23.  Hemorrhage
 Sepsis
 Hypertensive disorders in pregnancy
 Anemia
 Infective hepatitis
 Thrombo-embolism

24. Policy initiatives:
 Utmost efforts are to be made from all levels.
government and private agencies, so that the
upgraded health care delivery system should
be accessible to most if not all pregnant
women.
 The government must make maternal mortality
a priority public health issue and periodically
evaluate the programmes in an effort to prevent
or minimize maternal deaths.
 About 70 % of maternal death in India is
preventable.

25. Programme initiatives:
 Improvement of nutritional status and literacy
rate without discrimination against women.
65 % of the girls in India within 14 years are
anemic. 70 % of pregnant women suffer from
iron deficiency anemia.
 Early registration of pregnancy.
 Provision to identify the high risk cases and
their references to appropriate referral
hospitals where the ideal antenatal care
cannot be enforced, atleast a minimum of 3
visits should be carried out the first at 2nd
trimester, second at 32 weeks and third one at
36 weeks of gestation.

26.  Family planning counselling:
 Family planning is the first line of defence
against unwanted pregnancy and illegal
abortion.
 It will prevent pregnancies that are too early,
too closely spaced, too many or too late.
 It is estimated that about 25-40 % of the
maternal deaths from unwanted pregnancies
could be avoided if methods of
contraceptives were made available and
used.

27.  In the third world countries, about half of the
estimated 4,50,000 annual maternal deaths
could be avoided if all the pregnancies
occurred to women between the ages of 18-
35, if the interval of pregnancies were at least
2 years and if no woman had more than 4
children.
 Essential obstetric care:
 It is to be provided either by a field staff at
the door step of a pregnant woman or
preferably at the first referred level hospital.

28.  Efforts are not only made to upgrade the
hospital care and to refer the high risk
women as early as possible but services
need to be designed to provide conveyance
and/or to reduce the distance between the
pregnant mothers and the place of care they
required.
 About 80 % of the rural mothers delivered at
home and majority are attended by untrained
birth attendants.

29.  The quickest and cheapest means to provide
safe delivery services to mother in these
areas are to train the traditional birth
attendants, to upgrade the health centres, to
make all kinds of government vehicle
available in emergencies and all out increase
in number of health care providers such as
midwives, health visitors, social workers and
other auxiliary personnel.
 Integration of domiciliary, rural and
institutional services with efficient refferal
system.

30.  More maternal deaths could be prevented
when care is provided at the first refferal level
hospital by trained staff compared to that by
field staff.
 Frequent joint consultation amongst specialist
in the management of medical disorders of
pregnancy particularly anemia, diabetes,
hypertension and cardiac disease.
 Provision for good anesthetic facilities, blood
transfusion services and senior resident in
labour room for decision making regarding the
routine of delivery atleast in state hospitals.

31.  Maternal mortality conferences with frank
discussions regarding the causes of deaths
and to find out whether it was avoidable.
 Annual reports of such enquity committees
are to be published for necessary preventive
measures.
 Periodic refresher course for continuing
education of general practitioners,
obstetricians, midwives and auxiliary staff to
highlight the preventable factors.

32.  Perinatal mortality is defined as deaths
among fetuses weighing over 1000 gm at
birth who die before and during delivery or
within the first 7 days of delivery.
 The perinatal mortality rate is expressed in
terms of such deaths per 1000 total births.

33.  The Perinatal mortality closely reflects both the
standards of medical care and effectiveness of
social and public health measures.
 However, for international acceptance the limit
of viability is brought down to a fetus weighing
500 gm or more.
 During the past few decades, there has been a
phenomenal decrease in perinatal mortality
rate with the fall in maternal deaths.
 The major contribution towards this has come
from socio-economic changes, improvement in
health care, decrease in family size and a move
forwards hospital delivery.

34.  But where as the perinatal mortality is less
than 10 per 1000 total births in the developed
countries, it is much higher in the developing
countries.
 The major health problems in this part of the
globe arises from the synergistic effects of
malnutrition, infection and unregulated fertility
combined with lack of adequate obstetric care
and poor communication.

35.  “It is the mortality of infants occuring during
the period from the 28th week of pregnancy to
7 days after birth per 1000 total births.”
 In other words it includes still births + deaths
under one week.
Perinatal Mortality=
Number of deaths occuring during
28 weeks or more or under one week after birth x 1000
Total live + still births
 In India, perinatal mortlity rate is about 44 per
1000 live births.
 In developed countries, it is less than 10 per
1000 total births.

36. EPIDEMIOLOGICAL
MEDICAL
DISEASE
OBSTETRIC
COMPLICATIONS
COMPLICATIONS
OF LABOUR

37.  Age over 30 years, parity above 5, low socio-
economic condition, poor maternal nutritional
status, etc all adversly affects the pregnancy
outcome.
 In anemia with (Hb % <8g/dl), diabetes
mellitus, syphilis, acute fever and infection.
 The total risk of death increases due to
hypoxia, intrauterine growth restrictions,
prematurity and infection.
 Hypertensive disorders of pregnancy.

38.  Antepartum hemorrhage particularly abruptio
placenta is responsible for about 10 % of
perinatal deaths due to severe hypoxia.
 Pre-exlampsia, eclampsia is associated with
high perinatal loss either due to placental
insufficiency or prematurity- spontaneous or
induced.
 Cervical incompetence, premature effacement
and dilatation of cervix between 24-36 weeks is
responsible for significant perinatal deaths
from prematurity.

39.  Dystocia from disproportion, malpresentation,
abnormal uterine action, premature rupture of
membranes may result in asphyxia, amnionitis
and birth injuries contributes to perinatal
deaths.

40.  Multiple pregnancy most often leads to
premature delivery and usual complications.
 Congenital malformation is responsible for
8-10 % of perinatal deaths, the lethal
malformations are mostly related to nervous,
cardiovascular or gastrointestinal system.
 Intrauterine growth restriction and low birth
weight babies.

41.  Apart from preterm delivery, intra uterine
nutritional deficiency may be responsible for
such low weight babies which are more
vulnerable to biochemical, neurological and
respiratory complications resulting in high
perinatal deaths of about 50 % when the birth
weight is less than 2 kg.
 Pre-term labour and pre-term rupture of the
membranes are known leading causes of
prematurity.

42. Related clinical conditions
 In about 25 % deaths are related to prolonged
and difficult labour, in about 20 % related to
pregnancy complications and in about 40 %
deaths remain undermined.
Direct causes of death as revealed by autopsy
 About 80 % of the perinatal deaths are related
to perinatal hypoxia, low birth weight,
infection and intracranial hemorrhage.
 The undetermined group is reduced to 15 %.

43.  Thus autopsy study is essential in any
perinatal mortality study when the real cause
of death can only be ascertained so that
preventive measures can be taken to prevent
its occurence.

44.  As every mother has the right to conclude her
pregnancy safely so also has the baby got a
right to be born alive, safe and healthy.
 Many of the perinatal deaths are preventable
with proper care and good organizational set
up.
 It should be emphasized that in the developing
countries, high proportion of perinatal death is
accounted for by socio-biological factors
acting long before delivery.
 As such, improvement of obstetric service
only around delivery, will not minimize
perinatal deaths appreciably.

45.  Simultaneous demographic and social changes
help in reduction of perinatal mortality.
 The measures are easy to outline but difficult to
implement in practice in the developing world.
 Pre-pregnancy health care counseling
 Genetic counseling in high risk cases and the
role of prenatal diagnosis to detect genetic,
chromosomal or structural abnormalities are
essential.
 Termination of an affected fetus is a positive
step in reduction of deaths due to congenital
malformations.

46.  Regular antenatal care, with advice regarding
health, diet and rest.
 Improvement of maternal nutrition.
 Detection and correction of anemia and
prevention in multiple pregnancy.
 Immunization against tetanus should be done
as a routine.
 Screening of high risk patients those of poor
socio-economic status or high parity and very
young and twins, etc and their mandatory
hospital delivery.
 Risk approach to MCH care is essential.

47.  Careful monitoring in labor and avoidance of
traumatic vaginal delivery.
 To minimize sepsis, atleast three formalities
are to be taken- clean hands, clean surface
where delivery takes place and to cut the cord
clean.
 Providing an efficient neonatal service specilly
to look after the preterm babies.
 Health care education of the mother about the
care of the newborn.
 Educating the public to utilize family planning
aids and also to utilize the available maternity
and child health services.

48.  Autopsy studies of perinatal deaths.
 Continued studies of perinatal mortality
poblems by demographic studies, regular
clinically allied interdepartmental meetings
and pathological research.

49.  Life expectancy is a statistical measure of
how long an organism may live based on the
year of their birth, their current age and other
demographic factors including gender.
 In the year 1950-1955 the combined life
expectancy at birth for both genders was
46.5 years.
 Five decades later by 2008 it was 69 years an
increase of 22.5 years.

50.  GFR represents the number of children that
would be born to a woman if she were to live
to the end of her childbearing years and bear
children in accordance with current age
specific fertility rates, i.e., the GFR is the
total number of live births per 1000 women of
reproductive age (15-49 years) in population
per year.
GFR=
Number of live births in an area during the year x 1000
Mid-year female population age 15-44/49 in
the same area in the same year

51.  “A still birth is a birth of a newborn after 28th
completed week when the baby does not
breath or show any sign of life after
delivery.”
 Such deaths include antepartum deaths and
intrapartum deaths.
 Still birth rate is the number of such deaths
per 1000 births.

52.  Acute fetal distress
 Traumatic vaginal delivery leading to
asphyxia or intracranial hemorrhage.
 Asphyxia- premature babies are more
vulnerable.
 Congenital malformation of the fetus.
 About half of the still births are related to
preterm babies.