AHS Basic Community Health

2012 batch

Disease
Globally & Locally
Dr. N Sivarajah
Faculty of Medicine, University of Jaffna
August 09, 2012

AHS 2012

WORLD POPULATION TRENDS

1750 - 1998
5884

6000
5385
5000
4432

4000

3696
3037

3000
2526

2000

1650

1262
978
1000

791

0
1750

1800

1850

1900

1950

1960

YEAR
AHS 2012

1970

1980

1990

1998

Reached on
October 12,
1999

Since
Origin of
World

1800
1
billion

130
years

1930
2
billion

1960
3
billion

1974
4
billion

1987
5
billion

1999
6
billion

2025
8
billion

15 years
12 years

30
years
12 years
AHS 2012

Iceberg of Disease

Symptomatic Disease

What is seen by the

Physician

Pre-symptomatic Disease
What is in the
community and not seen
by the Physician

Dr. N Sivarajah

2012
MS B 31:AHS
Trends
in Mortality &
Morbidity

Health Trends in the World

Dr. N Sivarajah

AHS 2012

Leading Causes of Hospitalization - 2006

Rank
Order

Cause of
Hospitalization

Morbidity

Rank
Order

Cause of
Hospitalization

Morbidity

Traumatic Injuries

17.0 %

Diseases of the
Urinary tract

3.9 %

Diseases of the
Respiratory System

10.4 %

Intestinal Infectious
diseases

3.8 %

Ill defined conditions

8.4 %

Diseases of the
skin &
Subcutaneous
tissue

3.6 %

Viral diseases

7.3

10

Diseases of the
Musculoskeletal
system

3.3 %

Diseases of GI Tract

5.9 %

11

Hypertensive
diseases

2.6 %

Direct & Indirect

obstetric causes

5.1 %

Dr. N Sivarajah

Source: Annual health Bulletin 2006.

Ministry of Health, Sri Lanka
(http://www.epid.lk)

2012
MS B 31:AHS
Trends
in Mortality &
Morbidity

Leading Causes of Hospital Deaths 2006

(per 100, 000 population)
Rank
Order

Cause of Death

Mortality
(%)

Rank
Order

Cause of Death

Mortality
(%)

Ischemic Heart Disease

20.5

Zoonotic & other

Bacterial Diseases

8.0

Pulmonary Heart Disease

& Diseases of the
Pulmonary Circulation

16.5

Diseases of the
Urinary system

7.8

Neoplasms

16.3

Symptoms, signs &

abnormal clinical &
Laboratory findings

7.7

Cerebro-vascular
Diseases

14.5

10

Pneumonia

7.3

Diseases of the
Respiratory system,
excluding diseases of the
Upper Respiratory tract

11.4

11

Traumatic Injuries

6.2

Diseases of the GIT

11.3

Dr. N Sivarajah

Source: Annual Health Bulletin 2006.

Ministry of Health, Sri Lanka
(http://www.epid.lk)
AHS 2012

TRENDS IN HOSPITALIZATION (Major NCDs)

500
400
300
200
100
0

IHD
HT

Year

Dr. N Sivarajah

AHS 2012

00
20

99
19

95
19

90
19

85
19

19

19

80

DM

75

Cases /100,000

Trends in Hospitalization of
IHD, HT & DM 1975-2000 in SL

Trends in Hospital Deaths- 1997-2006

ISCHAEMC HEART
DISEASE

14

P
E
R
C
E
N
T
A
G
E

DISEASES OF GIT

12.6%

12
10

9.7%

9.9%

9..1%

8.9%

8
6

6.5%

NEOPLASM
S

2
0

1997

Dr. N Sivarajah

1998

1999

2000

2001

2002

YEAR
AHS
2012

2003

2004

2005

2006

Trends in Hospitalization for selected Infectious

Diseases - 1985 2006
(per 100.000 population)
INTESTINAL
INFECTIONS

MALARIA

HELMINTHIASIS

Dr. N Sivarajah

AHS 2012

10

Trends in Hospitalization for Diabetes 1985 2006

(Hospitalization per 100, 000 population)
Note: Data excludes North and Eastern Provinces
296.8
265.2

204.8

86.6

87.5

1985

1990

Dr. N Sivarajah

78.6

1995

2000

2012
MS B 31:AHS
Trends
in Mortality &
Morbidity

2005

2006
11

Hospitalization for Asthma 1985 2006

(Per 100,000 population)
Note: Data excludes North and Eastern Provinces
1000.0
900.0

910.4

800.0

894.8
700.0

817.3

779.3

600.0
500.0

554.7

400.0
300.0

395.0

200.0
100.0
0.0

1985

1990

1995

2000

2005

2006

YEAR
Dr. N Sivarajah

AHS 2012

12

Injury, Poisoning & consequence of external

causes
(per 100,000 population)
3,809.00

2006

3,460.60

2005

3,345.70

2000

2,552.10

1995

1990

1,799.80

1985

1,669.40

Dr. N Sivarajah

AHS 2012

13

Crude Birth Rates, Crude Death Rates,

Infant and Maternal Mortality Rates
Census
Year

Population
(Census)

CBR (per
1000
population)

CDR (per
1000
population)

IMR (per 1000

live Births)

MMR (per
10,000 Live
births)

1871

2 400 300

28.5

19.4

1881

2 759 738

27.1

27.2

170

1891

3 007 789

31.9

28.7

170

1901

3 555 954

37.5

27.6

170

1911

4 106 350

38.0

34.8

218

1921

4 498 605

40.7

31.2

192

210

1931

5 306 871

37.4

22.1

158

208

1946

6 653 339

37.4

19.8

141

155

1953

8 097 700

38.7

10.9

71

49

1963

10 582 064

34.1

8.5

56

24

1971

12 711 143

30.1

7.7

47

12

1981

14 850 001

28.0

6.0

34.4(1979)

9 (1979)

2001

18 732 256

18.9

5.9

12.2

2.3

Dr. N Sivarajah

AHS 2012

14

AHS 2012

15

Demographic Characteristics

Land area
62,705 sq. km
Maximum length
435kms.
Maximum width
225 kms.
Census Population (2011) 20.2 m
Population density (2011) 323 persons /sq. km.
Provinces
8
Districts
25
Divisional Secretaries areas
321

Dr. N Sivarajah

AHS 2012

16

Demographic Characteristics

Land area
62,705 sq. km
Maximum length
435kms.
Maximum width
225 kms.
Census Population (2011) 20.2 m
Population density (2011) 323 persons /sq. km.
Provinces
8
Districts
25
Divisional Secretaries areas
321
Source: Census of Population & Housing 2011 Preliminary report .

Dr. N Sivarajah

AHS 2012

www.statistics.gov.lk

17

RATES FOR SRI LANKA

CENSUS POPULATION (2001)

18,732,256

CRUDE BIRTH RATE

18.9 per 1000 population

CRUDE DEATH RATE

5.9 per 1000 Population

INFANT MORTALITY RATE

12.2 per 1000 live births

MATERNAL MORTALITY RATE 2.3 per 10.000 Live births

NEONATAL MORTALITY RATE
(2002)

8.4 per 1000 Live births

UNDER 5 MORTALITY RATE

(2002)

13.4 per 1000 Live births

Source: Census of Population and Housing.2001 Department of Census & statistics.

In Annual Health Bulletin. 2002 . pp ix-xii
Dr. N Sivarajah

AHS 2012

18

Crude Birth Rates, Crude Death Rates,

Infant and Maternal Mortality Rates
Census
Year

Population
(Census)

CBR (per
1000
population)

CDR (per
1000
population)

IMR (per 1000

live Births)

MMR (per
10,000 Live
births)

1871

2 400 300

28.5

19.4

1881

2 759 738

27.1

27.2

170

1891

3 007 789

31.9

28.7

170

1901

3 555 954

37.5

27.6

170

1911

4 106 350

38.0

34.8

218

1921

4 498 605

40.7

31.2

192

210

1931

5 306 871

37.4

22.1

158

208

1946

6 653 339

37.4

19.8

141

155

1953

8 097 700

38.7

10.9

71

49

1963

10 582 064

34.1

8.5

56

24

1971

12 711 143

30.1

7.7

47

12

1981

14 850 001

28.0

6.0

34.4(1979)

9 (1979)

2001

18 732 256

18.9

5.9

12.2

2.3

2011

20,277,597

Dr. N Sivarajah

AHS 2012

19

TRENDS IN BIRTH & DEATH RATES

CBR increased during
first half of the century

Significant decrease
in CBR was in mid
50s - (between 1981
and 1991 25%
decrease)
Dr. N Sivarajah

CRUDE BIRTH & DEATH RATES - 1871 TO 2001

80
34.8
70

31.2

27.6
28.7

60

PER 1000 POPULATION

Compulsory
registration contributed
to it

22.1

19.8

27.2
50

10.9

19.4

37.5
30

8.5

40.7

40

38.7

37.4

38

37.4

28.5

7.7
34.1

31.9

6
30.1

27.1

28
5.9

20

18.9

10

AHS 2012

1871

1881

1891

1901

1911

1921

1931

1946

1953

1963

1971

1981

2001

CENSUS YEARS

20

Expectation of life at Birth

Period

Male

Female

Period

Male

Female

1900-1902

36.4

34.2

1962-1964

63.3

63.0

1910-1912

33.4

29.3

1965

63.7

65.0

1920-1922

32.7

30.7

1967

64.8

66.9

1946-1947

46.8

44.7

1971

64.2

67.1

1948

54.9

53.0

1981

67.8

71.7

1949

56.1

54.8

1991-1996

69.5

74.2

1950

56.4

54.8

1996-2001

70.7

75.4

1952

57.6

55.5

1953

58.8

57.5

Dr. N Sivarajah

AHS 2012

21

Expectation of Life at Birth

EXPECTATION OF LIFE AT BIRTH BY SEX
80

EXPECTATION OF LIFE IN YEARS

70

60
50

40

Male

Female

30

20
10

0
'1900- '1910- 1920- 19461902 1912 1922 1947

1948

1949

1950

1952

1953 19621964

1965

1967

1971

1981 1991- 19961996 2001

PERIOD

AHS 2012

22

LITERACY RATE BY SEX - 1881 - 1994

100
92.5
87.9

91.1

90
85.8

85.6

83.2

80
75.9

PERCENT lITERATE

70

70.9

70.1

67.5

60
56.3
50

53.6

47.2

40

Male

43.8

42

female

36.1
30

29.8
21.2

20
12.5

10

8.5
3.1

5.3

0
1881

1891

1901

1911

1921

1946

1953

1963

1971

1981

1994

YEAR

Dr. N Sivarajah

AHS 2012

23

References
K Park (2000) Parks text book of
Preventive and Social Medicine. 19th
Edition. M/s Banarsidas Bhanot India.
Annual Health Bulletin 2006, Ministry of
Health, Sri Lanka
http://www.epid.lk for Annual Health
Bulletin 2006
www.jaffnahealth.org
Dr. N Sivarajah

AHS 2012

24

AHS 2012