Chapter Four

Demography and Health Services

Statistics

1
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

2
 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.

4
• Therefore, 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.
• It is indispensable to study these variables
through other socio-economic variables such
as place of birth, religion, occupation,
education, marital status, etc.
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 Sources of Demographic Data
• Demographic information is acquired through three main
ways: by complete enumerations (census) and sample
surveys at a point in time and through recording of vital
events as they occur over a period of time.
• Complete enumerations or censuses are taken by obtaining
information concerning every inhabitant of the area.
• Also coming into increasing use are sample surveys,
conducted by interviewing a part of the population to
represent the whole.
• On the other hand the information obtained from the
recording of vital events (birth, death, marriage, divorce,
etc) on a continuous basis completes the data collected
from periodic censuses & sample surveys.
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 A) THE CENSUS
• In modern usage, 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. There are two main different
schemes for enumerating a population in a
census.

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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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 THE CLASSICAL STAGES OF DEMOGRAPHIC TRANSITION

Demographers ,after discussing the stages of continuum of

demographic development ,came up with the following transition
stages

Stage 1(Stage of high birth rate and high death rate)

•Characterized by high birth rate and death rate resulting low total
population. It is virtually a stage of non growth.
• Distinctive to preindustrial or Agrarian society & is a pre-modern stage of
economic development(typically backward economies).
• Agricultural existence favors large families.
• Generally CBR>45 and CDR>35,but the high birth rates are balanced by
high death rates from diseases ,famine, war etc
• For instance, this has happened in India b/n 1911-1921.
• By the mid 20th century there were few countries still in this pre-transition
stage.
STAGE 2(Early expansionary stage)
Characterized by a fall on death rate but no corresponding fall
on birth rate. This results in an increase of population.
This decline in death rate marked the beginning of the transition.
-Represents a marked beginning of modernization and economic
development.
-Advances in sanitation and improved availability and quality of food, water
and shelter lead to fall in death rate and an increase
in life expectancy.
-These changes usually come about due to improvements in
farming techniques, access to technology, basic health
care and education.
-This has usually occurred without an immediate change in birth rate .The
improved condition of life may favor an increase
in fertility as well.
-Thus countries in this stage experience a large increase in their population
size.
 Stages of transition continued…..

STAGE 3(Stage of late expanding)

• Characterized by falling (declining)birth rate and low death
rate. As a result population growth begins to level off.
• It is a period of technological and economic development.
• In this stage birth rates sharply fall due to high access to
contraception and largely as a reflection of industrialization
and consequent urbanization.
• With urbanization, people tend to migrate from rural to
urban areas& this results not only the breaking of traditional
values but also creates incentives for having small families.
 Stages of transition continued…..

STAGE 4 (Stage of low birth rate and death rate)

• In this stage both birth rates and death rates are
low and population growth slows, stops or even
declines.
• The beginning of this stage marks the end of the
transition &
its culmination marks the coming of the post-transition
period.
• It is a period of high modernization.
• Europe was at this stage in the 1930s.
The following graph shows these stages.
21
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.
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.
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.
• Population Pyramid – Rapid Population Growth
 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
 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 .
 Population pyramid continued….

• Population Pyramid – Zero or Declining Growth

 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
 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
 Population Pyramid, Israel Arab Population, 2002

90+
Females
80-84 Males
70-74
60-64
Age Groups

50-54
40-44
30-34
20-24
'10-14
0-4
10 5 0 5 10
Percentages
Population Pyramid, Ethiopia 2005
 Ratio, Proportion and Rate
• Ratio: A ratio quantifies the magnitude of one
occurrence or condition in relation to another.
A. Sex Ratio (SR): sex ratio is defined as the
total number of male population per 100
female population, SR = M/F x 100 where M
and F are total number of male and female
populations, respectively. Sex ratios are used
for purposes of comparison.
The balance between the two sexes
The variation in the sex balance at different ages
It is also used for detecting errors in demographic data
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b. Child-Woman-Ratio (CWR): It is defined as
the ratio of the number of children under- five
years of age to the number of women in the
child bearing age group (usually 15-49).
= Nmberof children under 5 years of
age per 1000 women in the

The child woman ratio is also known as measure

of effective fertility because we are
considering survivals up to the age of 4 not
the dead ones.

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c. Dependency Ratio (DR): The dependency ratio
describes the relation between the potentially
self-supporting portion of the population and
the dependent portions at the extremes of age.
It is useful in economic studies.

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• Proportion:- is a type of ratio which quantifies
occurrences in relation to the population in which
these occurrences take place.
I.e., the numerator is also included in the denominator.
• Example: The proportion of malaria cases among
inhabitants of a certain locality.
• Rate: A rate is a proportion with a time element, i.e.,
in which occurrences are quantified over a period of
time.
• The term rate appropriately refers to the ratio of
demographic events to the population at risk in a
specified period.

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• Where K is a constant mainly a multiple of 10(100,
1000, 10000,…etc)
• Population at risk: This could be the mid-year
population (population at the first of July 1),
population at the beginning of the year or a more
complex definition. Period for a rate is usually a year.

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Rate could be crude or specific: - It is considered
as crude when it shows the frequency of a class of
events throughout the entire population without
regarding to any of the smaller groupings.
Crude rates are highly sensitive to the structure
(age) of the population and are not directly used
for comparison purposes.
 Where as a specific rate implies the events in a
particular category of age, sex, race, particular
disease, or other classification variables are used.

38
 I. Measures of Fertility

1. Crude Birth Rate (CBR): is the number of live

births in a year per 1000 mid-year population in
the same year.

(*) Live Birth is the complete expulsion or extraction

from its mother as a product of conception
irrespective of the duration of pregnancy, which
after such separation show evidence of life, (like
breathing, pulsation of the heart, etc.).
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2. General Fertility Rate(GFR): is the number of
births in a specified period per 1000 women
aged 15-49 year; i.e.

GFR is general because we are considering all

females in the age group 15-49 without
restricting to those who have child (children).

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3. Age Specific Fertility Rate (ASFR): is the
number of live births in a specified period per
1000 women of a given age or age group.

• ASFR is used to measure the reproductively

performance of a given age, thus showing
variation in fertility by age.
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4. Total Fertility Rate (TFR): is the sum of all age
specific fertility rates for each year of age from
15-49 years.
• It is the average number of children that a
synthetic (artificial) cohort (a group of persons
who share a common experience within a
defined period) of women would have at the
end of reproduction, if there were no mortality
among women of reproductive age; each
woman will live up to 49 years of age, about a
total of 35 years.
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 TFR 
 ASFR  age interval
1000

TFR is used as a standardized index for the overall

fertility level and measures the total number of
children a cohort of women will have at the end
of their reproductive age.
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5. Gross Reproduction Rate (GRR): Definition

GRR: is the average number of daughters a woman

would have or bear if she experiences a given
set of ASFR throughout the reproductive age
with no allowances of mortality over this
period.
Note: GRR is exactly like TFR, except that it counts
only daughters and literally measures
“reproduction”– a woman reproducing herself
in the next generation by having a daughter.
 B ( f )
GRR   i
P i ( f )
 n

GRR   ASFR ( f )  n
1000

where Bi(f) indicates the births of baby girls in the age

group i and Pi (f)represents the average female population of
age group i
ASFR(f) refers to age specific female birth rates and n is the
age interval.
GRR shows how many baby girls-potential future
mothers-would be born to 1000 women passing through
their child bearing years.
It is an indication of the extent to which women
reproduces themselves during a generation, assuming no
mortality. Thus, GRR ignores the impact of mortality on
 Gross Reproduction Rate: Calculation

GRR(per woman)=  ASFR( f )  n

1000

Other alternative calculations:

Let Bf= No of female births& Let B = No of male
m+f

and female births, i.e. total births, then

GRR  TFR  (Proportion of female births)
Bf
GRR  5   ASFR 
B mf
or , GRR = TFR/(1+sex ratio at birth)
• Example: If GRR = 1000 => the current generation of
females of child bearing age will maintain itself on the
basis of current fertility rate without mortality.
• If GRR > 1000 => no amount of reduction of deaths will
enable it to escape decline sooner or later and if GRR <
1000 the reverse happens.

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 6. Net Reproduction Rate (NRR):
 NRR is similar to GRR except that it allows for mortality. It
estimates the number of daughters who will live to replace their
mothers in the future, thereby measuring the replacement of
one generation by another.
 To measure net reproduction, we must take into account the fact
that the mother cohort’s initial population at birth is diminished
by mortality even before reaching childbearing age. This
proportionally reduces its capacity to effectively produce the
female births that will replace it in the overall population
 Thus, NRR is the average number of daughters that would be
born to a woman (or group of women) if she passed through her
lifetime from birth conforming to the age-specific fertility and
mortality rates of a given year.
 NRR…
This rate is like the GRR, but it is always lower
because it takes into account the fact that
some women will die before completing their
childbearing years
 One disadvantage of GRR was lack of
recognition of the impact of mortality on
population replacement. This limitation is
readily overcome (in the calculation of NRR)by
including survival estimates

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• Using statistics for single years of age, the formula for NRR is

L
NRR   ASFR ( f )
l
x

i.e. NRR =∑ (single year ASFRs for daughters*the

proportion surviving to their mother’s age)

where ASFR(f) is the age specific female fertility rate for single
ages , L x is the probability of daughters surviving to their
l0

mother’s age, Lx is average number alive at exact age x and l0 the

number of live births occurring in the population each year(is
usually assumed 1000);
Net reproduction rate (NRR)…
Using statistics for five age groups ,the formula becomes
x  49
B L x
NRR  5 
x  15
5
P
x 5
5  l0
5 x

L x
NRR  5  ASFR ( f ) 5
5  l0
Where 5L x is the probability of daughters surviving to
5  l0
the mid-point of their mother’s age group(i.e x to x+5),lo is
the total no of live births occurring in the population each
year(therefore, 5*l0 =5000) and 5 B xis the daughters’ age
5 Px
specific fertility rate for 5 year age group.
 Example calculating NRR
Age ASFR(f) Average no Survival factor or ASFR(f) * Survival factor
(A) (B) alive b/n exact probability of surviving E=B*D
from birth to age group of
Ages(from life mother(D)=C/5*lo =C/5000
table, assuming
1000 births per
year,5*lo)
(C)

15-19 21.6 4825 0.965 20.84

20-24 85.7 4805 0.961 82.38
25-29 86.6 4780 0.956 82.79
30-34 49.4 4750 0.95 46.93
35-39 23.7 4715 0.943 22.35
40-44 6.1 4660 0.932 5.69

45-49 0.5 4585 0.917 0.46

    ∑= 261.44
Female net Reproduction rate =261.44 X 5=1307
NRR(Per Woman)=1307/1000=1.3
Then the female population is more than replacing it self
 NRR continued….
• Replacement-level fertility is the level of fertility at which
women in the same cohort have exactly enough daughters
(on average) to “replace” themselves in the population.
• NRR=1 signifies exact replacement or replacement level
fertility(RLF), i.e., one daughter per woman. Once
replacement-level fertility has been reached, births will
gradually reach equilibrium with deaths, and in the
absence of immigration and emigration, a population
ultimately will stop growing and become stationary. The
time this process takes varies greatly depending upon the
age structure of the population.
• NRR<1denotes below RLF, where there are fewer
daughters to succeed their mothers’ generation.
• NRR>1indicates above replacement level fertility
 II. Measures of Mortality
1. Crude Death Rate (CDR): is defined as total number of
deaths due to all causes occurring in a defined area during a
defined period per 1000 midyear population in the same
area during the same period.

• where midyear population is population of the area as of July

1 (middle of the year).
• CDR measures the rate at which deaths are taking place from
all causes in a given population during a specified year.
54
2. Age-Specific Death Rate (ASDR): is defined as total
number of deaths occurring in a specified age group of
the population of a defined area during a specified
period per 1000 midyear population of the same age
group of the same area during the same period.

55
 3. Cause Specific Death Ratio and Rate: A cause
specific death ratio (proportionate mortality ratio)
represents the percent of all deaths due to a
particular cause or group of causes.
– CSD ratio for cause c = 1000

• where Dc is total deaths from cause c and Dt is total deaths from all causes
in a specified time period. Cause Specific Death Rate (CSDR) is the number
of deaths form cause c during a year per 1000 of the midyear population,
i.e.

56
4. Infant Mortality Rate(IMR): measures the risk of
dying during infancy (i.e. the first age of life), and is
defined as:

• Infant Mortality rate: the probability of dying

between birth and age one year per 1000 live
births.
5. Neonatal Mortality Rate (NMR): measures the risk
of dying within 28 days of birth. It is defined as:
•  
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6. Post - Neonatal Mortality Rate (PNMR): Measures the risk of dying
during infancy after the first 4 weeks of life, and is defined as:

7. Maternal Mortality Rate(MMR): is defined as the number of

deaths of mothers (Dm) due to maternal causes, i.e. complications
of pregnancy, child birth, and puerperium, per 100,000 live births
during a year, i.e.

• MMR measures the risk of dying of mothers from maternal causes.

Ideally the denominator should include all deliveries and abortions

58
 Population Growth and Projection
• The rate of increase or decline of the size of a
population by natural causes (births and
deaths) can be estimated crudely by using the
measures related to births and deaths in the
following way:
Rate of population growth
• Crude Birth Rate - Crude Death Rate = crude
rate of natural increase.
• This rate is based on naturally occurring events
– births and deaths.
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• When the net effect of migration is added to the
natural increase it gives what is known as total
increase.
• Based on the total rate of increase (r),
• the population (Pt) of an area with current
population size of
• (Po) can be projected at some time t in the short
time interval (mostly not more than 5 years)
using the following formula.

60
• For example if the CBR=46, CDR=18 per 1000 population
and population size of 25,460 in 1998, then Crude rate of
natural increase = 46 - 18 = 28 per 1000 = 2.8 percent per
year. The net effect of migration is assumed to be zero.
• The estimated population in 2003, after 5 years, using the
first formula will be

• P2003=P1998 ( 1+0.028) t = 25,460(1+0.028)5=

25,460(1.028)5=29,320
• The population of the area in 2003 will be about 29,230.
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 Population doubling time
• The doubling time of the size of a population
can be estimated based on the formula for
projecting the population.

• From the above formula, the time at which

the current population Po will be 2 ×Po can be
found by: =>2=

62
More practical approach to calculate the
population doubling time is: =
= 2
(Provided r is very small compared to 1)

63
 Health Services Statistics
• Health Service Statistics are very useful to
improve the health situation of the population
of a given country. For example, the following
questions could not be answered correctly
unless the health statistics of a given area is
consolidated and given due emphasis.

64
1. What is the leading cause of death in the area? Is it malaria,
tuberculosis, etc?
2. At what age is the mortality highest, and from what disease?
3. Are certain diseases affecting specified groups of the population
more than others? (this might apply, for example, to women or
children, or to individuals following a particular occupation)
4. In comparison with similar areas, is this area healthier or not?
5. Are the health institutions in the area able to cope with the
disease problem?
6. Is there any season at which various diseases have a tendency
to break out? If so, can these be distinguished?
7. What are the factors involved in the incidence of certain
diseases, like malaria, tuberculosis, etc.?

65
 Uses of Health Statistics
• The functions/uses of health statistics are
enormous. A short list is given below:
– Describe the level of community health
– Diagnose community ills
– Discover solutions to health problems and find
clues for administrative action
– Determine priorities for health programmes

66
– Develop procedures, definitions, techniques such
as recording systems, sampling schemes, etc.
– Promote health legislation
– Create administrative standards of health activities
– Determine the met and unmet health needs
– Disseminate information on the health situation
and health programmes
– Determine success or failure of specific health
programmes or undertake overall evaluation of
public health work
– Demand public support for health work
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Major limitations of morbidity and mortality data from
health institutions in Ethiopia include the following:
– Lack of completeness: Health services at present (in
2000) cover only 47% of the population
– Lack of representativeness: Illnesses and deaths
recorded by health institutions do not constitute a
representative sample of all illnesses & deaths occurring
in the community.
– Lack of denominator: The underlying population served
by a health institution is difficult to define
– Lack of uniformity in quality: No laboratory facilities in
health stations. Such facilities are available in hospitals.
– Lack of compliance with reporting: Reports may be
incomplete, not sent on time or not sent at all.
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Health service utilization rates (Hospital statistics)
– Indices relating to the hospital
1. Admission rate (AR): The number of (hospital) admissions
per 1000 of the population per year

• “Admission” is the acceptance of an in-patient by a hospital.

• Discharges and deaths: The annual number of discharges
includes the number of patients who have left the hospital
(cured, improved, etc.), the number who have transferred to
another health institution, and the number who have died.

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2. Average length of stay (ALS): This index indicates the
average period in hospital (in days) per patient
admitted. Ideally, this figure should be calculated as:

• That is, cumulative number of bed-days of all

discharged patients (including those dying in hospital)
during one year divided by the number of discharged
and dead patients in the same year.
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3. Bed-occupancy rate (BOR): This figure
expresses the average percentage occupancy
of hospital beds.

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4. Turnover interval (TI):- the turnover interval expresses the average
period, in days, that a bed remains empty, in other words, the average
time elapsing between the discharge of one patient and the admission of
the next.

• This figure is obtained by subtracting the actual number of hospitalization

days from the potential number of hospitalization days in a year and
dividing the result by the number of discharges (and deaths) in the same
year.
• The turnover interval is zero when the bed-occupancy rate is 100%. A
very short or negative turnover interval points to a shortage of beds,
whereas a long interval may indicate an excess of beds or a defective
admission mechanism.

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5. Hospital Death Rate (HDR)

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 Exercises
a. Calculate the population doubling time of a given
country with annual rate of growth( r ) = 1%.
b. The following summary table was taken from the
annual (1999) health profile of district z.

Year Total No of health institutions in the district Total

population Health posts Health Hospital number of
of the Centers s hospital
district beds

1999 400,000 14 2 1 80

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• During the same year, there were 14,308 discharges
and deaths. The annual number of hospitalized patient
days was also recorded as 28,616.
 Calculate:
I. the health service coverage of the district
II. the average length of stay
III. the bed occupancy rate
IV. the turnover interval
 What do you understand from your answers in parts 1 and 4?
 Show that the average time that elapsed between the discharge
of one patient and the admission of the next was about one hour.

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Thank you!!!

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