Demography and community health for healthcare.pdf
- 1. Demography & Community Health J. A. N. Tharaka Clinical Instructor School of Nursing- Nawaloka College of Professional Studies
- 2. Learning Objectives At the end of the session, students will be able to; Define the term demography and explain its relevance to nursing and community health. Describe the population distribution and density of provinces in Sri Lanka using recent data. Interpret census data related to mortality, morbidity, and life expectancy. Explain vital statistics and their use in assessing public health status. Analyse current epidemiological patterns of diseases in Sri Lanka. Apply demographic knowledge to nursing assessment and community health planning. 2
- 3. What is Demography? Definition “Demography describes the distribution of disease, death, and other health outcomes in the population according to person, place, and time, providing a picture of how populations change and their health needs.“ — Stanhope & Lancaster, Foundations for Population Health in Community/Public Health Nursing 3
- 4. Ways Demographic Data Influences Community Health Nursing To Assess the Health Needs of a Population Nurses use demographic data to understand who is at risk (e.g., children, the elderly, pregnant women). It helps to identify the health priorities of a community. To Plan and Deliver Targeted Health Programs Knowing the size and structure of a population helps in planning maternal health clinics, vaccination programs, or elderly care services. To Identify Health Trends and Disease Patterns Demographic statistics show changes over time. Nurses can detect rising trends like non-communicable diseases or ageing populations. To Reduce Health Disparities Demographic data helps nurses recognize inequalities in healthcare access among different social, economic, or regional groups. 4
- 5. Ways Demographic Data Influences Community Health Nursing Cont. To Support Evidence-Based Public Health Interventions Nurses use demographic findings to back up their community interventions and ensure they meet the actual needs of the population. To Guide Resource Allocation Resources like medicines, staff, and equipment can be distributed efficiently based on population size and health statistics. To Participate in Policy Making Nurses contribute to health policy using population-based data, helping to shape national health strategies. 5
- 6. Population Distribution and Density in Sri Lanka Definition of Population Distribution “Population distribution describes the way people are spread across a given area and is a key factor in determining health service delivery and planning in public health.” — Park, K. (2021). Textbook of Preventive and Social Medicine, 26th ed. Definition of Population Density ජන ඝනත්වය “Population density is the ratio of people to the physical space they occupy. It helps identify regions that are over- or under-populated relative to available resources and infrastructure." — World Health Organization (WHO), 2022 Formula of Arithmetic Density 6
- 7. Population Distribution and Density in Sri Lanka Cont. Types of Distribution Patterns a. An Even Distribution: Seen in developed countries with planned infrastructure. b. Clustered Distribution: Populations group around resources (e.g., water bodies, cities). c. Sparse Distribution: Found in mountainous, forested, or arid regions. Factors Influencing Population Distribution and Density Factor Effect on Distribution Physical Environment Climate, landforms, water availability affect habitability. Economic Activities Job availability in urban areas attracts more people. Social Infrastructure Schools, hospitals, transport — more access = more people. Historical/Political War, resettlement, colonization influence historical population patterns. Cultural Beliefs Certain ethnic or religious communities cluster together. 7
- 8. Population Distribution and Density in Sri Lanka Cont. Based on the 2024 Census Preliminary Report, Sri Lanka's population shows significant variation in density across provinces: Province Population (2024) Density (persons/km²) % of National Population Western ~6.11 million 1,578 /km² 28.1 % Central 2.71 million 453 /km² – Southern 2.61 million 446 /km² – North Western 2.58 million 305 /km² – Eastern 1.78 million 155 /km² – Uva 1.40 million 149 /km² – Northern 1.15 million 119 /km² 5.3 % North Central 1.41 million 118 /km² – Sabaragamuwa 2.02 million 393 /km² – Western Province (Colombo, Gampaha, Kalutara): The population comprises over 28% of the nation Density: ~1,578 persons/km²— highest of all provinces Northern Province: Hosts just ~5.3% of the country’s population Density: ~119 persons/km²—one of the lowest provinces 8
- 9. Urban vs Rural Population Distribution Definition of Urban Areas Urban areas are defined as geographically designated regions governed by Municipal Councils or Urban Councils, characterized by higher population density, structured infrastructure and greater access to services such as industry, trade, healthcare, education, sanitation, and transportation. Definition of Rural Areas Rural areas are defined as all geographic regions not classified as urban, typically governed by Pradeshiya Sabhas in Sri Lanka. These areas are characterized by lower population density, agriculture- based economies, limited infrastructure, and reduced access to healthcare, education, and public services. Total population: 21.76 million Urban population: ~3.70 million (≈19.4%) Rural population: ~15.75 million (≈80.6%) Urban–Rural Ratio • For every 1 urban resident, there are approximately 4 rural residents • This indicates that Sri Lanka remains predominantly rural 9
- 10. Urban vs Rural Population Distribution Cont. Setting Key Challenges Recommended Health-Care Strategies Urban(e.g., Colombo, Gampaha) • Overcrowding increases transmission of infectious diseases (e.g., dengue, COVID-19). • Poor waste management and sanitation promote vector breeding. • Air and water pollution contribute to respiratory and cardiovascular illnesses. • Increased cases of lifestyle-related non- communicable diseases (NCDs). • Overloaded health facilities and occasional drug shortages (especially during economic crises). • Strengthen urban primary health care with support from local government and public-private partnerships. • Improve environmental health: sanitation systems, clean water supply, solid waste disposal. • Enhance surveillance systems (e.g., eDCS) and scale up emergency services (e.g., Suwa Seriya 1990). • Implement robust medical supply chain management for crisis resilience. • Promote urban health education campaigns focusing on NCD prevention and hygiene. Rural(e.g., NCP, Uva) • Geographical isolation and limited transportation restrict access to healthcare. • Shortages of doctors, nurses, essential medications, and diagnostic tools. • High incidence of Chronic Kidney Disease of Unknown Origin (CKD) due to environmental factors. • Low health literacy and poverty reduce health- seeking behaviors. • Digital divide limits access to telehealth and health information. • Deploy mobile clinics and expand telemedicine services to reach underserved areas. • Recruit and retain rural health staff through incentives and rural posting policies. • Launch targeted community health programs: CKD screening, water purification, agrochemical education. • Empower Public Health Midwives (PHMs) and community health workers for outreach. • Develop local health education programs in native languages and culturally appropriate formats. Urban vs Rural Health System Challenges & Strategies in Sri Lanka 10
- 11. Census and Vital Statistics Definition of a Population Census - සංගණනය “The Census of Population and Housing is a complete enumeration of the population, housing units, and their characteristics at a given point in time, conducted every 10 years.” -Department of Census and Statistics – Sri Lanka. (2024). Census of Population and Housing 2024 – Preliminary Report. Sri Lanka Census Overview – 2024 Preliminary Findings Total population: 21,763,170 Population density: ~337 persons/km² Mid-year growth trend (2018–2023): Declining growth (from +1.05% to –0.65%) with current negative rate (–0.65%) The mid-year growth trend refers to the annual population growth rate estimated between mid-years (typically July 1st of each year), based on births, deaths, and migration Age pyramid shift: Increasing median age (from 21.4 years in 1981 to ~31 years in 2012), indicating population ageing Median age is the age at which half the population is younger and half is older 11
- 12. Census and Vital Statistics Cont. Vital Statistics Crude Birth Rate (CBR) Crude Birth Rate is the number of live births per 1,000 people in a given population over a year. It is called “crude” because it does not take into account the age or sex structure of the population. CBR = (Number of Live Births / Mid-Year Population) * 1,000 • According to the 2024 Preliminary Census Report, Sri Lanka’s CBR is 10.1 births per 1,000 population. • The rate has been declining due to increased literacy, family planning access, and urbanization. Crude Death Rate (CDR) Crude Death Rate is the number of deaths occurring during a specific year per 1,000 mid-year population. This rate provides a snapshot of overall mortality in a population, though it does not differentiate by age or cause. CDR = (Total number of deaths in a year / Total mid-year population) * 1000 • For Sri Lanka in 2024, the CDR is approximately 7.8 per 1,000, a slight decline from 8.2 in 2023 . • Crude Death Rate trends in Sri Lanka have decreased from around 8.1 in 2022 to 7.8 in 2024. 12
- 13. Census and Vital Statistics Cont. Key Vital Indicators Natural Increase Natural increase refers to the net change in population size due to births and deaths only ignoring migration. This indicates whether the population is growing or shrinking based purely on natural factors. It is calculated as: Natural Increase Rate (per 1,000)=Crude Birth Rate−Crude Death Rate • Natural Increase = 10.1 – 7.8 = 2.3 per 1,000 (≈ 0.23% annual growth) • A positive natural increase means births exceed deaths, contributing to population growth. • Sri Lanka’s moderate rate (~2.3‰) reflects: Declining fertility (due to improved family planning and women's education) Relatively low mortality (thanks to good healthcare and public health interventions) 13
- 14. Census and Vital Statistics Cont. Indicator Definition Latest Sri Lanka Data Community Health Implications Nursing & Community Strategies Infant Mortality Rate (IMR) Deaths of infants (<1 year) per 1,000 live births 5.3 per 1,000 (2023); slight decline from 5.5 (2022) Indicates neonatal/infant health and effectiveness of birth & postnatal care, immunization, nutrition, hygiene. • Ensure institutional deliveries with skilled birth attendants. • Conduct early postnatal follow-ups (within 24–48 hours and 7 days). • Promote exclusive breastfeeding (initiate within 1 hour; continue for 6 months). • Implement PHM-led home visits for infant weight checks, immunization, and parental guidance. • Use digital health tools (mobile alerts, tele-nursing) to track immunization and postnatal care. • Educate caregivers on danger signs: fever, poor feeding, difficulty breathing. 14
- 15. Census and Vital Statistics Cont. Indicator Definition Latest Sri Lanka Data Community Health Implications Nursing & Community Strategies Under-Five Mortality Rate (U5MR) Deaths of children (<5 years) per 1,000 live births 6.0 per 1,000 (2023) Reflects broader child health—including diarrhea, pneumonia, nutrition, and care- seeking. • Strengthen Integrated Management of Childhood Illnesses (IMCI), especially for diarrhea and pneumonia. • Ensure full immunization coverage (e.g., DTP3, MMR, Pentavalent). • Provide growth monitoring and nutrition support through well-baby clinics. • Conduct health education sessions on hygiene, safe drinking water, and sanitation. • Promote Vitamin A supplementation and deworming in high-risk areas. • Empower PHMs to focus on malnourished and developmentally delayed children in estate and rural sectors. Maternal Mortality Ratio (MMR) Maternal deaths per 100,000 live births due to pregnancy/c hildbirth complication s ~30 per 100,000 (latest WHO/World Bank estimates) Low rate reflects strong maternal care systems, but continued vigilance needed—especially in rural/remote areas. • • Ensure minimum four quality ANC visits, including early registration and screenings (BP, blood group, anemia, GDM). • Guarantee 100% skilled birth attendance and timely referral in high- risk pregnancies. • Provide Magnesium Sulfate (MgSO₄) for eclampsia and oxytocin for postpartum hemorrhage. • Offer postnatal care within 24 hours, 3 days, 7 days, and 6 weeks post-delivery. • Train PHMs and CHNs in risk identification, emergency signs, and maternal verbal autopsy. 15
- 16. Census and Vital Statistics Cont. Life Expectancy at Birth - ආයු අපේක්ෂාව Defined as the average number of years a newborn is expected to live under current mortality conditions. Latest Data (2024): •Overall Life Expectancy: 77.73 years (up from 77.48 in 2023) •Male: ~74.25 years •Female: ~80.90 years Healthy Life Expectancy (HALE) The average number of years a person is expected to live in good health, without significant illness or disability. HALE in 2021: 66.7 years (up from 65.0 in 2012) Morbidity Rate - පරෝගාතුර වීම Morbidity refers to the presence of disease, illness, injury, or disability within an individual or population. It is measured by incidence (new cases) and prevalence (total cases) of specific conditions 16 Total Fertility Rate The average number of children born to a woman over her reproductive life. TFR 2023: Approximately 1.974 births per woman, below the replacement level of 2.1 Downward Trend: From 2.007 in 2020 to 1.995 in 2021, and 1.984 in 2022, consistent with delayed childbearing and smaller family norms.
- 17. Age Structure •0–14 years: ~22% (~5.13 million children) •15–64 years: ~66% (~13.6 million working-age) •65+ years: ~12% (~1.6 million elderly) This distribution reflects a maturing population, with a shifting focus toward elderly care. Age structure is a demographic indicator that reflects the proportion of the population in different age groups, which influences public policy, health planning, and economic development." — Department of Census and Statistics, Sri Lanka (2024) Census and Vital Statistics Cont. “The dependency ratio is the average number of economically dependent individuals (under 15 or over 64 years) per 100 working-age individuals (15-64 years).” — Department of Census and Statistics, Sri Lanka (2024) Total Dependency: ~53.7 dependents per 100 working-age individuals Youth Dependency: ~35.4 Elderly Dependency: ~17.8 (up from ~17.3 in 2022) Dependency Ratios 17
- 18. Census and Vital Statistics Cont. Importance of Vital Statistics in Public Health Planning Disease Surveillance & Public Health Response •Death certificates with cause-of-death data enable tracking of disease patterns, outbreak detection, and resource allocation . Health Service Planning & Policy Making •Birth and death rates guide planning in maternal-child health, vaccination programs, chronic disease clinics, and emergency response services Measuring Health System Performance •Indicators derived from vital events (infant mortality, maternal mortality, life expectancy) are essential to assess progress toward national and global goals (e.g., SDGs, UHC) Identifying Vulnerable Populations •Disaggregated vital stats spotlight high-risk groups (e.g., regions with high maternal/infant mortality, elder deaths, or CKDu prevalence), facilitating targeted interventions Legal, Social & Economic Protection •Birth/death records grant individuals legal identity—for education, health access, citizenship—and support efficient social protection mechanisms 18
- 19. Epidemiological Patterns of Disease What is Epidemiology? වසංගතපේදය “The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.” — World Health Organization (WHO, 2024) Goals of Epidemiology Identify the causes of diseases and health conditions – Discover risk factors and modes of transmission Measure the frequency and burden of diseases – Use incidence, prevalence, and mortality rates to assess population health Study the natural history and progression of diseases – Understand how diseases develop, spread, and resolve over time Evaluate the effectiveness of health interventions – Assess real-world impact of vaccines, screenings, and treatment programs Support public health planning and policy-making – Provide evidence to guide healthcare resource allocation and priorities Prevent and control disease in populations – Design programs to reduce risk, promote health, and control outbreaks Identify groups at highest risk – Detect vulnerable populations needing targeted interventions 19
- 20. Epidemiological Patterns of Disease Cont. Key Epidemiological Terms Incidence- සිදුවීම Incidence is the number of new cases of a disease occurring in a specified population during a defined time period. Prevalence - පැතිරීම Prevalence is the total number of cases (both new and existing) of a disease in a population at a given point or over a period of time. Endemic- ආපේණික Endemic refers to the constant presence or usual prevalence of a disease within a geographic area or population group. Epidemic - වසංගතය An epidemic is the occurrence in a community or region of cases of an illness in excess of normal expectancy. Pandemic - ේයාේත වසංගතය A pandemic is an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people. Notifiable Disease A disease that, by legal requirement, must be reported to public health authorities when diagnosed by healthcare professionals, to allow for monitoring, control, and prevention of outbreaks. 20
- 21. Epidemiological Patterns of Disease Cont. Epidemiological patterns refer to how diseases occur, spread, and persist in a specific population over time. In Sri Lanka, these patterns reflect a dual burden of both communicable and non-communicable diseases, along with growing environmental and demographic influences. Epidemiological Transition in Sri Lanka Sri Lanka is experiencing a third-stage epidemiological transition, characterized by: Declining infectious disease mortality due to improved primary health care. Rising non-communicable diseases (NCDs) and aging-related morbidities. Persistence of infectious disease pockets in rural and underserved regions. Emerging environmental and lifestyle-related diseases, e.g., CKDu, dengue, and air pollution- related asthma. 21
- 22. Risk Factors and Disease Trends Understanding risk factors and disease trends is essential for community health nurses to design effective, preventive, and promotive health interventions. Category Major Risk Factors Community Health Nursing Focus Behavioral • Tobacco use • Alcohol consumption • Physical inactivity • Poor diet • Health education • Lifestyle counseling • Anti-tobacco/alcohol campaigns Environmental • Poor sanitation • Unsafe drinking water • Vector breeding (e.g., mosquitoes) • Water purification education • Waste management • Vector control awareness Biological • Aging population • Genetic predispositions • Childhood malnutrition • Elder care • Nutritional support • Early detection/screening Social/Structural • Poverty • Low education • Gender inequality • Urban overcrowding • School health programs • Women empowerment • Community outreach Occupational • Agrochemical exposure • Unsafe labor environments • PPE education • Occupational health checks in farming zones Epidemiological Patterns of Disease Cont. 22
- 23. Disease Epidemiological Trend Dengue Seasonal outbreaks (May–July, Oct– Dec); urban spike Leptospirosis Increasing post-floods; linked to paddy/agriculture Tuberculosis (TB) Endemic with hidden burden; post- conflict clustering Typhus & Hepatitis A Linked to poor sanitation, peaks after monsoon Epidemiological Patterns of Disease Cont. Communicable Disease Patterns 23 Vector-borne diseases like dengue remain prevalent; dengue cases reached 186,101 in 2017, with recent 2024 counts around 45,610. Sri Lanka has successfully eradicated diseases such as polio, malaria, neonatal tetanus, and filariasis.
- 24. Non-Communicable Disease (NCD) Burden Epidemiological Patterns of Disease Cont. Sri Lanka now faces a NCD epidemic: Cardiovascular disease accounts for about one-third of NCD deaths. Diabetes affects 1 in 5 adults aged 35–64 years (STEPS 2021) Obesity and hypertension are rising in school-aged children and youth. Cancer incidence (especially breast and oral) is increasing due to late detection. Mental health issues (depression, substance use) are rising post-COVID-19. Emerging Environmental & Occupational Illnesses Chronic Kidney Disease of Unknown Etiology (CKDu): • Linked to farming communities (North Central Province, Uva). • Associated with dehydration, agrochemicals, and hard water. • ~70,000 affected; over 1,400 annual deaths. Respiratory conditions are increasing due to: Urban air pollution, indoor smoke, and occupational exposure. Vector-borne diseases- ප ෝවන පරෝග (e.g., dengue, chikungunya) are on the rise due to climate change and poor waste disposal. 24
- 25. Core Principles for Preventive Program Planning Needs Assessment: Analyze demographic & health data at district/Grama Niladhari level. Prioritization: Focus on largest burdens or high-risk demographics. Intersectoral Collaboration: Engage PHMs, PHIs, local government, schools, agriculture departments. Community Engagement: Use PHM-led mobilization and volunteer networks in estate communities Monitoring & Evaluation: Use pre-post indicators (e.g., disease reduction, behavior change, service uptake). Evidence-Informed Revisions: Adapt programs based on demographics and outcome data trends. Preventive Programs 25
- 26. Data Source Example Nursing Action Age-specific morbidity stats I. High under-5 illness rates in rural zones II. Elderly Population Conduct immunization drives, growth monitoring, and health education. Provide routine home visits, fall-prevention, mental health support, increase emphasis on chronic disease monitoring and management, and geriatric care. NCD prevalence by region High diabetes and hypertension in urban areas Plan lifestyle clinics and diet counselling programs, implement community- level screening (BP, glucose), and facilitate chronic care clinics Maternal mortality rates High MMR in estate areas Early pregnancy registration and ≥ 4 ANC visits, Enhanced postnatal home visits by PHMs, especially in vulnerable zones and Nutrition education (Iron, folate, breastfeeding); protein supplementation for pregnant women Infectious disease outbreaks Rising dengue cases in Western Province Tuberculosis & Leptospirosis Lead vector-control programs, Community clean-up campaigns before monsoons, Larval source reduction and fogging coordination, Health education on symptom recognition and early healthcare seeking, outbreak response, Use of eDCS surveillance for hotspot identification and response. Emphasize environmental hygiene, early diagnosis, DOTS adherence, and public education School health data High rates of anemia or scabies in children Deliver school health programs, deworming, hygiene promotion, Continue immunizations, and nutrition monitoring 26 Preventive Programs Cont.
- 27. Summary Demography is the statistical study of human populations, focusing on size, structure, distribution, and trends. High population density in Western Province (e.g., Colombo, Gampaha). Infant Mortality Rate & Under-5 Mortality Rate: Sri Lanka maintains low child mortality rates, signalling strong primary care and immunization systems, but continued outreach is vital in underserved/populations with disparities. Maternal Mortality Rate: Low but fragile; preventing maternal deaths relies on robust antenatal, delivery, and postpartum systems, especially in rural and remote settings. Sri Lanka’s disease burden has shifted heavily toward NCDs, driven by demographic ageing and lifestyle factors. Communicable diseases, while reduced overall, still pose risks through outbreaks and endemic presence. Community health nurses must adopt a dual focus: traditional infection control (e.g., vector-borne diseases) and modern chronic care models (e.g., NCD prevention/management). Proactive community interventions, surveillance use, health education, and intersectoral collaboration are essential for addressing Sri Lanka’s evolving public health landscape. 27
- 28. Stanhope & Lancaster. Public Health Nursing: Population-Centred Health Care in the Community, 10th Ed. (2022) Park, K. Textbook of Preventive and Social Medicine, 26th Ed. (2021) Department of Census and Statistics, Sri Lanka – Census 2024 Preliminary Report Department of Census and Statistics – Population & Health Trends (2024) Department of Census & Statistics. Vital Statistics 2024 Ministry of Health Sri Lanka – Annual Health Bulletin 2023 WHO Community Health Guidelines World Health Organization – Sri Lanka NCD Country Profile 2022 References 28
- 29. Questions? 29