Basic Measurement of

UNIT 1 BASIC MEASUREMENT OF Mortality and Morbidity

MORTALITY AND MORBIDITY

Structure
1.1 Introduction
1.2 Concept of Mortality and Morbidity
1.3 Data for Mortality and Morbidity Measure
1.4 Mortality Measures
1.4.1 Crude Death Rate (CDR)
1.4.2 Age specific Death rate (ASDR)
1.4.3 Specific Death Rate (SDR)
1.4.4 Maternal Mortality Rate/Ratio (MMR/MMRT)
1.4.6 Incidence Rate (IR)
1.4.7 Prevalence Rate (PR)
1.4.8 Infant Mortality Rate (IMR)
1.4.9 Cause Specific Death Rate (CSDR)
1.4.10 Child Mortality Rate (CMR)
1.4.11 Software for mortality analysis
1.5 Lexis Diagram
1.6 Cohort Rate
1.7 Standardized Death Rate
1.7.1 Methods of Direct standardization
1.7.2 Methods of Indirect standardization
1.8. Measure of Morbidity
1.8.1 Crude Incidence Rate (CIR)
1.8.2 Attack Rate
1.8.3 Prevalence Rate
1.8.4 Case Fatality Rate (CFR)
1.8.5 Mutually Inclusive Measures
1.9 Let Us Sum Up
1.10 References and Suggested Readings
1.11 Check Your Progress- Possible Answers
1.12 Glossary

1.1 INTRODUCTION
We studied in the previous block that mortality is one of the components of population
change. Mortality means the departure of member from the households permanently
due to death. The idea of mortality measurement is the utilization for the construction
of life table which indicates the expectancy of life at different ages or the proportion
of the population at one age that survives to another age. 217
Mortality and Morbidity Mortality is defined as the demographic event of death. Since death is a biological
phenomenon that occurs just once to each individual, the analysis is simpler than,
say, the study of fertility wherein the event of birth can occur with varying frequency
among women. Mortality analysis begins with good quality data on deaths and
population. These data are conventionally obtained from vital registration systems
and population censuses respectively. The crude death rate and the specific death
rates (age, sex, age-sex- cause of death specific) are simple measures of mortality.
The other measures are based on the life tables. Since, death is biological phenomenon
which happened once to each individual or unit of the society.
After reading this unit learner will be able to:
(i) Explain the concept of mortality
(ii) Discuss about the morbidity trends
(iii) Describe the various methods or techniques of mortality analysis
(iv) Narrate the use of mortality analysis

1.2 CONCEPT OF MORTALITY AND MORBIDITY

Some literature review is required before going to read the mortality and morbidity.
Both mortality and morbidity are interlinked, but both are separate events. Morbidity
is the condition of health, while mortality is the risk of dying due to various causes.
A state of well being contributes to raise national productivity and improves many
social indicators of better living. Health of an individual is defined as a state of
complete physical, mental and social well being that enables an individual to be
productive, free from disease and thus able to access the opportunities available in
the environment (WHO, 1946). Morbidity led indoor treatment and “Hospitalization
is a two-edged sword. When, patients with border line personality disorder were
admitted. They enter an environment that reinforces the very behaviours that therapy
is trying to extinguish” (Paris, 2002).
Health and illness are the most important issue in the discussion about hospitalization.
A layman often says that illness occurs due to curse of God and good health is the
blessing of the God. They also believe that cause of illness is due to over diet and
under diet. There are two types of nutritional disorders, i.e. over nutrition and under
nutrition. Both conditions show the path of hospital. In higher social-economic groups
family members suffer from over nutrition. Dr. Swaminathan (an agricultural scientist)
and Dr. Ramchandran a nutritionist expressed concern over malnutrition and it results.
Ogden (1997) explain the eating behaviour in the form of theories that regarded
the individual as passively external food cues and later theories emphasized the
processing that food intake resulted from an interaction between individual and their
environment. And recent theories describe eating in terms of self-control, self-efficacy
and self-regulation. This is particularly salient in theories of overeating in normal
weight individuals and eating disorders.
According to NSSO the definition of ailment (illness or injury) means any deviation
from the state of physical and mental well being. An ailment may not cause any
necessity of hospitalization. An ailing member is a normal member of the household
who was suffering from any ailment during the reference period. In the survey, one
218 will be treated as sick if one feels sick. This was also include among other things
such as cases of visual, hearing, speech, locomotor and mental disabilities; injuries Basic Measurement of
Mortality and Morbidity
were cover all types of damages, such as cuts, wounds, haemorrhage, fractures
and burns caused by an accident, including bites to any part of the body; cases of
abortion - natural or accidental. In the survey cases of sterilization, insertion of IUD,
getting MTP etc; cases of pregnancy and childbirth were not included. Thus, mortality
is the rate of death while morbidity is the state of illness. Mortality may be due to
illness whereas morbidity due to various causes either diseases and diseases may
be communicable or non communicable.

1.3 DATA FOR MORTALITY AND MORBIDITY

MEASURES
Sample Registration System (SRS) which is called dual record system of registration
and Civil Registration System (CRS) which is called vital statistics data are best sources
of mortality analysis on annual basis. SRS data is available at national and state level
while CRS data has covered at district level. Quality of CRS data is not upto mark
or standards. Some states have reported bad quality of CRS data. Government of
India has also conducted Annual Health Survey (AHS) in 9 states BIMARU states
(Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, term BIMARU has coined
by Ashish Bose, 1980) and Assam, Chhattisgarh, Jharkhand, Orissa, Rajasthan, and
Uttarakhand. These states have reported highest percentage of neonatal deaths. This
survey consists of a three round panel survey that interviewed over 4 million households
in each round, as well as a one-time Clinical, Anthropometric, and Bio-Chemical Survey
(DSDR, 2022). AHS provides data at district level. Census and National Sample
Survey Organization (NSSO) also provides data on morbidity or illness or ailing or
disability. NSSO provides data for ailing in terms of one before the survey and 15
days before the survey and hospitalization during 365 days before the survey. Census
has collected data on disability related to seeing, hearing, speech, locomotor, multiple
disorders, mental illness, mental retarded, etc.

1.4 MORTALITY MEASURES

Mortality analysis is one of the most important measures to know the population
changes. If we notice, decline of fertility follows death rates. It indicates fertility
control is following mortality. Table 1.1 compiles the denominator and numerator
and radix for different mortality measures.
Table 1.1: Elements and components of measurement of Mortality
Measure Numerator Denominator Radix
Crude death Total number of deaths during Mid-interval population 1,000
rate (CDR) a given time interval

Age Specific Number of deaths between x Number of persons aged between 1000
death Rate and x+n in the year x and x+n at the middle of the year

Cause-specific Number of deaths assigned Mid-interval population 100000

death rate to a specific cause during a
given time interval

Proportionate Number of deaths assigned Total number of deaths from 1,000

mortality to a specific cause during all causes during the same time
a given time interval interval
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Mortality and Morbidity
Death-to- Number of deaths assigned Number of new cases of same 1000
case ratio to a specific cause during a disease reported during the
given time interval same time interval

Neonatal Number of deaths among Number of live births during the 1,000
mortality children < 28 days of age same time interval
rate (NNMR) during a given time interval

Post-neonatal Number of deaths among Number of live births during the 1,000
mortality rate children 28–364 days of age same time interval
(PNMR) during a given time interval

Infant Number of deaths among Number of live births during the 1,000
mortality children < 1 year of age same time interval
rate (IMR) during a given time interval

Maternal Number of deaths assigned Number of live births during the 100000
mortality to pregnancy-related causes same time interval
rate (MMR) during a given time interval

Source:[Link]

1.4.1 Crude Death Rate (CDR)

Crude Death rate (CDR) is the simplest measure of the general level of mortality
in a population. This rate has a simple interpretation, for it gives the number of deaths
that occur, on the average, per 1,000 people in the community, or it is the average
number of deaths occurring during a year per 1000 persons in the total population.
Further, it is relatively easy to compute, requiring only the total population size and
the total number of deaths. Besides, it is a probability rate in the true sense of the
term. It represents an estimate of the chance of dying for a person belonging to the
given population, because the whole population may be supposed to be exposed
to the risk of dying of something or the other. However, it has also some serious
drawbacks. In using the CDR, we ignore the fact that the chance of dying is not
the same for the young and the old or for males and females, and the fact that it
may also vary with respect to race, occupation or locality of dwelling.
Deaths in a year (D)
CDR = x1000
Population at mid-year (P)
This measure is generally a poor indicator of mortality as it does not take age structure
into account. The number of deaths is largely a function of the size and the age-sex
structure of the population. The risk of dying in general is high in the infant and
childhood ages, a decline drastically thereafter up to age 20 and then rise slowly
but steadily, increasing sharply at ages above 50. This type of curve known as the
reverse J-shaped curve is characteristics of age patterns of mortality in all populations.
Many developing countries with higher mortality levels at every age show a lower
than developed countries because the former have a much larger proportion of their
population at younger ages due to high fertility. A crucial factor in the study of mortality
to take account of its variations by age.

1.4.2 Age Specific Death Rate (ASDR)

The age-cause-specific death rates are obtained by selecting deaths in specific age
and cause group of the population as the numerator It should be noted that the
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sum of the cause-specific rates over all causes equals the crude death rate. Similarly, Basic Measurement of
Mortality and Morbidity
the sum of the age-cause-specific death rates equals the age-specific death rate at
a given age. Standardization is a technique, which provides a summary measure of
the rates (similar to the crude rates) while controlling for the compositional variation
between the populations being compared. Thus, a comparison of the standardized
rates gives a ‘true’ comparison of the phenomenon studied. We shall illustrate the
calculations of the standardized rates with the help of the death rates. The ASDR
is a type of central death rate, that is, a rate relating to the events in a given category
during a year to the average population of the category. In a high mortality situation,
the death rates by age, that is, the age specific death rates, form a U-shaped curve
indicating a high mortality in early and old ages. At low levels of mortality, the pattern
of ASDR changes to J-shaped indicating a relatively higher mortality in the very
early period of life, which drops to a low level after the hazards of early life and
extends over a long period of life, and finally it rises sharply in old ages.
The age-specific death rates are calculated from deaths and population both specific
to each age (or age group) of the population. Thus,

Where ‘x’ indicates the age and ‘n’ the class interval of age.

1.4.3 Specific Death Rate (SDR)

The crude death rates for specific causes of death are calculated in a similar way
by selecting deaths due to specific cause as the numerator and mid-year population
as the denominator. Thus,

The rates could be made specific to sex by selecting the numerator and the
denominator for each sex of the population. This measure is annual age specific
death rate while ASDR is the death rate of 5 years age groups.
The pattern of mortality by age is one of the initially high rates in the first year of
life (within the first year, mortality rates are highest in the first few days of life, very
high in the first month and declines throughout the rest of the year). After the first
year the rates decline rapidly to a minimum which usually occurs around the tenth
year of life. After reaching this minimum the age specific death rates increase gradually
upto about 40 years or 50 years of age and then increases at a relatively rapid
rate throughout the rest of life. Generally speaking the decline in the mortality rates
in early life is quite abrupt in populations with high mortality.

1.4.4 Maternal Mortality Rate/Ratio (MMR/MMRT)

The maternal mortality ratio (MMR) is widely used type of cause specific mortality
rate representing approximately the risk of dying as a result of complications of
pregnancy, childbirth and puerperium. This ratio is generally defined as the number
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Mortality and Morbidity of deaths due to puerperal causes per 100000 live births MMR may be looked
upon as an alternative to, or a refined version of the corresponding cause-of-death
rate. This rate is defined by the formula-

where
Dp = Total number of deaths from puerperal causes occurring within 42 days of
delivery among the female population aged 15-49 in the given period in the given
community.
Puerperal infection occurs when bacteria infect the uterus and surrounding areas
after a woman gives birth and hence becomes the cause of death.
B = Total number of live births occurring in the given period in the community.
M= number of married women aged 15 -49 years
Since MMRT is defined per 100000, married women and MMR is defined per
100000 live births, hence MMRT and MMR are connected by the following formula-

MMRT= MMR *GMFR

The life time risk is defined as the probability that at least one women of
reproductive age (15-49 years) will die due to child birth or puerperium assuming
that chance of death is uniformly distributed across the entire reproductive span
and has been worked out using the following formula:

1.4.6 Incidence Rate (IR)

This rate measures the annual incidence of a disease. The numerator of the rate is
the number of times attacks of a certain disease are reported in a year, and the
denominator is the population exposed to the disease during the same year. Note
that the rate can exceed 1, as there could be repeated attacks of the disease to
the same person.

1.4.7 Prevalence Rate (PR)

This rate is the proportion of the number of people reported as having a disease at
a specific point in time. The numerator is the number of people with a disease and
the denominator is the total population.

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1.4.8 Infant Mortality Rate (IMR) Basic Measurement of
Mortality and Morbidity
The groups of population which are at greater risk of dying are newborn infants
and mothers in the reproductive age groups. Conventional infant mortality rate is
defined as the number of deaths under age 1 year during specified period divided
by the number of live births in the same period and usually expressed per 1000
births.

IMR is not proper rate but a ratio, as the denominator is not wholly the population
at risk of the events in the numerator. Some of the deaths under age 1 year in the
given year may be among the births which occurred during the previous year and
some of the newborns during the year may die in the next year before reaching
their first birthday.
Also the risk of dying the first year of life is not uniform in the interval. The risk is
the maximum soon after birth and decreases slowly. During the early weeks, the
causes of infant deaths tend to be different from those which occur later. For this
reason IMR is often divided into two parts based on the intensity of risk of mortality.
The first four weeks or one month, called the neonatal period is found to have a
very high risk and the number of infant deaths during this period is termed neonatal
mortality rate (NMR).

Similarly, death of infants after four weeks is termed post neonatal mortality (PNMR).

1.4.9 Cause Specific Death Rate (CSDR)

For the control of diseases in any population, it is important to know the causes of
death. Thus cause specific measures of mortality are useful in understanding the
relative contributions of different causes to the overall mortality rates in the population
and resources to be mobilized for controlling the specific disease. The most commonly
used measure is the cause specific death rate as below-

Cause can be separately computed by age and sex. It can be also calculated cause
specific death ratio.

1.4.10 Child Mortality Rate (CMR)

It is define as the total number of deaths of children aged 1 to 4 (called under 5
mortality) in the given year and geographical region and to the 1000 population of
the same age in that year and same geographical regions.
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1.4.11 Software for Mortality Analysis

There are 15 spreadsheets for analyzing the mortality of a population. Some
spreadsheets were prepared for populations with full and acceptable data, while
others assume that only limited data are available. Although this set of mortality
spreadsheets is the largest, the authors did not include the techniques developed
and published by the United Nations in the MORTPAK package. Thus, the analysis
of mortality may require the use of both PASEX and MORTPAK packages. The
PASEX spreadsheets related to mortality are as follows:
1. ADJMX- Adjusts a pattern of mortality rates by age for both sexes combined
or for each sex (ASDRs or central death rates from an empirical or existing
life table) for obtaining a user-specified number of deaths in a population.
2. BTHSRV- Estimates infant mortality rates based on information on the number
of children born during a year prior to the census and the number still alive at
the census date.
3. E0LGST- Fits a logistic function to values of life expectancies at birth for each
sex simultaneously, given two or more observed values of life expectancies and
the two asymptotes of the logistic.
4. GRBAL- Uses the technique developed by Brass for estimating the
completeness of reporting of deaths over 5 years of age in relation to a population
(Brass, 1975).
5. and 6. INTPLTM and INTPLTF- Interpolate male and female life tables,
respectively, between the values of two given sets of ‘pivotal’ life tables.
7. and 8. OGITQX and LOGITLX- These two spreadsheets are used for
smoothening functions of a life table, using logits of the q(x) and l(x) functions
of a life table.
9. LTMXQXAD- Constructs a life table from age-specific death rates or from
the probabilities of dying between two specific ages.
10. LTNTH- Selects a Coale–Demeny model life table, region North, that will
reproduce a given crude death rate pertaining to a given population age structure.
11. LTPOPDTH- Constructs and smoothens a life table for both sexes or one
sex at a time, using population and death data.
12. LTSTH- This is the same as LTNTH, but using region South of the Coale–
Demeny model life tables.
13. LTWST- This is the same as LTNTH, but using region West of the Coale–
Demeny model life tables.
14. PREBEN- Estimates the level of mortality for ages 5 years and above during
an intercensal period using Preston-Bennett method, 1983.
15. PRECOA- Uses the technique developed by Preston and Coale for evaluating
224 an available age distribution of deaths in relation to the population.
Check Your Progress 1 Basic Measurement of
Mortality and Morbidity
Note : a) Write your answer in about 50 words
b) Check your answer with possible answers given at the end of the unit.
1) Explain Mortality and Morbidity
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2) List number of mortality measures and defined IMR
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1.5 LEXIS DIAGRAM

Lexis diagram is a two dimensional diagram used to characterize events that occur
to individuals belonging to different cohorts. In this diagram time is considered along
the horizontal axis and age along vertical axis. Each individual member of a population
o
is represented by a line at 45 of either axis starting at age x = 0 and at the moment
of birth and terminating at a point which corresponds to both his age and time of
death. A part of diagram can be represented as follows:

Source : Srinivasan, 1998

In the Lexis diagram, the time of occurrence of event is shown on the X- axis and
the duration since an initial reference data (e.g. Age since birth) on the Y-axis. In
the diagram above, time refers to the exact time of occurrence, and age, the exact
age of the person.
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Mortality and Morbidity
1.6 COHORT RATES
The rates for the cohorts are usually based on the probability concept. However,
cross-section rates for the cohorts (Known as Central rates) are also calculated.
Consider the following Lexis diagram.

Source : Srinivasan, 1998

If we know the population at exact age X during time t- t+1 (say PX) and at exact
age X+1 (say PX+1) during time t+1- t+2, and the deaths occurring to this cohort
in the parallelogram abcd (say DX), The probability of dying between exact ages
X and X+1 will be= Dx /P
The central death rate at age X will be =
Dx
Px + Px+1/2
(Px +Px+1)/2 will be the average or mid - year population (represented by the
vertical line ‘db’) on the assumption that the deaths have occurred uniformly over
the parallelogram ‘abcd’. However, this is not true for deaths, which occur at very
early ages, especially among the infants in their first 12 months of life. The mid-
year population is estimated by the use of the separation factors.

1.7 STANDARDIZED DEATH RATE

1.7.1 Method of Direct Standardization
In this method the distributions of the compositional variables (age, sex, marital status
etc.) of the populations that are being compared, are made identical and the
standardized rates (similar to the crude rates) are calculated such that the difference
between them is only due to the variation in the age-specific rates of their population.
A Standard population is selected which is employed for deriving all the standardized
rates in a set to be compared.
Data Needed
(1) For one compositional variable (say age) standardization, age distribution of
the standard population, and

226
(2) Age-specific death rates in all populations to be compared. Basic Measurement of
Mortality and Morbidity
Calculations
A. If M(i, x) represents the age-specific death rate at age (i) for population (x),
and P (i,s) is the standard population at age (i), P(s) is the total standard population.
The standardized death rate for population ‘x’

The numerator is the number of expected deaths in the standard population had
the age-specific death rates of population (x) applied to the standard population,
and the denominator is the total standard population. The rate is multiplied by 1,000
to express the rate as per 1,000 populations. (All the calculations are done with
the rates per person. Finally, the standardized death rate is multiplied by the constant
1,000).
B. If the standardized death rate is required after controlling for the two characteristics
of the population, say age and sex, the data needed will be the same as on the
previous page but split by sex as well. Thus, the standardized death rate for population
x will be:

C. If the death rates of males and females are to be compared, these are two different
populations, and the method given under A is to be used. Thus,

The standardized death rate of males =

The standardized death rate of females =

The Standard Population

The selection of the standard population is, in theory, arbitrary. However, this population
should be similar to the ones for whom the rates are being compared. The population
of India at a most recent census data is appropriate for measuring state differentials
in mortality, or for comparing mortality trends over time for India. If two country’s
rates are to be compared either one country’s age distribution or the average of
the two country’s distributions is appropriate.

1.7.2 Method of Indirect Standardization

This method is used when the age-specific death rates for the populations to
be compared cannot be calculated because of the distribution of the number
of death by age is unavailable or not reliably available, but the total number of
deaths and the age distribution of populations whose rates are to be compared
are available.
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Mortality and Morbidity Data Needed
(1) Observed number of deaths in all populations whose death rates are to be
compared.
(2) Age distribution of all populations whose death rates are to be compared.
(3) Age-specific death rates for a population to be used as standard.
(4) Crude death rate in the standard population.
Calculations
A. If P(i,x) represents the population ‘x’ at age (i), M(i,s) is age-specific death
rate at age ‘i’ in standard population, M(s) is the crude death rate in the standard
population, O(x) is the observed number of deaths in population ‘x’, and E(x) is
the expected deaths in population ‘x’, then

The standardized death rate for population x =

The expected deaths in population x = E(x) =

(All the calculations are done with the rates per person. Finally, the standardized
death rate is multiplied by the constant 1,000).
Foetal Death: It is known as the death prior to the complete expulsion or extraction
from its mother of a product of conception at any point of time of pregnancy.
Still Birth: It is used for death of foetus after completing 28 weeks and till the
time of birth.

1.8 MEASURE OF MORBIDITY

The aim of morbidity study is to review some of the problems and techniques that
have arisen in the different mode of measurement of sickness applicable to different
definitions of ill health and to different agencies identifying ill health (IIPS Study
material MPS05, B1U1). Morbidity measures have some duration of the study such
as beginning period to ending period of illness or ailing. Thus, four reference periods
are-
i. illness beginning during the period and ending during the period
ii. illnesses beginning during the period and still existing at the end of the period.
iii. Illness existing before the beginning of the period and ending during the
period.
iv. Illnesses existing before the beginning of the period and existing at the end
of the period.

1.8.1 Crude Incidence Rate (CIR)

Crude incidence rate is defined by the number of new cases of illness or injury (I)
228
in a community on an annual basis per 1000 average number of persons (P) living Basic Measurement of
Mortality and Morbidity
in the community during the reference period.

In the case of acute illnesses of a relatively short duration, the period prevalence
rate is approximately equal to the incidence rate when the period of observation is
sufficiently long.

1.8.2 Attack Rate

When a population is exposed to the risk of a disease for a limited period of time
only, the incidence rate may be termed as the attack rate. If this disease found in
any of the family members this person known as Index person

1.8.3 Prevalence Rate (PR)

Prevalence of a disease indicates how common the disease is in a population. It is
of two types- period (PPR) and point prevalence rate (PoPR). PPR is used to
measure the frequency of illness in existence during a defined period (day, month,
year). While PoPR is used to measure the number of cases of illness, new and
old, existing at a particular point of time such as 9 AM on Monday, the 27 September
2022 and related to the number of persons exposed to the risk at that point of
time. PoPR is more commonly used to know the case is new or old.
The prevalence rates are determined for chronic illnesses such as leprosy, tuberculosis,
filariasis, cancer, diabetes, HIV/AIDS, etc., where the onset is very ill defined.
Incidence rate are usually calculated for diseases whose onsets are clearly known
such as malaria, cholera, measles, etc.

1.8.4 Case Fatality Rate (CFR)

CFR is intended to measure the risk of death from a specific condition among those
suffering from it. It is usually computed only for acute conditions of a relatively short
duration. For accuracy the deaths Di should be related only to the causes from
which they may arise.
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Mortality and Morbidity

1.8.5 Mutually Inclusive Measures

P=Prevalence, I=Incidence, D= Duration, M= Mortality, F= Fatality
P= I x D F= M / I

Check Your Progress 2

Note : a) Write your answer in about 50 words
b) Check your answer with possible answers given at the end of the unit.
1) What is standard population?
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2) What is reference period for Morbidity measure?

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1.9 LET US SUM UP

You have studied mortality concepts and mortality measures, with specific data for
mortality and morbidity measures such as SRS, CRS and AHS along with NSSO
data for morbidity. Different measures of mortality such as CDR, ASDR, MMR,
IMR, CDR, etc. have read in this unit followed by morbidity measures such as
incidence rate, prevalence rate, cure rate. etc. you have also studies on
interrelationship between morbidity and mortality measures. Ailing and illness is the
health conditions of person in the households during a reference period. In next
unit you will be read the patterns of mortality across the states in India and at
international by age and sex.
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 Basic Measurement of
Acknowledge Mortality and Morbidity
Author is acknowledging to UNFPA, RGI, New Delhi, Census office, New
Delhi, Prof. K. Srinivasan, IIPS Mumbai, Mondal et al., for providing their
valuable information related to this Unit. Author has not taken permission
from the authors and institute, because it is not published paper work and
not for commercial purposes, but it is expanding their ideas to the learners.
If any time authors would challenge, the content that have borrowed from
these literature would be withdrawal any time.

1.10 REFERENCES AND SUGGESTED READINGS

Bogue, D. J, (1969): Principles of Demography, John Wiley & Sons, Inc., New
York.
Bhende, Asha and Tara Kanitkar, (2004): Principles of Population Studies, 5th Ed.
Himalaya Publishers, New Delhi.
IIPS (2008) Morbidity, Mortality and Public Health, Study material for Master of
Population Studies, MPS05, Block 1 and Unit 1.
Mondal, RB, Uyanga J, and Prasad H (2007) Introductory Methods in Population
Analysis, Concept Publishing Company, New Delhi-59
Mishra, B. D, (1981): An Introduction to the Study of Population, South Asian
Publishers, Pvt. Ltd.
Pathak, K. B and F. Ram, (1998): Techniques of Demographic Analysis, Himalaya
Publishing House, Mumbai.
Pressat, R, (1972): Demographic Analysis, Edward Arnold, London.
Ramamumar, R, (1986): Technical Demography, Wiley Eastern Ltd, New Delhi.
Shryock, H. S. et al (1979): The Methods & Materials of Demography, Condensed
Edition by Stockwell, E. G, Academic Press, New York.
Srinivasan K. (1998): Basic Demographic Techniques & Applications, Sage
Publications, New Delhi.
Srinivasan K. (2011): Training Manual on Demographic Techniques, Office of the
Registrar General and Census Commissioner, India, Government of India, New Delhi.
Or UNFPA, (2011): Training Manual on Demographic Techniques, Office of the
Registrar General & Census commissioner, Govt. of India.
DSDR (2022) [Link] downloaded
on 25 September 2022.
[Link] retrieved on 25
September 2022

1.11 CHECK YOUR PROGRESS - POSSIBLE

ANSWERS
Check Your Progress 1
Q1. Explain Mortality and Morbidity
A. Mortality means number of deaths occurs during a specific period of time
which may be natural deaths, age specific death, accidental death, etc. while 231
Mortality and Morbidity morbidity means the state of health of the person who has felt sickness
during a reference period. The morbidity may be due to communicable
disease or non communicable diseases. Morbidity may be cause of death
but all mortality is not due to morbidity.
Q2. List number of mortality measures and defined IMR
A. There are number of mortality measures such as crude death rate, specific
death rate, infant mortality rate (IMR), maternal mortality rate, child death
rate, etc. IMR is the best indicator of reproductive and child health care
system of any country. IMR is defined as number of child deaths below
one year age over per 1000 live births taken place during same year.
Check Your Progress 2
Q1. What is standard population?
A. The standard population should be similar to the ones for whom the rates
are being compared. The population of India at a most recent census date
is appropriate for measuring state differentials in mortality, or for comparing
mortality trends over time for India. If two country’s rates are to be compared
either one country’s age distribution or the average of the two country’s
distributions is appropriate.
Q2. What is reference period for Morbidity measure?
A. reference period is important for morbidity measures, which have some
duration of the study such as beginning period to ending period of illness
or ailing. There are four reference periods for morbidity measure -
1. Illness beginning during the period and ending during the period
2. Illnesses beginning during the period and still existing at the end of the period.
3. Illness existing before the beginning of the period and ending during the
period.
4. Illnesses existing before the beginning of the period and existing at the end
of the period.

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