Sources and Technical Notes

Table 16.2 Trends in Births, Life Expectancy, Fertility, and Age Structure, 197-95

Source: United Nations Population Division, World Population Prospects 1990 (U.N., New York, 1991).

The crude birth rate is derived by dividing the number of live births in a given year by the midyear population. This ratio is then multiplied by 1,000.

Life expectancy at birth is the average number of years that a newborn baby is expected to live if the age-specific mortality rates effective at the year of birth apply throughout his or her lifetime.

The total fertility rate is an estimate of the number of children that an average woman would have if current age-specific fertility rates remained constant during her reproductive years.

The percentage of population in specific age groups shows a country's age structure: 0-14,15-65, and over 65 years. It is useful for inferring dependency, needs for education and employment, potential fertility, and other age-related factors. For additional details, see sources or the Technical Note for Table 16.1.

Table 16.3 Mortality and Nutrition, 1970-95

Sources: Crude death rate and infant death rate data: United Nations Population Division, World Population Prospects 1990 (U.N., New York, 1991); Child deaths: United Nations Population Division, Mortality of Children Under Age 5: World Estimates and Projections, 1950-2025 (U.N.. New York, l988); Maternal deaths, wasting, and stunting: United Nations Children's Fund UNICEF), State of the World's Children 1991 (UNICEF, New York, 1991); Maternal deaths for Cape Verde, Comoros, Djibouti, The Gambia, Barbados, Belize, Guyana, Suriname, Bahrain, and the Solomon Islands and wasting and stunting data for Cape Verde, Djibouti. The Gambia, Liberia, Rwanda, Sierra Leone, Zaire, Barbados, Belize, Guyana, Nepal, and the Solomon Islands: United Nations Development Programme (UNDP) Human Development Report 1991 (Oxford University Press, Oxford, 1991). Per capita average calories available as a percentage of need and per capita total protein consumption: Food and Agriculture Organization of the United Nations (FAO), Agrostat PC (FAO, Rome, July 1991).

The crude death rate is derived by dividing the number of deaths in a year by the midyear population, and multlplying by 1,000.

The infant death rate is derived by dividing the number of babies who die before their first birthday by the number of live births in that year, and multiplying by 1,000.

Child deaths are derived by dividing the number of children under age 5 who die in a given year by the number of live births in that year, and multiplying by 1,000. Infant and child death rates are projected from the latest estimates available from the United Nations Population Division. These death rates are not comparable because different parameters were used in modeling projected changes.

Maternal deaths are the number of deaths from pregnancy- or childbirth-related causes per 100,000 live births. A maternal death is defined by the World Health Organization (WHO) as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy, including abortion. Most official maternal mortality rates are underestimated because causes of death are often incorrectly classified or unavailable. In some countries, over 60 percent of women's deaths are registered without a specified cause. Maternal deaths are highest among women of ages 10-15 years, and over 40 years, and in women with five or more children. Data are provided to UNDP and UNICEF by WHO and refer to a single year between 1980 and 1988 (1980 to 1987 for UNDP data). Data for some countries are outside the range of years indicated.

Wasting indicates current acute malnutrition and refers to the percentage of children between the ages of 12 and 23 months whose weight-for-height is less than 77 percent of the median weight-for-height of the reference population of the U.S. National Center for Health Statistics (NCHS). Stunting, an indicator of chronic undernutrition, refers to the percentage of children between the ages of 24 and 59 months whose height-for-age is less than 77 percent of the median. NCHS, among others, has found that healthy children under the age of 5 years do not differ appreciably in weight or height. WHO has accepted the NCHS weight-for-age and weight-for-height standards. Children with low weight-for-age are at a high risk of mortality. Data on wasting and stunting, provided to UNDP and UNICEF by WHO, refer to a single year between 1980 and 1989 (1980 to 1988 for UNDP data). Data for some countries are outside the range of years or ages indicated.

The per capita average calories available (as percent of need) and the per capita total protein consumption are calories and protein from all food sources: domestic production, international trade, stock drawdowns, and foreign aid. Total protein is the amount provided from animal and vegetable food sources. The quantity of food available for human consumption, as estimated by FAO, is the amount that reaches the consumer. The calories and protein actually consumed may be lower than the figures shown, depending on how much is lost during home storage, preparation, and cooking, and how much is fed to pets and domestic animals or discarded. Estimates of daily caloric requirements vary for individual countries according to the age distribution and estimated level of activity of the population.

Table 16.4 Access to Safe Drinking Water, Sanitation, and Health Services, 1980s

Sources: Drinking water and sanitation: World Health Organization (WHO), The International Drinking Water Supply and Sanitation Decade: Review of Mid-Decade Progress (as at December 1985) (WHO, Geneva, September 1987); WHO, The International Drinking Water Supply and Sanitation Decade: Review of National Progress (as at December 1983); WHO, The International Drinking Water Supply and Sanitation Decade: Review of National Baseline Data: December 1980 (WHO, Geneva, 1984); WHO, Global Strategy for Health for All. Monitoring 1988-1989. Detailed analysis of global indicators (WHO, Geneva, May 1989), and unpublished data (WHO, Geneva, July 1991). Access to health services: United Nations Children's Fund (UNICEF), State of the World's Children 1991 (UNICEF, New York, 1991). Numbers of trained medical personnel: WHO, 1988 World Health Statistics Annual (WHO, Geneva, 1988).

WHO collected data on drinking water and sanitation from national governments in 1980, 1983, 1985, and 1988 using questionnaires completed by public health officials, WHO experts, and Resident Representatives of the United Nations Development Programme. Data for a number of countries were gathered during 1986-87. For several countries in Africa. dates were not given. Urban and rural populations were defined by each national government.

WHO defines reasonable access to safe drinking water in an urban area as access to piped water or a public standpipe within 200 meters of a dwelling or housing unit. In rural areas, reasonable access implies that a family member need not spend a disproportionate part of the day fetching water. "Safe" drinking water includes treated surface water and untreated water from protected springs, boreholes, and sanitary wells.

Urban areas with access to sanitation services are defined as urban populations served by connections to public sewers or household systems such as pit privies, pour-flush latrines, septic tanks, communal toilets, and other such facilities. Rural populations with access were defined as those with adequate disposal such as pit privies, pour-flush latrines, and so forth. Application of these definitions may vary, and comparisons can therefore be misleading.

The population with access to health services is defined by UNICEF as the percentage of the population that can reach local health services by local transport in no more than one hour.

Data on number of trained medical personnel are the latest available to WHO regional offices at the beginning of 1988. Most are from 1983-86; however, some go back to 1977. Comparisons should be made with care, since categories and definitions vary among countries.

Health care personnel have been combined into three categories:

Doctors: all physicians or surgeons;

Nurses and midwives: all registered nurses and others in categories in which the term "nurse" or "nursing" appears; all midwives, birth attendants, and others in categories in which the term "midwife" appears;

Other: all others directly involved in diagnosis, treatment, and prevention of disease (e.g., dentists, paramedical personnel, medical assistants, acupuncturists), and all other reported categories (e.g., pharmacists, laboratory technicians, x-ray technicians, and hospital administrators).

Access to health personnel can vary substantally within a country. The degree of access in individual countries can be partly inferred from other health data (e.g., infant deaths, immunizations) presented here.

Table 16.5 Education and Child Health, 1970-90

Sources: Adult literacy for 1970: United Nations Children's Fund (UNICEF), State of the World's Children l989 and State of the World's Children 1991 (UNICEF, New York, 1989 and 1991); Adult literacy for 1990: United Nations Educational, Scientific and Cultural Organization (UNESCO). Compendium of Statistics on Illiteracy-1990 Edition (UNESCO, Paris, 1990); The percentage of population age 25 and over who have completed primary school and who have some postsecondary education: United Nations Educational, Scientific and Cultural Organization (UNESCO) Statistical Yearbook 1990 (UNESCO, Pans, 1990); Births attended by trained personnel, ORT use, and low-birthweight infants: UNICEF, State of the World's Children 1991 (UNICEF, New York, 1991) Births attended by trained personnel for Cape Verde, Comoros, Djibouti, Equatorial Guinea, The Gambia, Guinea-Bissau, Swaziland, Barbados, Belize, Guyana, Sunname, Bahrain, Yemen, Fiji and the Solomon Islands and low-birth-weight infants for Chad, Comoros, Djibouti, The Gambia, Guinea-Bissau, Barbados, Belize, Guyana, and Suriname: United Nations Development Programme (UNDP). Human Development Report 1991 (Oxford University Press, New York, 1991); TB, DPT, polio, and measles immunization: UNICEF, unpublished data, September 1991.

Adult female and adult male literacy rates refer to the percentage of people over the age of 15 who can read and write. UNESCO recommends defining as illiterate a person who cannot both read with understanding and write a short and simple statement on his or her everyday life. This concept is widely accepted, but its interpretation and application vary. It does not include people who, though familiar with the basics of reading and writing, do not have the skills to function at a reasonable level in their own society. Actual definitions of adult literacy are not strictly comparable among countries. Literacy data for 1990 are projected from past census figures, using estimates of age group size within country populations when available.

The percentage of population age 25 and over who have completed primary school and who have some postsecondary education are figures based largely on national censuses and sample surveys taken between 1970 and 1989. Primary education is defined as category 1 of the International Standard Classification of Education (ISCED). The length of primary education varies by country from three to nine years. The median length for all countries is six years for primary education, and five and a half years for secondary education. Postsecondary education consists of ISCED categories 5, 6, and 7. These categories include education at universities, technical schools, and teacher-training institutes.

The percentage of births attended by trained personnel includes all health personnel accepted by national authorities as part of the health system. Personnel included vary by country. Some countries include traditional birthing assistants and midwives; others, only doctors. WHO provides the data to UNICEF.

ORT (oral rehydration therapy) use refers to administration of oral rehydration salts to children to combat diarrheal disease leading to dehydration or malnutrition.

The percentage of low-birth-weight infants refers to all babies weighing 2,500 grams or less at birth. WHO has adopted the standard that healthy babies, regardless of race, should weigh more than 2,500 grams at birth. These data are provided to UNICEF by WHO, and refer to a single year between 1980 and 1988.

Immunization data show the percentage of 1-year-olds fully immunized in 1990 against: TB (tuberculosis); DPT (diphtheria, pertussis [whooping cough], and tetanus); polio; and measles. Data for measles immunizations include totals from countries where this vaccination is normally given to children after 1 year of age.