Population profile of India: past,present and future

India's 846.3 million people, who comprise 16% of the world population, inhabit just 2.4% of the total world area. India is the 2nd most populous country in the world. 74% of people live in 600,000 villages that follow traditional social and cultural practices. Population growth peaked during 1961-1981 at 2.2%/year. It began to fall slightly during 1981-1991 to 2.1%/year. Even though those younger than 15 years old comprise the largest population age group (39.6%), the group is decreasing (42% in 1971). India's dependency ratio is 0.9 for both children and the elderly and 0.8 for children alone. India has an excess number of males (929 females/1000 males), due largely to discrimination against females. Pregnancy and child birth are responsible for female death rates peaking at ages 15-29. Delayed marriages are more common than in the past (6.6% in 1981 and 19% in 1961). Most internal migration is from rural area to rural area (especially for females leaving their parents' home to go to that of their husband's) and rural area to urban area. Population density varies by state from 10 people/sq. km. to 6319 people/sq. km (mean = 267/sq. km.). Total fertility is 3.9 in rural areas and 2.7 in urban areas. 71% of births have a birth interval of less than 3 years. The 1985-1990 death rate in India compares to that of developed countries (9.8 vs. 10), but its infant mortality rate is still high (79 vs. 15). The population projections for 2001-2006 of the Standing Committee on Population Projections are 1003.1 million for population size, 23 for birth rate and 7.8 for death rate. It expects the population to stabilize (i.e., 0 growth rate) at 1.5 billion around 2080. This figure is much less than that of the World Bank's projection.     

Gender apartheid and its impact on Indian women's reproductive health

In India the 1991 census showed a declining sex ratio. The number of females was 929 per 1000 males compared to 934 in 1981. Early childhood mortality, malnutrition, high maternal mortality, and female feticide may all be contributing to this disturbing trend. Only 39.42% of women are literate compared to 63.86% of males. At least 50% of women suffer from anemia. Indian women face a 50-times higher rate of pregnancy- and delivery-related deaths than the women in the industrialized countries, a consequence of difficult access to health care, ignorance, poverty, and repeated and close pregnancies. Reproductive tract infections (RTIs) are common with outcomes such as ectopic pregnancy, infertility, and chronic pelvic pain. Also, cervical cancer is still a major killer of Indian women. Another area of concern is the population explosion. Overpopulation brings malnourished and dying children, slums, unemployment, deforestation, desertification and an unending cycle of poverty, illiteracy, and disease. India's population has reached 862 million, and according to the 1991 census there has been an increase of 23.5% during the past decade. India's annual population growth rate of 2.11% is only marginally less than the 2.23% of the preceding decade. The density of population has increased to 267 per square km compared to 216 in 1981. At the present rate of growth, the population by the turn of the century would reach 1 billion. Perhaps the real cause of failing to halt the galloping population growth is related to different human rights standards for men and women. Society accepts that men have the ultimate say when it comes to family planning and determining the size of the family. The medical profession can be an instrument of change, especially in regard to women's health related to wider sociological, cultural, historical, and economic issues.     

Indian women's reproductive health -- challenges and remedies

The state of Indian women's health is appalling. At least 50% of women of all age groups suffer from anaemia. The pregnant woman in India faces a risk of death due to pregnancy that is 50 times higher than for women in industrialized countries. According to the recently released provisional figures of the 1991 census, India's population has reached 844 million, showing an increase of 23.5% during the previous decade. The all-India growth rate of 2.11% annually is only marginally less from 2.23% of the earlier decade. Another disheartening feature of the 1991 census is the declining sex ratio. The number of females in India was 929 per 1000 males compared to 934 in 1981. Only 39.42% of females are literate, compared to 63.86% of males. A trial of the reproductive health care approach for population control and women's health could be a remedial measure. The existing programs such as family welfare, child survival, maternal and child health, safe motherhood initiative, and all-India hospital postpartum programs could serve as useful building blocks for broad-based reproductive health care. It is estimated that out of all pregnancies 50% are high risk pregnancies and require referral to an apex hospital, but so far only 6.2% of cases have access to such a facility. Thus, speedy transportation of such cases is urgently needed. The emphasis also has to be shifted from curative medicine to preventive medicine. The primary health care concept combining traditional and modern medicine is still needed. It is estimated that fewer than 30% of deliveries are in institutions, and the rest are conducted by traditional birth attendants (TBAs). TBAs should be trained in the techniques of asepsis and how to recognize high-risk pregnancy cases.     

Outcomes in rural obstetrics, Atherton Hospital 1991-2000

Analysis of annual obstetric audit data collected over the decade 1991-2000 from the Atherton Hospital in Far North Queensland provides ongoing evidence of safe obstetric practice provided by a group of non-specialist doctors in a rural community. During that period, there were 2997 deliveries; of these, 2400 (80.1%) were public patients and 596 (19.9%) were private patients. There were 16 perinatal deaths (perinatal mortality rate 5.3/1000). This is remarkably consistent with the outcome of the previous decade, 1981-90, when the total deliveries was 2883 with 15 perinatal deaths (perinatal mortality rate 5.2/1000). However, compared with 1981-90, the number of Caesarean sections rose from an overall rate of 13.0% (public 10.6%; private 18.3%) to an overall rate of 17.4% (public 16.7%; private 20.4%). In 1981-90, there were 909 private confinements (31.5% of total) and in 1991-2000 there were 597 (19.9% of total). This decline in the number of private obstetric cases may have significant implications for future models of care. There were no maternal deaths in the 20 years 1981-2000.     

Trends in, and transitions to, institutional residence among older people in England and Wales, 1971-91.

OBJECTIVES: To compare transitions from private households to institutions between 1971-81 and 1981-91 among elderly people and see whether (1) differentials in the risk of institutionalisation changed and (2) whether the risk was higher in the second period. DESIGN: Cross sequential analysis of data from the Office of National Statistics longitudinal study, a record linkage study which included individual level data from three national censuses, (1971, 1981, and 1991) and linked vital registration data. SUBJECTS: Altogether 26,400 people aged 65 and over in 1971-81 and 32,500 persons aged 65 and over in 1981-91. These samples represent 1% of the population of England and Wales. RESULTS: In both periods models including age, housing tenure, and marital status or household/family type terms fitted the data reasonably well. The effect of age was stronger in the second decade, while that of marital status was reduced. The risk of transition to an institution was nearly 33-52% higher in the second decade after controlling for these factors. CONCLUSIONS: During the 1980s the availability of state financed institutional care increased substantially; a growth which the 1990 NHS and Community Care Act was designed to reverse. Increased access to institutional care undoubtedly is one factor underlying the higher transition rate to institutions observed in 1981-91 than for the previous decade. During 1981-91, transitions to live with relatives also declined substantially. It is not clear whether this simply represents the continuation of a previous trend or whether the increased availability of institutional care led to some substitution for family care. Either interpretation has worrying implications for policy makers keen to promote care in the community.     

Urban-Rural Flows of Physicians

CONTEXT: Physician supply is anticipated to fall short of national requirements over the next 20 years. Rural areas are likely to lose relatively more physicians. Policy makers must know how to anticipate what changes in distribution are likely to happen to better target policies. PURPOSE: To determine whether there was a significant flow of physicians from urban to rural areas in recent years when the overall supply of physicians has been considered in balance with needs. METHODS: Individual records from merged AMA Physician Masterfiles for 1981, 1986, 1991, 1996, 2001, and 2003 were used to track movements from urban to rural and rural to urban counties. Individual physician locations were tracked over 5-year intervals during the period 1981 to 2001, with an additional assessment for movements in 2001-2003. FINDINGS: Approximately 25% of physicians moved across county boundaries in any given 5-year period but the relative distribution of urban-rural supply remained relatively stable. One third of all physicians remained in the same urban or rural practice location for most of their professional careers. There was a small net movement of physicians from urban to rural areas from 1981 to 2003. CONCLUSIONS: The data show a net flow from urban to rural places, suggesting a geographic diffusion of physicians in response to economic forces. However, the small gain in rural areas may also be explained by programs that are intended to counter normal market pressures for urban concentrations of professionals. It is likely that in the face of an overall shortage, rural areas will lose physician supply relative to population.     

Mortality of Polish actors in 1981-1999

The objective of this study was to compare the mortality of Polish actors (males and females) with the general Polish population for the period 1981-1999 and for two sub-periods: 1981-1991 and 1992-1998. Initially the studied cohort included 3992 dramatic actors (2161 males, 1831 females) of age 18-80 years (at the moment of cohort entrance). After detailed data verification statistical analysis was made for 2120 actors and 1767 actresses, contributing 29477.1 and 24886.2 person-years of observation, respectively. A total of 633 deaths (368 males and 265 females) were noted during the analyzed period. Statistical approach based on the follow-up method. Comparison with the reference population (Polish males and females from urban areas) was made by means of the standardized mortality ratios (SMRs) and their 95% confidence intervals. Direct comparison of the selected subgroups' mortality based on the rate ratio analysis. Standardized mortality ratios were 0.739 (95%CI: 0.666-0.819) for the actors and 0.887 (95%CI: 0.784-1.001) for actresses. Mortality of the actors' cohort was found to be significantly lower than in the reference population during total analyzed period, whereas for actresses no significant differences were found. Age-specific SMR dependence was found. Statistically significant lowering of SMR was observed for actors up to 80 years old. Finally, it could be concluded that in contrast to the actresses' cohort the actors' mortality in 1992-1999 significantly decreased in relation to 1981-1991 period. Moreover, the decrease of the actors' mortality exceeded tendencies observed for Polish urban population.     

2012年滨州市、德州市5类人群性病知识知晓率调查

目的了解滨州、德州两市中五类人群（城市居民、农村居民、在校学生、流动人口、暗娼和男男同性恋）性病（STD）知识知晓情况。方法2012年8～10月,选择滨州、德州市15-49岁的城市居民、农村居民、在校学生、流动人口、高危人群,合计调查1172人进行调查。结果调查五类人群1172人,其中城市居民303人,农村居民301人,学生299人,流动人口188人,高危人群（暗娼和男男同性恋）81人,STD防治知识总知晓率为57．48％。知识知晓率,城市居民为57．03％、农村居民为50．23％、在校学生为62．98％、流动人口为51．65％、高危人群（暗娼和男男同性恋）为79．14％。结论滨州、德州市五类人群尤其是流动人口和农村居民STD知识知晓率较低。     

Eight million women have unmet need for family planning in Uttar Pradesh

The 1992-93 National Family Health Survey sampled almost 90,000 women in India to find that 41% of currently married Indian women aged 13-49 use some form of contraception, ranging from 13% of women in Nagaland to 63% in Kerala. Uttar Pradesh is the country's most populous state, with a 1991 population of 139 million. With only 20% of reproductive-age women in Uttar Pradesh using contraception, the level of fertility in the state is higher than that of any other state in India. According to the survey, the rate of total fertility (TFR) in Uttar Pradesh is 4.8 children per woman, higher than the national TFR of 3.4, while the rate of infant mortality is 100 infant deaths per 1000 births. Total population size in Uttar Pradesh grew by 25% over the period 1981-91. 60% of currently married women who have a need for family planning are not having their need met. The level of unmet need is greatest among women who live in rural areas, are illiterate, are Muslim, belong to scheduled tribes, and are either of high or low parity. The government has launched an Innovations in Family Planning Services Project designed to increase contraceptive use in the state. The authors recommend that the family welfare program place greater emphasis upon birth spacing methods such as the condom and pill, while also ensuring that women are aware of their ability to opt for female sexual sterilization.     

The chimera of a Muslim population growth rate

Preliminary results from the 1991 census indicate that overall, the rate of growth of the Muslim population has been 32.8% while that of the Hindu population was 22.8%. However, these data on growth rates by religious communities are not cross-tabulated with their determinants, income and literacy. Organized propaganda harbinging a high rate of Muslim population growth argues that Muslim men tend to have multiple wives and do not practice family planning. As such, Muslims have a higher birth rate than do Hindus and will soon outnumber Hindus in India. Data from official and nonsectarian agencies, however, indicate that polygamy is more common among Hindus than among Muslims and Islam does not prohibit family planning. While the birth rate among Muslims is slightly higher than that of Hindus, the situation is complex and involves socioeconomic determinants of fertility. One study projecting the prevailing growth rates among Hindus and Muslims into the next century indicates that the Muslim population will increase in size far less than will the Hindu population. Muslims will therefore not outnumber Hindus in India.     

Family welfare

Between 1901-1921, India gained 12.9 million people because mortality remained high. The death rate fell between 1921-1951, but birth rates remained the same. Therefore 110 million people were added--2 times the population increase between 1891-1921. Between 1951-1981, the population increased to 324 million. Socioeconomic development was responsible for most of the downward trend in the birth rate during the 20th century. Even though large families were the norm in early India, religious leaders encouraged small family size. The 1st government family planning clinics in the world opened in Mysore and Bangalore in 1930. Right before Independence, the Bhore Committee made recommendations to reduce population growth such as increasing the age of marriage for girls. Since 1951 there has been a change in measures and policies geared towards population growth with each of the 7 5-Year Plans because policy makers applied what they learned from each previous plan. The 1st 5-Year Plan emphasized the need to understand what factors contribute to population growth. It also integrated family planning services into health services of hospitals and health centers. The government was over zealous in its implementation of the sterilization program (2nd 5-Year Plan, 1956-1961), however, which hurt family planning programs for many years. As of early 1992, sterilization, especially tubectomy, remained the most popular family planning method, however. The 7th 5-Year Plan changed its target of reaching a Net Reproductive Rate of 1 by 2001 to 2006-2011. It set a goal of 100% immunization coverage by 1990 but it did not occur. In 1986, the Ministry of Health and Family Welfare planned to make free contraceptives available in urban and rural areas and to involve voluntary organizations. The government needs to instill measures to increase women's status, women's literacy, and age of marriage as well as to eliminate poverty, ensure old age security, and ensure child survival and development.     

脊髓灰质炎麻痹后遗症调查报告

1981年在我国十二个省市34个城乡点(各17个)进行了脊髓灰质炎麻痹后遗症现患调查。调查对象为30岁及以下人口,共3,521,373人。城市及农村分别查出2,154和2,087例患者,患病率分别为1.45%和1.02%。居民普服小儿麻痹活苗在城市及农村分别在1960~66年及1964~72年开始;普服之后,此病后遗症病例数呈明显大幅度下降,尤其在最近10年之内,但亦有少数点偶出现小爆发。1976~1980年农村点的灰质炎后遗症的现患率比城市点高约5倍。由现患率推算估计1976~1980年城市和农村各占全体居民的脊髓灰质炎年平均发病率分别为0.22/10万及1.05/10万。如果继续提高服苗率及健全有关活苗的供应量、运输、保存、使用等方面组织管理,有可能进一步降低此病发病率。     

A study of colo-rectal carcinoma in the Asian and European populations in the city of Leicester from 1981 to 1991

For many years clinical reports have suggested that colo-rectal cancer is uncommon in the Asian population resident in England and a report in 1990 confirmed this in Asians living in Bradford. This study aims to establish the incidence of colo-rectal cancer in the Asian population resident in the city of Leicester during the 11 y period 1 January 1981-31 December 1991. The relative frequency of colo-rectal carcinoma in Asians compared to Europeans over the period studied was 0.16 (Asian/European, 95% confidence interval (CI) 0.04-0.75). This difference was statistically significant and further analysis showed that there was a real trend with an increased relative frequency amongst the younger age groups. Although there was a significantly lower incidence of colo-rectal carcinoma in the Asian population in Leicester city over the period studied it is unknown whether this is due to environmental or genetic factors. During the next decade it is likely to become clearer as to whether this difference will persist or whether there will be an increase in the incidence of colo-rectal carcinoma in Asians in Leicestershire.     

TB control programme in India

The National Tuberculosis Control Program (NTP) in India has used effective ambulatory treatment since 1962, employing multidrug therapy consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol. The NTP organization consists of 390 district TB centers in charge of case detection through clinical examination, sputum and X-ray examinations, case management, as well as monitoring, reporting, and supervision. 330 clinics also belong to NTP in the urban areas, providing 47,300 beds for serious TB cases. The number of new TB cases has increased from 1.13/1000 population in 1981 to 1.80/1000 in 1991. Therefore, the NTP strategy has been revised to achieve a high cure rate (85%) and treat at least 100 sputum-positive patients per 100,000 population, thereby reducing morbidity and mortality. The estimated annual risk of infection ranges from 0.6% to 2.3%, while in rural South India the risk of infection decreased from 1% in 1961 to 0.61% in 1985. The poorly functioning control program has resulted in a large number of chronic cases and drug resistance to both rifampicin and isoniazid, with the potential of development of an incurable form of TB. At least 50% of the population above the age of 20 is infected, and the current risk of infection for India is 1.7-2%. The proportion of smear-positive cases decreased from 25% in 1980 to about 20% in the late 1980s; however, failures and partially treated patients are included in these reported figures. At the current average annual risk of infection of 1.7%, 1.6 million new TB cases occur every year, of which 710,000 are smear-positive. About 75% of cases diagnosed occur between 15 and 44 years of age, with two-thirds of them occurring among males; however, 50% of female cases occur before the age of 34 years. TB mortality is estimated at 420,000 deaths per year (i.e., 50/100,000 population). HIV seropositivity is high among TB patients: at the end of 1993 there were 331 (60%) patients with active TB among 559 AIDS cases. Operations research of the NTP is underway to improve efficiency.     

浙江省失地农民与城市居民的健康素养比较分析

目的了解浙江省失地农民的健康素养水平,为制定相关健康政策以及有针对性开展健康素养干预提供依据。方法在浙江省抽取杭州市、宁波市、绍兴市、金华市4个监测点,每个监测点抽取4个街道,其中2个街道作为失地农民对象的来源,2个街道作为城市居民对象的来源。每个街道各抽取1个居委会,每个居委会随机抽取调查200人,共调查3263人。调查内容包括人口基本情况、健康相关行为、健康素养3方面,调查采用入户调查,由调查对象自填完成。结果失地农民以前吸烟的比例（22.65%）要高于城市居民（20.69%）,两者差异有统计学意义（P〈0.05）,失地农民饮酒率（33.56%）略高于城市居民（32.71%）,城市居民的锻炼次数和锻炼时间都优于失地农民。失地农民健康素养为12.78%,城市居民健康素养为20.96%,差异有统计学意义（P〈0.01）,其中失地农民在健康生活方式和行为素养水平和科学健康观中与城市居民相差最大。结论浙江省失地农民健康素养水平与城市居民相比较低,要整合资源,增强失地农民健康教育工作的合力,开展针对失地农民健康素养水平提高相关工作,提倡戒烟限酒,适量运动等良好的生活方式。     

住院病人结构改变与人口老化

本文探讨了我校一附院６０年代，８０年代、９０年代内科住院病人结构，结果发现１９６１－１９６４，１９８１－１９８４，１９９４年住院病人中６０－和６５岁以上老年人比例逐渐增高，分别为５．１３％６ ５．３９％，６．５３％和１１．２５％，１２．４％和２１．０４％。结果提示现代临床工作要适应住院病人年龄结构和疾病结构的改变，加强老年医学研究。     

甘肃45~69岁人群健康素养水平及影响因素

目的了解甘肃省45~69岁常住居民健康素养水平分布状况,并探索其影响因素,为中老年人制定健康教育干预策略和措施提供依据。方法采用多阶段分层整群随机抽样和概率比例规模抽样(PPS)法,抽取全省87个县市区45~69岁常住居民作为调查对象,采用问卷调查法调查居民健康素养水平。问卷内容包括人口学资料与健康素养相关问题等两大类,并采用Logistic回归分析其影响因素。结果2017年甘肃省45~69岁居民健康素养具备率为6.52%;基本知识和理念、健康生活方式与行为、基本健康技能3个方面健康素养具备率分别为15.59%、8.36%和8.72%;六类健康问题素养具备率由高到低依次为:科学健康观素养(29.37%)、安全与急救素养(28.94%)、健康信息素养(15.38%)、传染病防治素养(12.43%)、基本医疗素养(11.02%)和慢性病防治素养(10.53%)。多因素Logistic回归分析结果提示,城乡、文化程度、职业和收入是健康素养水平的影响因素。结论甘肃省45~69岁常住居民健康素养水平较低,应加强健康教育和监测研究,并制定有效的对策和措施,提高健康素养水平。     

Association between unemployment,income, education level,population size and air pollution in Czech cities: Evidence for environmental inequality? A pilot national scale analysis

We analyzed differentials in exposure to SO(2), PM(10) and NO(2) among Czech urban populations categorized according to education level, unemployment rate, population size and average annual salary. Altogether 39 cities were included in the analysis. The principal component analysis revealed two factors explaining 72.8% of the data variability. The first factor explaining 44.7% of the data variability included SO(2), PM(10), low education level and high unemployment, documenting that inhabitants with unfavorable socioeconomic status mainly reside in smaller cities with higher concentration levels of combustion-related air pollutants. The second factor explaining 28.1% of the data variability included NO(2), high salary, high education level and large population, suggesting that large cities with residents with higher socioeconomic status are exposed to higher levels of traffic-related air pollution. We conclude that, after more than a decade of free-market economy, the Czech Republic, a former Soviet satellite with a centrally planned economy, displays signs of a certain kind of environmental inequality, since environmental hazards are unevenly distributed among the Czech urban populations.     

Some effects of the urban structure on heat mortality

During heat waves the death rate from heat-related ailments is often much higher in cities than in outlying environs. The higher death rate in cities appears to be a result of climate modification due to urbanization. Daytime urban-rural climatic differences are small. Nighttime urban-rural climatic differences, however, are often significant—air temperature is warmer within cities at night, long-wave radiant heat load is greater, wind speed is often lower, and inside air temperature of characteristic urban buildings is warmer. Noeturnal urban heat islands of 4–7° are shown to be associated with heat waves in two cities. During heat waves inhabitants of urban areas may experience sustained thermal stresses both day and night while inhabitants of the outlying environs often obtain some relief from thermal stresses during nocturnal hours. It is suggested that excess deaths occurring in urban areas during periods of extreme heat can be significantly reduced through appropriate urban land use.     

我国18岁及以上城市居民高血压知晓率现状

目的了解我国城市居民高血压知晓率现状,为防治高血压提供科学依据。方法利用2007—2008年卫生部中央补助地方慢病综合干预与控制项目,对我国13个省(市)项目点数据中高血压知晓率进行分析。结果在调查的40504名城市居民中,筛查出的高血压患者11430人,知道自己患有高血压者8244人,高血压知晓率为72.13%(标化知晓率为53.61%),其中男性为68.20%,女性为74.79%。18~44、45~59和60岁~年龄组高血压知晓率分别为44.85%,66.41%和79.83%;东、中、西部地区居民高血压知晓率分别为72.9%,72.44%和70.63%;文盲、半文盲、小学、初中、高中或中专、大专及以上文化程度高血压知晓率分别为68.99%,77.18%,73.61%,75.48%和72.90%;有高血压家族史的居民高血压知晓率为82.88%,无高血压家族史者为66.50%。结论与2002年相比,我国城市居民高血压知晓率虽有显著的提高,但仍偏低。应进一步提高人群高血压知晓率。