Population

We Found Answers of These:

What are the changes that are taking place in the size of population, and how are these
changes brought about?
What is the significance of these changes from the standpoint of human welfare?
What are the people found and what are the changes taking place in their distribution in
communities and in areas
What kind of people are found in any given population group and how do those in one
group differ from in the other

Demography
Demos: People
Graphy: To study or to describe
Demography is the study of the growth, change, and structure of the human population.
Changes in a population's size and structure are caused by changes in the birthrate, the
death rate, and the net migration rates. Understanding a society's demography is an
essential tool in determining current and future public health needs.
Size (change; increasing or decreasing)
Composition (Age, sex)
Distribution (Rural, Urban, District, Region)
Demography may be defined narrowly or broadly
The narrowest sense is that of formal demography Formal demography is concerned
with the size, distribution, structure, and change of population
Size is simply the number of units (person) in the population
Distribution refers to the arrangements of the population space given time, that is area
indicated
Structure is the distribution of the population among its age and sex groups
Change is the growth or decline of the total population or one of the its structure.
A boarder sense includes additional characteristics of the units. These include ethnic,
social and economic.
Widest sense of demography extends to applications of its data and findings in a number
of fields including the study of problems that are the related to demographic and public
health phenomena.
Here we can say, in the narrow scope it is the demographic analysis
And wider scope population studies
Demographic analysis is confined to the study of components of population variation and
change
Population studies are concerned not only population variables but also with relationships
between population changes and other variables
Importance of Population study
Population study is concerned not only with the population variables but also with the
relationship between population variables such as social, economic, political, biological,
genetic, and geographical and interrelationship between those variables. It includes both
qualitative and quantitative aspects of human population.
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Note By: Keshab Shrestha (1st Batch)

(L.B. College of Health Science)

 Population studies were not given much priority in the past. But at present days people of
different field require the information about population, so its importance is increasing
day by day.
Population education is very important at present to be a successful sociologist,
politician, administrator and environmentalist. Its study is very important in various field
like to do social work, to develop economic field, to do political work, different
administration work, and to make rules and regulation
Populations change through three processes: fertility, mortality, and migration.
Fertility involves the number of children that women have and is to be contrasted with
fecundity (a woman's childbearing potential).
Mortality is the permanent end of the life and it study of the causes, consequences, and
measurement of processes affecting death to members of the population.
Migration is the mobility one place to another (Change usual residence).
Sources of Data:
1) Primary Data:
Information that has been collected at first hand. Data that you collect yourself
using for your own purpose.
Census
Survey
Vital Event
2) Secondary Data:
Secondary data is data that has already been collected and collated by somebody
for some reason other than the current study. It can be used to get a new
perspective on the current study, to supplement or compare the work or to use
parts of it, as another study may prove costly and time consuming. Data is
collected from external sources.
Published documents, Monograph, Population reports

Census:
Census is the procedure of systematically acquiring and recording information about the
members of a given population. It is a regularly occurring and official count of a
particular population.
The term is used mostly in connection with national population and door to door
censuses' (to be taken every 10 years according to United Nations recommendations),
agriculture, and business censuses
Census data is commonly used for research, business marketing, and planning as well as
a base for sampling surveys
Census is derived from Latin world censere, meaning to value or tax. Ancient, census
was taken for the purpose of identifying person who could be taxed and military service
or force. But now, census is taking to identify entire population status.
Census is the total process of collecting, compiling, analyzing and publishing
demographic, economic and social data pertaining, at a specified time to all persons in a
country or in a well-delimited part of a country.
In other words, the entire enumeration of the population of a country or a region at a
particular time is known as a census.
Population Census is the primary source of information on population size and its
characteristics. The data collected through population census serves as bench mark for all
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Note By: Keshab Shrestha (1st Batch)

(L.B. College of Health Science)

types of socio-economic development planning and evaluation and provide basis for all
administrative activities, demographic research and various projections of population
characteristics.
Census taking is a universal practice and is undertaken in almost all countries of the
world. Through population census a vast amount of data on all basic demographic and
socio-economic variables is collected about each person living within country/territory.
The main advantage of population census is the large amount of data it produces at one
point of time and the availability of data at the lowest level.
Types of Census method:
1) De-facto
2) De-jure
De-facto:
Census is taken on the basis of actual presence.
De-jure:
Census is taken on the basis of usual residence (permanent residence)
This method is considered more scientific.
Our country Nepal also uses this method for census.
History:
United States of America had its first census in 1790.
England and France had their first census in1801.
Nepal started its population census in 1911.
During the period 1965-74, a total of 85 countries in the world conducted census
operation.
In past, census is carried out to count.
Now, it is carried out to assess the national needs and plan program for the peoples
welfare.
Characteristics:
Fill count of population which includes each and every individual and is carried out at
regular interval.
It is taken at regular interval, usually 10 years, (UK & Japan-5 years).
It pertains to a particular territory and the information is collected by making house to
house visit on the specified datas.
Purpose of Census:
Collect various information regarding population i.e. Pop distribution, age, sex, PGR,
birth, death, fertility, migration, etc.
Describe the status of country.
Compares with other countries.
Make plan about health service, housing, drinking water, quality of food, etc.
Evaluate the effectiveness and efficiency of program.
Main areas of Census:
Total population at the time of census
Age, sex composition & marital status
Religion
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Note By: Keshab Shrestha (1st Batch)

(L.B. College of Health Science)

Occupation
Fertility
Language spoken, education, economic status.
Place of birth
Citizenship
Place of residence (Rural-Urban)

Uses of Census in Health Matters:

It determines popn of an area which forms a basis for calculation of health indices .e.g.
birth, death, fertility, marriage, etc.
Average rate of growth of popn per years computed from the popn enumerated in two
census years.
All health services are planned and community measures are adopted as per nature and
size of the popn.
Knowledge of popn distribution helps in planning of the welfare services such as
provision of schools, food supplies, orphanages, etc.
Census data are also used for constructing life-tables and analyzing economic
development.
DEFINITION:
Population census is total process of collecting, compiling, evaluating, analyzing and
publishing / disseminating demographic, social and economic data of all persons in a
country or a well defined territory, at a specified time.
A modern census has four key elements. It should be:
1. Universal
2. Simultaneous
3. Periodic
4. Individual
For Public Health:
Public health policy decisions and needs assessments are predicated on interpretations
and conclusions drawn from combining the results from many individuals or a
population. The use of current estimates of population characteristics is necessary to
make estimates of disease, injury, disability, behaviors of interest to public health, and
their distributions. Often, these estimates require population denominators from the
census.
Characteristics of Census:
i) Largeness to cover entire area / population
ii) Accuracy and reliability of information
iii) Time oriented activity
There are two methods for enumerating a population: de facto, which allocates persons
according to their location at the time of enumeration; and de jure, which assigns persons
according to their usual place of residence. The United States uses a de jure enumeration
because it provides a better indication of the permanent population and household
composition of an area. In Nepal mixed methods was used at 2001 census
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Note By: Keshab Shrestha (1st Batch)

(L.B. College of Health Science)

Essential Features:
1) Individual Enumeration-Implies that each individual is enumerated and his/her
characteristics recorded separately
2) Universality Within A Defined Territory-Census should cover the entire country or well
defined territory and include every person living therein
3) Simultaneity-Data collected should refer to the same well defined reference periodgenerally the census day with specific time
4) Defined Periodicity-Census should be taken at regular intervals so that comparable
information is made available in a fixed sequence. A series of censuses makes it possible
to appraise the past, describe the present and estimate the future
Importance of Census:
Provide bench mark data for all socio-economic development plans/policies and their
evaluation
Provide basis for all administrative activities, demographic research and projection of
population to meet future requirements.
Provide population data for smallest Admn. Units / areas.
Establish sampling frame for intercensal sample surveys on various topics and others
statistical programs
Provide changing patterns of urban / rural concentrations and development of urbanized
areas.
Survey:
To examine or look at comprehensively.
A gathering of a sample of data or opinions considered to be representative of a whole.
The word survey comes from the Latin word sur (over) and videre (to see).
A process that involve the systematic collection of needed information about populations
are usually called Surveys.
When they deal with only a fraction of a total population- a fraction representatives of the
total- they are called Sample survey.
In a survey, direct (or indirect) contact is made with the units of the study 9e.g.
individuals, organizations, communities) by using measurement such as questionnaires
and interviews.
Surveys can be classified broadly into two types:
1) Descriptive survey
2) Analytical survey
Descriptive survey the objective is simply to obtain certain information about large group.
Analytical survey, comparisons are made between different sub-group of the population in order
to discover whether differences exit among them that may enable researchers to form or verify
hypotheses about the forces at work in the population.
Types of survey:
There are two types of survey.
1) Census
2) Sample survey
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Note By: Keshab Shrestha (1st Batch)

(L.B. College of Health Science)

Some classify into 4 types:

1) Comprehensive survey
2) Sample survey
3) Mixed survey
4) Pilot survey
Example of sample survey in Nepal:
Demographic and health survey 2006
Nepal Micronutrient Status Survey 1998
Family Health Survey 1984
Nepal Fertility Survey 1976
Pros and Cons of survey:
Advantages:
Saving time
Saving money
Detail study
Accuracy of research
Administrative convenience- less data is taken so easy to manage.
May be used in case of impossibilities of census mrthod.
Disadvantages:
More chances of bias
Difficulties of representative sample
In the Community Diagnosis:
Survey have been used to,
Diagnose community health
Study the history of health of populations
Study the working of health of health services
Complete the clinical history of chronic diseases
Search for the cause of health and disease
Contribute to the formation of health care policy, and
Evaluate the effects of different approaches to the organization of health services.
Steps of Survey:
Defining study

Deciding Methodology

Report writing

Choosing study area

and popn

Determining sample
size and sampling

Data collection
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Construction and Pretest of survey

Note By: Keshab Shrestha (1st Batch)
(L.B. College of Health Science)

Selection of Topics:
Mainly depends upon needs of data users(planners, administrators and researchers)
Continuity of census information Traditional topics
Quality of data collected in previous census
Availability of qualified and dedicated field staff
Ability of respondents in answering complex questions
Availability of resources in term of money, men and technical capabilities
International practice and UN / ESCAP recommendation

Demographic Transition:
Demographic Transition is a theory describing a possible transition from high birth
rates and death to low birth and death rates as part of the economic development of a
country from a pre-industrial to an industrialized economy.
Usually it is described through the "Demographic Transition Model" (DTM) that
describes the population changes over time. It is based on an interpretation begun in 1929
by the American demographer Warren Thompson of prior observed changes, or
transitions, in birth and death rates in industrialized societies over the past two hundred
years.
Most developed countries are already in stage four of the model.
The majority of developing countries are in stage 2 or stage 3, and no country is currently
still in stage 1.
The model has explained human population evolution relatively well in Europe and other
highly developed countries.
Many developing countries have moved into stage 3.
Stage one (High Stationary): In pre-industrial society death rates and birth rates were
both high and fluctuated rapidly according to natural events, such as drought and disease,
to produce a relatively constant and young population.
Stage Two (Early expanding): This stage leads to a fall in death rates and an increase in
population. The changes leading to this stage in Europe were initiated in the Agricultural
Revolution of the 18th century and were initially quite slow. In the 20th century, the falls
in death rates in developing countries tended to be substantially faster.
Stage Three (Late expanding): This Stage moves the population towards stability through
a decline in the birth rate. There are several factors contributing to this eventual decline,
although some of them remain speculative.
Stage Four (Low stationary): Traditionally many demographers have assumed that the
demographic transition would be complete when populations reached similarly low birth
and death rates so that populations would become essentially stable, although no
convincing social mechanism has been put forward for this view. Countries that are at
this stage (Total Fertility Rate=2)
Stage Five (Declining):The original Demographic Transition model has just four stages,
but it is now widely accepted that a fifth stage is needed to represent countries those
populations are now reproducing well below their replacement levels, that is they are not
producing enough children to replace their parent's generation.

Note By: Keshab Shrestha (1st Batch)

(L.B. College of Health Science)

Vital Events
World Population Trends:
At the begging of the Christian era or 1 AD, the world population was estimated to be
around 250 million.
It is estimated that the world population size will be reached around 9.0 billion in the mid
of this century.
Estimated world population and average annual growth rate (%) are presented in table A.
Table A: World Population Trends
Year Population (billion) Annual growth rate (%)
1
0.25
1650
0.5
0.1
1750
0.7
0.4
1850
1.2
0.5
1900
1.6
0.6
1950
2.55
1.1
1960
3
1.8
1970
3.7
1.9
1980
4.5
1.9
1990
5.3
1.7
2000
6.1
1.6
2006
6.5
1.2
Source: "The World population data sheet 2001 to 2006

Table B: Milestones
(when did/will we reach the next Billion)
Year
Population (billion) Duration
1804
1
1927
2
123
1960
3
33
1974
4
14
1987
5
13
1999
6
12
2013
7
14
2028
8
15
2054
9
26
Source: United Nations Population Division, "World Population Prospects: The 1998 Revision".

Note By: Keshab Shrestha (1st Batch)

(L.B. College of Health Science)

Rank Country
World
1
China
2
India
3
USA
4
Indonesia
5
Brazil
6
Pakistan
7
Bangladesh
8
Russia
9
Nigeria
10
Japan

Table C: Current world population (ranked)

Population (all estimates)
Area sq.km.
7/1/2007
yearly growth daily increase
510,072,000
6,602,224,175
1.17%
211,090
9,596,960
1,321,851,888
0.61%
21,946
3,287,590
1,129,866,154
1.61%
49,714
9,631,418
301,139,947
0.89%
7,376
1,919,440
234,693,997
1.21%
7,800
8,511,965
190,010,647
1.01%
5,247
803,940
164,741,924
1.83%
8,251
144,000
150,448,339
2.06%
8,475
17,075,200
141,377,752
-0.48%
-1,875
923,768
135,031,164
2.38%
8,801
377,835
127,433,494
-0.09%
-307

Population Growth:
The term "population growth" refers to how the number of individuals in a population
increases (or decreases) with time. This growth is controlled by the rate at which new
individuals are added to the population -- the birth rate, and the rate at which individuals
leave the population -- the death rate.
The average annual percent change in the population, resulting from a surplus (or deficit)
of births over deaths and the balance of migrants entering and leaving a country. The rate
may be positive or negative. Also known as population growth rate or average annual rate
of growth.
Growth rates are calculated using the formula:
r (t) = ln [ P(t+1) / P(t) ]
Where:
t = year
r (t) = growth rate from midyear t to midyear t+1
P (t) = population at midyear t
ln = natural log
Table D: Relation between Growth Rate and Population
Rating
Annual growth rate (%) Doubling Time
Stationary population No growth
Slow growth
Less than 0.5
<139
Moderate growth
0.5 - 1.0
139 70
Rapid growth
1.0 1.5
70 47
Very rapid growth
1.5 2.0
47 35
Explosive growth
2.0 2.5
35 28
2.5 3.0
28 - 23
Source: United Nations Population Division, "World Population Prospects:

Note By: Keshab Shrestha (1st Batch)

(L.B. College of Health Science)

 The doubling time (also called the generation time) is the period of time required for a
quantity to double in size or value.
For a constant growth rate of r%, the formula for the doubling time Td is given by

Fertility:
Fertility is the potential of a woman or of women in a society to bear live children. This
contrasts with fertility, which is a measurement of actual childbearing. Technically,
fertility simply denotes successful production of offspring. Fecundity, derived from the
word fecund, generally refers to the ability to reproduce. Fecundity in a population is, of
course, closely linked to the proportion of women of childbearing age.
The fertility rate is a demographic measure of the number of children per woman.
Although it has been until recently considered to be a fairly reliable indicator of
population growth.
Fertility measurement methods:
Crude Birth Rate (CBR): Birth rate is the simplest indictor; it is defined as the number of
live birth per 1000 estimated mid year population, in a given year.
CBR = Number of the live births during the year/Total mid year population*K
General Fertility Rate (GFR): It is the number of live birth per 1000 women in the
reproductive age group (15 49 years) in a given year.
GFR = Number of the live births in an area during the year/mid year female population
age 15 49 in the same area and the year*1000
Age-specific Fertility Rate (ASFR): ASFR is the number of the live birth in a year to
1000 women in any specific age group. ASFR gives light of the fertility pattern.
ASFR= Number of the live births in a particular age group/Mid year female population
of the same year*1000
Total Fertility Rate (TFR): TFR is the average number of children that would be born per
woman if all women lived to the end of their childbearing years and born children
according to a given set of age-specific fertility rates. It is commuted by the summing the
ASFR for all ages.
TFR= 5*(pf 15-19+pf 20-24++pf 45-49)/1000
Gross Reproduction Rate (GRR): Average number of girls that would be born to a
women if she experience the current fertility pattern throughout her reproductive span (15
49 years), assuming no mortality.
GRR=5*(pf15-19+pf20-24+..+pf 45-49, for female birth)/1000
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Note By: Keshab

Shrestha (1st

(L.B. College of Health Science)

 Net Reproduction Rate: NRR is defined as the number of daughters a new born girl will
bear during her lifetime assuming fixed ASFR and mortality rate.
NRR is the demographic indicator.
NRR 1 is equivalent to attaining approximately the 2 child born.
If NRR is less than 1, then the reproductive performance of the all population is said to be
below replacement level.

Population pyramid:
Population pyramid is a graphical representation of the age and sex distribution of a
population.
Numbers or proportions of males and females in each age group are plotted as horizontal
bars with the males on the left and females on the right.
Pyramids may be constructed to show single years of age or, 5-year age groups.
Types of population pyramid:
While all countries population pyramids differ, three types have been identified by the
fertility and mortality rates of a country.
Stationary pyramid - A population pyramid showing an unchanging pattern of fertility
and mortality.
Expansive pyramid - A population pyramid showing a broad base, indicating a high
proportion of children, a rapid rate of population growth, and a low proportion of older
people.
Constrictive pyramid - A population pyramid showing lower numbers or percentages of
younger people.
Uses of population pyramid:
Population pyramids can be used to find the number of economic dependents being
supported in a particular population.
Economic dependents are defined as those under 15 (children who are in full time
education and therefore unable to work) and those over 65 (those who have the option of
being retired).
Of course, in some less developed countries children start work well before the age of 15,
and in some developed countries it is not unusual to start work until 18 or 21, and people
may work beyond the age of 65. Therefore, the definition provides an approximation.
In many countries, the government plans the economy in such a way that the working
population can support these dependents.
Effects of Overpopulation:
Some problems associated with or exacerbated by human overpopulation:
Increased levels of air pollution, water pollution, soil contamination and noise pollution
Deforestation and loss of ecosystems that sustain global atmospheric oxygen and carbon
dioxide balance; about eight million hectares of forest are lost each year.
Changes in atmospheric composition and consequent global warming
High infant and child mortality. High rates of infant mortality are caused by poverty.

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Note By: Keshab

Shrestha (1st

(L.B. College of Health Science)

 Increased incidence of hemorrhagic fevers and other infectious diseases from crowding,
lack of adequate sanitation and clean potable water, and scarcity of available medical
resources.
Starvation, malnutrition or poor diet with ill health and diet-deficiency diseases.
Low birth weight due to the inability of mothers to get enough resources to sustain a fetus
from fertilization to birth.
Low life expectancy in countries with fastest growing populations
Unhygienic living conditions for many based upon water resource depletion, discharge of
raw sewage and solid waste disposal
Elevated crime rate due to drug cartels and increased theft by people stealing resources to
survive
Conflict over scarce resources and crowding, leading to increased levels of warfare
Over-utilization of infrastructure, and public health systems
Sex Ratio:
Sex ratio is the ratio of males to females in a population.
The primary sex ratio is the ratio at the time of conception,
secondary sex ratio is the ratio at time of birth, and
Tertiary sex ratio is the ratio of mature organisms.
In humans the secondary sex ratio is commonly assumed to be 105 boys to 100 girls
(which sometimes is shortened to "a ratio of 105").
In bilogy, sex ratio is defined as the proportion of males in the population.
References:
Mausner & Bahn; Epidemiology, an Introductory Text 2nd edition, 1985
Parks Textbook of Preventive and Social Medicine 19th edition, 2007
KM Rashid, Mahmudur Rahaman, Sayeed Hyder Textbook of Community Medicine and
Public Health, 2007
New ERA, Nepal Population Perspective Plan 2002 2027, 2006
MOHP, Population Report of Nepal, 2004
UNFPA, World Population Datasheet, 2006
Bogue D.N. Principles of Demography, 1969
CIA, The World Factbook 2006-2007".
United Nations Population Division, "World Population Prospects: The 1998 Revision".

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Shrestha (1st

(L.B. College of Health Science)

Measurement
Measurements in Epidemiology:
It provides means and ways to describe the health of a community, or to compare events
among various populations, both in terms of magnitude and severity; provides means and
ways to see whether the association between a factor and disease could be established and
provides means and ways to measure the impact of such diseases on the respective
population.
Tools of measures
The epidemiology usually expresses disease magnitude as rate, ratio or proportion.
In epidemiology, the most important tools for measuring disease the rate, but we also use
ratios and proportions.
A ratio expresses the relationship between two numbers in the form x;y or x/y*k. For
example: the ratio of male to female birth in Nepal.
A proportion is a specific types of ratio in which the numerator is added in the
denominator and the resultant value is expressed as percentage
A rate is expressed per 100 or some other round figure (100, 100000). Rate is a special
form of proportion that includes specification of time.
The rate is the basic measure of disease occurrence because it is the measure that most
clearly expresses probability or risk of disease in a defined population over a specified
period of time. Rates is defined as:
Morbidity:
Morbidity refers to a diseased state, disability, or poor health due to any cause.
The term morbidity can refer to the state of poor health, the degree or severity of a health
condition, the prevalence of a health condition; the total number of cases in a particular
population at a particular point in time, the incidence of a disease; the number of few
cases in a particular population during a particular time interval.
Incidence and Prevalence rate are used for disease frequency measurement.
A number of different rates of morbidity, or illness, are used in public health and
epidemiology.
Incidence rates measures the probability that healthy people will develop a disease during
a specified period of time; hence of a disease in a population over a period of time.
Incidence Rate:
Incidence rate= Number of new cases of a disease during a specified time
period/population at risk.
Thus incidence tells the rate at which new disease occurs in a defined, previously diseasefree group of people.
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Note By: Keshab

Shrestha (1st

(L.B. College of Health Science)

 Incidence Rate is defined as the number of new cases occurring in a defined population
during a specified period of time.
Incidence Rate (IR) = Number of new cases of a specified disease during a given time
period/Population at risk during that period*k.
Incidence rate must include unit of time.
Incidence rate refers to:
1) Only to new cases
2) During a given period (usually one year)
3) Population at risk
Prevalence Rate:
Prevalence rate measures the number of people in a population who have the disease at a
given time.
All current cases (Old+New) existing in a given point in time or over a period in a given
population.
Prevalence dependents on two factors; the past and the duration of their illness.
Point prevalence rate: Point prevalence of a disease is defined as the number of all
current cases (old+new) of a disease at one point in time in relation to a defined
population.
Point Prevalence Rate = Number of all current cases of a specified disease existing at a
given point in time/Estimated population at the same time*k.
Period Prevalence Rate: Period prevalence rate is measured the frequency of all current
cases (old+new) existing during a defined period of time. It is defined as the number of
existing cases of a specified disease during a given period of time per 100 estimated midyear populations at risk.
Period Prevalence Risk= Number of existing cases of a specified disease during a given
period of time/estimated mid-year population at risk*k.
Cumulative Incidence Rate:
Cumulative Incidence Rate is a simple measurement of the occurrence of a disease.
Unlike incidence rate, it is measures the denominator only at the beginning of a study.
Cumulative Incidence Rate=Number of new cases of a disease during a specified time
period/population at risk at the beginning of the time.
Mortality:
According to the WHO Death is the permanent disappearance of all evidence of life at
any time after birth has taken place.
Death can thus occur only after alive birth, and the span between birth and death is life.
Various measures are employed for the mortality analysis. Crude death rate and infant
death rate are communally used for mortality measurement.
Mortality Measurement:
Crude Death Rate (CDR): the simple measure of mortality is the crude death rate. CBR is
defined as the number of deaths per 1000 estimated mid-year population in a specific year.
CDR= Number of deaths during the year/Mid-year population*k or D/P*K

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Note By: Keshab

Shrestha (1st

(L.B. College of Health Science)

 Case Fertility Rate (CFR) = Case fertility rate represents the killing power of a disease.
It is simply the ratio of deaths to case. It is defined as the number of deaths due to a
particular disease per 100 cases to the same disease in the specific year.
CFR = Total number of deaths due to a particular disease/total number of cases due to
the same disease*100.
Age Specific Death Rate (ASDR) is the number of death of persons per 1000 population
in a particular age group in a year.
ASDR= Dx.Px*K
Dx= total population in the age of persons in the age group x.
ASDR is calculated for male and female separately if both types of data are available.
Infant Mortality Rate (IMR)= Infants are defined in demography as an exact age group,
namely, age 0 or those children in the first year of life, who have not, yet reached age 1.
Infant Mortality Rate is the ratio of infants under one year of age to the total number of
live birth. It is the number of infant deaths per 1000 live birth of same year.
IMR= D0/B*K or Death of infants less than one year/Number of live birth in the same
year*K.
Neo-natal Death Rate= Death of infant under 1 month/Live birth*K
Post-Natal Death Rate= Death of infants 1 to 11 months/Live birth*K.
Child Mortality Rate (CMR)= CMR is the number of death of children aged 1 to 4
years in the specific mid/year population.
Da/Pa*K
Da= number of death of children aged 1 to 4 years in a specific year.
Pa= total number of children aged 1 to 4 years in the same mid-year population.
Under 5 Mortality Rate (U5MR)= U5MR is defined as the number of death of children
under 5 years of age per thousand live births.
U5mrB= D under 5 yrs/B*K.
D under 5yrs= number of death of children under 5 years of age in a year.
B= number of live births in the same year.
Maternal Mortality Rate (MMR)= MMR is defined as the death of a women while
pregnant or within 42 days of termination of pregnancy, irrespective of duration and site
of pregnancy from any cause related to or aggravated by the pregnancy or its
management but not from accidental or incidental causes.
MMR is the number of death of women due to complication of pregnancy, child birth or
within 42 days of delivery from pregnancy from puerperal causes per 100000 live births
in a year.
MMR= Dp/B*K
Child Women Ratio (CWR)= CWR is the ratio of the children under 5 years of age to
women in the child bearing ages.
P0-4/f15-49*K
P0-4= is the number of children under 5 years.
F15-49= is the number of women between the ages of 15 and 49.

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(L.B. College of Health Science)

Migration
Migration is a from geographic or social mobility involving a change of usual residence
between clearly defined geographic units. Some changes of residence, however, are
temporary and do not involve changes in usual residence; these are usually excluded from
migration. They include brief departures for visiting, vacation, or business, even across
national boundaries. Other changes in residence, although permanent, are short distance
movements and, hence are also excluded.
Concept of Mobility:
Mobility ass used in demography usually refers to spatial, physical or geographic
movement of people.
Source of Data:
Primary Data Sources : Census, Survey and Vital Event
Secondary Data Sources : Population Monograph, Population Records, Publication,
Published Reports
Definition of Various Terms of Mobility:
Mover
Life Time Migrants
Migrant
Net Migration
Place of Origin
Gross Migration
Place of Destination
Migration Stream
Immigration
Return Migration
Emigration
Place of Birth
In-migration
Out-migration
Type of Migration:
1) Internal Migration
2) International Migration
1) Internal Migration:
Internal migration is defined as movement of population within a country with change in
address. Volume of internal migration depends on the size of the defined geographical
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area. For example, area can be defined as a ward of a VDC and any movements between
wards could be regarded as migratory movement.
2) International Migration:
International migration has been further divided into two components, viz; emigration,
meaning people moving out of the country while immigration, indicating foreigners
moving into the country.

Type of Migration by Duration:

Permanent Migration: More than 5 years
Semi-permanent Migration: Up to 5 years or Less
Temporary Migration: Up to 1 year or Less
Seasonal Migration: Up to 6 months or Less
Type of Migration by Geographic Region:
1) Inter-regional Migration: One region to other region
2) Intra-regional Migration: Within same region
Type of Migration by Area of Residence:
1) Rural to Urban Migration
2) Rural to Rural Migration
3) Urban to Urban Migration
4) Urban to Rural Migration
Basic Measures of Internal Migration:
1) In-migration Rate
2) Out-migration Rate
3) Net Migration Rate
4) Gross Migration Rate
In-migration Rate:
In-migration rate is defined as the number of in-migrants per 1000 estimated mid-year
population in a particular area in a specific year.
mi=I/P*1000
Where mi= In-migrants rate
I=Total number of in-migrants in a particular area in a given year
P=Total mid-year population in that area in the same year
Out-migration Rate:
Out-migration rate is defined as the number of out-migrants per 1000 estimated mid-year
population in a particular area in a specific year.
mo=O/P*1000
Where mo= Out-migrants rate
O=Total number of out-migrants in a particular area in a given year
P=Total mid-year population in that area in the same year
Net Migration Rate:
Net Migration rate is the difference between in-migrants and out-migrants per 1000
estimated mid-year population in a particular area in a specific year.
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(L.B. College of Health Science)

mn=I-O/P*1000
Where mn= Net migration rate
I=Total number of in-migrants in a particular area in a given year
O=Total number of out-migrants in a particular area in the same year
P=Total mid-year population in that area in the same year

Gross Migration Rate:

Gross Migration rate is the total numbers of in-migrants and out-migrants per 1000
estimated mid-year population in a particular area in a specific year.
mg=I+O/P*1000
Where mg= Gross Migration Rate
I=Total number of in-migrants in a particular area in a given year
O=Total number of out-migrants in a particular area in the same year
P=Total mid-year population in that area in the same year
Basic Measures of International Migration:
1) Immigration Rate
2) Emigration Rate
3) Net Immigration/Emigration Rate
4) Gross Immigration/Emigration Rate
Immigration Rate:
Immigration rate is defined as the number of immigrants entered in a country per 1000
estimated mid-year population in a specific year.
mI=I/P*1000
Where mI= Immigrants rate
I=Total number of immigrants entered in a country in a particular in a given year
P=Total mid-year population in that country in the same year
Emigration Rate:
Emigration rate is defined as the number of emigrants crossed border in a country per
1000 estimated mid-year population in a specific year.
mE=E/P*1000
Where mE= Emigrants rate
E=Total number of Emigrants crossed a country in a given year
P=Total mid-year population in that area in the same year
Net Immigration/Emigration Rate:
Net immigration/emigration rate is the difference between immigrants and emigrants in a
country or cross border per 1000 estimated mid-year population in a specific year.
mN=I-E/P*1000
Where mN= Net immigration/emigration rate
I=Total number of immigrants entered in a country in a given year
E=Total number of emigrants crossed country border in the same year
P=Total mid-year population in that country in the same year
Gross Immigration/Emigration Rate:
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(L.B. College of Health Science)

 Net immigration/emigration rate is the total number of immigrants and emigrants in a

country or cross border per 1000 estimated mid-year population in a specific year.
mG=I+E/P*1000
Where mG= Gross immigration/emigration rate
I=Total number of immigrants entered in a country in a given year
E=Total number of emigrants crossed country border in the same year
P=Total mid-year population in that country in the same year

Urbanization
Urbanization is regarded as one of the most important demographic features of a country.
It is generally defined as the percentage of total population living in urban settlements.
In other words, urbanization is the growth in the proportion of persons living in urban
settlements. In the context of Nepal, urban settlements are the designated urban areas.
Nepal is one of the least urbanized countries in the world with about 14 per cent of its
total population residing in urban areas.
Among the member countries of the SAARC (South Asian Association for Regional
Cooperation) also Nepal has the lowest proportion urban population.
However, tempo of urbanization has been increasing over the years.
Measures of Urbanization:
Percentage of urban population = Urban population / Total Population *100
Ratio of rural and urban population = Urban population/Rural population

Ageing
The old age is a relative concept. Demographers consider 65 years of age as the old age
for international comparison of elderly people. The World Assembly on Aging adopted,
as its main focus of concern, the population aged 60 or over as elderly population. The
age 60 is also a convenient one for its statistical analysis. The United Nations considers
60 years as the boundary of old ages.
The age cut-off for the elderly population varies across the countries and overtime.
Aging refers to the increasing inability of the body to maintain itself and to perform the
functions it once did.
Ageing is a natural outcome of demographic transition from high fertility and mortality to
low fertility and mortality.
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 Ageing is an emerging social issue for Nepal because fertility has started going down in
recent years, the mortality is declining fast and the life expectancy is continuing to
increase for both sexes in Nepal

Population momentum
Population momentum is an effect which causes population growth. This phenomenon
refers to the percentage of the population that are in their child bearing years who have
not yet had children, and thus are scheduled to eventually have children which add to the
population through reproduction.
The higher the percentage of people aged, for example 18 and under, the larger the
population growth will be because there is such a large percentage of the population
capable of having children. This means the population will continue to grow, even if the
fertility rate reaches replacement level.
The reason is that population momentum would have an effect is that high fertility levels
in the past caused a largely young population which still has to reach child-bearing years.

Projection
Projection - method or technique of predicting future population (Hinde, 1998)
A judgmental statement that is the "best guess" about a future condition; a forecast is the
analyst's determination of the most likely future. Because of their difficulty, high
likelihood of inaccuracy, and controversial results, forecasts are often left to well-paid
consultants that have mastered the various projection methods.
Actual prediction which demographers feel confident about sometimes projection is used
to describe the predicted population or forecast
Projections are about future growth:
Total population - age sex distribution
Projections for sub divisions
Projections of ethnic groups, school age pop, labour force, etc, employment and other
demographic aspects
Population Projection:
Information regarding population is the major foundation for development planning at all
levels.
Censuses are not enough for planning beyond census years, so based on the information
collected in the population census, projections have to be made to determine the most
plausible growth of the population.
Population projections are most valuable inputs for development planning and there is no
doubt that they should be as accurate as possible.
The estimates will be accurate if data used are accurate and assumptions involved in the
projections hold true in reality. In general, three scenarios of population projections are
usually made
The Importance of Population:
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(L.B. College of Health Science)

 Of all responsibilities of the profession, the estimation of current levels and the predict ion
of future levels of population remain among the most important for planners.
Social Services and planning
Educational planning - need for future population by single years of age from 5 to 16
years
Planning for number of households and land allocation in the country or the city Planning
for low cost housing needs
Housing needs are influenced by the number of households and the marital status,
household sizes.
Economic services and planning
Planning or future labour force needs of population, labour force rates by gender, urban d
rural localities etc
Planning labour market needs by qualification of people - doctors, nurses etc
Retirement from labor force, need for doctors and teachers, medical facilities, need for
land and housing development, social service organization etc
At any level of geography, the full ranges of revenues, services, conditions, and needs are
predicated on the local population level. Clearly, "everything flows from population". For
example:
City /municipals rates are tied to the number of properties in the city
Local tax revenues are generally tied to the number of persons (or households).
A declining population is leads to declining revenues for a municipality, hence the
importance of the issue of "growth" to local governments.
Methods of Projection:
Linear Growth Rate Method
Geometric Growth Rate Method
Exponential Growth Rate Method
Population Doubling Time Estimation
Balancing Equation
1) Linear Growth Rate Method:
Assuming the population growth rate is the same at each year.
Equation Pn=P0 (1+rn)
Where Pn= Population at the begging of the period
P0 = Population at the end of the period
r= Annual rate of increase
n= Time interval
Pn=P0 (1+rn)
or, Pn - P0 = P0 +P0rn
or, Pn - P0 =P0rn
or, rn = Pn - P0 / P0
or, r = Pn - P0 / nP0
or, n = Pn - P0 / rP0
Question:
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(L.B. College of Health Science)

 The population was respectively 15022831 and 18491097 at 1981 and 1991. Find the rate
of population growth rate.
2) Geometric Growth Rate Method:
The population growth is equal at the interval of time being but not same each year.
Equation Pn=P0 (1+r)n
Where Pn= Population at the begging of the period
P0 = Population at the end of the period
r= Annual rate of increase
n= Time interval
Pn=P0 (1+r)n
or, Pn/P0 = (1+r)n
Taking log in both side, we got
or, log (Pn/P0 ) = log(1+r)n
or, log (Pn/P0 ) = n log(1+r)
or, log(1+r) = 1/n log (Pn/P0 )
Taking antilog in both side, we got
or, antilog{log (1+r)}= antilog{1/n log(Pn/P0 )}
or, 1+r= antilog{1/n log(Pn/P0 )}
or, r= antilog{1/n log(Pn/P0 )}- 1
or, n= log(Pn/P0 )/log (1+r)
Question:
The population was respectively 15022831 and 18491097 at 1981 and 1991. Find the rate
of population growth rate.
3) Exponential Growth Rate Method:
Assuming the population growth is not equal at the interval of time being or not same
each year, but it will be fluctuate .
Equation Pn=P0 ern
Where Pn= Population at the begging of the period
P0 = Population at the end of the period
r= Annual rate of increase
n= Time interval
e= Natural logarithm
Pn=P0 ern
or, ern = Pn/P0
Taking log in both side, we got
or, log ern = log (Pn/P0 )
or, rn loge = log (Pn/P0 )
or, n loge = log (Pn/P0 )/r
or, r loge = log (Pn/P0 )/n

(value of loge =1, always)

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(L.B. College of Health Science)

Question:
The population was respectively 15022831 and 18491097 at 1981 and 1991. Find the rate
of population growth rate.
4) Population Doubling Time Estimation:
Doubling time is also estimated by using exponential growth rate method.
Here, Pn=P0 ern
As the latter population is doubled, hence
P0=2P0
or, 2P0= P0 ern
or, 2= ern
Taking log in both side, we got
or, log2= log ern
or, rn loge=log2
(value of loge=o.693)
or, n=log2/r loge
Question:
The population was respectively 18491097 and 23153423 at 1991 and 2001. Find the rate
of population growth rate and population doubling time.
5) Balancing Equation:
Balancing equation is that, where demographics components (fertility, mortality and
migration) are used for estimating future size of population.
Equation Pn-P0 = (B-D)+(I-E)
or, Pn = P0 + (B-D)+(I-E)
Where, Pn= Population at the begging of the period
P0 = Population at the end of the period
B= # Birth
D= # Death
I= # Immigrants
E= # Emigrants
Question:
The population was 88970 of Bardia at 1990, within ten years, Population at the begging
of the period ( 2000), the information were found birth 29370, death 15410, emigrants
4985 and immigrants 6330. Estimate population of 2000 by using given information.

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(L.B. College of Health Science)

Population Theories and Models

Natural Increase= Crude Birth Rate Crude Death Rate
1) Malthus Theory of Population Growth:
In 1798 Thomas Malthus published his views on the effect of
population on food supply. His theory has two basic principles:
Population grows at a geometric rate i.e. 1, 2, 4, 16, 32, etc.
Food production increases at an arithmetic rate i.e. 1, 2, 3, 4, etc.
The consequence of these two principles is that eventually,
population will exceed the capacity of agriculture to support the new population numbers.
Population would rise until a limit to growth was reached. Further growth would be
limited when:
Preventive checks - postponement of marriage (lowering of fertility rate),
increased cost of food etc.
Positive checks - famine, war, disease, would increase the death rate.
Malthusian ideas are often supported by Western governments because it highlights the
problem of too many mouths to feed, rather than the uneven distribution of resources;

2) Esther Boserups Theory of Population Growth:

In contrast to Malthus, instead of too many mouths to feed, Boserup
emphasized the positive aspects of a large population;
In simple terms, Boserup suggested that the more people there are, the
more hands there are to work;
She argued that as population increases, more pressure is placed on
the existing agricultural system, which stimulates invention;
The changes in technology allow for improved crop strains and
increased yields.
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Demographic Transition
Demographic Transition is a theory describing a possible transition from high birth
rates and death to low birth and death rates as part of the economic development of a
country from a pre-industrial to an industrialized economy.
Usually it is described through the "Demographic Transition Model" (DTM) that
describes the population changes over time. It is based on an interpretation begun in 1929
by the American demographer Warren Thompson of prior observed changes, or
transitions, in birth and death rates in industrialized societies over the past two hundred
years.
The Demographic Transition Model:
The model of demographic transition suggested that a population's mortality and fertility
would decline as a result of social and economic development. It predicted that all
countries would over time go through four demographic transition stages.

STAGE 1 High Stationary or Pre-Industrial:

HIGH BIRTH RATES
Little or no family planning
Parents have many children because few survive
Many children are needed to work the land
Children are a sign of virility
Some religious beliefs and cultural traditions encourage large families
HIGH DEATH RATES
Disease and plague (e.g. bubonic, cholera, kwashiorkor)
Famine , uncertain food supplies, and poor diet
Poor hygiene, no piped clean water or sewage disposal
POPULATION GROWTH-- SLOW

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Birth Rate
Death Rate
Natural Increase
Fertility Rate
Infant Mortality Rate
Example Region

High
High
Low
High
High
Various isolated communities in the least
Developed regions of Africa; war-torn
Regions (eg Afghanistan, Sudan, Angola);
Political hotspots (eg North Korea)

Other Characteristics: Characterizes pre-industrial societies. Most of the population is

rural and involved in subsistence agriculture.

STAGE 1 Pyramid

Due to high birth rates, the pyramid shape would have a wide base;
Due to high death rates, the pyramid would be very short in height; concave shape
indicates low life expectancy.

STAGE 2 Early Expanding or Early Industrial (Rapid population growth):

Ehrlich described this stage as the population explosion
HIGH BIRTH RATES
As STAGE 1
FALLING DEATH RATES
Improved medical care e.g. vaccinations , hospitals, doctors, new drugs, and
scientific inventions
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(L.B. College of Health Science)

 Improved sanitation and water supply

Improvements in food production in terms of quality and quantity
Improved transport to move food and doctors
A decrease in child mortality
POPULATION GROWTH-- RAPID

EARLY STAGE 2
Birth Rate
Death Rate
Natural Increase
Fertility Rate
Infant Mortality Rate
Example Region

High
Decreasing
Increasing
High
High
Sub-Saharan Africa

Other Characteristics: Characterizes post-industrial societies. Most of the population is rural, but
urbanization is increasing rapidly. Dependency load begins to increase rapidly as the young
cohort (%<15 yrs old) begins to dominate the proportion of the population.

LATE STAGE 2
Birth Rate
Death Rate
Natural Increase
Fertility Rate
Infant Mortality Rate
Example Region

High
Lowered
Increasing rapidly
High
Declining
Many African countries, Middle East

Other Characteristics: The beginning of the population explosion. Often, social and economic
problems begin on a large scale. Urbanization continues to grow rapidly. Dependency load is
huge due to a massive, young cohort (<15yrs old).
STAGE 2 Pyramid

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 As death rates are addressed, the population explosion begins;

The height of the pyramid grows to reflect the prevention of more deaths; shape becomes
less concave as life expectancy increases;
The width of the base remains large due to the ongoing high birth rates

STAGE 3 Late Expanding or Late Industrial:

FALLING BIRTH RATES
Family Planning utilized; contraceptives, abortions, sterilization, and other
government incentives adopted
A lower infant mortality rates means less pressure to have children
Increased mechanization and industrialization means less need for labour
Increased desire for material possessions and less desire for large families
Emancipation of women
DEATH RATES LOW
As Stage 2
POPULATION GROWTH STILL GROWING BUT SLOWING
EARLY STAGE 3
Birth Rate
Death Rate
Natural Increase
Fertility Rate
Infant Mortality Rate
Example Region

Decreasing
Low
High, but decreasing
Decreasing
Decreasing
South and East Asia

Other Characteristics: Birth control is introduced and begins wide social acceptance. Social and
economic issues begin to be addressed. Dependency load is still large due to a large young
cohort group (<15yrs old).
LATE STAGE 3
Birth Rate
Death Rate
Natural Increase
Fertility Rate
Infant Mortality Rate
Example Region

Decreasing to a manageable level

Low
Decreasing sharply
Decreasing sharply
Lowered
Latin America, Tiger Economies

Other Characteristics: Ends the population explosion. People choose smaller families due to
many social and economic factors. Urbanization dominates. Population stabilization begins.
Population continues to grow due to the large young population reaching childbearing age.
STAGE 3 Pyramid

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STAGE 4 Low Stationary or Low Fluctuating:

BIRTH RATES LOW
Fertility rates plunge to below replacement rate (2.1 children per woman)
because:
Valuation of women beyond childbearing and motherhood becomes
important
Increasing value is placed on material goods over family size in modern
industrialized society
Widespread choice of contraception by families
DEATH RATES LOW
Child mortality reduced and life expectancy increased due to:
Capital ($$$) investment in medical technology
Widespread knowledge of healthy diet and lifestyle
POPULATION GROWTH SLOW OR DECLINING (due to aging societies)

Birth Rate
Death Rate
Natural Increase
Fertility Rate
Infant Mortality Rate
Example Region

Low
Low with spurts as a result of an aging society
Low or negative
Near or below replacement rate
Low
MEDCs, China

Other Characteristics: Population growth no longer a social and economic issue. Birth and death
rates fluctuate minimally and natural increase stops. An overwhelmingly urban society.
Dependency load is small (large working age group).
STAGE 4 Pyramid

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 Birth rates and death rates are low; as fertility continues to decline, an AGING SOCIETY
emerges.
Pyramid seems to invert
Most developed countries are already in stage four of the model.
The majority of developing countries are in stage 2 or stage 3, and no country is currently
still in stage 1.
The model has explained human population evolution relatively well in Europe and other
highly developed countries.
Many developing countries have moved into stage 3.
Criticism of the DTM
The model is an over-generalization of the industrialized European experience;
Model is too rigid in assuming all countries proceed from stage 1-4; it ignores variables
and exceptions (eg. War, political turmoil);
Industrialization is difficult to achieve for LEDCs in a trading system that protects the
industries of MEDCs;
The model assumes that reductions in fertility are a function of increased wealth and
industrialization other factors such as the status of women and other social development
are ignored.
What is Population Policy?
Measures formulated by a range of social institutions including Government which may
influence the size, distribution or composition of human population (Driver,1972).
A deliberate effort by a national government to influence the demographic variables like
fertility, mortality and migration (Organski & Organski,1961).
A set of Coordinated laws aimed at reaching some demographic goal (BiurgeoisPichat,1974)
Population policy means either direct intervention in the population development by
adopting and implementing targeted measures or, more often, by creating conditions of
such population development which corresponds with the long-term intention of a state.
As a rule, this involves measures influencing fertility and indirectly also marriage, but it
also includes migration policy
Types of Population Policies:
1) Explicit : Document by a national government announcing its intention to affect the
population growth and composition
2) Implicit : Directives not necessarily issued to influence the population growth and
composition but may have the effect of doing so.
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 The population policy is either antinatalist, designed to curb high fertility, preventing
high fertility and thus hampering a rapid growth in the population number, or
Pronatalist, which involves the intention of maintaining a favorable development of
fertility or, in the case of a negative situation, it wants to achieve its reversal.
The antinatalist type of population policy is used in many developing countries,
The Pronatalist appears in European populations with low fertility, which involves
decrease in the population number through population change (numbers of deaths exceed
the number of live-born children).
Most European countries do not have any population policy as they evidently do not feel
its need.
Population policies are deliberately constructed or modified institutional arrangements
and/or specific programs through which governments influence, directly or indirectly,
demographic change.
For any given country, the aim of population policy may be narrowly construed as
bringing about quantitative changes in the membership of the territorially

Quality of life
The term quality of life is used to evaluate the general well-being of individuals and
societies.
The term is used in a wide range of contexts, including the fields of international
development, healthcare, and political science.
Quality of life should not be confused with the concept of standard of living, which is
based primarily on income.
Instead, standard indicators of the quality of life include not only wealth and
employment, but also the built environment, physical and mental health, education,
recreation and leisure time, and social belonging
Definition of Quality of Life:
The quality, resulting from the total functioning of the individual that empowers him to
achieve a personally satisfying and socially useful self, Johns E.B.
The quality of life is a very complex concept involves the satisfaction of emotional needs
and social aspiration of the community or society as well as the societys ability to meet
the basic needs of food, energy, space, housing etc by itself, Dr. R.C. Sharma.

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Understanding:
Quality of life is the sense of being pleased (happy) or (satisfied) with those life element
that are most important to a person.
In addition, quality of life sense of being pleased with that one has. Although satisfaction,
happiness or pleasure is the control elements in this definition, it should not be seem a
momentary state of happiness or pleasure but rather a long herm sense of happiness. May
be it is best expressed as a sense of fullness or completeness of life
Importance:
Importance in population dynamism
Importance in political context
Importance in socio-culture context
Importance in socio-economic context
Importance in religious and cultural context
Importance in educational context
Importance in ecological balance context
Importance in natural resource utilization and conservation context
Eight Fundamentals of Quality of Life:
Health and Nutrition
Education
Real Wage
Non-human Productive Resources
Housing Utilities and Environment
Public Safety and Justice
Political Values
Social Mobility

Quality of life factors to determine a nation's score:

Health: Life expectancy at birth (in years).
Family life: Divorce rate (per 1,000 population), converted into index of 1 (lowest
divorce rates) to 5 (highest).
Community life: Variable taking value 1 if country has either high rate of church
attendance or trade-union membership; zero otherwise.
Material well being: GDP per person, at PPP in $.
Political stability and security: Political stability and security ratings.
Climate and geography: Latitude, to distinguish between warmer and colder climates.
Job security: Unemployment rate (%.)
Political freedom: Average of indexes of political and civil liberties. Scale of 1
(completely free) to 7 (unfree).
Gender equality: Measured using ratio of average male and female earnings.

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Family Quality of Life Model:

33
Batch)

Note By: Keshab

Shrestha (1st

(L.B. College of Health Science)