SGD 16 LBM 3

Step 1

Demographic
Is study of size teritorial distribution and composition and population changes there in and
the component of such changes which maybe identified as natality, teritorial movement
(migration) and social mobility (change of state)
Is a comes from the greek namely demos means people or residence and grafein means
writing so the demography as writing or essay about people and residence.
MMR
(Maternal mortality rate) is the number of women dying during the pregnancy or 42 days
after termination of pragnancy regardless of the duration and place of birth which is caused
by the pragnancy or its management and not due to other causes per 100.000 live births.
Mortality
Death or mortality is an accident of dissapearing all of the signs of life permanently and it
happen anytime after live births (WHO)
MDGs
Are 8 goals to be achieve by various nations in 2015 to address development challenges
around the world including poverty in human right in one package.

Step 2

1. Why the doctor must learn demographic?

2. What are the purpose of demographic?
3. What are the benefits of demographic?
4. What are the components of demographic? Explain and described!
5. How to get demographic data?
6. What are the factors that affect the components of dermographic?
7. Why MMR used to measure global health indicator ?
8. What are the goals of MDGs?
9. What are the actions to reach MDGs goals?
10. What are the indicators of mortality?
11. What the effects from increase of mortality?

Step 3

1. Why the doctor must learn demographic?

Demographic science is to study change in population by utilizing data and population data
especially concerning in the number distribution and composition the changes are
influencing by population growth, fertility, mortality, and migration which is caused by
change in the number structure and distribution of population.
2. What are the purpose of demographic?
Demographic is for learn about number of population and distribution and it to learn about
growth and development of population and correlation between development and
distribution of population, then it is for prediction about growth and distribution population.
3. What are the benefits of demographic?
 o Provides an overview of the situation in the objective condition necessary to
determine the policy and planning process.
o Indentify a population problems
o As a parameter to determine the success of a health program seen from the
development of public health degree.
o As a basic for implementation of healthh development related to basic health
development policy.
o As a means of evaluation of health programs that have been done by the
government.
o As a stool or a reference to determine the condition of lives of individuals and
communities.
4. What are the components of demographic? Explain and described!
5 components:
a. Birth / fertility
Birth means ability of mother to have a baby.
Capability of all women to give birth
b. Death / mortality
The accident of dissapearing of signs of life permanently and it happened anytime after
live birth
c. Marriage
Status of people or somebody to have status of marriage or not. Devided into 4 :
- Had not already marriage
- Marriage
- Divorced
- Widow or widower

Change status the person from the single become marriage status

d. Migration
The movement of population permanently from one place into another place so it
movement of population.
The move of population to aim stabilize a place.
e. Social mobility
The movement of status, so social mobility is the movement of population and status.
Have stimulator :
- Changing of social condition
- Teritorial
- Job
- Politic situation
Inhibit :
- Lower education
- Discrimination about people
- Poverty

5. How to get demographic data? Data resources?

o From census survey of the population registration by quesioner
6. What are the factors that affect the components of dermographic?
a. Birth :
- Pronatality : marriage at a young age, assumption a lot of kids alot of luck
- Antinatality : family planning program (KB)
 b. Death :
- Promortality : incompatible health facilities, disaster, war, traffic accidents,
suicide, Bad life style, genetics and environment.
- Antimortality : healthy environment , compatible health facilities, education
and religion.
c. Migration : supply of natural resources, social-cultural environment, economic potency,
future tools
7. Why MMR used to measure global health indicator ?
Because its one of MDGs goals so a lot of nation use that to measure one of the health
indicators. Karena angka kematian ibu menggambarkan pelayanan kesehatan di suatu
tempat baik atau tidak. Pelayanan kesehatan baik MMR menurun dan sebaliknya.
Indicator maternal health : MMR, IMR.
What are the challenges to prevent of MMR?
8. What are the goals of MDGs?
There are 8 goals :
- Eradicate extrem poverty and hunger
- Achieve universal primary education
- Promote gender equality and empower women
- Reduce child mortality
- Improve maternal health
- Combat HIV/AIDS, malaria and other diseases.
- Ensure environmental sustein ability
- Develop a global partnership for development.
9. What are the actions to reach MDGs goals?
Apa yang membedakan MDGs di negara berkembang dan negara maju (pola yg membedakan
apanya)?
10. What are the indicators of mortality?
o Angka kematian kasar (Crude DEATH Rate): how many death per a thousand people
in a certain years in a certain location.
Formulation : CDR = (D/P) x K
D : jml kematian tahun ttt
P : jml penduduk
K : konstanta (/1000)
o Baby Death Rate (AKB) : kematian yg terjadi antara saat setelah nayi lahir sampai
bayi blm berusia 1 th.
Penyebab endogen (neonatal) eksogen (post neonatal).
Formulation : AKB= D(0sampai <1th)/ jml lahir hidup x konstanta
Konstanta : 1000
D : jml kematian bayi
o Angka kematian balita (AKBA)
0-5 years
o AKA (chilld) ; 1-5 years
o MDR (mother death rate)
o Umur harapan hidup
11. What the effects from increase of mortality?
12. Apakah di setiap negara maju dan berkembang MDGs sama?
13. What are the causes of death?

Step 4
Step 7

1. Why the doctor must learn demographic?

The importance of the demography is listed below:
a. Political advantages: The demography provides the sources for counting the number of the voter with their age and
sex structure. It also helps to know the growth rate voters so that the politicians feel easy in grouping and constitution
areas and managing the elections.
b. Social advantages: The demography helps the people to attain their basic as well as extra need to lead happier
and healthier life. It also provides the ideas to set up the laws and rules in accordance with the population growth in
the community for better security provisions.
c. Economic advantages: The demography assists to adopt the controlling measures to cope up with the economic
development rate. If the population growth and economic growth rate are not balanced, there will be the great poverty
and famine in the country. The demography helps to estimate the population density and the per capita income.
d. Administrative advantages: The demography is essential for conduction the administrative activities. The adminis-
trators will be failed or unable to set up the rules or to rule the nation in the absence of the demography.
e. Planning advantages: The planners feel easy to plan for the development. They are also useful for plan-
ning & development of the student. The sources and tools are distributed and managed for the proper development of
the nation.
http://www.slcguru.com/demographic-components-process-measures/

2. What are the purpose of demographic?

a) Mengetahui kuantitas dan distribusi penduduk dalam satu daerah tertentu
b) Menjelaskan pertumbuhan masa lampau, penurunannya dan penyebarannya
c) Mengembangkan hubungan sebab akibat antara perkembangan penduduk
dengan bermacam aspek-aspek sosial
d) Mencoba meramalkan pertumbuhan penduduk di masa datang dan kemungkinan
konsekuensinya
Mantra, Ida Bagoes.2003. Demografi Umum. Pustaka Pelajar Offset, Yogyakarta

3. What are the benefits of demographic?

Pada akhirnya, keempat tujuan pokok tersebut akan bermanfaat

untuk:
a. Perencanaan pembangunan yang berhubungan dengan
pendidikan, perpajakan, kemiliteran, kesejahteraan sosial,
perumahan, pertanian dan lain-lain yang dilakukan pemerintah
 menjadi lebih tepat sasaran jika mempertimbangkan komposisi
penduduk yang ada sekarang dan yang akan datang.
b. Evaluasi kinerja pembangunan yang dilakukan oleh pemerintah
dengan melihat perubahan komposisi penduduk yang ada
sekarang dan yang lalu beserta faktor-faktor yang
mempengaruhinya.
c. Melihat peningkatan standar kehidupan melalui tingkat harapan
hidup rata-rata penduduk, sebab tidak ada ukuran yang lebih
baik kecuali lamanya hidup sesorang di negara yang
bersangkutan.
d. Melihat seberapa cepat perkembangan perekonomian yang
dilihat dari ketersediaan lapangan pekerjaan, persentase
penduduk yang ada di sektor pertanian, industri dan jasa.
Lembaga Demografi FE UI. 2007. Dasar-dasar Demografi. Jakarta :
Lembaga Penerbit FE UI

Demography is much more than just numbers, and relevant to much of what we seek to
know and understand about the distant past. In pre-modern societies, population size was
the best indicator of economic performance; the distribution of people between town and
country was instrumental in the creation of collective identity and may reflect the scale of
division of labor and commerce; human mobility mediated information flows and culture
change; mortality and morbidity were principal determinants of well-being and determined
fertility (and thus gender relations), investment in human capital, and economic productivity,
and more generally shaped peoples hopes and fears.
Walter Scheidel. Population and demography. Stanford University.2006.
http://www.princeton.edu/~pswpc/pdfs/scheidel/040604.pdf

4. What are the components of demographic? Explain and described!

Several demographic variables play central roles in the study of human

populations, especially fertility andfecundity, mortality and life
expectancy, and migration.
Fertility and fecundity

A population's size is first affected by fertility, which refers to the number of

children that an average woman bears during her reproductive yearsfrom puberty
to menopause. People sometimes confuse the term fertility with fecundity, which
refers to the number of children an average woman is capable of bearing. Such
factors as health, finances, and personal decision sharply affect fecundity.
To determine a country's fertility rate, demographers use governmental records to
figure the crude birth rate (the number of live births for every thousand people in
a population). They calculate this rate by dividing the number of live births in a year
by the total population, and then multiplying the result by 1,000. As one might
expect, the governmental records used in this type of research may not be
completely accurate, especially in thirdworld countries where such records may not
even exist.

While the world's average fertility rate is about 3 children per woman, its fecundity
rate is about 20 per woman. The highest fertility rate (nearly 6 children per woman)
in the world occurs in Africa, whereas the lowest occurs in Europe (about 1.5). The
fertility rate for women in the United States is about 2.

Mortality and expectancy

Mortality, or the number of deaths in a society's population, also influences

population size. Similar to the crude birth rate, demographers calculate the crude
death rate, or the number of deaths annually per 1,000 people in the population.
Demographers calculate this figure by dividing the number of deaths in a year by
the total population, and then multiplying the result by 1,000. The crude death rate
in the United States normally stays around 8 or 9.
Infant mortality rate, which is the number of deaths among infants under age one
for each 1,000 live births in a year, provides demographers with another measure.
Compared to other countries, North American infant mortality rates tend to be low.
Still, the figures can vary considerably within a society. For example, African
Americans have an infant mortality rate of about 19 compared to those of whites
who have a rate of about 8.
A low infant mortality correlates with a higher life expectancy, which is the
average lifespan of a society's population. U.S. males and females born today can
look forward to living into their 70s, which exceeds the life expectancy of those in
lowincome countries by 20 years.
Migration

Finally, migration (the movement of people from one place to another) affects
population size. While some migration is involuntary, such as when slaves where
brought to America, other migration is voluntary, such as when families move from
cities into suburbs.
Migration into an area, called immigration, is measured as the immigration rate,
which is the number of people entering a region per each 1,000 people in the
population. Migration out of an area, or emigration, is measured as theemigration
rate, which is the number leaving per each 1,000 people in the population. Internal
migration is the movement from one area to another within a country's borders.
Population growth

Fertility, mortality, and migration all influence the size of a society's population.
Poorer countries tend to grow almost completely from internal causes (for example,
high birth rates due to the absence of reliable contraception), while richer countries
tend to grow from both internal causes and migration. Demographers determine a
population's natural growth rate by subtracting the crude death rate from the
crude birth rate. The world's lowgrowth nations tend to be more industrialized, such
as the United States and Europe. The highgrowth countries tend to be less
industrialized, such as Africa and Latin America.
Population composition

Demographers also take an interest in the composition of a society's population. For

example, they study the gender ratio (or sex ratio), which is the number of males
per 100 females in a population. The sex ratio in the United States is about 93 males
for every 100 females. In most areas of the world, the gender ratio is less than 100
because females normally outlive men. Yet in some cultures that practice female
infanticide, such as among the Yanomamo, the ratio can reach well above 100.
Malthusian theory

The field of demography arose two centuries ago in response to the population
growth of that day. Thomas Robert Malthus (17661834), English economist and
clergyman, argued that increases in population, if left unchecked, would eventually
result in social chaos. Malthus predicted that the human population would continue
to increase exponentially (1, 2, 4, 16, 256 ) until the situation is out of control. He
also warned that food production would only increase arithmetically (1, 2, 3, 4, 5 )
because of limitations in available farmland. To say the least, Malthus provided a
disturbing vision of the future that included massive, global starvation as a
consequence of unrestrained population growth.

As it turned out, Malthus' predictions were mistaken because he failed to account for
technological advancements and ingenuity that would increase agricultural and farm
production, not to mention the increasing development and acceptance of birth
control methods. Yet Malthus' forebodings do not lack merit. As noted by the New
Malthusians, a group of demographers, assets such as habitable and fertile land,
clean air, and fresh water are finite resources. And with medical advances increasing
fertility and lowering death rates, the global population continues to grow
exponentially with no end in sight.

Demographic transition theory

Replacing Malthus' ideas today, demographic transition theory defines population
growth in an alternating pattern of stability, rapid growth, and then stability again.
This theory proposes a threestage model of growth.
Stage 1: Stable population growth. In this stage, birth and death rates
roughly balance each other. Most societies throughout history have stayed at
this stage.

Stage 2: Rapid population growth. Death rates fall sharply while birth
rates remain high in Stage 2. Most poor countries today fit into this stage.
Malthus formed his ideas during one such highgrowth period.

Stage 3: Stable population growth. In this stage, fertility falls because

high living standards make raising children expensive. Women working outside
the home also favor smaller families, brought about by widespread use of birth
control. Death rates drop because of technological advances in medicine. With
low birth rates and death rates, the population only grows slowly, if at all. It
may, in fact, witness population shrinkage, in which deaths outnumber
births in a society.

Stage 3 suggests that technology holds the key to population control. Instead of the
outofcontrol population explosions that Malthus predicted, demographic transition
theory claims that technology will ultimately control population growth and ensure
enough food for all.

Population control: The importance of family planning

Historically, many groups and societies have discouraged contraception (the

prevention of conception, or birth control) to assure survival of its members and
humanity as a whole. Certain religious groups strongly disapprove of sexual activity
that does not culminate in coitus and the possibility of conception. Other groups
place little importance on the matter of contraception. The Yanomamo of South
America, for instance, harbor little or no concept of contraception. Instead, they
parent as many children as possible, and then kill off those they view as the
undesirable, such as some females and deformed infants.

Modern medicine has spread throughout different parts of the world, and people of
all ages now live longer, causing the world's population to explode in growth. In fact,
at five billion today, the world's population doubles, on average, every 35 years,
with most of this growth occurring in developing countries. Given this population
crisis, certain governments, like that of China, regulate the number of births allowed
per household.
Besides the issue of controlling overpopulation, other benefits to practicing
contraception exist. For example, a young couple may want to postpone having
children until their finances improve. Or an unmarried, sexually active teenager may
wish to finish her education or get married before starting a family, thereby reducing
her chances of eventually relying on the government for financial support.

Family planning also plays an important role in protecting the physical health of both
mother and child. The older or younger a woman is, and the closer together she
bears children (that is, more frequently than every two years), the greater the risk
of pregnancy and birth complications, early infant mortality, and maternal death. For
example, women over age 40 or under age 19 have an increased risk of bearing a
child of low birth weight, and thus a variety of birth defects and even outright death.
Estimates say that approximately one million teenage women in the United States
become pregnant each year.

http://www.cliffsnotes.com/sciences/sociology/population-and-urbanization/population-
and-demographic-variables
5 components:
Macam-macam komponen Demografi:
Kelahiran/ Fertilitas
Kematian/ Mortalitas
Perkawinan
Migrasi
Mobilitas Sosial
Adapun variable utama demografi ada 3, yaitu:
Kelahiran/ Fertilitas

Fertilitas sebagai istilah demografi diartikan sebagai hasil reproduksi yang nyata dari
seorang wanita atau kelompok wanita. Dengan kata lain fertilitas ini menyangkut
banyaknya bayi yang lahir hidup. Fertilitas mencakup peranan kelahiran pada perubahan
penduduk.
Istilah fertilitas adalah sama dengan kelahiran hidup (live birth), yaitu terlepasnya bayi
dari rahim seorang perempuan dengan ada tanda-tanda kehidupan; misalnya berteriak,
bernafas, jantung berdenyut, dan sebagainya (Mantra, 2003:145).

Kematian/ Mortalitas

Menurut PBB dan WHO, kematian adalah hilangnya semua tanda-tanda kehidupan
secara permanen yang bisa terjadi setiap saat setelah kelahiran hidup. Still birth dan
keguguran tidak termasuk dalam pengertian kematian. Perubahan jumlah kematian (naik
turunnya) di tiap daerah tidaklah sama, tergantung pada berbagai macam faktor
keadaan. Besar kecilnya tingkat kematian ini dapat merupakan petunjuk atau indikator
bagi tingkat kesehatan dan tingkat kehidupan penduduk di suatu wilayah.

Migrasi

Mobilitas diartikan dengan perpindahan. Mobilitas penduduk mempunyai pengertian

pergerakan penduduk dari satu daerah ke daerah lain. Baik untuk sementara maupun untuk
jangka waktu yang lama atau menetap seperti mobilitas ulang-alik (komunitas) dan migrasi.
 Mobilitas penduduk adalah perpindahan penduduk dari suatu tempat ke tempat yang
lain.Dalam ilmu sosiologi mobilitas dibagi menjadi dua yaitu mobilitas vertikal dan mobilitas
horizontal. Mobilitas vertikal adalah perpindahan/ perubahan status sosial, misalnya dari
orang miskin menjadi kaya. Mobilitas horizontal adalah perpindahan penduduk secara
geografis. Mobilitas horizontal disebut juga dengan migrasi. Migrasi penduduk adalah
perpindahan penduduk dari tempat ke satu tempat yang lain melewati batas administratif
dengan tujuan menetap.

http://digilib.its.ac.id/public/ITS-NonDegree-16186-Chapter1-pdf.pdf

5. How to get demographic data? Data resources?

1. Sensus Penduduk

Keseluruhan proses pengumpulan (collecting), menghimpun dan menyusun (compiling)

dan menerbitkan data demografi, ekonomi dan sosial yang menyangkut semua orang
pada waktu tertentu di suatu negara atau wilayah tertentu.

Perhitungan penduduk dalam sensus dapat dilakukan dengan

sistem de jure :mencacah menurut tempat tinggal tetap

Sistem de facto :pencacahan dilakukan dimana seseorang ditemukan pada saat sensus
Kombinasi keduanya

2. Registrasi penduduk

Mencatat kejadian2 kependudukan yg terjadi setiap saat, spt kelahiran, kematian,

mobilitas penduduk keluar dan mobilitas penduduk masuk, baik itu permanent maupun
non permanent.
Catatan mobilitas penduduk permanent lebih lengkap dibanding dengan mobilitas
penduduk non permanent. Orang2 yg pindah domisili harus mempunyai surat pindah dari
daerah asal, selanjutnya disampaikan pada kantor kelurahan/desa dimana mereka akan
menetap.

3. Survey Penduduk

Data mobilitas penduduk bisa juga didapatkan dari penelitian survey yg dilaksanakan
disuatu wilayah. Biasanya yg diteliti aspek2 ekonomi, proses, dan dampak moobilitas
terhadap tingkat ekonomi rumah tangga daerah asal. Ada 2 pendekatan dalam
mendapatkan data tentang mobilitas penduduk di suatu daerah, yaitu pendekatan
 retrospektif adalah menanyakan riwayat mobilitas penduduk yg dilaksanakan oleh pelaku
mobilitas yg telah kembali ke daerah asal serta pendekatan prospektif.
Demografi Umum, Prof. Ida Bagoes Mantra,Ph.D, hal 188

6. What are the factors that affect the components of dermographic?

Contraceptive Prevalence
Demographers attribute much of the recent decline in global fertility to improved
access to and use of family planning information and methods. More than half of all married
women in developing countries now use
family planning, compared to 10% in the 1960s. Across the developing world, use of modern
methods of contraception ranges from less than 8% of married women in Western and Central
Africa to 65% in South America. The highest contraceptive prevalence rate in the world is in
Northern Europe, where 75% of married women are currently using a modern method of
family planning.
Despite these gains in availability, contraceptive services are still difficult to obtain,
unaffordable, or of poor quality in many countries. Approximately 201 million married
women worldwide who would prefer to delay or avoid having another child are not using
modern methods of contraception (Alan Guttmaches Institute and UNFPA, 2003). Unmet
need is highest in sub-Saharan Africa, where 46% of women at risk of unintended pregnancy
are not using any contraceptive, presumably reflecting lack of access or other barriers.
Meanwhile, in developing countries, the number of women in their childbearing years is
increasing by about 22 million women a year. For fertility rates to continue their global
decline, family planning services will have to expand rapidly to keep up with both population
growth and rising demand.

Mortality from HIV/AIDS and Other InfectiousDiseases

Like no other disease, AIDS debilitates and kills people in their most productive
years. Ninety percent of HIV-associated fatalities occur among people of working age, who
leave behind large numbers of orphans currently 11 million in sub-Saharan Africa alone
with few means of supporting themselves. A projected 1018% of the working-age population
will be lost in the next 5 years in nine central and southern African countries, primarily due to
AIDS-related illnesses (Cincotta et al., 2003).
High rates of AIDS mortality lead to a bottle-shaped population age structure, with
very high proportions of young people and many fewer older adults. As birth rates remain
high while people of reproductive age die from AIDS-related causes, the share of young
dependants to each working-age adult rises dramatically. Without significant advances in HIV
prevention or in access to life-saving drugs in poor countries, AIDS-related mortality rates
could increase significantly. UN population projections suggest that some countries will
experience lower population growth rates from AIDS, but high fertility rates mean that
population size in these countries is likely to still increase significantly.
Population growth also threatens global health through increased vulnerability to
other infectious diseases. A growing population size living in and moving to and from densely
populated areas creates expanded opportunities for disease to spread and intensify. At the
country and community levels, governments often lack the resources to improve sanitation
and public health services at the same rate that populations are increasing. At the household
level, evidence from demographic surveys suggests that children born after several siblings
tend to receive fewer immunizations and less medical attention than children born earlier or in
smaller families (Rutstein, 2005). The cumulative effect of all these influences is a greater risk
of disease with higher birthrates and rapid population growth.

Gender Equity
 When women are able to determine the size of their families, fertility rates are
generally lower than in settings where womens status is poor. In particular, there is a strong
correlation between female school enrollment rates and fertility trends. In most countries,
girls who are educated, especially those who attend secondary school, are more likely to delay
marriage and childbearing. Women with some secondary education commonly have between
two and four fewer children than those who have never been to school (Conly, 1998).
Early childbearing often limits educational and employment opportunities for women.
When women have an education, their children tend to be healthier; in India, a baby born to a
woman who has attended primary school is twice as likely to survive as one born to a mother
with no education. By delaying marriage and childbearing, educating girls also helps lengthen
the span between generations and slow the momentum driving future population growth.

Migration
The movement of people from one country to another emigration in the case of those
who leave their native country and immigration to describe the increase in a countrys
foreign-born population continues to increase in both scale and frequency. International
migration has doubled in the past 25 years, with about 200 million people 3% of the worlds
population today living in a country different from the one in which they were born.
Approximately 60% of international migrants have chosen to live in developed countries, but
migration within developing countries remains significant. Asia has three times as many
international migrants as any other region of the developing world.
Although there are many reasons for increases in migration, the dramatic population
growth of the past few decades has been a primary impetus. This has led, with a 15- to 20-
year time lag, to the rapid growth of the worlds labor force, especially among the young
adults who make up the age group most likely to migrate. Tens of millions of people are
added to the labor force each year, and the search for decent jobs is the leading reason people
migrate. In addition deteriorating environmental conditions related to population growth
water and food shortages, for example, or human-induced climate change can also spur
large movements of population across international borders. Lower rates of population growth
can help ease the pressures to migrate and improve the underlying conditions that force many
people to seek a better life elsewhere.

Government Policies
Throughout history, government regulations on fertility either by promoting or restricting
childbirth have directly affected population dynamics. Authoritarian regimes have pursued
pro-natalist policies to increase the size of a population for militaristic, nationalist, and/or
economic reasons. A few countries, including the worlds most populous China and India
have placed direct and indirect regulations on their citizens fertility as a means of reducing
population growth.
All state regulation of fertility, whether pro-natalist or intended to slow population
growth, has been strongly criticized by human rights advocates. The importance of individual
freedom of choice concerning fertility and reproductive health was outlined and agreed upon
by 19 countries in 1994 at the International Conference on Population and Development.
Worldwide, more than one-fifth of all pregnancies are terminated annually. The
prevalence of abortion is one indication of the high level of unintended pregnancy worldwide.
Political disagreements over the highly contentious issue of abortion have in recent years
hampered the funding of population and reproductive health programs in both the United
States and in many developing countries.
As in the case of abortion, government policy related to international migration
cannot really be called population policy, since in no cases is it expressly designed to remedy
perceived deficiencies in national population trends. Nonetheless, government policies on
migration and the process itself do influence the pace and distribution of population change,
and it remains possible that some countries with especially low fertility may design future
migration policies specifically to slow either the aging or the decline of their populations, or
both.
 EPIDEMILOGY AND DEMOGRAPHY IN PUBLIC HEALTH, 368-374

1. The birth (natal)

The driving factors for birth (pronatalitas)
o The notion that many children a lot of luck.
o The nature of human beings who want to continue the descent.
o Marriage early age (younger age).
o There is the assumption that a tad higher value, when compared with girls, so for
those families who do not have the boys will try to have a boy.
o The existence of a high evaluation of the child, so for families who do not have
children will seek how to make having children.
Birth inhibiting factor (antinatalitas)
o The existence of Family Planning (FP).
o Progress in the field of science and medicine.
o The government regulation of child allowance for civil servants restrictions.
o The existence of laws restricting marriage and arranged marriage age.
o Delays age of marriage for reasons of economy, education and careers.
o There is a feeling of shame when having many children.
2. Death (Mortality)
The driving factors for mortality (promortalitas)
o The presence of diseases such as dengue fever, avian flu, and so on.
o The existence of natural disasters such as earthquakes, tsunamis, floods and so
on.
o Health and nutrition of low population.
o The existence of war, accidents, and so on.
o High level of pollution so that the environment is not healthy.
Factors inhibiting death (antimortalitas)
o The level of public health and nutrition are already good.
o State in a safe condition and there was no fighting.
o The existence of scientific and technological advances in the medical field so that
various diseases can be treated.
o The existence of a strong religious understanding by the public.
3. Migration
Buku TEKNIK DEMOGRAFI, MUNIR dan BUDIARTO, FKUI

7. Why MMR used to measure global health indicator ?

Sejak tahun 1988 Depkes RI fokus programnya pada peningkatan Kesehatan dan
kesejahteraan Ibu dan Anak. Maternal Mortality Rate (MMR) atau Angka Kematian
Ibu adalah salah satu Indikator kesehatan Wanita,tapi juga menggambarkan tingkat
akses,integritas dan efektivitas sektor kesehatan.Sehingga MMR sering dipakai
untuk menggambarkan tingkat kesejahteraan suatu negara. Beberapa faktor yg
diperkirakan menjadi masalah tersebut, termasuk kualitas Pelayanan Kesehatan oleh
tenaga kesehatan yang tidak adekuat dan buruk,berdampak pada lebih dari 200.000
kematian ibu setiap tahunnya. Status dan pendidikan wanita yang rendah utamanya
di daerah pedesaan sehingga memberikan dampak negatif pada kematian maternal.
Adanya keterbatasan akses pada pertolongan persalinan oleh tenaga terampil dan
sistem rujukan yang tidak memadai mengakibatkan hampir 40% wanita melahirkan
 tanpa pertolongan tenaga kesehatan trampil dan 70% tidak mendapatkan pelayanan
pasca persalinan dalam waktu 6 minggu setelah persalinan.
Dalam rangka mewujudkan kesehatan Ibu dan Anak,maka WHO, UNFPA,
UNICEF, World Bank, dan lain-lain menempatkan Kesehatan Ibu menjadi agenda
utama pada upaya peningkatan kesehatan masyarakat dalam skala internasional
dimana titik beratnya pada mobilitas Sumber Daya Manusia yang berkualitas di
dukung dengan Pelayanan yang berdasarkan Evidence-based.
Untuk menurunkan AKI/MMR menjadi 125/100.000 kelahiran hidup maka harus di
dukung dengan berbagai sumber daya, seperti sumber daya manusia, sarana dan
prasarana, anggaran yang cukup dan dukungan kebijakan oleh para pengambil
keputusan pada level top leader dan harus komitmen dengan kebijakan tersebut.
Langkah tersebut sudah di dukung dengan membangun Puskesmas di setiap
kecamatan dan penempatan minimal1(satu) orang tenaga dokter dan dokter gigi
serta beberapa tenaga bidan dan perawat di setiap puskesmas. Dari segi penyebaran
sarana fisik pelayanan kesehatan khususnya Puskesmas boleh dikatakan sudah
merata di seluruh pelosok indonesia,tetapi kondisi ini tidak di ikuti sepenuhnya
dengan peningkatan mutu pelayanan kesehatan dan keterjangkauan oleh seluruh
lapisan masyarakat.

http://dinkes.sulbarprov.go.id/index.php?
option=com_content&view=article&id=50:penilaiantenagakesehatanteladanprovinsis
ulawesibarat&catid=35:sekretariat&Itemid=53

What are the challenges to prevent of MMR?

Interventions to Reduce Maternal Mortality

Evidence-based interventions for reducing maternal mortality strategically target the main
causes of death (Figure 1). The consensus among international organizations is that quality
care requires services throughout a womans reproductive life. These organizations design
programs that focus on improving outcome during the intrapartum/postpartum period,
offering family planning services, providing safe abortions, and increasing antepartum care.

Intrapartum and Postpartum Period

Interventions focused on the intrapartum period have been implemented. For example, efforts
to address or treat postpartum hemorrhage and infection at health-care facilities have been
made by providing oxytocics and antibiotics, manual removal of the placenta, blood
transfusion, and if needed, hysterectomy.4 Health-care facilities are more familiar with
eclampsia prevention treatment using anticonvulsants. Instrumented vaginal deliveries are
encouraged and basic surgical equipment for cesarean deliveries is required.5 Because most
women in developing nations deliver at home, organizations such as the World Health
Organization, Institute of Medicine, World Bank, and the Lancets Maternal Survival Steering
Group prioritize professional skilled birth attendance at delivery.6 Studies have determined a
direct relationship between having skilled birth attendants during labor and decreased
maternal mortality ratios (Figure 2). Programs designed for home-based deliveries
recommend skilled birth attendants carry emergency first aid kits, and easy access to health
facilities if labor becomes dysfunctional.

Family Planning

Donors, UN organizations, and governments have made great strides in promoting family
planning and contraceptive use. Due to this effort, millions of maternal deaths have been
prevented. However, contraceptive use in many resource-poor nations is still not at optimal
levels. The overall lack of contraceptive access rate is 50%, with a low of 4% in Europe and
high of 57% in countries in Africa.7 This lack of access to contraception leads to unwanted
pregnancies, increased demand for abortions, and deaths related to unsafe abortions.
Measuring maternal mortality requires that the mother be pregnant, so prevention of
pregnancy makes it difficult to quantify how many deaths have been prevented. Nevertheless,
if unwanted pregnancies are prevented, data suggest that between 25% to 40% of maternal
deaths could be eliminated.4

Safe Abortions

Given the high rate of maternal death due to unwanted pregnancies, some countries, such as
South Africa, Tunisia, and Cape Verde, are recognizing the importance of developing wider
access to safe abortions. In countries such as Mali, Sudan, Benin, and Burkina Faso, where
legally, politically, and culturally access to abortion creates internal dispute, governments
have allowed women access to safe abortions under specific circumstances, such as in cases
of rape or fetal malformation. There are still some countries where womens access to safe
abortions is nonexistent and medical communities face resistance when advocating policy
change. Women who seek help may be ostracized.8

Antepartum Care

Following the Safe Motherhood Conference, a key action point was improving antepartum
care in order to identify high-risk pregnancies. Although it seems logical that it should be a
core component to maternal health, program evaluations demonstrate that antepartum care
shows little impact on reducing maternal mortality.5 Screening tests during the antenatal
period were found to be inefficient and to overwhelm referral health centers.4 Also, women
offered free antenatal care did not necessarily use it because they felt that they were well and
did not need to see a healthcare provider.9 This does not disprove the need for antepartum
care or its importance, but rather indicates that resources might be allocated elsewhere to
make a greater impact on maternal mortality.
3 delay :

Maternal mortality in resource-poor nations has been attributed to the 3 delays: delay in deciding
to seek care, delay in reaching care in time, and delay in receiving adequate treatment. The first
delay is on the part of the mother, family, or community not recognizing a life-threatening condition.
Because most deaths occur during labor or in the first 24 hours postpartum, recognizing an
emergency is not easy. Most births occur at home with unskilled attendants, and it takes skill to
predict or prevent bad outcomes and medical knowledge to diagnose and immediately act on
complications. By the time the lay midwife or family realizes there is a problem, it is too late.

The second delay is in reaching a health-care facility, and may be due to road conditions, lack of
transportation, or location. Many villages do not have access to paved roads and many families do
not have access to vehicles. Public transportation (or animals) may be the main transportation
method. This means it may take hours or days to reach a health-care facility. Women with life-
threatening conditions often do not make it to the facility in time.

The third delay occurs at the healthcare facility. Upon arrival, women receive inadequate care or
inefficient treatment. Resource-poor nations with fragile health-care facilities may not have the
technology or services necessary to provide critical care to hemorrhaging, infected, or seizing
patients. Omissions in treatment, incorrect treatment, and a lack of supplies contribute to maternal
mortality.

Nawal M Nour, MD, MPH. An introduction to maternal mortality.US National Library of Medicine
National Institute of Health. 2008. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505173/

8. What are the goals of MDGs?

The Eight Millennium Development Goals are:

1. to eradicate extreme poverty and hunger;
2. to achieve universal primary education;
3. to promote gender equality and empower women;
4. to reduce child mortality;
5. to improve maternal health;
6. to combat HIV/AIDS, malaria, and other diseases;
7. to ensure environmental sustainability; and
8. to develop a global partnership for development.
http://www.who.int/topics/millennium_development_goals/about/en/index.html
9. What are the actions to reach MDGs goals?
 Eradicate extrem poverty and hunger

Halve the proportion of people who suffer from hunger

Globally, there is evidence of improvements in children's nutritional status. The percentage of underweight
children is estimated to have declined from 25% in 1990 to 15% in 2013. Stunting in children under five years
of age has decreased globally from 40% to 25% over the same period.
In Asia, the number of stunted children is estimated to have more than halved between 1990 (192 million) and
2013 (91 million). However, in Africa the number of stunted children increased from 46 million in 1990 to 59
 million in 2013. Despite these overall gains, around 99 million of children under five were estimated to be
underweight in 2013.

WHO activities
WHO is working with countries:
to build capacity in using standard growth assessment tools;
to assist in planning and conducting nutritional surveys;
to support the analysis and interpretation of nutritional survey results;
to support the development of nutritional surveillance systems;
to strengthen and support the development of nutritional surveillance systems;
to develop national nutrition plans and policies; and
to strengthen the delivery of essential nutrition actions.

Achieve universal primary education

Despite impressive strides forward at the start of the decade, progress in reducing the number of children out
of school has slackened considerably.
High dropout rates remain a major impediment to universal primary education. An estimated 50 per cent of
out-of-school children of primary school age live in conflict-affected areas.

Promote gender equality and empower women

The MDG 3 indicators track key elements of women's social, economic and political participation and guide
the building of gender-equitable societies.
All the MDGs influence health, and health influences all the MDGs. The MDGs are inter-dependent. For
example, better health enables children to learn and adults to earn. Gender equality is essential to the
achievement of better health.

Target 3.A. Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all
levels of education by no later than 2015
Girls' education is critically linked to self-determination, improved health, social and economic status as well
as positive health outcomes for the mother and the child. Yet, girls still account for 55% of the out-of-school
population.
Maternal deaths and pregnancy-related conditions cannot be eliminated without the empowerment of women.
Maternal mortality is the number one cause of death for adolescents 1519 years old and in many countries,
sexual and reproductive health services tend to focus exclusively on married women and ignore the needs of
adolescents and unmarried women.
Empowerment of women, including ensuring access to health information and control of resources such as
money, is important for achieving gender equality and health equity. However, the ratio of female-to-male
earned income is well below parity in all countries for which data are available.
Up to one in three women worldwide will experience violence at some point in her life, which can lead to
unwanted pregnancy and abortion, among other things.
WHO key working areas
In partnership with Member States and others, WHO:
furthers the empowerment of women, especially as it contributes to health;
supports the prevention of and response to gender-based violence;
promotes women's participation and leadership, especially in the health sector;
 defines ways in which men can be engaged to promote gender equality and to contribute more to
their own health and that of their families and communities;
builds the capacity of WHO and its Member States to identify gender equality-related gaps; and
provides support for gender-responsive policies and programmes.

Reduce child mortality

Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
6.6 million children under five died in 2012. Almost 75% of all child deaths are attributable to just six
conditions: neonatal causes, pneumonia, diarrhoea, malaria, measles, and HIV/AIDS. The aim is to further cut
child mortality by two thirds by 2015 from the 1990 level.
Reaching the MDG on reducing child mortality will require universal coverage with key effective, affordable
interventions: care for newborns and their mothers; infant and young child feeding; vaccines; prevention and
case management of pneumonia, diarrhoea and sepsis; malaria control; and prevention and care of
HIV/AIDS. In countries with high mortality, these interventions could reduce the number of deaths by more
than half.
WHO strategies
To deliver these interventions, WHO promotes four main strategies:
appropriate home care and timely treatment of complications for newborns;
integrated management of childhood illness for all children under five years old;
expanded programme on immunization;
infant and young child feeding.
These child health strategies are complemented by interventions for maternal health, in particular, skilled care
during pregnancy and childbirth.

Improve maternal health

Target 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Target 5.B. Achieve, by 2015, universal access to reproductive health

Globally, an estimated 289 000 women died during pregnancy and childbirth in 2013, a decline of 45% from
levels in 1990. Most of them died because they had no access to skilled routine and emergency care. Since
1990, some countries in Asia and Northern Africa have more than halved maternal mortality.
There has also been progress in sub-Saharan Africa. But here, unlike in the developed world where a
woman's life time risk of dying during pregnancy and childbirth is 1 in 3700, the risk of maternal death is very
high at 1 in 38. Increasing numbers of women are now seeking care during childbirth in health facilities and
therefore it is important to ensure that quality of care provided is optimal.
Globally, over 10% of all women do not have access to or are not using an effective method of contraception.
It is estimated that satisfying the unmet need for family planning alone could cut the number of maternal
deaths by almost a third.
The UN Secretary-General's Global Strategy for Women's and Children's Health aims to prevent 33 million
unwanted pregnancies between 2011 and 2015 and to save the lives of women who are at risk of dying of
complications during pregnancy and childbirth, including unsafe abortion.
WHO key working areas
Strengthening health systems and promoting interventions focusing on policies and strategies that
work, are pro-poor and cost-effective.
Monitoring and evaluating the burden of maternal and newborn ill-health and its impact on societies
and their socio-economic development.
 Building effective partnerships in order to make best use of scarce resources and minimize
duplication in efforts to improve maternal and newborn health.
Advocating for investment in maternal and newborn health by highlighting the social and economic
benefits and by emphasizing maternal mortality as human rights and equity issue.
Coordinating research, with wide-scale application, that focuses on improving maternal health in
pregnancy and during and after childbirth.

Combat HIV/AIDS, malaria and other diseases.

Target 6A. Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Target 6B. Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it.

HIV/AIDS
At the end of 2013, 35 million people were living with HIV. That same year, some 2.1 million people became
newly infected. Close to 12 million people in low- and middle-income countries were receiving antiretroviral
therapy at the end of 2013. More than two-thirds of new HIV infections are in sub-Saharan Africa.
As the world moves towards reaching the target date for the Millennium Development Goals, WHO is working
with countries to implement the Global Health Sector Strategy on HIV/AIDS for 2011-2015. WHO has identified
six operational objectives for 20142015 to support countries most efficiently in moving towards the global HIV
targets. These are to support:
strategic use of ARVs for HIV treatment and prevention;
eliminating HIV in children and expanding access to paediatric treatment;
an improved health sector response to HIV among key populations;
further innovation in HIV prevention, diagnosis, treatment and care;
strategic information for effective scale up; and
stronger links between HIV and related health outcomes.

Target 6C. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

Malaria
Around the world, 3.2 billion people are at risk of contracting malaria. In 2013, an estimated 198 million cases
occurred, and the disease killed approx. 584 000 people most of them children under five in Africa. On
average, malaria kills a child every minute.
WHO-recommended strategies to tackle malaria include:
prevention with long-lasting insecticidal nets and indoor residual spraying;
diagnostic testing and treatment with quality-assured anti-malarial medicines;
preventive therapies for infants, children and pregnant women;
tracking every malaria case in a surveillance system;
scaling up the fight against emerging drug and insecticide resistance.
In a 2007 resolution, the World Health Assembly called for a 75% reduction in the global malaria burden by
2015.

Tuberculosis
There were an estimated 9 million new cases of TB in 2013(including 1.1 million cases among people with
HIV) and an estimated 1.5 million deaths (including 360 000 people with HIV), making this disease one of the
world's biggest infectious killers.
The world is on track to reach the MDG target of reversing TB incidence by 2015. However incidence is falling
very slowly. WHO is working to combat the epidemic through the Stop TB Strategy. This six-point strategy
seeks to:
 1. pursue high-quality DOTS expansion and enhancement; DOTS is a five-point package to
a. secure political commitment, with adequate and sustained financing
b. ensure early case detection, and diagnosis through quality-assured bacteriology
c. provide standardized treatment with supervision and patient support
d. ensure effective drug supply and management and
e. monitor and evaluate performance and impact;
2. address TB/HIV, multidrug-resistant TB and the needs of poor and vulnerable populations;
3. contribute to health system strengthening based on primary health care;
4. engage all care providers;
5. empower people with TB, and communities through partnership; and
6. enable and promote research.

Ensure environmental sustein ability

Target 7C: By 2015, halve the proportion of people without sustainable access to safe drinking water and
basic sanitation

Improved drinking water

By the end of 2011, 89% of the world population used an improved drinking-water source, and 55% had a
piped supply on premises. This left an estimated 768 million people without improved sources for drinking
water, of whom 185 million relied on surface water for their daily needs.
Improved sanitation
Some 2.4 billion people one-third of the worlds population will remain without access to improved
sanitation in 2015, according to a joint WHO/UNICEF report "Progress on sanitation and drinking-water".
The "2013 update", warns that, at the current rate of progress, the 2015 Millennium Development Goal (MDG)
target of halving the proportion of the 1990 population without sanitation will be missed by 8% or half a
billion people.
WHO activities
WHO is working with countries and other UN agencies to:
monitor progress towards the drinking water and sanitation target, through updated and refined
estimates in collaboration with UNICEF in the Joint Monitoring Programme for Water Supply and
Sanitation (JMP);
report on trends in policy, institutional and finance issues related to sanitation and drinking-water
through the UN-Water Global Annual Assessment of Sanitation and Drinking-Water (GLAAS);
develop guidelines on quality of drinking-water, safe use of wastewater in agriculture and
aquaculture, and management of safe recreational waters;
provide guidance, capacity strengthening and good practice models to countries on drinking-water
supply risk management, water resource management systems, and safe re-use of wastewater;
manage networks of specialized issues including: small community water supply management; for the
promotion and dissemination of information on household water treatment and safe storage; and for
drinking-water regulators;
assess needs and ensuring safe drinking water and sanitation to health facilities and vulnerable
groups during emergencies and natural disasters.

Develop a global partnership for development.

Target 8E. In cooperation with pharmaceutical companies, provide access to affordable essential medicines
in developing countries
 Although nearly all countries publish an essential medicines list, the availability of medicines at public-health
facilities is often poor. Surveys conducted in over 50 low- and middle-income countries indicate that the
availability of selected generic medicines at health facilities was only 38% in the public sector and 64% in the
private sector. Lack of medicines in the public sector forces patients to purchase medicines privately.
In the private sector, generic medicines cost on average six times more than their international reference
price, while originator brands are generally even more expensive. High prices often make medicines
unaffordable, with common treatments costing the lowest paid government worker several days' wages.
WHO's activities
WHO has developed global indicators for availability, price and affordability of essential medicines.
WHO/Health Action International pricing survey methodology used in over 50 countries has increased
awareness of the pricing, affordability and availability of branded and generic medicines in the public
and private sectors.
WHO provides pharmaceutical manufacturers with the information they need to produce quality, safe,
effective essential medicines to address leading public health concerns.
WHO offers essential capacity building and quality assurance monitoring for over 250 medicines to
treat millions of patients with HIV/AIDS, tuberculosis and malaria, and with reproductive health needs
in developing countries.

http://www.who.int/topics/millennium_development_goals/en/
20 ways the WHO helps countries reach the MDGs :
a. Increase access to safe, effective, quality medicine and diagnostic.
b. Prevent people from falling into poverty because they have to pay for health care
themselves.
c. Develop strategies to address critical shortages of health workers.
d. Improve the availability, quality and analysis of health information.
e. Ensure that sick children get quality health care within 24 hours of becoming ill, and
provide safe, effective medicines for children.
f. Continue to immunize children against measles and other vaccine-preventable diseases,
and introduce new, life-saving vaccines such as those against pneumonia and rotavirus
diarrhoea.
g. Reduce deaths from pneumonia and diarrhoea, which together kill almost 3 million
children under 5 years old each year.
h. Assess childrens growth according to a global standart to identify cases of malnutrition in
time to intervene effectively, and develop national nutrition plans and policies for infants
and children.
i. Improve essential antenatal and postnatal care for all mothers and babies, providing
integrated services to address all maternity needs, and supporting care in the home.
j. Increase access to sexual and reproductive health services, including family planning,
infertility services, prevention and treatment of sexually transmitted infection and skilled
care before during and after pregnancy and childbirth.
k. Address gender inequalities that limit the ability of women and girls to protect their health
and provide a full range of health services women of all ages whoever they are and
wherever they live.
l. Reduce AIDS death, improve quality of life for people living with HIV and reduce the
number of new infection by providing comprehensive prevention, treatment and care
services.
m. Promote a comprehensive approach to preventing mother to child transmission of HIV
that integrates a full range of antenatal and postnatal services.
n. Reach national targets improving TB control, surveilence and care.
 o. Increase survival rates of people with both TB and HIV.
p. Improve local availability of effective antimalaria medicine and rapid diagnostic test.
q. Curb the spread of malaria by promoting the use of insectiside-treated nets and integrated
vector management-better water, sanitation and irrigation management.
r. Monitor AIDS, TB and malaria prevention, treatment and care coverage via WHOs
annual status reports and maternal and child health with the countdown to 2015 reports
that tract progress on MDGs 4 and 5.
s. Prevent, eliminate or eradicate neglected tropical disease (NTD)
t. Improve the availability of safe drinking water and sanitation.

20 ways the WHO helps countries reach the MDGs.World Health Organization.
http://www.who.int/topics/millennium_development_goals/20ways_mdgs_20100517_en.pdf?
ua=1

10. What are the indicators of mortality?

 http://www.depkes.go.id/en/downloads/profil/merauke/drajatkesehatan.txt

1. Angka Kematian Kasar (AKK) atau Crude Death Rate (CDR).

2. Angka Kematian Bayi (AKB)

3. Angka Kematian Balita (AKBa 0-5 tahun)

4. Angka Kematian Anak (AKA 1-5 tahun)

5. Angka Kematian IBU (AKI)

6. Umur Harapan Hidup (UHH) atau Life Expectancy

Angka Kematian Kasar (AKK) atau Crude Death Rate (CDR)

Konsep Dasar

Angka Kematian Kasar (Crude Death Rate) adalah angka yang menunjukkan berapa
besarnya kematian yang terjadi pada suatu tahun tertentu untuk setiap 1000 penduduk.
Angka ini disebut kasar sebab belum memperhitungkan umur penduduk. Penduduk tua
mempunyai risiko kematian yang lebih tinggi dibandingkan dengan penduduk yang masih
muda.

Kegunaan

Angka Kematian Kasar adalah indikator sederhana yang tidak memperhitungkan

pengaruh umur penduduk. Tetapi jika tidak ada indikator kematian yang lain angka ini
berguna untuk memberikan gambaran mengenai keadaan kesejahteraan penduduk pada
suatu tahun yang bersangkutan. Apabila dikurangkan dari Angka kelahiran Kasar akan
menjadi dasar perhitungan pertumbuhan penduduk alamiah.

Definisi

Angka Kematian Kasar adalah angka yang menunjukkan banyaknya kematian per 1000
penduduk pada pertengahan tahun tertentu, di suatu wilayah tertentu.

Rumus :

CDR= xK

D
CDR =Crude Death Rate ( Angka Kematian Kasar)

D = Jumlah kematian (death) pada tahun tertentu

P = Jumlah Penduduk pada pertengahan tahun tertentu

K = Bilangan konstan 1000

Angka Kematian Bayi

Konsep Dasar

Kematian bayi adalah kematian yang terjadi antara saat setelah bayi lahir sampai bayi
belum berusia tepat satu tahun. Banyak faktor yang dikaitkan dengan kematian bayi.
Secara garis besar, dari sisi penyebabnya,kematian bayi ada dua macam yaitu
endogen dan eksogen.
Kematian bayi endogen atau yang umum disebut dengan kematian neonatal; adalah
kematian bayi yang terjadi pada bulan pertama setelah dilahirkan, dan umumnya
disebabkan oleh faktor-faktor yang dibawa anak sejak lahir, yang diperoleh dari orang
tuanya pada saat konsepsi atau didapat selama kehamilan. Kematian bayi eksogen
atau kematian post neo-natal, adalah kematian bayi yang terjadi setelah usia satu
bulan sampai menjelang usia satu tahun yang disebabkan oleh faktor-faktor yang
bertalian dengan pengaruh lingkungan luar.
Kegunaan angka kematian bayi dan balita

Angka Kematian Bayi menggambarkan keadaan sosial ekonomi masyarakat dimana

angka kematian itu dihitung. Kegunaan Angka Kematian Bayi untuk pengembangan
perencanaan berbeda antara kematian neo-natal dan kematian bayi yang lain. Karena
kematian neo-natal disebabkan oleh faktor endogen yang berhubungan dengan
kehamilan maka program-program untuk mengurangi angka kematian neo-natal
adalah yang bersangkutan dengan program pelayanan kesehatan Ibu hamil, misalnya
program pemberian pil besi dan suntikan anti tetanus.
Sedangkan Angka Kematian Post-NeoNatal dan Angka Kematian Anak serta Kematian
Balita dapat berguna untuk mengembangkan program imunisasi, serta program-
program pencegahan penyakit menular terutama pada anak-anak, program
penerangan tentang gisi dan pemberian makanan sehat untuk anak dibawah usia 5
tahun.

Angka Kematian Anak

Konsep

Yang dimaksud dengan anak (1-4 tahun) disini adalah penduduk yang berusia satu
sampai menjelang 5 tahun atau tepatnya 1 sampai dengan 4 tahun 11 bulan 29 hari.
Angka Kematian Anak mencerminkan kondisi kesehatan lingkungan yang langsung
mempengaruhi tingkat kesehatan anak. Angka Kematian Anak akan tinggi bila terjadi
keadaan salah gizi atau gizi buruk, kebersihan diri dan kebersihan yang buruk,
tingginya prevalensi penyakit menular pada anak, atau kecelakaan yang terjadi di
dalam atau di sekitar rumah (Budi Utomo, 1985).

Definisi

Angka Kematian Anak adalah jumlah kematian anak berusia 1-4 tahun selama satu
tahun tertentu per 1000 anak umur yang sama pada pertengahan tahun itu. Jadi
Angka Kematian Anak tidak termasuk kematian bayi.
Angka Kematian Balita

Konsep

Balita atau bawah lima tahun adalah semua anak termasuk bayi yang baru lahir, yang
berusia 0 sampai menjelang tepat 5 tahun (4 tahun, 11 bulan, 29 hari). Pada
umumnya ditulis dengan notasi 0-4 tahun.

Definisi

Angka Kematian Balita adalah jumlah kematian anak berusia 0-4 tahun selama satu
tahun tertentu per 1000 anak umur yang sama pada pertengahan tahun itu
(termasuk kematian bayi).

Indikator Kematian IBU

Konsep

Kematian ibu adalah kematian perempuan pada saat hamil atau kematian dalam
kurun waktu 42 hari sejak terminasi kehamilan tanpa memandang lamanya
kehamilan atau tempat persalinan, yakni kematian yang disebabkan karena
kehamilannya atau pengelolaannya, tetapi bukan karena sebab-sebab lain seperti
kecelakaan, terjatuh dll (Budi, Utomo. 1985).

Definisi

Angka Kematian Ibu (AKI) adalah banyaknya kematian perempuan pada saat hamil
atau selama 42 hari sejak terminasi kehamilan tanpa memandang lama dan tempat
persalinan, yang disebabkan karena kehamilannya atau pengelolaannya, dan bukan
karena sebab-sebab lain, per 100.000 kelahiran hidup.

Kegunaan

Informasi mengenai tingginya MMR akan bermanfaat untuk pengembangan program

peningkatan kesehatan reproduksi, terutama pelayanan kehamilan dan membuat
 kehamilan yang aman bebas risiko tinggi (making pregnancy safer), program
peningkatan jumlah kelahiran yang dibantu oleh tenaga kesehatan, penyiapan sistim
rujukan dalam penanganan komplikasi kehamilan, penyiapan keluarga dan suami
siaga dalam menyongsong kelahiran, yang semuanya bertujuan untuk mengurangi
Angka Kematian Ibu dan meningkatkan derajat kesehatan reproduksi.

Keterbatasan

AKI sulit dihitung, karena untuk menghitung AKI dibutuhkan sampel yang besar,
mengingat kejadian kematian ibu adalah kasus yang jarang. Oleh karena itu kita
umumnya dignakan AKI yang telah tersedia untuk keperluan pengembangan
perencanaan program.

Angka Harapan Hidup

Konsep Dasar

Keberhasilan program kesehatan dan program pembangunan sosial ekonomi pada

umumnya dapat dilihat dari peningkatan usia harapan hidup penduduk dari suatu
negara. Meningkatnya perawatan kesehatan 14 melalui Puskesmas, meningkatnya
daya beli masyarakat akan meningkatkan akses terhadap pelayanan kesehatan,
mampu memenuhi kebutuhan gizi dan kalori, mampu mempunyai pendidikan yang
lebih baik sehingga memperoleh pekerjaan dengan penghasilan yang memadai, yang
pada gilirannya akan meningkatkan derajat kesehatan masyarakat dan
memperpanjang usia harapan hidupnya.

Definisi

Angka Harapan Hidup pada suatu umur x adalah rata-rata tahun hidup yang masih
akan dijalani oleh seseorang yang telah berhasil mencapai umur x, pada suatu tahun
tertentu, dalam situasi mortalitas yang berlaku di lingkungan masyarakatnya.
Angka Harapan Hidup Saat Lahir adalah rata-rata tahun hidup yang akan dijalani oleh
bayi yang baru lahir pada suatu tahun tertentu.

Kegunaan
 Angka Harapan Hidup merupakan alat untuk mengevaluasi kinerja pemerintah dalam
meningkatkan kesejahteraan penduduk pada umumnya, dan meningkatkan derajat
kesehatan pada khususnya. Angka Harapan Hidup yang rendah di suatu daerah harus
diikuti dengan program pembangunan kesehatan, dan program sosial lainnya
termasuk kesehatan lingkungan, kecukupan gisi dan kalori termasuk program
pemberantasan kemiskinan.

Cara Menghitung

Idealnya Angka Harapan Hidup dihitung berdasarkan Angka Kematian Menurut Umur
(Age Specific Death Rate/ASDR) yang datanya diperoleh dari catatan registrasi
kematian secara bertahun-tahun sehingga dimungkinkan dibuat Tabel Kematian.
Tetapi karena sistem registrasi penduduk di Indonesia belum berjalan dengan baik
maka untuk menghitung Angka Harapan Hidup digunakan cara tidak langsung
dengan program Mortpak Lite.

Mortalitas, oleh PARDOMUAN B.M.SIANIPAR

11. What the effects from increase of mortality?

Masalah kependudukan :

kependududkan dalam jumlah yang besar

pertumbuhan penduduk cukup tinggi
penyebaran penduduk yang tidak merata
sifat sosial ekonomi yang mencerminkan keterbelakangan.
Ekspansif, yaitu tingginya tingkat kelahiran dan menurunnya tingkat kematian.
Migrasi penduduk dari desa ke kota terus meningkat dan terjadi arus tenaga kerja terlatih
dari daerah terbelakang.
Pertumbuhan angkatan kerja/ tenaga kerja yang pesat yang kurang dapat diimbangi oleh
kemampuan penciptaan kesempatan kerja sehingga terjadi pengangguaran terbuka yang
terakumulasi setiap tahunnya.
Buku Demografi Umum Prof. Ida Bagoes Mantra, Ph.D

1) Bidang ekonomi
2) Aspek pemenuhan gizi
3) Aspek pendidikan
4) Lapangan kerja

Buku Pelayanan keluarga berencana, Anggraini dan Martini

 Solusi dari masalah kependudukan
Menekan laju pertumbuhan penduduk melalui program KB
Melaksanakan transmigrasi
Menetapkan UU perkawinan yang didalamnya terdapat batasan usia pernikahan
Mempermudah dan meningkatkan pelayanan dalam bidang pendidikan
Mendorong masyarakat utnuk menjadi orang tua asuh bagi anak yang kurang mampu
Menyediakan beasiswa berprestasi, khususnya bagi anak yang tidak mampu
Membuka jalur pendidikan nonformal (kursus)
Melengkapi sarana dan prasarana sosial masyarakat hinga ke pelosok desa sehingga
kebutuhan sosek masyarakat desa dapat terpenuhi.
Buku Pelayanan keluarga berencana, Anggraini dan Martini

12. Apakah di setiap negara maju dan berkembang MDGs sama?

SAMA NO. 8
13. What are the causes of death?
Cause-Specific Mortality And Morbidity
Out of every 10 deaths worldwide, 6 are due to noncommunicable conditions; 3 to
communicable, reproductive or nutritional conditions; and 1 to injuries. Many developing countries
have mortality patterns that reflect high levels of infectious diseases and the risk of death during
pregnancy and childbirth, in addition to the cancers, cardiovascular diseases and chronic respiratory
diseases that account for most deaths in the developed world.

Years of life lost (YLL) take into account the age at which deaths occur by giving greater
weight to deaths occurring at younger ages and lower weight to deaths occurring at older ages.
Globally, communicable diseases account for 51% of years of life lost, with noncommunicable
diseases accounting for 34% and injuries for 14%. However, there are large variations across regions.
In high-income countries, communicable diseases account for only 8% of years of life lost, compared
with 68% in low-income countries.

This table includes country-specific results from death registration, health system
information systems, incidence and prevalence surveys, survey and census data on child deaths,
sibling deaths and deaths in the household as well as studies on deaths due to HIV/AIDS and conflict.
There are considerable uncertainty ranges for many countries due to limitations in data availability,
quality and timeliness. Uncertainty in estimated all-cause mortality for 2007 ranges from 1% for
high-income countries to 1520% for sub-Saharan Africa, reflecting a large difference in data
availability. Uncertainty ranges are generally larger for deaths from specific causes. For example, the
relative uncertainty for deaths from ischaemic heart disease ranges from around 12% for high-
income countries to 2535% for subSaharan Africa.

For any given disease, incidence is the number of new cases each year, prevalence is the
number of people with the disease at a point in time, and mortality is the number who die from that
cause each year.

While global tuberculosis prevalence is estimated to have decreased between 1990 and 2007
due to improved treatment, incidence has increased over this period, mainly due to a resurgence in
the WHO African and European Regions. These numbers are surrounded by much uncertainty due to
an absence of population-based data on the rates of clinically confirmed tuberculosis cases. In most
countries, tuberculosis case-detection estimates are based primarily on the number of people with
pulmonary tuberculosis who present to health facilities; those who do not reach health facilities are
not included in the calculations.

The prevalence of HIV infection is highest in the African Region. Two thirds of the global total
of 33 million people with HIV live in this region. In countries with generalized epidemics, HIV
prevalence is estimated from antenatal clinic attendees and population-based surveys. In
concentrated and low level epidemics (where HIV prevalence in pregnant women is below 1%),
estimates are derived from surveillance of populations with high-risk behaviours.

World Health Organization Statistic 2009.

http://www.who.int/whosis/whostat/EN_WHS09_Table2.pdf

Factors that affect mortality:

a. Marital status
Mortality resident married turned out to be lower than the unmarried, and the greater the
difference for men than women. It is sebagain caused by factors that marriage usually
requires healthy people, as well as differences in habits and living conditions.
b. Residence
Mortality in rural areas are generally lower than in urban areas, but now the difference is
already reduced. Some diseases attack the hot climate areas, and there is also a hit cold
spots; consequently differences in climate may also be a factor in the cause of death. For this
reason also in the same residence mortality can fluctuate seasonally.
c. Way of life
In general if the social conditions of the more satisfying (measured in terms of the quality of
housing, sanitation, health care, etc.), the death rate will decline. Living habits, such as
smoking, eating and drinking, may also affect mortality.
d. Genetic factors
Some of the diseases it can be transmitted from one generation to another generation; thus
there are also some specific reason why the family should try to extend life. Although the
number of such diseases is not so much, and its influence on mortality is felt uncertain. Thus
this adult offspring comparative difference is considered insignificant.
Teknik Demografi, PT Bina Aksara

1. Karena Degenerasi
melemah/berkurangnya fungsi biologis dari
tubuh/organ
tidak spesifik menjadi penyebab kematian
prosesnya lambat
berhubungan dengan penyakit-penyakit kronis,
seperti:
penyakit jantung dan kardiovaskuler,
kanker,
stroke,
arteriosklerosis/pengapuran,
DM,
sirosis hati,
tukak lambung/duodenum (maag).
2. Karena Penyakit Infeksi Menular
3. Karena Kondisi Lingkungan Sosial dan
Ekonomi
http://staff.blog.ui.ac.id/r-suti/files/2010/10/dem4a-mort.pdf