Transcript Document 7731720

CHP400:
Community Health Program - lI
KJBKBKLJBKLB
Mohamed M. B. Alnoor
D E M O G R A P H Y
Definition
Demography is the science that studies
human population.
Demography: The study of populations,
especially with reference to size and density,
fertility, mortality, growth, age distribution,
migration, and vital statistics, and the
interaction of all these with social and
economic conditions.
(Oxford Dictionary)
D E M O G R A P H Y
Elements of Demography:
Three main elements of demography:
1- Size of population (census)
2- Composition
3- Distribution
D E M O G R A P H Y
Elements of Demography:
Size of population
Number of all persons in the community.


Census
Estimated population
D E M O G R A P H Y
Elements of Demography:
Census
A process of enumeration of all persons in
the community.
•
Time: 10 Years
•
Procedures: Enumeration
Demographic
Socioeconomic
• Inter-census years: Estimation
D E M O G R A P H Y
Elements of Demography:
Census
Types
1- De Jure
Counting individuals at their legal
residence regardless of their physical
presence.
• Factual
• Expensive
D E M O G R A P H Y
Elements of Demography:
Census
Types
2- De Facto
Counting individuals wherever they
actually are on day of census. regardless
of their physical presence.
• Easier
• Economic
D E M O G R A P H Y
Elements of Demography:
Estimation
Methods
1- Natural increase
(Number of live births – Number of deaths)
added to last census population.
(No migration in or out.)
D E M O G R A P H Y
Elements of Demography:
Estimation
Methods
2- Arithmetic mean
Two consecutive censuses
Mean annual increase
Example:
1410: 30000,
1420: 40000
Annual increase = 10000/10 =1000
1429
40000 + (9 X 1000) = 49000
D E M O G R A P H Y
Elements of Demography:
Estimation
Methods
3- Geometric method
Most accurate
Special equation
(compound interest formula)
D E M O G R A P H Y
Elements of Demography:
Estimation
Methods
3- Geometric method
Compound Interest Formula
P = principal amount (the initial amount you borrow
or deposit)
r = annual rate of interest (as a decimal)
t = number of years the amount is deposited or
borrowed for.
A = amount of money accumulated after n years,
including interest.
n = number of times the interest is compounded per
year
D E M O G R A P H Y
Last Saudi Census data
(2010/1431)
Population (total) 27,163,977
Saudi 18.707.576
Males 9,527,173 (50.9%)
Females 9,180,403 (49.1%)
Non-Saudi 8,429,401
Males 5,932,974 (70.4%)
Females 2,496,427 (29.6%)
D E M O G R A P H Y
Saudi Population Pyramid ( 2006)
THE AGE-SEX COMPOSTION OF POPULATIONS
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
THE AGE-SEX COMPOSTION OF POPULATIONS
Population pyramid is the graphical presentation of the
age and sex composition of a population of an area
or country at a point in time.
The shape of the pyramid reflects the major influences
of births and deaths, in addition to any changes due
to migration.
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
THE AGE-SEX COMPOSTION OF POPULATIONS





Sex
 Males are shown on the left side of the pyramid
 Females on the right
Age
 young persons at the bottom, and
 the elderly at the top.
The pyramid consists of a series of bars, each drawn
proportionately to represent the percentage contribution of each
age - sex group
(often in five-year groupings) to the total population
The total area of the bars represents 100 per cent of the
population.
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
THE AGE-SEX COMPOSTION OF POPULATIONS
1.
2.
3.
4.
Sex ratio: Percentage of males and females.
Age structure:
 Base denotes births (broad or narrow base)
 Apex denotes elderly
Mortality and emigration:
Shape of sides (sloping or steep).
Life expectancy: (Average number of years that a
newborn is expected to live if current mortality
rates continue to apply)
Height of the pyramid and shape of the apex.
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
THE AGE-SEX COMPOSTION OF POPULATIONS
5.
Median Age: (lower or higher)
The point in the vertical axis of age through which passes
the horizontal line that divides the surface area of the
pyramid into two equal parts (50%) younger and 50%
older).
The position of this defined point is inversely related to the
width of the base.
The wider the base, (i.e. the higher the birth rate), the lower
the median age and vice versa.
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
THE AGE-SEX COMPOSTION OF POPULATIONS
6. Dependency Ratio

The dependency ratio describes the relation between
the potentially self-supporting portion of the
population and

the dependent portions at the extreme of age (below
15 and above 65).
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
THE AGE-SEX COMPOSTION OF POPULATIONS
Types of Dependency Ratio



Young dependency: Proportion of population
below 15 years of age.
Old dependency: Proportion of population
above 65 years of age.
Total dependency: Proportion of population
below 15 years of age plus the proportion of
population above 65 years of age.
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
Types of Dependency Ratio
Young dependency ratio =
Old dependency ratio =
Population below 15 years
Population 15 – 64years
Population above 65 years
Population 15 – 64years
X 100
X 100
Total dependency ratio
Population below 15 years + those above 65 years
X 100
=
Population 15 – 64years
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
How can you calculate the dependency ratio.
Use the figures below to calculate the
dependency ratio for Britain in 1990.

0 - 14 = 11.052 million

15 - 64 = 37.690 million

65 + = 9.156 million



Young dep=0.29
Old dep=0.24
Total dep=0.53
D E M O G R A P H Y
Population Pyramid
The importance of the population pyramids
Use the figures below to calculate the
dependency ratio for Egypt in 1990.

0 - 14 = 22.04 million

15 - 64 = 32.66 million

65 +
= 1.99 million



Young dep=0.67
Old dep=0.06
Total dep=0.73
D E M O G R A P H Y
Population Dynamics
Objectives
By the end of this lecture you will be able to:
1.
List factors affecting Population Dynamics
2.
Define and Calculate Fertility rates
3.
Define and calculate Mortality Rates
4.
Define and mention types of migration
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics

Fertility (births),

Mortality (deaths)

Migration.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)

Crude Birth Rate (CBR)

General Fertility Rate (GFR)

Age Specific Fertility Rate

Total Fertility Rate (TFR)

Gross Reproduction Rate (GRR)
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)
Crude Birth Rate (CBR)
Is the simplest indicator of fertility.
It is defined as:
the number of live births per 1000 mid-year
population in a given year and locality.
Total number of live births in a certain year and locality
CBR=
X 1000
Estimated midyear population ( same year and locality)
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)
Crude Birth Rate (CBR)
Example
In a certain Country in Year 2000,
live births: 325,000; population: 13,000,000
Total number of live births in a certain year and locality
CBR=
X 1000
Estimated midyear population ( same year and locality)
=… Live Births/ 1000 population in a year.
Crude birth rate= 325,000/13,000,000 x 1000
= 25 live births per 1000 population per year
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)
General Fertility Rate (GFR)
The number of live births in a calendar year,
divided by the number of women in the child
bearing ages 15-49 at mid year, multiplied by 1000
Total number of live births in a certain year and locality
X 1000
GFR=
Midyear reproductive female population( aged 15 - 49)
= …Live birth/1000 female population aged 15-49.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)
General Fertility Rate (GFR)
Example
In a certain Country in Year 2000,
Number of live births: 325,000;
Number of women 15 – 49 : 2,600,000
Calculate GFR
Total number of live births in a certain year and locality
X 1000
GFR=
Midyear reproductive female population(aged 15 - 49)
General fertility rate= 325,000 /2,600,000 x 1000
= 125 live births per 1000 women ages 15-49 per year
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)
Age Specific Fertility Rate
Total number of live births born by females in a
specific age group in a certain year and locality
X 1000
=
Female population in the same specific age group
= …Live births/1000 female population in specified age group.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)


Age Specific Fertility Rate
Adolescent fertility rate
It is the age-specific fertility rate for women aged 15-19.
The annual number of births to women aged 15-19 years
per 1,000 women in that age group.
Total number of live births born by females
(15-19) age group in a certain year and locality
X 1000
=
Female population in the (15-19) age group
= …Live births/1000 females in 15-19 age group.
Calculation of ASFR is important because early pregnancy is
related to higher risks of maternal and infant mortality
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)
Total Fertility Rate (TFR)



TFR represents the average number of births that
would be born to a woman throughout her
reproductive period.
It is expressed as children per woman.
In Saudi Arabia, Total fertility rate (per woman) 3.5
(2006)
• In developing countries the TFR is over 6.0 children
per woman.
• In most developed countries the TFR is under 2.0.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Fertility (Natality Rates)
Gross Reproduction Rate (GRR)

GRR represents the average number of
female births that would be born to a woman
throughout her reproductive period.

It is expressed as daughters per woman.

It predicts the fertility of the next generation
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
A mortality rate is a measure of the frequency
of occurrence of death in a defined population
during a specified period of time.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Crude Death Rate (CDR)
The crude death rate is the mortality rate
from all causes of death
for an entire population
Crude Death Rate 
Total number of deaths in a certain year and locality
Estimated mid  year population (Same year and locality)
X 1000
= … Deaths/1000 individual in the specified year and locality.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Crude Death Rate (CDR)
Example
In a certain Country in Year 2000,
Total population: 13,000,000;
Deaths: 65,000
Crude Death Rate = 65,000/13,000,000 x 1000
= 5 deaths per 1000 per year
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates

•
•

An age-specific mortality rate is a mortality rate limited to a
particular age group.
The numerator is the number of deaths in that age group
The denominator is the number of persons in that age group
in the population.
Examples of age-specific mortality rates are infant, neonatal,
post-neonatal and under 5-years mortality rates.
Number of persons dying in a certain
age and a certain year and area
Age specific death rate 
x 1000
Total number in the same age group
in the same year and same area
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Example
In a certain Country in Year 2000,
For age group: 25-34 yrs: population = 5,000,000; and
deaths = 20,000 within same age group
Age-specific death rate=
20,000/5,000,000 x 1000
= 4 deaths per 1000 population per year for age group 25-34
Number of persons dying in a certain
age and a certain year and area
Age specific death rate 
x 1000
Total number in the same age group
in the same year and same area
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Infant Mortality Rate (per 1 000 live births)
Infant mortality rate is the probability of a child born in
a specific year or period dying before reaching the
age of one
In Saudi Arabia (2006)
• Both sexes 21.0 • Females 20.0 • Males 22.0
Infant Mortality Rate =
Total number of deaths from
zero up to less than one year during
a year in a given locality
Total number of live births
in the same year and locality
X 1000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Infant Mortality Rate
In a certain Country in Year 2000,
Number of live births: 325,000;
infant deaths: 2,750
Infant Mortality Rate = 2,750/325,000 x 1000
= 8.5 infant deaths per 1000 live births per year
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Infant Mortality Rate
Infant deaths per 1000 live births
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Neonatal Mortality Rate (per 1 000 live births)
The number of deaths of neonates (infants <28 days of
age) in a calendar year, divided by number of live
births in that year, multiplied by 1000.
In Saudi Arabia (2004):
 Neonatal Mortality Rate =11 /1000 live births
Neonatal Mortality Rate =
Total number of deaths from
zero up to less than 28 days during
a year in a given locality
Total number of live births
in the same year and locality
X 1000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Neonatal Mortality Rate
In a certain Country in Year 2000,
Number of deaths at <28 days:2,250;
number of live births: 325,000
Calculate Neonatal mortality rate?
Neonatal mortality rate= 2,250/325,000x1000
= 6.9 neonatal deaths per 1000 live births
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Neonatal Mortality Rate
Causes of Neonatal mortality





Birth defects (leading cause )
Prematurity / low birth weight (LBW) (the
second leading)
Sudden infant death syndrome.
Maternal pregnancy complications.
Respiratory distress syndrome
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Post - neonatal Mortality Rate (per 1 000 live births)
Post-neonatal mortality rate is the number of deaths
among infants from 28 days up to 1 year of age during a
given time period divided by the number of live births
during the same time period multiplied by 1,000
Post - neonatal
Mortality Rate
=
Total number of deaths from
28 days up to less than one year
during a year in a given locality
Total number of live births
in the same year and locality
X 1000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Early
Neonatal
Late
Neonatal
Neonatal
Birth (0 day)
Post-Neonatal
28 day
I
n
f
1year
a
n
c
y
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Still birth Ratio (per 1 000 live births)
Number of fetal deaths of > 28 weeks gestation
in certain year and locality per 1000 live births
Still birth Ratio
=
Number of foetal deaths from
> 28 weeks of gestation in a year
and in a given locality
Number of live births
in the same year and locality
X 1000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Still birth Ratio
In a certain Country in Year 2000,
Still births: 1,520;
live births: 325,000
Still births ratio = 1,520/325,000 x 1000
= 4.69 fetal deaths per 1000 live births
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates


Age-specific Mortality Rates
Still birth Rate (per 1 000 total births)
For international comparison purposes,
stillbirths are defined as third trimester fetal
deaths (> 1000 grams or > 28 weeks).
Total births : Total births is defined as the sum
of live births and still births.
Still birth Rate
Number of still birth during a
year and in a given locality
=
Total birth (live births + still birth)
in the same year and locality
X 1000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Still birth Rate (per 1 000 total births)
In a certain Country in Year 2000,
Still births: 1,520;
live births: 325,000
Still births rate = 1,520 /(325,000+ 1,520) x 1000
= 4.66 fetal deaths per 1000 total births
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Still birth Rate (per 1 000 total births)




Placental problems.: Placental abruption due to preeclampsia and smoking.
Birth defects: between 5 and 10 percent of stillborn
babies have chromosomal abnormalities.
Growth restriction: Small for gestational age.
Infections. Bacterial infections occur between 24 and
27 weeks of gestation. They are an important cause of
fetal deaths.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Perinatal Mortality Rate (per 1 000 total births)
It is expressed as the sum number of still births and
early neonatal deaths (less than 7 days of life) per
1000 total births (still births plus live births).
PMR =
No. of still birth + No. of early neonatal deaths in a
year and in a given locality
Total birth (live births + still birth) in the same year
and locality
X 1000
It is the best indicator of MCH services
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Perinatal Mortality Rate (per 1 000 total births)
In a certain Country in Year 2000,
Still birth (Fetal deaths):1,520;
early neonatal deaths: 1,925;
live births: 325,000
Perinatal mortality rate=
(1,520 + 1,925)/(325000+1,520) x 1000
= 10.6 perinatal deaths per 1000 Total births
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Under - 5 Mortality Rate (per 1 000 live births)
Under-five mortality rate is the probability of a
child born in a specific year or period dying
before reaching the age of five.
In KSA (2006): deaths per 1 000 live births:
• both sexes 26 • female 23 • male 28
The under – 5
=
mortality Rate
Total number of deaths among
children under-5 years of age
during a year and in a given locality
Total number of live births
in the same year and locality
X 1000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Current Situation
Under - 5 Mortality



Each year nearly 11 million children die before
the age of five, 30,000 every day, largely from
preventable causes.
41% of these deaths occur in Africa, which
has only 10 % of the world’s under-five
population.
33% of all child deaths occur in the first month
of life.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Age-specific Mortality Rates
Adult Mortality Rate (per 1 000 population)
Probability that a 15 year old person will die
before reaching his/her 60th birthday.
In Saudi Arabia (2006)
• both sexes 178 • female 136 • male 205
Total number of persons dying
between age 15 – 60 during
a year and in a given locality
Adult mortality
=
Rate
Total number of population between
15 – 60 in the same year and locality
X 1000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Maternal Mortality Ratio (per 100 000 live births)
The death of a woman
 while pregnant or irrespective of
the duration or
 within 42 days of
end of pregnancy site of pregnancy
from any cause
• related to
• or aggravated by
 pregnancy
 or its management
but not from accidental or incidental causes.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Maternal Mortality Ratio (per 100 000 live births)
The number of maternal deaths per 100 000 live
births during a specified time period (usually 1 year).
In Saudi Arabia (2005) MMR= 18/100 000 live birth
Number of Maternal deaths assigned
to causes related to pregnancy
in a given year and locality
X 100 000
Maternal mortality ratio =
Total number of live births
in the same year and locality
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Maternal Mortality Ratio (per 100 000 live births)
Rheumatic Heart Disease
Abruptio Placenta
Amniotic Fluid Embolism
Placenta Previa
Puerperal Sepsis
Uterine Atony
Eclampsia
Hypertension in
Pregnancy
Postpartum
Hemorrhage
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Maternal Mortality Ratio (per 100 000 live births)
In a certain Country in Year 2000,
number of deaths due to maternal causes: 51,
Number of live births: 325,000
Calculate Maternal mortality ratio
Maternal mortality ratio = 51/325,000 x 100,000
= 15.7maternal deaths per 100,000 live births per year
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Cause-specific mortality rate
The number of deaths attributed to a specific
cause divided by the population at the midpoint
of the time period multiply by 100,000.
Cause – specific
Mortality Rate
Deaths of a specific cause
in a given year and locality
=
Estimated mid – year population
in the same year and locality
X 100 000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Cause-specific mortality rate
Example of Cause-specific mortality rates
Deaths due to tuberculosis (per 100 000 population)
In Saudi Arabia (2006) =5.0
Specific death rate
due to tuberculosis =
No. of deaths of tuberculosis
in a given year and locality
Estimated mid – year population
in the same year and locality
X 100 000
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Cause-specific mortality rate
In a certain Country in Year 2000,
Total population: 13,000,000;
Deaths due to (cause) accidents: 5,200
Cause-specific death rate= 5,200/13,000,000 x 100,000
= 40 accidental deaths per 100,000 population per year
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Proportionate mortality rate
Defined as the number of deaths assigned to a
specific cause in a calendar year, divided by the
total number of deaths in that year, the quotient
multiplied by 100
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Proportionate mortality rate
In a certain Country in Year 2000,
total deaths from all causes: 65 000;
deaths from cancer: 29 250
Cancer
Proportionate = 29 250/ 65 000 x 100
mortality rate
= 45% of total deaths per year are
from cancer
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Mortality Rates
Case Fatality Rate (Death to case ratio)
Case Fatality
=
Rate ( CFR )
Total number of deaths from
a certain disease
in a year in a given locality
Total number of cases having
the same disease
in the same year and locality
X 100
It reflects severity (virulence) of diseases
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
S U M M A R Y
Rates with denominators as total population
(Mid-year population):
• Crude mortality rate (Crude Death rate)
• Crude Birth rate (Crude Birth rate)
• Cause-specific mortality rate
Rates whose denominators are live births:
•
•
•
•
•
•
Infant mortality rate
Neonatal mortality rate
Postneonatal mortality rate
Under-Five mortality rate
Maternal mortality ratio
Still birth ratio
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Migration
Migration is the movement of populations across a
specified boundary for the purpose of residing.
Migration is the change of residence of a person or
group of persons for better life and higher
standard of living.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Migration

The terms immigration and emigration are used
to refer to moves between countries (international
migration).

The parallel terms: in-migration and out-migration
are used for internal movement between
different areas within a country (internal migration).
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Migration
Types of migration
Internal migration
It is the movement within the boundaries of a
given country.
Examples of internal migration:
1 - Rural - Urban migration.
2 - Movement of nomads.
3 - Movement of temporary and seasonal nature.
4 - Movement between and within urban areas.
D E M O G R A P H Y
Population Dynamics
Factors affecting population Dynamics
Migration
Types of migration
a) Permanent migration:
eg. Arabs to the U.S.A., Australia and Canada.
b) Temporary migration:
The intent is return to the motherland after few years.
e.g. Professionals and laborers to Gulf Countries.
In many countries, the effect of migration is
minimal when compared to fertility and mortality.