In 1938, the year before the outbreak of the Second world War, the countries with the largest populations were China, the Soviet Union, and the United States, although the United Kingdom had the largest overall population when it's colonies, dominions, and metropole are combined. Alongside France, these were the five Allied "Great Powers" that emerged victorious from the Second World War. The Axis Powers in the war were led by Germany and Japan in their respective theaters, and their smaller populations were decisive factors in their defeat. Manpower as a resource In the context of the Second World War, a country or territory's population played a vital role in its ability to wage war on such a large scale. Not only were armies able to call upon their people to fight in the war and replenish their forces, but war economies were also dependent on their workforce being able to meet the agricultural, manufacturing, and logistical demands of the war. For the Axis powers, invasions and the annexation of territories were often motivated by the fact that it granted access to valuable resources that would further their own war effort - millions of people living in occupied territories were then forced to gather these resources, or forcibly transported to work in manufacturing in other Axis territories. Similarly, colonial powers were able to use resources taken from their territories to supply their armies, however this often had devastating consequences for the regions from which food was redirected, contributing to numerous food shortages and famines across Africa, Asia, and Europe. Men from annexed or colonized territories were also used in the armies of the war's Great Powers, and in the Axis armies especially. This meant that soldiers often fought alongside their former-enemies. Aftermath The Second World War was the costliest in human history, resulting in the deaths of between 70 and 85 million people. Due to the turmoil and destruction of the war, accurate records for death tolls generally do not exist, therefore pre-war populations (in combination with other statistics), are used to estimate death tolls. The Soviet Union is believed to have lost the largest amount of people during the war, suffering approximately 24 million fatalities by 1945, followed by China at around 20 million people. The Soviet death toll is equal to approximately 14 percent of its pre-war population - the countries with the highest relative death tolls in the war are found in Eastern Europe, due to the intensity of the conflict and the systematic genocide committed in the region during the war.

In 2022, India overtook China as the world's most populous country and now has almost 1.46 billion people. China now has the second-largest population in the world, still with just over 1.4 billion inhabitants, however, its population went into decline in 2023. Global population As of 2025, the world's population stands at almost 8.2 billion people and is expected to reach around 10.3 billion people in the 2080s, when it will then go into decline. Due to improved healthcare, sanitation, and general living conditions, the global population continues to increase; mortality rates (particularly among infants and children) are decreasing and the median age of the world population has steadily increased for decades. As for the average life expectancy in industrial and developing countries, the gap has narrowed significantly since the mid-20th century. Asia is the most populous continent on Earth; 11 of the 20 largest countries are located there. It leads the ranking of the global population by continent by far, reporting four times as many inhabitants as Africa. The Demographic Transition The population explosion over the past two centuries is part of a phenomenon known as the demographic transition. Simply put, this transition results from a drastic reduction in mortality, which then leads to a reduction in fertility, and increase in life expectancy; this interim period where death rates are low and birth rates are high is where this population explosion occurs, and population growth can remain high as the population ages. In today's most-developed countries, the transition generally began with industrialization in the 1800s, and growth has now stabilized as birth and mortality rates have re-balanced. Across less-developed countries, the stage of this transition varies; for example, China is at a later stage than India, which accounts for the change in which country is more populous - understanding the demographic transition can help understand the reason why China's population is now going into decline. The least-developed region is Sub-Saharan Africa, where fertility rates remain close to pre-industrial levels in some countries. As these countries transition, they will undergo significant rates of population growth

This dataset provides values for POPULATION reported in several countries. The data includes current values, previous releases, historical highs and record lows, release frequency, reported unit and currency.

Historical chart and dataset showing World population growth rate by year from 1961 to 2023.

The earliest point where scientists can make reasonable estimates for the population of global regions is around 10,000 years before the Common Era (or 12,000 years ago). Estimates suggest that Asia has consistently been the most populated continent, and the least populated continent has generally been Oceania (although it was more heavily populated than areas such as North America in very early years). Population growth was very slow, but an increase can be observed between most of the given time periods. There were, however, dips in population due to pandemics, the most notable of these being the impact of plague in Eurasia in the 14th century, and the impact of European contact with the indigenous populations of the Americas after 1492, where it took almost four centuries for the population of Latin America to return to its pre-1500 level. The world's population first reached one billion people in 1803, which also coincided with a spike in population growth, due to the onset of the demographic transition. This wave of growth first spread across the most industrially developed countries in the 19th century, and the correlation between demographic development and industrial or economic maturity continued until today, with Africa being the final major region to begin its transition in the late-1900s.

The Global Population Count Grid Time Series Estimates provide a back-cast time series of population grids based on the year 2000 population grid from SEDAC's Global Rural-Urban Mapping Project, Version 1 (GRUMPv1) data set. The grids were created by using rates of population change between decades from the coarser resolution History Database of the Global Environment (HYDE) database to back-cast the GRUMPv1 population count grids. Mismatches between the spatial extent of the HYDE calculated rates and GRUMPv1 population data were resolved via infilling rate cells based on a focal mean of values. Finally, the grids were adjusted so that the population totals for each country equaled the UN World Population Prospects (2008 Revision) estimates for that country for the respective year (1970, 1980, 1990, and 2000). These data do not represent census observations for the years prior to 2000, and therefore can at best be thought of as estimations of the populations in given locations. The population grids are consistent internally within the time series, but are not recommended for use in creating longer time series with any other population grids, including GRUMPv1, Gridded Population of the World, Version 4 (GPWv4), or non-SEDAC developed population grids. These population grids served as an input to SEDAC's Global Estimated Net Migration Grids by Decade: 1970-2000 data set.

This dataset provides values for POPULATION reported in several countries. The data includes current values, previous releases, historical highs and record lows, release frequency, reported unit and currency.

Among the total migrant stock worldwide, i.e., the total number of people living outside their country of origin, the highest number came from India, with nearly ** million as of 2020. This is relatively unsurprising as it is also the most populous country in the world. Mexico, Russia, and China followed in the places behind. There are varying reasons for people to emigrate from their country of origin, from poverty and unemployment to war and persecution.

Countries used for estimates of bilateral international migration flows based on methods presented in Abel & Cohen (2019) and Abel & Cohen (2022). The countries in the list correspond to both the estimates in the Figshare collection for the total bilateral international migration flow estimates and the Figshare collection for the sex-specifc bilateral international migration flow estimates.Version DetailsThe countries in the list are for the update of estimates of international migration flows based on the most recent published UN DESA International Migrant Stock (IMS2024) and World Population Prospects (WPP2024) data inputs. Refer to the version history for previous country list files based on older versions of the IMS and WPP data.

In 2023, it is estimated that the BRICS countries have a combined population of 3.25 billion people, which is over 40 percent of the world population. The majority of these people live in either China or India, which have a population of more than 1.4 billion people each, while the other three countries have a combined population of just under 420 million. Comparisons Although the BRICS countries are considered the five foremost emerging economies, they are all at various stages of the demographic transition and have different levels of population development. For all of modern history, China has had the world's largest population, but rapidly dropping fertility and birth rates in recent decades mean that its population growth has slowed. In contrast, India's population growth remains much higher, and it is expected to overtake China in the next few years to become the world's most populous country. The fastest growing population in the BRICS bloc, however, is that of South Africa, which is at the earliest stage of demographic development. Russia, is the only BRICS country whose population is currently in decline, and it has been experiencing a consistent natural decline for most of the past three decades. Growing populations = growing opportunities Between 2000 and 2026, the populations of the BRICS countries is expected to grow by 625 million people, and the majority of this will be in India and China. As the economies of these two countries grow, so too do living standards and disposable income; this has resulted in the world's two most populous countries emerging as two of the most profitable markets in the world. China, sometimes called the "world's factory" has seen a rapid growth in its middle class, increased potential of its low-tier market, and its manufacturing sector is now transitioning to the production of more technologically advanced and high-end goods to meet its domestic demand.

On March 10, 2023, the Johns Hopkins Coronavirus Resource Center ceased its collecting and reporting of global COVID-19 data. For updated cases, deaths, and vaccine data please visit: World Health Organization (WHO)For more information, visit the Johns Hopkins Coronavirus Resource Center.COVID-19 Trends MethodologyOur goal is to analyze and present daily updates in the form of recent trends within countries, states, or counties during the COVID-19 global pandemic. The data we are analyzing is taken directly from the Johns Hopkins University Coronavirus COVID-19 Global Cases Dashboard, though we expect to be one day behind the dashboard’s live feeds to allow for quality assurance of the data.DOI: https://doi.org/10.6084/m9.figshare.125529863/7/2022 - Adjusted the rate of active cases calculation in the U.S. to reflect the rates of serious and severe cases due nearly completely dominant Omicron variant.6/24/2020 - Expanded Case Rates discussion to include fix on 6/23 for calculating active cases.6/22/2020 - Added Executive Summary and Subsequent Outbreaks sectionsRevisions on 6/10/2020 based on updated CDC reporting. This affects the estimate of active cases by revising the average duration of cases with hospital stays downward from 30 days to 25 days. The result shifted 76 U.S. counties out of Epidemic to Spreading trend and no change for national level trends.Methodology update on 6/2/2020: This sets the length of the tail of new cases to 6 to a maximum of 14 days, rather than 21 days as determined by the last 1/3 of cases. This was done to align trends and criteria for them with U.S. CDC guidance. The impact is areas transition into Controlled trend sooner for not bearing the burden of new case 15-21 days earlier.Correction on 6/1/2020Discussion of our assertion of an abundance of caution in assigning trends in rural counties added 5/7/2020. Revisions added on 4/30/2020 are highlighted.Revisions added on 4/23/2020 are highlighted.Executive SummaryCOVID-19 Trends is a methodology for characterizing the current trend for places during the COVID-19 global pandemic. Each day we assign one of five trends: Emergent, Spreading, Epidemic, Controlled, or End Stage to geographic areas to geographic areas based on the number of new cases, the number of active cases, the total population, and an algorithm (described below) that contextualize the most recent fourteen days with the overall COVID-19 case history. Currently we analyze the countries of the world and the U.S. Counties. The purpose is to give policymakers, citizens, and analysts a fact-based data driven sense for the direction each place is currently going. When a place has the initial cases, they are assigned Emergent, and if that place controls the rate of new cases, they can move directly to Controlled, and even to End Stage in a short time. However, if the reporting or measures to curtail spread are not adequate and significant numbers of new cases continue, they are assigned to Spreading, and in cases where the spread is clearly uncontrolled, Epidemic trend.We analyze the data reported by Johns Hopkins University to produce the trends, and we report the rates of cases, spikes of new cases, the number of days since the last reported case, and number of deaths. We also make adjustments to the assignments based on population so rural areas are not assigned trends based solely on case rates, which can be quite high relative to local populations.Two key factors are not consistently known or available and should be taken into consideration with the assigned trend. First is the amount of resources, e.g., hospital beds, physicians, etc.that are currently available in each area. Second is the number of recoveries, which are often not tested or reported. On the latter, we provide a probable number of active cases based on CDC guidance for the typical duration of mild to severe cases.Reasons for undertaking this work in March of 2020:The popular online maps and dashboards show counts of confirmed cases, deaths, and recoveries by country or administrative sub-region. Comparing the counts of one country to another can only provide a basis for comparison during the initial stages of the outbreak when counts were low and the number of local outbreaks in each country was low. By late March 2020, countries with small populations were being left out of the mainstream news because it was not easy to recognize they had high per capita rates of cases (Switzerland, Luxembourg, Iceland, etc.). Additionally, comparing countries that have had confirmed COVID-19 cases for high numbers of days to countries where the outbreak occurred recently is also a poor basis for comparison.The graphs of confirmed cases and daily increases in cases were fit into a standard size rectangle, though the Y-axis for one country had a maximum value of 50, and for another country 100,000, which potentially misled people interpreting the slope of the curve. Such misleading circumstances affected comparing large population countries to small population counties or countries with low numbers of cases to China which had a large count of cases in the early part of the outbreak. These challenges for interpreting and comparing these graphs represent work each reader must do based on their experience and ability. Thus, we felt it would be a service to attempt to automate the thought process experts would use when visually analyzing these graphs, particularly the most recent tail of the graph, and provide readers with an a resulting synthesis to characterize the state of the pandemic in that country, state, or county.The lack of reliable data for confirmed recoveries and therefore active cases. Merely subtracting deaths from total cases to arrive at this figure progressively loses accuracy after two weeks. The reason is 81% of cases recover after experiencing mild symptoms in 10 to 14 days. Severe cases are 14% and last 15-30 days (based on average days with symptoms of 11 when admitted to hospital plus 12 days median stay, and plus of one week to include a full range of severely affected people who recover). Critical cases are 5% and last 31-56 days. Sources:U.S. CDC. April 3, 2020 Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). Accessed online. Initial older guidance was also obtained online. Additionally, many people who recover may not be tested, and many who are, may not be tracked due to privacy laws. Thus, the formula used to compute an estimate of active cases is: Active Cases = 100% of new cases in past 14 days + 19% from past 15-25 days + 5% from past 26-49 days - total deaths. On 3/17/2022, the U.S. calculation was adjusted to: Active Cases = 100% of new cases in past 14 days + 6% from past 15-25 days + 3% from past 26-49 days - total deaths. Sources: https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e4.htm https://covid.cdc.gov/covid-data-tracker/#variant-proportions If a new variant arrives and appears to cause higher rates of serious cases, we will roll back this adjustment. We’ve never been inside a pandemic with the ability to learn of new cases as they are confirmed anywhere in the world. After reviewing epidemiological and pandemic scientific literature, three needs arose. We need to specify which portions of the pandemic lifecycle this map cover. The World Health Organization (WHO) specifies six phases. The source data for this map begins just after the beginning of Phase 5: human to human spread and encompasses Phase 6: pandemic phase. Phase six is only characterized in terms of pre- and post-peak. However, these two phases are after-the-fact analyses and cannot ascertained during the event. Instead, we describe (below) a series of five trends for Phase 6 of the COVID-19 pandemic.Choosing terms to describe the five trends was informed by the scientific literature, particularly the use of epidemic, which signifies uncontrolled spread. The five trends are: Emergent, Spreading, Epidemic, Controlled, and End Stage. Not every locale will experience all five, but all will experience at least three: emergent, controlled, and end stage.This layer presents the current trends for the COVID-19 pandemic by country (or appropriate level). There are five trends:Emergent: Early stages of outbreak. Spreading: Early stages and depending on an administrative area’s capacity, this may represent a manageable rate of spread. Epidemic: Uncontrolled spread. Controlled: Very low levels of new casesEnd Stage: No New cases These trends can be applied at several levels of administration: Local: Ex., City, District or County – a.k.a. Admin level 2State: Ex., State or Province – a.k.a. Admin level 1National: Country – a.k.a. Admin level 0Recommend that at least 100,000 persons be represented by a unit; granted this may not be possible, and then the case rate per 100,000 will become more important.Key Concepts and Basis for Methodology: 10 Total Cases minimum threshold: Empirically, there must be enough cases to constitute an outbreak. Ideally, this would be 5.0 per 100,000, but not every area has a population of 100,000 or more. Ten, or fewer, cases are also relatively less difficult to track and trace to sources. 21 Days of Cases minimum threshold: Empirically based on COVID-19 and would need to be adjusted for any other event. 21 days is also the minimum threshold for analyzing the “tail” of the new cases curve, providing seven cases as the basis for a likely trend (note that 21 days in the tail is preferred). This is the minimum needed to encompass the onset and duration of a normal case (5-7 days plus 10-14 days). Specifically, a median of 5.1 days incubation time, and 11.2 days for 97.5% of cases to incubate. This is also driven by pressure to understand trends and could easily be adjusted to 28 days. Source

The region of present-day China has historically been the most populous region in the world; however, its population development has fluctuated throughout history. In 2022, China was overtaken as the most populous country in the world, and current projections suggest its population is heading for a rapid decline in the coming decades. Transitions of power lead to mortality The source suggests that conflict, and the diseases brought with it, were the major obstacles to population growth throughout most of the Common Era, particularly during transitions of power between various dynasties and rulers. It estimates that the total population fell by approximately 30 million people during the 14th century due to the impact of Mongol invasions, which inflicted heavy losses on the northern population through conflict, enslavement, food instability, and the introduction of bubonic plague. Between 1850 and 1870, the total population fell once more, by more than 50 million people, through further conflict, famine and disease; the most notable of these was the Taiping Rebellion, although the Miao an Panthay Rebellions, and the Dungan Revolt, also had large death tolls. The third plague pandemic also originated in Yunnan in 1855, which killed approximately two million people in China. 20th and 21st centuries There were additional conflicts at the turn of the 20th century, which had significant geopolitical consequences for China, but did not result in the same high levels of mortality seen previously. It was not until the overlapping Chinese Civil War (1927-1949) and Second World War (1937-1945) where the death tolls reached approximately 10 and 20 million respectively. Additionally, as China attempted to industrialize during the Great Leap Forward (1958-1962), economic and agricultural mismanagement resulted in the deaths of tens of millions (possibly as many as 55 million) in less than four years, during the Great Chinese Famine. This mortality is not observable on the given dataset, due to the rapidity of China's demographic transition over the entire period; this saw improvements in healthcare, sanitation, and infrastructure result in sweeping changes across the population. The early 2020s marked some significant milestones in China's demographics, where it was overtaken by India as the world's most populous country, and its population also went into decline. Current projections suggest that China is heading for a "demographic disaster", as its rapidly aging population is placing significant burdens on China's economy, government, and society. In stark contrast to the restrictive "one-child policy" of the past, the government has introduced a series of pro-fertility incentives for couples to have larger families, although the impact of these policies are yet to materialize. If these current projections come true, then China's population may be around half its current size by the end of the century.

Total current population for China in 2025 is 1,424,381,924, a 0.06% decline from 2024.

<ul style='margin-top:20px;'>

<li>Total population for China in 2024 was <strong>1,425,178,782</strong>, a <strong>1.03% increase</strong> from 2023.</li>
<li>Total population for China in 2023 was <strong>1,410,710,000</strong>, a <strong>0.1% decline</strong> from 2022.</li>
<li>Total population for China in 2022 was <strong>1,412,175,000</strong>, a <strong>0.01% decline</strong> from 2021.</li>
</ul>Total population is based on the de facto definition of population, which counts all residents regardless of legal status or citizenship. The values shown are midyear estimates.

Norway NO: International Migrant Stock: % of Population data was reported at 14.236 % in 2015. This records an increase from the previous number of 10.770 % for 2010. Norway NO: International Migrant Stock: % of Population data is updated yearly, averaging 7.160 % from Dec 1990 (Median) to 2015, with 6 observations. The data reached an all-time high of 14.236 % in 2015 and a record low of 4.542 % in 1990. Norway NO: International Migrant Stock: % of Population data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Norway – Table NO.World Bank.WDI: Population and Urbanization Statistics. International migrant stock is the number of people born in a country other than that in which they live. It also includes refugees. The data used to estimate the international migrant stock at a particular time are obtained mainly from population censuses. The estimates are derived from the data on foreign-born population--people who have residence in one country but were born in another country. When data on the foreign-born population are not available, data on foreign population--that is, people who are citizens of a country other than the country in which they reside--are used as estimates. After the breakup of the Soviet Union in 1991 people living in one of the newly independent countries who were born in another were classified as international migrants. Estimates of migrant stock in the newly independent states from 1990 on are based on the 1989 census of the Soviet Union. For countries with information on the international migrant stock for at least two points in time, interpolation or extrapolation was used to estimate the international migrant stock on July 1 of the reference years. For countries with only one observation, estimates for the reference years were derived using rates of change in the migrant stock in the years preceding or following the single observation available. A model was used to estimate migrants for countries that had no data.; ; United Nations Population Division, Trends in Total Migrant Stock: 2008 Revision.; Weighted average;

United States US: Population Density: People per Square Km data was reported at 35.608 Person/sq km in 2017. This records an increase from the previous number of 35.355 Person/sq km for 2016. United States US: Population Density: People per Square Km data is updated yearly, averaging 26.948 Person/sq km from Dec 1961 (Median) to 2017, with 57 observations. The data reached an all-time high of 35.608 Person/sq km in 2017 and a record low of 20.056 Person/sq km in 1961. United States US: Population Density: People per Square Km data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s United States – Table US.World Bank.WDI: Population and Urbanization Statistics. Population density is midyear population divided by land area in square kilometers. Population is based on the de facto definition of population, which counts all residents regardless of legal status or citizenship--except for refugees not permanently settled in the country of asylum, who are generally considered part of the population of their country of origin. Land area is a country's total area, excluding area under inland water bodies, national claims to continental shelf, and exclusive economic zones. In most cases the definition of inland water bodies includes major rivers and lakes.; ; Food and Agriculture Organization and World Bank population estimates.; Weighted average;

This statistic shows the 20 countries with the highest population growth rate in 2024. In SouthSudan, the population grew by about 4.65 percent compared to the previous year, making it the country with the highest population growth rate in 2024. The global population Today, the global population amounts to around 7 billion people, i.e. the total number of living humans on Earth. More than half of the global population is living in Asia, while one quarter of the global population resides in Africa. High fertility rates in Africa and Asia, a decline in the mortality rates and an increase in the median age of the world population all contribute to the global population growth. Statistics show that the global population is subject to increase by almost 4 billion people by 2100. The global population growth is a direct result of people living longer because of better living conditions and a healthier nutrition. Three out of five of the most populous countries in the world are located in Asia. Ultimately the highest population growth rate is also found there, the country with the highest population growth rate is Syria. This could be due to a low infant mortality rate in Syria or the ever -expanding tourism sector.

Poland PL: Population Density: People per Square Km data was reported at 124.027 Person/sq km in 2017. This records an increase from the previous number of 124.008 Person/sq km for 2016. Poland PL: Population Density: People per Square Km data is updated yearly, averaging 123.940 Person/sq km from Dec 1961 (Median) to 2017, with 57 observations. The data reached an all-time high of 126.232 Person/sq km in 1998 and a record low of 97.829 Person/sq km in 1961. Poland PL: Population Density: People per Square Km data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Poland – Table PL.World Bank.WDI: Population and Urbanization Statistics. Population density is midyear population divided by land area in square kilometers. Population is based on the de facto definition of population, which counts all residents regardless of legal status or citizenship--except for refugees not permanently settled in the country of asylum, who are generally considered part of the population of their country of origin. Land area is a country's total area, excluding area under inland water bodies, national claims to continental shelf, and exclusive economic zones. In most cases the definition of inland water bodies includes major rivers and lakes.; ; Food and Agriculture Organization and World Bank population estimates.; Weighted average;

Historical chart and dataset showing total population for Russia by year from 1950 to 2025.

Comoros KM: Population Density: People per Square Km data was reported at 448.247 Person/sq km in 2022. This records an increase from the previous number of 439.642 Person/sq km for 2021. Comoros KM: Population Density: People per Square Km data is updated yearly, averaging 247.359 Person/sq km from Dec 1961 (Median) to 2022, with 62 observations. The data reached an all-time high of 448.247 Person/sq km in 2022 and a record low of 108.114 Person/sq km in 1961. Comoros KM: Population Density: People per Square Km data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Comoros – Table KM.World Bank.WDI: Population and Urbanization Statistics. Population density is midyear population divided by land area in square kilometers. Population is based on the de facto definition of population, which counts all residents regardless of legal status or citizenship--except for refugees not permanently settled in the country of asylum, who are generally considered part of the population of their country of origin. Land area is a country's total area, excluding area under inland water bodies, national claims to continental shelf, and exclusive economic zones. In most cases the definition of inland water bodies includes major rivers and lakes.;Food and Agriculture Organization and World Bank population estimates.;Weighted average;

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which