USAID Country Health Statistical Report

Bulgaria

October 2003
Table of Contents

1. About the Report

2. Country Profile

I. Statistical Overview

• Demographic Indicators 

• Socioeconomic Indicators 

• Family Planning Indicators 

• Maternal Health Indicators 

• Child Survival Indicators 

• HIV/AIDS Prevention Indicators 

• Infectious Diseases Control Indicators 

II. Trends in Health Indicators

• Current and Projected Population by Age and Sex 

 (Figure 1 and Table 1.1)

• Population Estimates and Projections 

 (Table 1.2)

• Estimated Total Fertility Rate per Woman 

 (Figure 2 and Table 2)

• Infant Mortality Rates / Under-5 Mortality Rates 

 (Figure 3 and Table 3)

• Vaccination Coverage (DPT3) Trends 

 (Figure 4 and Table 4)

• Contraceptive Prevalence Rates - Married Women 

 (Figure 5 and Table 5)

3. Data Notes

4. Sources
About the Report

Released October 2003

This report is one of a series of Country Health Statistical Reports produced on behalf of the United States Agency for International 

Development (USAID) by the Population, Health and Nutrition Information (PHNI) Project. Each profile contains statistical data on 

current health conditions, population dynamics, health and family planning behavior, and health and population trends in a given

developing country. Information is compiled from PHNI's health statistics database, which draws data from a diverse range of sources 

listed at the end of this profile.

Hard copy editions of USAID's profiles are available from PHNI'S publications department. Reports are available on the USAID Global 

Health Web site in Portable Document Format (pdf). Any feedback you have on the content or presentation of this report would be 

greatly appreciated. We would also appreciate receiving any more recent, more accurate, or more representative information. Contact 

us at the following: 

Population, Health and Nutrition Information Project 

600 13th Street, NW, Suite 710 

Washington, DC 20005 

Phone: 202-393-9001 

Fax: 202-393-9019 

E-mail: dolphnhelp@phnip.com

The PHNI Project, a USAID project managed by Jorge Scientific Corporation, with The Futures Group International and John Snow, 

Inc., prepared this document under the Data for Decision Making Project (936-3098.01), contract number HRN-C-00-00-00004-00, with 

the Bureau for Global Health, USAID.
I. Statistical Overview

 *see data notes

Demographic Indicators

Indicator Value Data Unit Year Source

Total Population 7,588,399 2003 BUCEN-IDB-2003 

Population Growth Rate <0.01 % 2003 BUCEN-IDB-2003 

Percent Urban 67.5 % 2001 World Bank/WDI-2003 

Women, 15-19 250,344 2003 BUCEN-IDB-2003 

Women, 15-49 1,842,787 2003 BUCEN-IDB-2003 

Life Expectancy at Birth 71.5 2003 BUCEN-IDB-2003 

Crude Birth Rate 9.6 per 1,000 2003 BUCEN-IDB-2003 

Crude Death Rate 14.3 per 1,000 2003 BUCEN-IDB-2003 

Number of Live Births 73,076 000s 2003 BUCEN-IDB-2003 

Socioeconomic Indicators

Indicator Value Data Unit Year Source

GNI per Capita (PPP) 6,740 $ 2001 World Bank/WDI-2003 

Health Expenditure as Percentage of GDP 3.9 % 2000 World Bank/WDI-2003 

Physicians per 1,000 People 3.4 2000 World Bank/WDI-2003 

Adult Literacy Rate 98.5 % 2001 World Bank/WDI-2003 

Adult Literacy Rate, Female 98 % 2001 World Bank/WDI-2003 

Adult Literacy Rate, Male 99 % 2001 World Bank/WDI-2003 

Gross Enrollment Rate - Primary School 103.5 % 1999-2000 UNESCO-2002 

Gender Parity Index - Net Enrollment Rate 0.98 1999-2000 UNESCO-2002 

Access to an Improved Water Source (Rural) 100 % 2000 World Bank/WDI-2001 

Access to an Improved Water Source (Urban) 100 % 2000 World Bank/WDI-2001 

Access to Improved Sanitation Facilities (Rural) 100 % 2000 World Bank/WDI-2001 

Access to Improved Sanitation Facilities (Urban) 100 % 2000 World Bank/WDI-2001 
Family Planning Indicators

Indicator Value Data Unit Year Source

Total Fertility Rate (BUCEN) 1.4 2003 BUCEN-IDB-2003 

Total Fertility Rate (DHS) Data Not Available 

Contraceptive Prevalence Rate, Modern Methods, All Women Data Not Available 

Contraceptive Prevalence Rate, Modern Methods, Married Women Data Not Available 

Median Age of Sexual Debut Among Women, Ages 25-49 Data Not Available 

Mean Ideal Family Size Data Not Available 

Women 20-24 Who Gave Birth Before Age 20 Data Not Available 

Maternal Health Indicators

Indicator Value Data Unit Year Source

Maternal Mortality Ratio (WHO/Hill) 23 Per 100,000 live births 1995 WHO/Hill-2001 

Maternal Mortality Ratio (DHS) Data Not Available 

Antenatal Care (at least 1 visit) Data Not Available 

Antenatal Care (2+ visits) Data Not Available 

Antenatal Care (4+ visits) Data Not Available 

Assisted Delivery by a Health Professional Data Not Available 

Assisted Delivery by Doctor Data Not Available 

Assisted Delivery by Other Health Professional Data Not Available 
Child Survival Indicators

Indicator Value Data Unit Year Source

Acute Respiratory Infection (ARI) and Oral Rehydration Therapy (ORT)

ARI Treatment - Children Under 5 Data Not Available 

ORT Use Rate (ORS, RHS, or Increased Fluids) Data Not Available 

Mortality Indicators

Infant Mortality Rate (BUCEN) 22.1 per 1,000 live births 2003 BUCEN-IDB-2003 

Infant Mortality Rate (DHS) Data Not Available 

Infant Mortality Rate, Females (BUCEN) 17.9 per 1,000 live births 2003 BUCEN-IDB-2003 

Infant Mortality Rate, Males (BUCEN) 26 per 1,000 live births 2003 BUCEN-IDB-2003 

Under-5 Mortality Rate (BUCEN) 17.5 per 1,000 live births 2003 BUCEN-IDB-2002 

Under-5 Mortality Rate (UNICEF) 16 per 1,000 live births 2001 UNICEF-2003 

Under-5 Mortality Rate (DHS) Data Not Available 

Nutrition Indicators

Exclusive Breastfeeding (under 4 mos.) Data Not Available 

Exclusive Breastfeeding (under 6 mos.) Data Not Available 

Stunted (height-for-age) Data Not Available 

Underweight (weight-for-age) Data Not Available 

Wasted (weight-for-height) Data Not Available 

Vaccination Coverage

DPT3 Vaccination Rate (DHS) Data Not Available 

DPT3 Vaccination Rate (WHO) 94 % 2001 WHO/Global Summary-2002 

Measles Vaccination Rate (DHS) Data Not Available 

Measles Vaccination Rate (WHO) 90 % 2001 WHO/Global Summary-2002 

Polio Vaccination Rate (DHS) Data Not Available 

Polio Vaccination Rate (WHO) 94 % 2001 WHO/Global Summary-2002 

Tetanus Toxoid Vaccination Data Not Available 
HIV/AIDS Prevention Indicators

Indicator Value Data Unit Year Source

HIV Prevalence, Adults 0.01 1 % 2001 UNAIDS-2002 

HIV Prevalance, Females 15-24, High Estimates Data Not Available 

HIV Prevalance, Females 15-24, Low Estimates Data Not Available 

HIV Prevalence, Males 15-24, High Estimates Data Not Available 

HIV Prevalence, Males 15-24, Low Estimates Data Not Available 

Males Reporting Condom Use With Last Non-Regular Partner Data Not Available 

Females Reporting Condom Use With Last Non-Regular Partner Data Not Available 

Infectious Diseases Control Indicators

Indicator Value Data Unit Year Source

TB Estimated Number of Cases 2,535 2001 WHO/TB Control Report-2003 

TB Case Detection Rate 79 % 2001 WHO/TB Control Report-2003 

TB (DOTS) Treatment Success Rate Data Not Available 

Malaria Data Not Available 

1 This value was estimated by dividing Adults (15-49) living with HIV/AIDS by Population Adults (15-49).
II. Trends in Health Indicators

Figure 1: Current and Projected Population by Age and Sex (in thousands)

Table 1.1: Current and Projected Population by Age and Sex

Source: BUCEN-IDB 

Age Group Male - 2000 Male - 2020 Female - 2000 Female - 2020

0-4 171,096 140,884 161,911 133,459 

5-9 201,063 155,484 191,391 147,281 

10-14 256,509 166,879 245,183 158,225 

15-19 279,596 169,467 263,212 160,522 

20-24 306,319 153,052 289,403 143,825 

25-29 283,162 180,396 276,453 171,725 

30-34 256,542 229,207 256,523 221,382 

35-39 251,710 243,347 258,277 235,113 

40-44 262,773 263,762 274,171 260,745 

45-49 271,159 240,565 287,115 250,134 

50-54 276,955 214,311 299,012 231,464 

55-59 220,568 204,719 245,359 231,276 

60-64 201,673 202,914 235,184 240,651 

65-69 203,842 190,502 248,615 240,987 

70-74 165,381 167,004 217,275 229,966 

75-79 115,444 102,906 169,837 158,884 

80+ 67,582 106,708 108,200 221,211 

TABLE 1.2: Population Estimates and Projections

Source: BUCEN-IDB 

1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

7,867,374 8,489,574 8,843,528 8,894,028 7,818,495 7,148,785 6,568,957 5,940,822 5,305,010 4,651,477
Figure 2: Estimated Total Fertility Rate per Woman

Table 2: Estimated Total Fertility Rate per Woman

Source: BUCEN-IDB 

1960 1970 1980 2000 2010 2020 2030 2040 2050

2.3 2.2 2.1 1.3 1.4 1.5 1.6 1.6 1.7

Figure 3: Infant Mortality Rates / Under-5 Mortality Rates

Table 3: Infant Mortality Rates / Under-5 Mortality Rates

Source: BUCEN-IDB 2003

Indicator 1950 1960 1970 1980 2000 2010 2020 2030 2040 2050

Infant Mortality Rate (BUCEN) 94.5 45.1 27.3 20.2 24.6 17.3 12.4 9.3 7.2 5.9

Under-5 Mortality Rate (BUCEN) 19.6 13.6 10.1 7.9 6.4 5.4
Figure 4: Vaccination Coverage (DPT3) Trends

Table 4: Vaccination Coverage (DPT3) Trends

Source: WHO/Global Summary 

1985 1990 1995 2000 2001

99.0 99.0 96.0 93.0 94.0

Figure 5: Contraceptive Prevalence Rates, Modern Methods, Married Women 

Data Not Available

Table 5: Contraceptive Prevalence Rates, Modern Methods, Married Women

Data Not Available
Data Notes

 *Indicator definitions that differ from those in the data notes section are identified by footnotes accompanying the indicator tables.

Demographic Indicators

Total Population The number of people in a given area (i.e., country) in a particular time period (usually a midyear 

estimate). 

Population Growth Rate The average annual growth rate is the rate of natural increase in a population plus the net migration rate. 

The rate of natural increase is the difference between the birth rate and the death rate, but it is 

conventionally measured in percentage terms (per hundred rather than per thousand). 

Percent Urban The percentage of the midyear population living in areas defined as urban in each country and reported 

to the United Nations. 

Women, 15-19 The number of women between the ages of 15-19 in the midyear population. 

Women, 15-49 The number of women between the ages of 15-49 in the midyear population. 

Life Expectancy at Birth The average number of years that a person at age 0 will live if age-specific death rates remain constant. 

Life expectancy at birth is highly affected by rates of infant and child death. 

Crude Birth Rate The number of births per thousand of the population. The product of the number of live births, divided by 

the midpoint population, multiplied by 1,000. 

Crude Death Rate The number of deaths per thousand of the population. The product of the number of deaths divided by 

the midpoint population, multiplied by 1,000. 

Number of Live Births The number of live births, annually, within a country. 

Socioeconomic Indicators

GNI per Capita (PPP) The gross national income (GNI) converted to international dollars using purchasing power parity (PPP) 

rates. An international dollar has the same purchasing power over GNI as a U.S. dollar has in the United 

States. 

Health Expenditure as 

Percentage of GDP 

Total health expenditures is the sum of public and private health expenditures figured as a percentage of 

a country's gross domestic product (GDP). It covers the provision of health services (preventive and 

curative), family planning activities, nutrition activities, and emergency aid designated for health but does 

not include provision of water and sanitation. 

Physicians per 1,000 

People 

Physicians are defined as graduates of any faculty or school of medicine who are working in the country 

in any medical field (practice, teaching, research). 

Adult Literacy Rate The percentage of people ages 15 and over who can, with understanding, read and write a short, simple 

statement about their everyday life. 

Adult Literacy Rate, 

Female 

The percentage of women ages 15 and over who can, with understanding, read and write a short, simple 

statement about their everyday life. 

Adult Literacy Rate, Male The percentage of men ages 15 and over who can, with understanding, read and write a short, simple 

statement about their everyday life. 

Gross Enrollment Rate - 

Primary School 

Total enrolment in primary level of education, regardless of age, expressed as a percentage of the 

official school-age population corresponding to primary level of education in give school-year. GER can 

be over 100% due to the inclusion of over-aged and under-aged pupils/students because of early or late 

entrants, and grade repetition. 

Gender Parity Index - Net 

Enrollment Rate 

The ratio of the female-to-male net primary school enrollment rates measures progress towards gender 

equity in school attendance and the level of learning opportunities available for women in relation to 

those available to men. Calculation Method: Divide the female net primary school enrollment rate by the 

male net primary school enrollment rate. 
Access to an Improved 

Water Source (Rural) 

Access to an improved water source in rural areas. Refers to the percentage of the rural population with 

reasonable access to an adequate amount of water from an improved source, such as a household 

connection, public standpipe, borehole, protected well or spring, or rainwater collection. Unimproved 

sources include vendors, tanker trucks, and unprotected wells and springs. Reasonable access is 

defined as the availability of at least 20 liters a person a day from a source within one kilometer of the 

dwelling. 

Access to an Improved 

Water Source (Urban) 

Access to an improved water source in urban areas. Refers to the percentage of the urban population 

with reasonable access to an adequate amount of water from an improved source, such as a household 

connection, public standpipe, borehole, protected well or spring, or rainwater collection. Unimproved 

sources include vendors, tanker trucks, and unprotected wells and springs. Reasonable access is 

defined as the availability of at least 20 liters a person a day from a source within one kilometer of the 

dwelling. 

Access to Improved 

Sanitation Facilities 

(Rural) 

Access to improved sanitation facilities in rural areas. Refers to the percentage of the rural population 

with access to at least adequate excreta disposal facilities (private or shared, but not public) that can 

effectively prevent human, animal, and insect contact with excreta. 

Access to Improved 

Sanitation Facilities 

(Urban) 

Access to improved sanitation facilities in urban areas. Refers to the percentage of the urban population 

with access to at least adequate excreta disposal facilities (private or shared, but not public) that can 

effectively prevent human, animal, and insect contact with excreta. 

Family Planning Indicators

Total Fertility Rate 

(BUCEN) 

The number of children a woman between ages 15-49 would have during her reproductive life, if, for all 

of her childbearing years she were to experience the age-specific birth rates for that given year. 

Total Fertility Rate (DHS) The number of children a woman between ages 15-49 would have during her lifetime if she were to bear 

children at the currently observed rates. 

Contraceptive Prevalence 

Rate, Modern Methods, 

All Women 

Percentage of all women ages 15-49 currently using a modern method of contraception. Modern 

methods include oral contraceptives, IUDs, injectables, female and male sterilization, all emergency 

contraception, and barrier methods (diaphragm, foam, jelly, male and female condom). 

Contraceptive Prevalence 

Rate, Modern Methods, 

Married Women 

Percent of currently married ages women 15-49 currently using a modern method of contraception. 

Modern methods include oral contraceptives, IUDs, injectables, female and male sterilization, all 

emergency contraception, and barrier methods (diaphragm, foam, jelly, male and female condom). 

Median Age of Sexual 

Debut Among Women, 

Ages 25-49 

Median age of first sexual intercourse for women ages 25-49. 

Mean Ideal Family Size Mean ideal number of children for all women, according to number of living children. 

Women 20-24 Who Gave 

Birth Before Age 20 

Percentage of women ages 20-24 who have already given birth. 

Maternal Health Indicators

Maternal Mortality Ratio 

(WHO/Hill) 

The estimated number of women who die as a result of pregnancy or childbirth per 100,000 live births 

arrived through Hill et al., adjustment procedure depending on the nature of data used. 

Maternal Mortality Ratio 

(DHS) 

The estimated number of women who die as a result of pregnancy or childbirth per 100,000 live births, 

arrived mostly through the "sisterhood method". The data are aggregated based on different time 

periods ranging from four to ten years preceding the survey. Thus, the data may not be suitable for trend 

analysis due to over-lapping year ranges of estimates. For further information on methodology please 

refer to: Stanton, Cynthia, Noureddine Abderrahim, and Kenneth Hill. 1997. DHS Maternal Mortality 

Indicators: An assessment of Data Quality and Implications for Data Use. Calverton: Macro International 

Inc., or individual country DHS reports. 

Antenatal Care (at least 1 

visit) 

Percentage of women of reproductive age (15-49) who receive at least one antenatal care visit during 

pregnancy (in the three-year period preceding the survey). 

Antenatal Care (2+ visits) Percentage of women of reproductive age (15-49) who receive at least two antenatal care visits during 

pregnancy (in the three-year period preceding the survey). 
Antenatal Care (4+ visits) Percentage of women of reproductive age (15-49) who receive four or more antenatal care visits during 

pregnancy (in the three-year period preceding the survey). 

Assisted Delivery by a 

Health Professional 

The percentage of births/deliveries that occur with the assistance of any trained health professional 

during the five-year period preceding the survey. May include doctors, nurses, midwives, village health 

workers, or any other trained health professional. 

Assisted Delivery by 

Doctor 

The percentage of live births/deliveries that occur with the assistance of a doctor during the five-year 

period preceding the survey. 

Assisted Delivery by 

Other Health 

Professional 

The percentage of live births/deliveries that occur with the assistance of a nurse, midwife, village health 

worker, or any other trained health professional besides a doctor during the five-year period preceding 

the survey. 

Child Survival Indicators

ARI Treatment - Children 

Under 5 

Percentage of children under five years who were ill with an acute respiratory infection (ARI), which is 

associated with cough, rapid breathing and a high fever,during the two weeks preceding the survey, and 

who were treated with specific remedies. 

ORT Use Rate (ORS, RHS, 

or Increased Fluids) 

Oral Rehydration Therapy (ORT). Percentage of children under age 5 with diarrhea two weeks prior to 

survey who received increased fluids, oral rehydration solution (ORS) or recommended home solution 

(RHS). 

Infant Mortality Rate 

(BUCEN) 

The estimated annual number of deaths of infants under 12 months in a given year per 1,000 live births 

in that same year. 

Infant Mortality Rate 

(DHS) 

The estimated annual number of deaths of infants under 12 months in a given year per 1,000 live births 

in that same year (five-year period preceding survey). 

Infant Mortality Rate, 

Females (BUCEN) 

The estimated annual number of deaths of female infants under 12 months in a given year per 1,000 live 

births in that same year. 

Infant Mortality Rate, 

Males (BUCEN) 

The estimated annual number of male infants under 12 months in a given year per 1,000 live births in 

that same year. 

Under-5 Mortality Rate 

(BUCEN) 

Annual number of deaths that occur in children 0-4 years old per 1,000 births. 

Under-5 Mortality Rate 

(UNICEF) 

Annual number of deaths that occur in children 0-4 years old per 1,000 births (five-year period preceding 

survey). 

Under-5 Mortality Rate 

(DHS) 

Annual number of deaths that occur in children 0-4 years old per 1,000 births (five-year period preceding 

survey). 

Exclusive Breastfeeding 

(under 4 mos.) 

Percentage of children under 4 months exclusively breastfed. Exclusive breastfeeding is defined as 

providing no food or liquid other than breast milk to the child during the 24-hour period before the 

survey. 

Exclusive Breastfeeding 

(under 6 mos.) 

Percentage of children under 6 months exclusively breastfed. Exclusive breastfeeding is defined as 

providing no food or liquid other than breast milk to the child during the 24-hour period before the 

survey. 

Stunted (height-for-age) Percentage of children under age five whose height-for-age is below minus-two standard deviations from 

the median of the reference population. 

Underweight (weight-forage) 

Percentage of children under age five whose weight-for-age is below minus-two standard deviations 

from the median of the reference population. 

Wasted (weight-forheight) 

Percentage of children under age five whose weight-for-height is below minus-two standard deviations 

from the median of the reference population. 

DPT3 Vaccination Rate 

(DHS) 

Proportion of living children 12-23 months old who have received three complete doses of vaccines 

against diphtheria, pertussis, and tetanus. 

DPT3 Vaccination Rate 

(WHO) 

Proportion of living children 12-23 months old who have received three complete doses of vaccines 

aginst diphtheria, pertussis, and tetanus. 
Measles Vaccination Rate 

(DHS) 

Percentage of living children 12-23 months old who have received one dose of MCV (fully immunized 

against measles). 

Measles Vaccination Rate 

(WHO) 

Percentage of living children who have received one dose of MCV (fully immunized) against measles. 

Polio Vaccination Rate 

(DHS) 

Proportion of living children 12-23 months who have received three doses of polio vaccine. 

Polio Vaccination Rate 

(WHO) 

Percentage of children receiving three doses of polio vaccine. 

Tetanus Toxoid 

Vaccination 

Percentage of pregnant women receiving two (or more) doses of tetanus toxoid (three-year period 

preceding survey). 

HIV/AIDS Prevention Indicators

HIV Prevalence, Adults The estimated number of adults (ages 15-49) living with HIV/AIDS at the end of 1999 divided by the 

1999 adult population (ages 15–49). 

HIV Prevalance, Females 

15-24, High Estimates 

HIV prevalence, adolescent females 15-24 for high estimates. 

HIV Prevalance, Females 

15-24, Low Estimates 

HIV prevalence, adolescent females 15-24 for low estimates. 

HIV Prevalence, Males 15-

24, High Estimates 

HIV prevalence, adolescent males 15-24 for high estimates. 

HIV Prevalence, Males 15-

24, Low Estimates 

HIV prevalence, adolescent males 15-24 for low estimates. 

Males Reporting Condom 

Use With Last NonRegular Partner 

Among men who have had sex in the last year, percentage who used condoms during their last sexual 

intercourse with a non-regular partner/non-cohabitating partner. 

Females Reporting 

Condom Use With Last 

Non-Regular Partner 

Among women who have had sex in the last year, percentage who used condoms during their last 

sexual intercourse with a non-regular partner/non-cohabitating partner. 

Infectious Diseases Control Indicators

TB Estimated Number of 

Cases 

The estimated number of cases (all forms). 

TB Case Detection Rate TB Case Detection Rate is defined as the percentage of the annual new smear-positive notifications of 

the estimated annual new smear-positive incidence. 

TB (DOTS) Treatment 

Success Rate 

The proportion of smear-positive patients who were cured plus the proportion who completed treatment. 

Malaria Reported number of cases of malaria during the year for which data reported. 
Statistical Sources For Bulgaria

BUCEN-IDB 2002 United States Census Bureau (BUCEN), International Programs Center. International 

Database. October 2002. 

BUCEN-IDB 2003 United States Census Bureau (BUCEN), International Programs Center. International 

Database. July 2003. 

UNAIDS 2002 Report on the Global HIV/AIDS Epidemic. July 2002. The Joint United Nations 

Programme on HIV/AIDS, Geneva. 

UNESCO 2002 Education for All: Is the World on Track? United Nations Educational, Scientific and 

Cultural Organization, Paris 

UNICEF 2003 UNICEF Web site. Progress since the World Summit for Children. 

www.childinfo.org/cmr/revis/db2.htm. Data accessed on Web site in January 2003. 

WHO/Global Summary 2002 WHO Vaccine-Preventable Diseases Monitoring System. 2002 Global Summary. World 

Health Organization, Geneva. 

WHO/Hill 2001 Kenneth Hill, Carla Abou Zahr & Tessa Wardlaw: Estimates of Maternal Mortality for 

1995. Bulletin of the World Health Organization, vol. 79, no. 3, 182-193, 2001. 

WHO/TB Control Report 2003 Global Tuberculosis Control, WHO Report 2003. World Health Organization, Geneva. 

World Bank/WDI 2001 World Bank Development Indicators 2001, CD-Rom. Washington, DC: The World Bank, 

2001. 

World Bank/WDI 2003 World Bank Development Indicators 2003, CD-Rom. Washington, DC: The World Bank, 

2003.