With a land area of 11,000 square kilometers, the country is one of the most densely populated countries in Africa with a population density of 134 persons per square kilometer. Increased population density coupled with the Sudano-Sahelian deforestation has increased pressure on agricultural land and contributed to declining agricultural output, which has led to an out-flow of persons from rural to urban areas. This is more evident in the northern part of the country. A population movement from rural to urban areas has resulted in about 55 per cent of the population currently living in Banjul, Kanifing and the Brikama Local Government Areas. In total about 50 per cent of the population now lives in urban areas compared to 37 percent a decade ago. Immigration from neighbouring countries also contributed in the high urbanization rate. According to results of the 2003 Population and Housing Census, the population is estimated to be growing at an annual rate of 2.74 per cent at the national level and at a much faster rate in the Kanifing and Brikama Local Government Areas. The population drift to the western part of the country is attributable to the over concentration of economic activities in the Greater Banjul Area. Over the inter-censal period, 1993-2003, a rapid decline was observed in the population growth rate. This may be explained by a combination of factors related to declining fertility levels, the return of large numbers of refugees to their countries in the recent past and the migration of youth out of the country over the years. With peace attained in conflict areas like Sierra Leone, Liberia, Guinea Bissau and Southern Senegal (Cassamance), many refugees from these countries have either returned home or have been resettled in Europe and the Americas. Although fertility levels in The Gambia remain amongst the highest in the world, recent estimates from the 2003 census indicate declining fertility. The total fertility rate estimated at 6.4 in 1983 declined to 6.04 in 1993 and further declined to 5.13 in 2003. The decline in fertility can be explained, mainly, by a delay in marriage and therefore childbearing and to an extent increased contraceptive use. Increased girls education, which has immensely contributed to the delay in marriage amongst girls, is another explanatory factor to declining fertility levels in The Gambia. Regional variations have been observed in fertility levels ranging from 3.93 in Banjul to 6.19 in the Kuntaur Local Government Area. Current high fertility levels coupled with the decline in mortality (IMR and under-five) rates in the country have resulted in a very youthful population structure. About 42 per cent of the population is aged less than 15 years, 22 per cent aged 15-24 years, 52 per cent aged 15-59 years and only 5 per cent aged 60 years and over. Mortality levels have been falling rapidly over the past three decades. Infant mortality rate (IMR) estimated at 167 deaths per 1000 live births in 1983 declined to 84 deaths per 1000 live births in 1993 and 75 deaths per 1000 live births in 2003. Improvements in child survival can be attributed to gains made in terms of increased access to health services and immunization coverage in the country over the years. Mortality levels have been falling rapidly over the past three decades. Infant mortality rate (IMR) estimated at 167 deaths per 1000 live births in 1983 declined to 84 deaths per 1000 live births in 1993 and 75 deaths per 1000 live births in 2003. Improvements in child survival can be attributed to gains made in terms of increased access to health services and immunization coverage in the country over the years.