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‘Sullivan’s index’ also k/a ‘Disability Free Life Expectancy’ or “Active Life Expectancy”
• ‘Life expectancy’ MINUS ‘duration of disability’
• Health expectancy calculated by Sullivan’s method is the number of remaining years, at a particular age, that an individual can expect to live in a healthy state.
• The data for calculation is obtained from
o population surveys and
o life tables
• This data is often readily available.

Disability Adjusted Life Years (DALY) – Measuring the burden of disease in a population
Why measure the burden of disease?
1. To aid in setting health service priorities
2. To aid in identifying disadvantaged groups and targeting of health interventions;
3. To provide a comparable measure of output for planning and evaluation.
DALYs as a measurement tool
1. Burden of disease is measured in terms of TIME
• i.e., The TIME of healthy living lost due to disease or premature death

Eligible Couples
• Definition: a currently married couple wherein the wife is in the reproductive age (i.e. 15 -49 yr. of age)
• Appx. 150 – 180 eligible couples per 1000 population in India
• These couples are in need of family planning services
• The “eligible couple register” is maintained and updated by the ANM/ MPHW/ ASHA

1) Crude birth rate

2) General fertility Rate

3) General marital fertility rate (GMFR): It is the number of live births per 1000 married women in the reproductive age-group (15 – 49 yr.) in a given year

These newborns would need special care and should be referred to the FRU

Objective
• To assist the newborn in adaptation to the extra-uterine environment
This involves the following:
1. Cardio – respiratory function: Initiation of respiration and oxygenation of blood
2. Body temperature maintenance
3. Feeding establishment
4. Infection prevention
5. Early detection and management of:
• Congenital disorders
• Other disorders
• Infection

Confirmation of Pregnancy:
The simple way to confirm pregnancy in the first trimester is to conduct a urine examination using a pregnancy test kit.
The kit detects pregnancy on the basis of presence of HCG in the urine
The test can be performed soon after a missed period and simple to perform
The pregnancy test should be offered to any women who is in reproductive age group and comes with a history of amenorrhea or symptoms of pregnancy
The kit made available by the GOI is k/a ‘Nischay’

Specific Health Protection during Antenatal Visits
1. Anemia
2. Other nutritional deficiencies
3. Toxemias of pregnancy (TOP)
4. Tetanus
5. Syphilis
6. German measles
7. Rh status
8. HIV infection
9. Hepatitis B infection
10. Prenatal genetic screening

The ANM should calculate the estimated number of pregnancies in one year in her area
She can match the estimated number with the actual number of the registered pregnancies
In any month, the no. of registered AN women should be HALF of the estimated annual number
Calculation of the estimated number of pregnancies in the YEAR:
Obtain information regarding:
The Population size and
The birth rate of the area under her jurisdiction
Calculate the number of live births in her jurisdiction using the following formula:

• The main purpose of the antenatal care is to identifying the ‘high – risk’ cases among a large antenatal population, and at the earliest possible
• These high risk cases can be provided skilled care while the routine appropriate care is provided to all the remaining
• The ‘high – risk’ antenatal women are:
o Elderly primi (primi ≥ 30 yr.)
o Short statured primi (≤ 140 cm)
o Mal-presentations like breech, transverse lie
o Antepartum hemorrhage, threatened abortion
o Pre – eclampsia and eclampsia
o Anemia
o Twins, hydramnios