sheeloopoonam@yahoo.com's blog

This blog explains the additional, age-specific points that must be covered while taking the history of a pediatric patient, beyond the standard general history format. It guides MBBS students through essential components such as birth history, feeding practices, immunization status, developmental milestones, past illnesses, drug history, family and social environment, and clues to growth or developmental problems. The blog provides a structured, student-friendly approach to ensure that important pediatric details are not missed during case taking.

The Human Development Index (HDI) is a composite index measuring achievement in key dimensions of human development:
1. A long and healthy life,
2. Being knowledgeable and
3. Have a decent standard of living.

A. Consolidates three indicators:
1. Infant mortality rate
2. Literacy rate
3. Life expectancy at one year of age

B. For EACH component, the performance of the country is placed on a scale from 0 to 100
• 0 = ‘worst performance’
• 100 = ‘Best performance’
The average (arithmetic mean) of the three scores is calculated, which is the PQLI for the country
It also obviously ranges from 0 to 100
Hence, an EQUAL weightage is given to each component

E.g. when a health intervention is aimed at preventing or treating a non- fatal disease, the relationship between QUALYs gained and DALYs saved depend on age of onset, duration of disease as well as the quality of life and disability weights
Reference:
Franco Sassi. Calculating QALYs, comparing QALY and DALY calculations, Health Policy Plan (2006) 21 (5): 402-408

• A measure of disease burden including both:
– Quality and
– Quantity of life lived
• Used mainly for assessing the value for money of a medical intervention i.e. cost – effective analysis for comparing different interventions
• Based on the number of QUALYs gained by the intervention
• Each year in perfect health = 1.0
• Death = 0.0
• 1 QUALY = one year of life X one utility value = one year of life lived in perfect health
• Half a year lived in perfect health is equivalent to 0.5 QUALY = 1 year X 0.5 utility value

• Previously k/a DALE (Disability Adjusted Life Expectancy)
• Definition: equivalent number of years in “full health” that a new-born can expect to live based on current rates of ill health and mortality
• Indicator used to measure healthy life expectancy
• Based on:
o life expectancy at birth BUT
o Includes an adjustment for time spent in poor health as perceived by the individuals in the following areas of their personal health:
1. Sensory ( vision, hearing and speech),
2. Mobility,

Life expectancy (LE) estimates are insensitive to the health status of the population.
They provide no indication of the quality of life, only the quantity
Moving beyond LE are the indicators below:

1 HALE (Health – Adjusted Life Expectancy)
2 “Sullivan’s index” or Disability – free life expectancy or Active life expectancy
3 QALY (Quality – adjusted life years)
4 Disability – adjusted life years (DALY)

‘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