ADIS Projects Final Manual II

DEPARTMENT OF COMMUNITY MEDICINEGOVERNMENT MEDICAL COLLEGE

CHANDIGARH

FAMILY STUDY MANUAL

VOLUME - II

ROLL NO. :

BATCH :

NAME :

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FROM "HIPPOCRATIC OATH"

"Into whatever house I enter, I will go with the object of helping the sick, holding aloof from all voluntary and

all other hurtful wrong doing, and from licentious practices whether with women or men free or bound, and

regarding the things, I see or hear, in the exercise of my art, or outsides its exercise, in my intercourse with

men, which ought not to be divulged, I will keep silent regarding them as inviolable secrets".

I certify that I have read the " Hippocratic Oath", and understand that the family records to be entered

in the note book are of a confidential nature.

----------------------------------------------(Student's Signature)

CERTIFICATE

This is to certify that Mr. / Ms. ___________________________has completed his/her assignment of family

study satisfactorily / unsatisfactorily.

Professor & Head,Deptt. of Community Medicine,Govt. Medical College,Chandigarh-160047

Dated :____________

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FIELD WORK & ASSESSMENTS.

NO.DATE OF VISIT FAMILY ASPECT STUDIED GRADE PAGE FACULTY REMARKS

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

PART-A

PART-B

GUIDELINES FOR FAMILY STUDY

VITAL STATISTICS OF THE AREA

COMMUNITY SURVEY

ENVIRONMENTAL SURVEY

FAMILY RECORD

ECONOMIC SURVEY

IMMUNIZATION RECORD

PERSONAL HYGIENE

FAMILY WELFARE SURVEY

HEALTH KNOWLEDGE

SURVEY FOR SOCIAL PROBLEMS

DIET SURVEY & NUTRITION

STATUS

ANTENATAL CARE

POSTNATAL CARE

INFANT HEALTH CARE

UNDERFIVE HEALTH CARE

ADOLESCENT HEALTH CARE

INDIVIDUAL HEALTH CARE

GERIATRIC HEALTH CARE

SUMMARY & CONCLUSION

ANNEXURES I-XI

STUDENT OWN FAMILY STUDY

OVERALL GRADING:GRADE

A- >70% B- 60-70%

C- 50-60% D- <50% I/C Academics

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GUIDELINES FOR FAMILY STUDYEach student will be assigned two families-one at RHTC Palsora and another his /her own family at

home.

FAMILY:

A family is a social unit of biologically related people sharing from the same kitchen and living under

one roof.

SPECIFIC INSTRUCTIONAL OBJECTIVES:

To enable each student:

1. To understand that the family is the basic and social unit of the community.

2. To obtain first hand experience of application of principles of Preventive Medicine for the welfare of

the family, i.e health promotion and specific protection, earliest diagnosis and prompt treatment and

limitation of disability and rehabilitation (if required).

3. To orient them so that they can help the families as family physician.

4. To help them in learning about general medical practice at family / household level. In addition to

these, the other objectives are:

i. To observe and study the environmental factors responsible for good health, for

causation and transmission of diseases in the family.

ii. To learn the importance of observing the person in his natural environment i.e, in

prepathogenic phase affected by multiplicity of factors and their importance in

causation of disease.

iii. To study the socio-economic factors responsible for the good health and disease as well,

in the family.

iv. To assess the nutritional status of the family and dietary pattern of community as a

whole and advise them accordingly.

v. To study the health status of each individual in family and advise accordingly.

vi. To study and observe the psychosocial or emotional factors having their relation and

impact on the health and disease of the family.

vii. To suggest feasible, practical and affordable (cost effective) improvements in the

environment

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viii. to take part / in the health education program organised from time to time / for the

promotion / actively of health and prevention of diseases in future.

ix. To ascertain the need of family welfare measures of the family and motivate them to

select the family planning devices as per their felt needs (cafeteria approach) and

the availability under National Family Welfare Program (NFWP).

x. To get first hand experience of various social and cultural practices prevalent in the community with the

help of Medico-social worker and apply this knowledge for providing the comprehensive health care to

the family.

FAMILY STUDY CASE STUDY

Family study aims at the complete health study of the family.

It aims at the health of an individual only.

All the aspect of health i.e. promotive, preventive, curative are given importance.

Mainly curative aspect is dealt with

Aims at all the five levels of prevention.Only deals with the treatment of diseased part.

To study the epidemiology of disease in respect of agent, host and environment.

To study the disease in question and its treatment only i.e. mainly the host part is kept in view. Environment and social factors are ignored and not given any importance.

Case or patient in chronic/acute illness has to take domicillary treatment. So study of socioeconomic status, physical, biological & Psycho-social environment, habits and customs related with health practices of family are also done.

Hospital is the place of stay and its environment is only a temporary phase which may not help ultimately for complete cure.

RESPONSIBILITIES OF STUDENTS:

It is envisaged that the students, are friends, guides and health advisors to the assigned families and

shall act as family Physician during the whole period of their training at the centres. Medical services needed

by the members of the families are being provided through the Rural Health Training Centre (RHTC), Palsora,

Urban Health Training Centre (UHTC), Sector 44, and referral is done to OPDs of various Departments of the

Govt. Medical College & Hospital (GMCH), Chandigarh.

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The students must imbibe the missionary spirit and adopt a humane approach. You should always

remember your duty and responsibilities (Hippocratic oath). In obtaining the information from the family

always attempt to convey the idea that we are truly interested in their overall welfare and all the information

gathered will remain confidential especially about their income, marital life and interfamilial relations.

You shall visit your families as and when allotted as part of your practical work and maintain their

records. You are free to visit your families at any other time if you or your family so desires. In addition you

have to carry out the environmental and socio-economic survey of the house and the family and conduct the

physical examination of all members of your families with appropriate recommendations for improvement of

the socio-economic status, environmental conditions and treatment of illness if any. The faculty / staff of the

department of community medicine is always available for regular guidance.

You must wear your apron and always carry your stethoscope, tape and torch with you, whenever you

visit your families. All other equipments required are made available from the concerned Health Centre.

You shall present your family to the whole class bringing out all the important features on socio-

economic status, the dietary factors, environment on one hand, the growth and development of the children in

the family, antenatal mother, geriatric person, common disease in the family, their problems on the other hand

and how you tried to help them. The outlines for guidance are also provided.

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VITAL STATISTICS OF THE STUDY AREA Date:__________

STUDY AREA INDIA

Total Births :

Live Births :

Still Births/Abortions

Crude Birth Rate

Total Death

Crude Death Rate

Total Infant Deaths

Infant Mortality Rate

Total Maternal Deaths

Maternal Mortality Rate

Total Population Male:

Female:

Antenatal Mothers

Infants

<5yrs

>60yrs

Total Number of Eligible Couples

Total Number of Eligible Protected

Condom users

Cu-T Insertions

OCP - Users

Tubectomies Done

Vasectomies Done

i) Couple Protection Rate (Contraceptive Prevalence)

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COMMUNITY SURVEY Date:__________

1. Name of Place: Union Territory Chandigarh.

2. Name of Study Area: Urban Area/Peri-Urban Area/Urban Slums/Rural Area:_______________.

3. Main Religion represented in the population:Sikhs Hindus Others

4. Important Community / Social organizations Govt.:1.____________.2._______________

NGOs: 1.____________.2._______________

__________________________________________

Principal industries/means of livelihood: ___________________________________.

Method of Village/Urban Government: Gram Panchayat/NAC/MCC

Recording births & deaths: Gram Pradhan/Panchayat Secretary/Chowkidar/ANM/TBA/Any other

Educational facilities available: No. of Schools : Govt.____________.Public__________

No. of Colleges : Govt.____________.Public__________

Health facilities available:

Medical Care: _________________________________

Medical practitioners (No.) Modern Medicine/Ayurveds/Homeopaths/other indigenous:______.

TBAs: _______________AWS/AWW/AWH______________VHG_____________

6. Water Supply: Tap/Well/Other Specify: continuous/intermittent supply

7. Excreta disposal: Sanitary Latrine Personal

Community

Any other, specify: __________________________.

8. Waste water disposal: Open drain/closed drain/water logging

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9. Refuse disposal: Dumping/Composting/ Bins (Municipal Corporation)

10. Disposal of dead: Ritual burning/Crematorium/other, specify___________.

11. Channels of Communication in the community:

Interpersonal:

Mass Media: TV/Radio/Newspaper

Folk Media: _______________________________.

Important customs prevalent in community: Birth ________________________________

Marriage ________________________________

Others ________________________________

Main health problems in community 1. ________________________________

(Interview opinion leaders/ Panchayat members) 2. ________________________________

3. _________________________________

4. _______________________________

Unmet needs of community 1. _______________________________

2. _______________________________

3. ______________________________

COMMUNITY DIAGNOSIS: 1. _________________________.

2. _________________________.

3. _________________________.

QUESTIONS:

What is the significance of conducting community survey?

What are the different ways of conducting community survey?

What is Community Diagnosis?

How can community diagnosis help in health planning and management?

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ENVIRONMENTAL SURVEY

Date:__________

LEARNING OBJECTIVES: To enable medical students

To assess the Environmental Status.

To understand the influence of environmental factors on health of the family.

To suggest suitable modifications in the environment to alleviate/prevent health problems in the family within the

given constraints.

Name of Ward / Mohalla /Street: Sector House No.

HOUSING CONDITION:

House: Owned / Rented Type: Kuchha / Pucca / Mixed

Roof: Thatched / Tin or Cement Sheets / Bricks / Cemented & Plastered.

Walls: Mud / Bricks

Floor: Mud with cowdung / Cemented / Tiled.

Number of Doors Area sq. ft.

Number of Windows Area sq. ft.

*Open space around the house:

Numbers of Rooms

*Separate kitchen:

*Separate bath room:

Latrine: Own / Community / Indiscriminate defecation.

Total floor space area of living rooms sq.ft. Floor space/Area/person sq.ft.

**Overcrowding (see annexure I)

*Cross Ventilation Lighting: Adequate / Inadequate

*Dampness Water Supply: Tap water / Hand pump / Well

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If tap water:

* Own tap / Community tap

* Continuous / Intermittent

Water storage: Drums/Buckets/Utensils/Any other, specify_____________________.

Stored water : Covered / Uncovered

Method of drawing water from pot : Mug/Ladle/Steel Glass / Tumbler / Other specify___________

Sullage disposal : Kuchha drains / Pucca drains/ None / Any other, specify____________________

Cooking : Gas / Stove / Chula / Electric Plate Smoke vent : Present / Absent

Refuse disposal : Own bin / Community bin / Indiscriminate throwing / Dumping / Any other, specify

If Bins used, Whether Covered / Uncovered

**Animals/Birds in the house

Animals kept in the house / separate shed If yes, distance of shed from the house ft.

Insects / Rodents / Mosquitoes / Houseflies of medical importance seen If yes,

specify________.

* Preventive measures used

* Measures Used: Mosquito Nets / Repellants / Sprays / Rat traps / Flytraps / Any other, specify._____

**Good cleanliness inside the house Good cleanliness outside the house

GENERAL REMARKS:

Environment: Disease Breeding Why: ______________________________________

Health Promoting Why: ______________________________________

Please write * Yes - 01, * No - 02 ** Present - 01, ** Absent – 02

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QUESTIONS:

Enumerate criteria for overcrowding.

Enumerate diseases associated with overcrowding.

What are the diseases transmitted by Mosquitoes?

Classify various water borne diseases.

Enumerate the household methods for disinfection of water.

How can you find out whether water being supplied through municipal corporation is potable and fit for

drinking or not?

What are diseases associated with cattles and pets?

What is manure pit and soakage pit?

What is sanitary landfill and composting? Differentiate between sewage, sewerage and sullage.

Comment upon physical and biological environment of the family allotted to you.

Comment on adequacy of ventilation and lighting in family allotted to you?

What do you mean by kitchen hygiene?

What do you mean by VIP latrine?

SKETCH OF THE HOUSE OF ALLOTED FAMILY:

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FAMILY RECORD LEARNING OBJECTIVES: Date:__________

The student should be able - To conduct the Interview as per steps in interview technique.

- To learn the importance of each variable in relation to the identification and family record collected below.

- To learn types, functions, advantages & disadvantages of particular type of family and

- To learn the role of family in health and disease.

Total family members Type of family: Joint/Nuclear/Extended/ Three generation Religion: Hindu/sikh/muslim

FAMILY COMPOSITION

S.No.

Name Age Sex Relation to head of family

Education Occupation Income/month

Immunization Status

Any Health

Problems

Remark If any

Head of family comes first. Rest in chronological (order of age), including deaths / still births.

** Any birth / death during clinical posting to be recorded and to be updated in flying posting before examination.

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QUESTIONS: What are the steps of interview technique? Difference between family and household. Enumerate functions of family. Enumerate merits and demerits of nuclear and joint family. How much should be the spacing between two children? Why? Name the diseases associated with the occupations of the family members Explain the following terms:

Broken family Extended family Problem family New familiy

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SOCIO-ECONOMIC SURVEY Date: __________

LEARNING OBJECTIVES: To enable medical students:

To learn the methods of assessment of socio-economic status and significance of different classifications to

various set-ups

To learn the concept of poverty line

To learn association of socio-economic status with health.

To be able to advice the family members for modification of expenditure pattern to improve health status in the

available economic resources

INCOME SOURCE AND EXPENDITURE PATTERN:

6.2.1 Monthly income (in rupees)

Land House ShopWages/SalaryOf all members

CottageIndustry

Others Total

6.2.2 Per capita income per month: ______________

2. EXPENDITURE (Monthly):A.

Food

Housing

Clothing

Transport

Education

Medical aid

Electricity / Water

Communication (Telephone/Mobile)

Fuel

Ceremonies

Any other, specify

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Total expenditure (monthly) ___________________C. Assessment:

(a) Above/below poverty line

(b) Socio-economic status based on Modified Kuppuswamy scale ( See Annexure IIA & B):

- Score : Income ____ + Occupation ____ + Education ______ : Total ______

- Socio-economic status based on the score obtained: _________

QUESTIONS:

Name the different scales used to measure the socio- economic status.

What are the limitations of Kuppuswamy classification?

How much is the per capita per month income in India at present?

What is the economic criteria for poverty line and name the other criteria?

Enumerate the diseases associated with upper socio-economic status.

Enumerate the diseases associated with lower socio-economic status.

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IMMUNIZATION RECORD (For Under Five Children & Antenatal Mothers only)LEARNING OBJECTIVES: To enable medical students: Date:__________

To learn methods of eliciting information about immunization status of the individuals.

To learn eligibility, contraindications, precautions, dosages, route of administration, vaccination schedule, side effects of the vaccines,

cold chain maintenance etc. regarding vaccines used under National Immunization Program.

To be able to perform immunisation.

S. No.

Name Age BCG

DPT OPV Measles TT Hepatitis A/B

Chickenpox / MMR/ Typhoid

etc.

Immunization Complete / Partial / Nil

Reasons for failure of Immunization

I II III B I II III B I IIC

1

2

3

4

M

I

II

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QUESTIONS:

What is the National Immunization Schedule?

What are the common complications of vaccines?

Discuss specific complications of vaccines used in national immunization schedule.

What are dosages, routes and sites of administration of vaccines used in UIP?

What advice you will give to mother after DPT & BCG vaccination of the child?

Why Measles vaccine is recommended at the age of nine months?

What is toxic shock syndrome?

If a child has been vaccinated just one day before PPI under NIS, whether that child be vaccinated again

during PPI? Discuss reasons.

Suggest Immunization schedule for a two years, four years and six years old unimmunized child.

What are the newer vaccines?

Differentiate between EPI and UIP.

What is cold chain? Name the different equipments used in maintaining cold chain

What is ‘Reverse Cold Chain’? Give examples.

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PERSONAL HYGIENELEARNING OBJECTIVES: To enable the medical students: Date:__________

To do assessment of personal hygiene of individual and family. To learn the influence of poor personal hygiene on health status. To learn how to impart health education regarding personal hygiene to individual and family

** S.No. OF FAMILY MEMBERS1 2 3 4 5

CLEANLINESS:Bath: Daily/OccasionalUse of soap : Daily/OccasionalWashing of hands : before taking food

After going to toiletCLOTHING :

*Clean How often exchanged?How often washed?

SKIN :*Clean *Any skin disease If yes, specify: If, present : Under Tt/Cured/Not Tt /Others

NAILS*Trimmed

HAIR :

*Combed Washed :Regularly/irregularly*Soap / Shampoo used*Presence of liceIf yes, specify-Tt taken or not.

EYES*Presence of discharge *Presence of congestion If yes, specify status

EARS*Presence of wax *Presence of dischargeIf yes, specify status

LIPS:Normal /Chapped/Angular/ Stomatitis

TEETH:Brushed :Regularly/irregularly*Presence of tartar/caries *Use of brush/datoon

TONGUE:Clean/coated*Presence of ulcers If yes, advice given-specify

MOUTH:*Washed after meals *Presence of bad odour

*Presence of gingivitis / stomatitis *Please fill: Yes - 01, No - 02 **S.No. is according to Family Record

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QUESTIONS:

What are the different types of hygiene you know?

What is the difference between hygiene and sanitation.

What are the diseases transmitted/associated with application of Kajal?

What are the diseases associated with poor genital hygiene?

Which disease is likely to be transmitted by walking bare foot?

What do you mean by effective handwashing?

What is occular hygiene? How is it different from visual hygiene?

Enumerate diseases cause by poor personal hygiene?

What is the correct method of brushing? What is the life of toothbrush?

How will you assess the quality of soap and which soap you will recommend for washing and bathing purpose?

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FAMILY WELFARE SURVEY Date:__________

LEARNING OBJECTIVES: To enable the medical students:

1.To learn the problem of population explosion and its reasons.

2. To learn about the various family planning devices under cafeteria approach.

3.To learn the attitude of people towards National family welfare program (NFWP).

KNOWLEDGE:*India is facing the problem of population explosion :

Reasons for population explosion : ___________________ ____________________________________ _________________

In your opinion, how many children a couple should have: ___________Family planning methods known :

Barrier methods/ OCP / Cu-T / Saheli / Tubectomy / Vasectomy / Any other, specify :

v) What in your view should be the spacing between 2 children : ___________________.

ATTITUDE:Attitude towards use of family planning methods : Using / Willing to use;

If cant use, why; specify________________________________________________.

Attitude towards spacing of children: Doing / willing to do; If not, why; specify______________.

Ideal number of children in their view: _________________________.

*Is a male child must:

*Preference of son to daughter:

If yes, give reason: _______________________________________________.

vi) Which permanent sterilization methods (Tubectomy/vasectomy) you will prefer and why?

______________________________________________

PRACTICE: i) FP methods: Used / Not used

S.no. Contraceptive Duration Using/Withdrawn Side effect/any other problem1. Condoms

2. Cu-T

3. OCP / Saheli

4. Tubectomy Done

5. Vasectomy Done

* Please fill : Yes - 01, No - 02 **Unmet need of Contraception

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QUESTIONS:

1. What are different kinds of family planning devices available in the National family welfare

program?

2. What do you mean by ‘cafeteria approach’ under NFWP?

3. Who is an ideal candidate for Cu T?

4. Is it essential to know about attitude of elderly in the house regarding family planning methods?

5. What is PNDT act?

6. What are conventional contraceptive? What is an ideal contraceptive?

7. Define Sex Ratio. Enumerate reasons for the decline in sex ratio.

8. What is meant by Unmet Need for family planning?

9. Define the following terms: a) Target Couple b) Eligible Couple c) Couple Protection Rate

10. What are the ‘Natural family planning methods’?

11. Explain scope of family planning services.

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SOCIO-CULTURAL ENVIRONMENT Date:__________

LEARNING OBJECTIVES: To enable the medical students:-

To learn the importance of socio-cultural factors in health and disease

To learn the level of knowledge, attitude, customs, beliefs and practices of the family in health and

disease

To learn the benefits and harmful effects of the customs and practices scientifically and advise the

family accordingly.

Information regarding customs and health practices Name of the respondent: _____________________

MarriageWhat is the legal age for marriage in India for boys: ___ , for girls __

At what age you were married ? _____

In your opinion, what should be the age at marriage for boys __ , & girls ___

Child bearing1. Age at first pregnancy of the respondent (if applicable) _____

2. Number of children born: __________

3. Age at last pregnancy: ____________

4. Details regarding the last pregnancy and its outcome:

- Registered in antenatal clinic : Yes/No _________ Or Period of gestation at the

time of registration in Antenatal Clinic ______ weeks/not registered.

- Received antenatal care: Yes/No _______ Number of antenatal visits _____

- Food intake : Whether food intake increased : Yes/No since second trimester?

- Any food restriction: Yes/No, If yes,

- For which food item? ___________________________ , Why _____

_______________________________________________________

- Any special/additional food item given ? Yes/No, Names:______________

Reasons _____________________________________________________

- Number of hours of rest in daytime : Nil/ __________

- Any complications during pregnancy: Yes/No _______________________

- Anemia : Present/ Absent (as per record/history)

- Outcome of pregnancy: Abortion/still birth/ preterm/full term

- Delivery: Institutional/ Home Delivered by : Doctor/Nurse/Trained

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Dai/Untrained Dai/Relatives or neighbours/self

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- Cord applicants : ash/cowdung/ghee/ antiseptic/other _________none applied

- No. of days of isolation during puerperium: _____

Child rearing

1. Should colostrum be given to the newborn child ? Yes/No and why ? _____

______________________________and have you given it to your baby ? Y/N

After how many hours/days of birth, breast feeding should be given ? ____

And why ? ______________________________________ and when have you started breast

feeding ? ______

Any prelacteal feeds given to the child? ___________________________

Do you give any other food than breast milk before six months of age? Yes/No ______________

Do you give water to a child who is getting only breast feed? Yes/No _____

At what age supplementary feeding should be started ? ____

When did you start supplementary foods for your child ? _____

Which foods should be introduced at 6 m ____________________________ _______________,

8 m __________________________________________.

Have you registered your child with well baby clinic/under five clinic ? Y/N

Against what diseases, vaccines should be given for an infant ?

_________, __________, _________, _________, ________, __________

Is your child vaccinated for the vaccines due for date ? Y/N, If no, reasons

______________________________________________________

Apart from vaccine preventable diseases, which diseases commonly occur during first year ?

_____________________________________________

Did your child ever suffer from diarrhoea ? Y/N. If Yes, what actions did you take: a) ORS given :

Y/N, b) Home Available Fluids given : Y/N, if Yes, specify ________________________ c)

Any other action, specify: _____________.

Did your child ever suffer from pneumonia? Y/N, If yes, could you recognize it? Y/N, What were

the signs and symptoms? _________________________,

What actions did you take: ________________________________________.

Other child rearing practices

1. Application of kajal. Y/N, If yes, with common applicator Y/N

2. Massage with oil Y/N

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3. Exposure to sunlight Y/N

4. Use of ghutti Y/N

5. Food prohibited during fever: Y/N

6. Restrictions of fluids during diarrhea : Y/N

Concept of disease causation:

i) "Evil eye" ii) Karma"

iii) Punishment by God iv) Bad weather

v) Dirty water / food vi) Any other, specify

* Are diseases preventable?

Knowledge, attitude and practices in some common diseases (Students should impart health education)

1. Tuberculosis

Is tuberculosis curable ? Y/N

What measures should be taken to prevent transmission of the disease ?

___________________________________________________________

___________________________________________________________

Should the patient of T.B. be isolated ? Y/N

What is the duration of treatment ? ________ If complete treatment is not taken, what will

happen to the patient ? _______________________

2. Measles

Can it be prevented ? Y/N, If yes, how ? __________________________

What do you do in case a child gets measles? _____________________

___________________________________________________________

What is the cause of measles ? __________________________________

3. Poliomyelitis

(a) Can it be prevented? Y/N, If yes, how ___________________________

4. KAP regarding any other disease existing in the family? (e.g. Hypertension. Diabetes etc.

Attach separate sheets.)

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Nutrition

Which are the faulty cooking practices in the family? Enlist them (See Annexure III)

i) ______________________________________________________________

ii) ______________________________________________________________

iii) ______________________________________________________________

2) Which are the beneficial cooking practices in the family? Enlist them (See Annex. III)

i) ______________________________________________________________

ii) ______________________________________________________________

iii) ______________________________________________________________

Health services utilization:Which are the health centers /agencies serving in your village/ locality?

________________________________________________________________________

Are you availing benefits regularly? Yes / No, If No, please specify:

________________________________________________________________________

Are you satisfied with the health services provided? Yes / No, If No, please specify:

________________________________________________________________________

Are you visited by the medical social/health workers/ANM regularly? Yes/No

Where do you go in case of emergency? ________________ _________________

Analysis and interpretation

Customs and practices conducive to health _________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Customs and practices harmful for health

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

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Customs and practices having no bearing on health

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

QUESTIONS:

What are the various socio-cultural factors affecting health and diseases of the community?

What is social pathology?

What are the customs you have observed in the community which do not have a bearing on

health of the community?

Enlist the diseases to which social stigma is attached?

Define custom, culture, mores and folkways.

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SURVEY FOR SOCIAL PROBLEMS Date:__________

LEARNING OBJECTIVES: To enable the medical students:To learn regarding various social problems in the family and the communityTo suggest suitable measures to tackle those problems

Unemployed adult: Yes No

Poverty: Yes No

Overcrowding: Yes No

Gambling: Yes No

Marital conflicts / Abuse / Divorce or Separation: Yes No

Any unmarried mother: Yes No

In case of working mother, who takes care of the children: _____________________

Orphans in the family: Yes No

Children >6 years, not going to school: Yes No

If yes, state the reason _________________________.

Children <14 years, working: (Child Labour) Yes No

If yes, place of work __________________________.

11. Any Delinquent Child in the Family:

Illness in the family: Yes No

If yes, effect of illness on:

i) Individual Patient: At Psychosocial / Emotional Level:_________________________At Economic Level: ___________________________________

ii) Family: Psychosocial_______________________________________Economic ________________________________________

iii) Attitude of family members:

Positive & Caring Co-operative & Sympathetic /EmpatheticIndifferent & Non Co-operative

Attitude of Neighbours :________________________________.

Indifferent & Non Co-operative Emphathetic / Sympathetic & Co-operative29

QUESTIONS:

What are the various social problems in the family and at the community level?

Suggest suitable measures to manage social problem in your family?

Explain various factors responsible for social problems?

Name the different social institutions existing in your field practice area. In what ways do these

impact the health status of the people ?

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DIETARY ASSESSMENT (To Be Completed In Three Visits) Date:__________


To analyze the concept & importance of balanced diet.

Merits and demerits of various methods of dietary survey.

To collect the accurate information regarding food consumption of both the household and individual

member.

To understand the concept of energy consumption unit (ECU) and calculation of dietary intake per

consumption unit, detect deficiencies/excesses and correlate them to the nutritional status of the

family members.

To advise the family regarding required change in diet in case of deficiency/excess.

To calculate food intake according to various food items and nutrients relevant to that particular area and

the group.

Collection, analysis, interpretation and advice regarding diet to the individual suffering from nutritional

disorder/needing special nutrition to the vulnerable groups.

Visit I: Date:_______________

Recommended daily allowance of family members

The following information is aimed to find out the dietary requirement of family members as per recommendation. This will help students to understand what is required for the family members of the family allotted to them and then compare that with what they are actually taking (See annexure X).

Name Age Sex Occupation Cereals Pulses GLVOther

vegetablesRoots

& tubers

MilkSugar Fat

& oil

31

DAILY DIET CONSUMPTION BY THE FAMILY IN GRAMS(MODIFIED QUESTIONNAIRE METHOD)

Method for assessment of average daily consumption: Find out fortnightly/monthly consumption for items procured fortnightly/monthly e.g. rice, wheat,

pulses, oil etc. and calculate average daily consumption

Find out weekly consumption for items such as fish, meat, eggs, fruits etc. and calculate average

daily consumption

Find out daily consumption of regularly used items such as milk, vegetables etc.

Find out consumption of any occasionally used items during last 24 hours e.g. chocolates, biscuits,

sweets, ice-cream etc.

Take into account if any member has not taken meal during the 24 hrs. period of taking history

Deduct the consumption of food by guests, if any

Don’t take the diet consumed on the occasion of fast, feast and festival.

Now, calculate the average daily consumption (last 24 hrs.) by the family and enter below(See annexure IV, V, VI, VII & IX):

S. No. item gms. S. No. item gms.

1. Wheat 2. Rice

3. Pulses 4. Sugar / jaggery

5. Oil/Ghee (total) 6. Saturated fat

7. Un-saturated fat 8. Fish

9. Meat 10. Poultry

11. Eggs 12. Fruits

13. Vegetables green leafy 14. Vegetables, non-leafy

15. Tuber 16. Milk

17. Milk product (specify) 18. Any other, specify

Calculation of Consumption units:. Total number of family members:___________________________.

. Total number of consumption units *: _________________________.

* Key for calculating consumption units(ANNEXURE VIII)32

Visit II: Date____________

Intake of foodstuffs per consumption unit (C.U.): (Prepare bar diagram)Foodstuff Average intake Recommended % % Deficit/Excess

(for 1 C.U.)

Cereal gms 460 gms.

Pulses gms 40 gms.

Milk gms 150 gms.

Fruits gms 80 gms.

Green Vegetables gms 40 gms.

Other vegetables gms 60 gms.

Tubers gms 50 gms.

Fats & Oils gms 40 gms.

Sugar & Jaggery gms 30 gms.

Eggs gms 50 gms.

Meat/Fish gms 30 gms.

9.3 Average Daily Consumption Of Individual Suffering From Nutritional Disorder/Needing Special

Nutrition (Dietary intake should be studied for all individuals qualifying this condition. Format given

below to be copied for each of them)

Name of the individual : _______________ Age ______ Sex ___

Physiological/pathological condition needing special nutrition : _______________________

Foodstuff Average intake* Recommended % % Deficit/excess (for the individual)

Cereal gms gms.

Pulses gms gms.

Milk gms gms.

Fruits gms gms.

Green Vegetables gms gms.

Other vegetables gms gms.

Tubers gms gms.

Fats & Oils gms gms.

Sugar & Jaggery gms gms.

Eggs gms. gms.

Meat/Fish gms gms.

Average means usual intake as informed by respondent. 33

CONSUMPTION OF FOOD ITEMS & NUTRIENTS (PER CONSUMPTION UNIT)(Construct bar diagram):

Sr.No.

Food items Qty.gms

Calories Proteins(gms.)

Fatgms

Vit. A*(μg)

Thiamine(mg)

Riboflavin(mg)

Niacin(mg)

AscorbicAcid (mg)

Iron(mg)

Calcium(mg)

1. Cereals

2. Pulses

3. Milk

4. Fruits

5. Green leafyVegetables

6. Other Vegetables

7. Roots & Tubers

8. Fats & Oils

9. Sugar & Jaggery

10. Eggs

11. Meat & Fish

12. Any other (nuts etc.)

Specify

Total per consumption UnitRecommended value daily intake per C. U.

2425 60 20 2400 1.2 1.4 16 40 28 400

Percentage

* in terms of β carotene

34

Deficiencies in the Diet & advice given:

Family diet according to per consumption unit

Deficiencies: _______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Advice given:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

35

Visit III: Date____________

Nutritional Status Of Family

Sr.No.

Name AgeNutritional assessment based on anthropometrics/clinical

examination *

Dietary deficiencies

Action taken

* Mention values for anthropometry and clinical findings and your diagnosis based on these.

36

QUESTIONS:

What are the various methods of assessing nutritional status of an individual?

What are the different methods of conducting diet survey? What are the advantages and

disadvantages of various methods of conducting diet survey?

What is the objective of conducting diet survey?

What dietary advice and treatment you will give to a three-year child suffering from Vit. A

deficiency?

What dietary advice you will give to a patient of Diabetes Mellitus?

What dietary advice you will give to a pregnant and lactating mother?

What is the protein requirement of a one-year old normal child?

What are the parameters for assessing protein quality in foodstuffs?

What are clinical features and management of rickets?

What is D.A.S.H. diet?

Classify malnutrition and discuss management of various types of malnutrition.

What is therapeutic diet?

37

PREVENTIVE CHECK-UP Date:__________


To learn about common health conditions in the various age groups.

To learn the concept of high risks and screening.

Importance of screening/preventive check-up in relation to health status. Identification of target groups for

preventive check up and individuals to be screened for the diseases relevant to their age and various

tests to be used for screening.

Early diagnosis of risk factors and health problems, timely referral, management at domestic and institutional

level and health education.

ANTENATAL CARE (ANC)

Date:__________

Name Age

Religion Occupation

Address

LMP EDD

Registered/unregistered: ______________If registered, name the centre:____________.

Date of first visit (check-up) Number of visits paid

*Planned pregnancy If unplanned: Wanted/Unwanted.

Present complaints:

1.________________________________ 3._____________________________________

2.________________________________ 4._____________________________________

Onset duration & progress(ODP) of presenting illness:

________________________________________________________________________________________

________________________________________________________________________________________

38

Menstrual history_________________________________ Age at menarche

Obstetric history: _________________________________ Age of marriage

Sno. No. of pregnancies

Age Sex Place of delivery

Conducted by

Any complications

Live/Still birth/IUD

* Please fill = Yes - 01, No - 02

H/o Past illness:___________________________________________________________________

_______________________________________________________________________________

Family history :___________________________________________________________________

Personal history :__________________________________________________________________

* Appetite * Bowel & bladder

* Sleep * Habits

Diet history :_____________________________________________________________________

Contraceptive history:______________________________________________________________

Care provided for present pregnancy:

*T.T given :

If yes, no. of doses : reqd. _________ given: ________.

*Folic Acid & iron tablets given :

If yes, no. of tablets __________ since _____________.

If no, specify reason : ___________________________.

Economic / Environmental history :GENERAL EXAMINATION

Height : cm Weight: kg Blood Pressure:_____ mmHgResp Rate min Pulse Rate min Pallor OedemaClubbing: Cyanosis IcterusBreast examination:___________________________________________________________

39

SYSTEMIC EXAMINATION

*P/A Inspection: Abd distension Visible pulsations Visible movements

Linea Nigra Striae gravidarumPalpation:

Fundal Ht Presentation:_____________ Lie:__________*Foetal movements

Auscultation: Foetal Heart Sound Respiratory Distress

INVESTIGATIONS:5. 1) Blood group: Self: _______ Husband: ________ Compatible: Yes/No

2) VDRL : + -

3) Hb gm% 4) Urinary Albumin gm%

5) USG:______________ Urinary Sugar

RISK ASSESSMENT:

*High Risk: If yes, reasons 1.__________2.___________3.___________

ADVICE / ACTION TAKEN BY STUDENT

1. Personal hygiene ______________________ _______________________

Physical activity ______________________ _______________________

Rest ______________________ _______________________

Diet ______________________ _______________________

Drugs ______________________ _______________________

Regular check-up ______________________ _______________________

T.T./Folic acid+ F.S. tablet ________________ _______________________

Any Other :_____________________________

ANTE NATAL FOLLOW UPS.No. DATE OF

VISITCOMPLAINTS DIAGNOSIS & TREATMENT REMARKS

40

Questions: Enumerate high-risk pregnancy criteria. What is meant by the term ‘high risk’ newborn?

How many minimum visits should be made at ANC clinic and what actions should be taken at each visit?

What additional nutrients should be provided during pregnancy?

What are the drugs contraindicated during pregnancy?

What are the facilities for ANC care in the area?

What do you mean by TORCH infection?

How will you prepare a lady for safe delivery? What do you mean by five cleans?

Define a) Maternal death b) Maternal mortality rate (MMR) c) Late maternal death d) pregnancy related

death.

Enumerate the causes contributing towards maternal mortality and what steps can be taken to counter them.

41

POSTNATAL CARE (PNC)Date:__________

Name Age

Religion Occupation

Address

H/O Delivery: Complaints at present:1.____________________________________________________________________2. ____________________________________________________________________3. ____________________________________________________________________4. ____________________________________________________________________ODP of presenting illness: ______________________________________________________________________________________________________________________Menstrual history: ______________________Obstetric history: __________________Past history.: _________________________________________________________________________________________________________________________________Family history: __________________________________________________________Personal history: ________________________________________________________Bowel/Bladder: _____________________ Appetite : ___________________________Habits: ____________________________ Sleep : _____________________________

Diet History: ____________________________________________________________________________________________________________________________________

Contraceptive History: ____________________________________________________Economic/Environmental History in brief: ______________________________________________________________________________________________________________

GENERAL EXAMINATION

Height : cm Weight: kg Blood Pressure:_____ mmHg

Resp Rate min Pulse Rate min Pallor Oedema

Clubbing: Cyanosis Icterus

Breast examination:___________________________________________________________

42

SYSTEMIC EXAMINATION

*P/A Inspection: Abd distension Visible pulsations Visible movements

Linea Nigra Striae gravidarumPalpation:

Fundal Ht

QUESTIONS:

What are the contraceptive methods for such a case?

What is the minimum number of postnatal visits required?

What are the common complications during postnatal period?

What are the facilities for PNC in the area studied by you?

Define : Perinatal mortality rate. Enlist the various causes contributing towards perinatal mortality.

43

EXAMINATION OF NEWBORN Date:__________

H/o Delivery : _________________________________________________________________Any complaints1. ___________________________________________________________________________2. ___________________________________________________________________________

ODP of presenting illness: ____________________________________________________________________________________________________________________________________Family tree: ________________________________________________________________________________________________________________________________________________Feeding history (right from birth): _______________________________________________________________________________________________________________________________Immunization: _________________________________________________________________

Height : cm Weight: kg CyanosisResp Rate min Pulse Rate min Pallor

IcterusAnthropometry : Length :

Head : Chest: Weight: Mid-arm:

Foot to toe examination (for congenital malformations)

If any abnormality detected please specify, otherwise write NAD / WNL

Anterior fontanelle: __________.

Umbilical cord: __________.

Ears: __________.

Eyes: __________.

Mouth: __________.

Nose: __________.

Neck: __________.

Chest: __________.

Hip: __________.

Genitalia: __________.

Legs: __________.

Feet: __________.

Nails: __________.

Rectum: __________.

Examination of Reflexes: Normal / Abnormal, If any Abnormal reflex detected, please specify: ______________________________________________________________________________

Diagnosis: _____________________________________________________________________

Investigation:

1) Blood group 2) Hb gm% 3) Any other : ________________________.

Treatment, If any :_______________________________________________________________

44

Advice:

Feeding: ________________________________________________________________

Immunization: ___________________________________________________________

Follow-up: growth monitoring by growth chart

Cord care : _____________________________________________________________

No Application of kajal

Advice / Action taken by Student:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

POST NATAL FOLLOW UP

S.No. DATE OF VISIT

COMPLAINTS DIAGNOSIS & TREATMENT REMARKS

45

INFANT HEALTH CARE Date:__________

Informant: _______________________. Name: __________________________________.

Any complaints:1._______________________________________________________________________2._______________________________________________________________________3._______________________________________________________________________

ODP of present illness: _____________________________________________________

________________________________________________________________________

H/o delivery in brief: _______________________________________________________

Family tree: ______________________________________________________________

*Working mother:

Nutrition history:

Breast feeding/Top feeding/Weaning __________________________________________

Food Items Calories Proteins1. _______________________________________________________________________2. _______________________________________________________________________3. _______________________________________________________________________Total: ____________________________________________________________________Required: ________________________________________________________________Deficit/Excess: ____________________________________________________________Immunization history: complete / incomplete, If incomplete specify reason______________________________________________________________________________________

Milestones: (Record actual months)

1. Social smile (2 months)_________ 2. Head holding (3months)_________________3. Turning over (4-5months)________ 4. Sitting with support (5-6mths)____________5. Teething (6months)______________ 6. Sitting without support (6-8mths)__________7. Crawling (9-10mths)_____________8. First words (10-11mths)__________________Walking with support (10-11months)

Customs & beliefs related to infant care in this infant:___________________________________________________________________________________________________________________Economic/Environmental History in brief: _____________________________________________________________________________________________________________________________

GENERAL EXAMINATION

Height: cm Weight: kg Blood Pressure:_____ mmHgResp Rate min Pulse Rate min Pallor Oedema


46

Signs of nutritional deficiencies: ___________________________________________________

Anthropometry: _________________________________________________________________


Systemic Examination:

Respiratory system Central nervous system

Cardiovascular system Musculo skeletal system

Diagnosis:________________________________________________________________

Investigation, If any :_______________________________________________________

Treatment, If any:__________________________________________________________

Advice / Action taken by Student:

1. Personal hygiene:____________________________________________________

2. Diet: ______________________________________________________________

3. Immunization as per National Immunization Schedule:

Follow-up(Growth monitoring) according to growth chart

Family planning: Yes / No, please specify ______________________________

Removing misconceptions in child care if any ; specify:

A) ____________________________________________________________________B) ____________________________________________________________________C) ____________________________________________________________________D) ____________________________________________________________________


INFANT HEALTH FOLLOW UP

S.No. DATE OF VISIT COMPLAINTS DIAGNOSIS & TREATMENT REMARKS

47

UNDERFIVE CHILD CARE Date:__________

Informant: _______________________. Name: __________________________________.

Any complaints:1._______________________________________________________________________2._______________________________________________________________________3._______________________________________________________________________

ODP of present illness: ______________________________________________________

_________________________________________________________________________

H/o delivery in brief: ________________________________________________________

Family tree: _______________________________________________________________

*Working mother :

Nutrition history:

Breast feeding/Top feeding/Weaning ___________________________________________

Food Items Calories Proteins1. _______________________________________________________________________2. _______________________________________________________________________3. _______________________________________________________________________Total: ____________________________________________________________________Required: _________________________________________________________________Deficit/Excess: ____________________________________________________________Immunization history: complete / incomplete, If incomplete specify reason______________________________________________________________________________________

Milestones: (Record actual months)1. Social smile (2 months)_________ 2. Head holding (3months)________________3. Turning over (4-5months)________ 4. Sitting with support (5-6mths)____________5. Teething (6months)______________ 6. Sitting without support (6-8mths)__________7. Crawling (9-10mths)_____________8. First words (10-11mths)_________________Walking with support (10-11months) Customs & beliefs related to underfive care in this child:_________________________________________________________________________________________________________________Economic/Environmental History in brief: _____________________________________________________________________________________________________________________________

GENERAL EXAMINATIONHeight : cm Weight: kg Blood Pressure:_____ mmHgResp Rate min Pulse Rate min Pallor Oedema


48

Signs of nutritional deficiencies: ___________________________________________________

Anthropometry: _________________________________________________________________


Systemic Examination:

If any abnormally detected please specify, otherwise write NAD / WNL

Respiratory system _____________ Central nervous system____________________

Cardiovascular system _____________ Musculo skeletal system_____________

GIT __________________Eye___________________Ear_______________________

Diagnosis:______________________________________________________________________

Investigation, If any :______________________________________________________________

Treatment, If any:___________________________________________________________ _____

Advice / Action by Student:

1. Personal hygiene:___________________________________________________________

2. Diet: _____________________________________________________________________

3. Immunization as per National Immunization Schedule:

Follow-up(Growth monitoring) according to growth chart

Family planning: Yes / No, please specify ___________________________________

Removing misconceptions in child care if any ; specify:

A) __________________________________________________________________________B) __________________________________________________________________________C) __________________________________________________________________________D) __________________________________________________________________________


UNDERFIVE HEALTH FOLLOW UPS.No. DATE OF


49

QUESTIONS:

What are the common health problems of the under five children?

Name the medical conditions for which the child is normally asymptomatic?

What are the components of newborn care?

What are the different health care targets related to under five children in the national health policy?

What information can you get from the road to health card? Who prepared this card?

What are the effects of eating junk food?

What are the various national health programs associated with health of under five children?

How will you keep a healthy child healthy?

50

ADOLESCENT HEALTH CARE Date:__________

Name Age

Religion Occupation

Marital Status : Married / Unmarried

Address

Complaints (If any):1.____________________________________________________________________2. ____________________________________________________________________3. ____________________________________________________________________4. ____________________________________________________________________ODP of presenting illness: _____________________________________________________________________________________________________________________

Past history: ___________________________________________________________________________________________________________________________________________________Family history: __________________________________________________________________Personal history: ________________________________________________________________Bowel/Bladder: _____________________ Appetite : ___________________________________Habits: ____________________________ Sleep : ______________________________________

Diet History: ____________________________________________________________________________________________________________________________________________________

IN FEMALES : Menstrual history: ______________________Obstetric history: ______________Menstrual hygiene practiced : Yes / NoH/O of passage of white discharge per vaginum: Yes / No

Economic/Environmental History in brief: _____________________________________________________________________________________________________________________________

GENERAL EXAMINATIONBuilt & Nourishment: Well / Poor

Height : cm Weight: kg Blood Pressure:_____ mmHgResp Rate min Pulse Rate min Pallor Oedema

Clubbing: Cyanosis IcterusLymphadenopathy: Yes / No, If yes, please specify:_________________________________________

Any signs of nutritional deficiencies: Yes / No, If yes, please specify:___________________________

51

SYSTEMIC EXAMINATION :If any abnormally detected please specify, otherwise write NAD / WNL



GIT __________________Eye___________________Ear_______________________

SIGNS OF PUBERTY:1. __________________________________6.____________________________________

2. ___________________________________7.____________________________________

3. ___________________________________8.____________________________________

4. ___________________________________9.____________________________________

5. ___________________________________10.___________________________________

Is there any role model in your life: Yes / No, If yes, please specify____________________

___________________________________________________________________________

If givan a choice what would you like to become in your life?__________________________

___________________________________________________________________________

If givan a choice what would your parents want you to become?________________________

___________________________________________________________________________

Do you have good and trustworthy friends? Yes / No

Have you ever tried to use any of the following:

1. Alcohol:

2. Cigarette :

3. Drugs :

4. Any other:

Are you addicted to any of the above? Yes / No

If yes, type Duration Years

Have you heard about HIV / AIDS? Yes / No

Who are the persons who may get HIV / AIDS?

1.___________________2._____________________3._______________4._____________

What are you doing to protect & promote your health?

_____________________________________________________________________________

________________________________________________________________________________52

Diagnosis of health status: Healthy / Not Healthy if not, please specify_____________________

________________________________________________________________________________

Health advice given:_______________________________________________________________

ADOLESCENT HEALTH FOLLOW UP

S.No. DATE OF VISIT


QUESTIONS:

Who is an adolescent?

Is it a vulnerable period of life? Why?

What are the common health problems seen in adolescent age groups?

What are the national health programs associated with health of adolescents?

53

GERIATRIC HEALTH CARE Date:__________

Name Age

Religion Occupation

Address

Working / Not working, If not working, specify the source of income________________________Chief Complains including Psychosocial Problems (If any):1. ____________________________________________________________________

2. ____________________________________________________________________

3. ____________________________________________________________________

4. ____________________________________________________________________

ODP of presenting illness: __________________________________________________________________________________________________________________________________________

Past history.: _____________________________________________________________________________________________________________________________________________________Family history: ___________________________________________________________________

Personal history: ________________________________________________________________

Bowel/Bladder: _____________________ Appetite : ___________________________________

Habits: ____________________________ Sleep : ______________________________________

Diet History: ____________________________________________________________________________________________________________________________________________________

IN FEMALES : H/o menopause:____________________________________________________

Psychosocial and Environmental History in brief: ______________________________________________________________________________________________________________________




Lymphadenopathy: Yes / No, If yes, please specify:_________________________________________

Any signs of nutritional deficiencies: Yes / No, If yes, please specify:___________________________54

SYSTEMIC EXAMINATION:


Locomotor system (joints) :_____________________________________________

Respiratory system _____________ Central nervous system__________________

Cardiovascular system ______________________________________________

GIT __________________Eye___________________Ear____________________

Diagnosis:___________________________________________________________________

Investigation, If any :__________________________________________________________

Treatment, If any:_____________________________________________________________

ADVICE/ACTION TAKEN BY STUDENT

Attitude towards illness ______________________________________________

Effect of illness on patient & family members ____________________________

Problems in the family due to illness.________________________________________

GERIATRIC HEALTH FOLLOW UPS.No. DATE OF


QUESTIONS: Enumerate the common health problems of geriatric age group.

For which problems the middle-aged people must be screened?

Name the lifestyle related diseases and how will you apply behaviour change communication

(BCC) for their prevention?

What is geriatrics? How can you classify old age people? Differentiate between geriatrics and gerontology?

What are the services being provided to this age group? What are the normal dietary modifications required after the age of 40 yrs, 50 yrs and 60 years?

Why?

Name some non- government organizations (NGOs) working actively for the welfare of the elderly.

55

56

INDIVIDUAL HEALTH Date:__________

Name Age

Religion Occupation

Address

Chief Complaints (If any):1. ____________________________________________________________________2. ____________________________________________________________________3. ____________________________________________________________________4. ____________________________________________________________________ODP of presenting illness: _______________________________________________ _____________________________________________________________________

Past history: ___________________________________________________________ ______________________________________________________________________Family history: _________________________________________________________Personal history:________________________________________________________Bowel/Bladder: _____________________ Appetite : __________________________Habits: ____________________________ Sleep : _____________________________

Diet History: __________________________________________________________________________________________________________________________________

IN FEMALES : Menstrual history: ______________________Obstetric history: __________________Contraceptive History: _______________________________________________________________

IN CHILDREN :Family tree:_____________________________________________________________________Immunization History:____________________________________________________________Economic/Environmental History in brief: ___________________________________________________________________________________________________________________________



Clubbing: Cyanosis IcterusLymphadenopathy: Yes / No, If yes, please specify: _________________________________________


57

SYSTEMIC EXAMINATION :




GIT __________________Eye___________________Ear______________________

Diagnosis: _____________________________________________________________________

Investigation, If any :_____________________________________________________________

Treatment, If any:________________________________________________________________

ADVICE/ACTION TAKEN BY THE STUDENT

Attitude towards illness ________________________________________________

Effect of illness on patient & family members ______________________________

Problems in the family due to illness.__________________________________________

INDIVIDUAL HEALTH FOLLOW UPS.No. DATE OF


58


Name Age

Religion Occupation

Address

Chief Complaints (If any):1. ____________________________________________________________________2. ____________________________________________________________________3. __________________________________________________________________________________4. ____________________________________________________________________ODP of presenting illness: ________________________________________________ _____________________________________________________________________

Past history: ___________________________________________________________ ______________________________________________________________________Family history: ________________________________________________________Personal history: ________________________________________________________Bowel/Bladder: _____________________ Appetite : ___________________________Habits: ____________________________ Sleep : _____________________________

Diet History: ____________________________________________________________________________________________________________________________________

IN FEMALES : Menstrual history: ______________________Obstetric history: ______________Contraceptive History: ___________________________________________________________

IN CHILDREN :Family tree:_____________________________________________________________________Immunization History_____________________________________________________________Economic/Environmental History in brief: ___________________________________________________________________________________________________________________________



Clubbing: Cyanosis IcterusLymphadenopathy: Yes / No, If yes, please specify:___________________________________


59



Respiratory system _____________ Central nervous system_____________


GIT __________________Eye___________________Ear____________________

Diagnosis:________________________________________________________________


Treatment, If any:___________________________________________________________


Attitude towards illness _____________________________________________


Problems in the family due to illness._________________________________________



60


Name Age

Religion Occupation

Address

Chief Complaints (If any):1.____________________________________________________________________2. ____________________________________________________________________3. ____________________________________________________________________4. ____________________________________________________________________ODP of presenting illness: _____________________________________________________________________________________________________________________

Past history: _________________________________________________________________________________________________________________________________Family history: __________________________________________________________Personal history: ________________________________________________________Bowel/Bladder: _____________________ Appetite : ___________________________Habits: ____________________________ Sleep : _____________________________

Diet History: ____________________________________________________________________________________________________________________________________________________

IN FEMALES : Menstrual history: ______________________Obstetric history: __________________Contraceptive History: ___________________________________________________________

IN CHILDREN :Family tree:_____________________________________________________________________Immunization History:_____________________________________________________________Economic/Environmental History in brief: _________________________________________________________________________________________________________________________





61





GIT __________________Eye___________________Ear____________________

Diagnosis:________________________________________________________________


Treatment, If any:___________________________________________________________







62


Name Age

Religion Occupation

Address



Diet History: ____________________________________________________________________________________________________________________________________________________







63





GIT __________________Eye___________________Ear____________________

Diagnosis:________________________________________________________________


Treatment, If any:___________________________________________________________





INDIVIDUAL HEALTH FOLLOW UP

S.No. DATE OF VISIT


64


Name Age

Religion Occupation

Address



Diet History: ____________________________________________________________________________________________________________________________________________________







65





GIT __________________Eye___________________Ear____________________

Diagnosis:________________________________________________________________


Treatment, If any:___________________________________________________________





INDIVIDUAL HEALTH FOLLOW UP

S.No. DATE OF VISIT


66

SUMMARY & CONCLUSION OF THE FAMILY STUDY Date:__________

1. Specify the health problems in the family:Medical ______________________________________________________________

Nutritional ___________________________________________________________

Environmental ________________________________________________________

Social ________________________________________________________________

2. Enlist the medico-social problems as felt by the family:__________________________________________________________________________________________________________________________________________________

Name Age Conditions for which individual needs to

be screened

Methods of screening

Findings/Results of the test

Action taken

List the medical problems detected: ________________________________________________________________________________________-_______________________________________________________________________________________

Which of the above problems could have been prevented?

__________________________________________________________________________________________

67

DEPARTMENT OF COMMUNITY MEDICINEGOVERNMENT MEDICAL COLLEGE, CHANDIGARH

STUDENT'S OWN FAMILY STUDY Date:__________

Name of student Batch

Address

Population of the area/sector Religion

Facilities in your area/sector :

Education : Primary Middle/High School

Secondary College

Medical: Doctors : Private Govt. Nursing Home

Govt. Dispensary Hospital

Social : Organisation Clubs

FAMILY RECORD

SNo.

Name Age/DOB

Sex Marital Status

Relation Education Occup-ation

Height(mtrs)

Weight(Kg)

Illness(if any)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.68

IMMUNIZATION STATUS

S.No. BCG ScarPresent/Absent

TT(Mention

Year)

Hepatitis Any other (eg MMR)

Immunization Status

1

2

3

4

ENVIRONMENTAL STATUS

Total area : Sq. ft. Overcrowding : Present/Absent

Drinking Water Tap water Aqua Guard Filter/Zero B Any other(Specify) _______

Mode of refuse disposal (House to Public bin): _________________________________

Animals/Birds (Pets): _______________________________________________

Y/N, If yes, please (specify) _________________________________________

Immunization status: Nil/Given, specify_________________________________

Insect/ Mosquito repellents : Not used/Mat/Ointment/Spray/Any other_________

ECONOMIC STATUS:

Total Family Income : Rs. Per Capita Income (PCI) : Rs. (monthly)

SOCIAL STATUS

Habits: (Father/Head)

Yes/No Frequency DurationSmoking

Alcohol

Beetal chewing

Any other

69

A. KAP OF MOTHER REGARDING COMMUNICABLE DISEASES

(Please encircle the correct options)Multiple option possibleYes - 1, No - 2

HIV/AIDSa) It is:

1. A sexually Transmitted disease and occur by sexual contact.2. Caused by HIV

3. A curable disease.

4. Once infected, the person will be infected for life.

5. Leads to development of many other diseases.

6. A disease of only Foreigner.

7. A diseases of high risk groups

8. Any other specify:______________________________________________

b) High Risk Groups are:-Commercial sex worker

Health professional

Truckers

Migrant labourers

Street children

c) It is transmitted by:-

1. Transfusion of infected blood.

2. Contaminated needles & syringes

3. Touching the patient.

4. Most commonly by sexual intercourse.

5. Sharing food same utensils and towels.

Coughing and sneezing

Mother to child

Bite of mosquito and utensils

9. Any other specify:______________________________________________

70

d) Treatment -

1. No treatment available

2. No vaccine available

3. Use of strong antibiotic / injection

4. No treatment but prevention possible

5. Any other specify:_______________________________________________

e) Prevention & control is possible by : -

1. Use of condoms during intercourse.

2. To keep away from patients suffering from AIDS.

3. Using Disposable syringes / needles.

4. Screening of Blood for HIV before its transfusion.

5. Any other specify:_________________________________________________

2. TUBERCULOSIS

a) Tuberculosis is an infectious diseases:-

It affects lungs only.

It affects lungs and any other part of body

3. Patient becomes weak.

4. Cough persists for more than three weeks

5. Occurs because of evil forces / past sins


b) How does it spread?

1. By sputum

2. By drinking contaminated water

3. By sharing towels

4. By drinking contaminated milk


71

c) Treatment -

It is curable

DOTS treatment is available

It is available free at Govt. Hospital

3. Treatment is costly.

Treatment is to be taken for (i) <6 months,

(ii) 6-9 months

(iii) 1 year

Drugs have severe side effects.

Any other specify:_________________________________________________

d) DOTS provider is :-

Voluntary worker

School teacher

MPW / ANM


e) Prevention & Control is possible -

1. Patients should cover mouth while coughing.

2. Family contacts should be given ATT drugs.

Patients should be isolated.

BCG vaccine should be given to children <2 years

Infection can still spread even if patient is taking treatment


3. DIARROHEA

a) Diarrhoea means :-

1. More number of stools than usual.

2. Stools may have blood.

3. Stools are watery.

4. No deficiency of water can occur.


72

b) Mode of spread -1. Caused by some curse or evil eyes.2. Caused by wrong feeding habits

3. Spreads by eating uncovered foods in market.

4. Dirty hands and flies also spread it

By consuming unsafe water


c) Treatment -1. Breast feeding should be continued2 Feeding should be stopped.

3. Person should avoid milk and other fluids.

4. Plenty of fluids (ORS) should be given.

5. Consult a doctor.

6. Cannot be controlled without medicines


Prevention & control is possible -

1. By keeping your environment clean.

2 By protecting foods from flies.

3. By washing hands regularly.

4. By storing water in covered buckets

5. By using tumbler with long handle for taking out water


B. KAP OF MOTHER REGARDING MCH / RCH SERVICES: a) Pregnancy: Pregnant mother should not

1. Take non-vegetarian food.

2. Take drugs without medical advice.

3. Eat extra food than her daily average intake.

Smoke or take alcohol

Take papaya, black gram, bengal gram etc.


73

Pregnant mother should take:

1. More energy dense food.

2. More iron & calcium during her pregnancy.

3. Take more spicy food.

4. More sleep & rest

5. Go for check-up regularly

6. Take vaccine for tetanus

7. Gain weight around 11 kg


Place of delivery should be i) home based

ii)institutional delivery

High risk pregnancy are:

Abnormal presentation

Bleeding PV

Mothers age >30

Teenage pregnancy

High blood pressure during pregnancy

Diabetes during pregnancy


b) Child:1. Should bathe child immediately

2 Janam ghuti and honey should be given

Baby should be kept in separate cot

Breast milk is the only thing that should be given to child for

first 6 months

Colostrum (first thick milk after delivery) should not be given

to the child.

Top feeds/milk should be started after 6 months.

Milk should be diluted before giving it to the child.

Kajal should be applied in eyes

Should anything be applied on umblical stumpAny other specify:_________________________________________________

74

C. KAP OF MOTHER REGARDING NON-COMMUNICABLE DISEASES

HYPERTENSION (HIGH BLOOD PRESSURE)

a) What happens in high blood pressure?

1. Palpitation in chest

2. Weakness in body.

3. Increased pressure in blood vessels.

Headache


b) Risk Factors -

1. Can be transmitted from parents to children.

2. Increases by consuming more salt.

3. Increases by taking more oily food, alcohol & smoking

Can occur in young people.

Only a diseases of elderly


c) Treatment, Prevention & Control is possible -

1. Diet control - low fat, high fiber diet

2. Can be controlled by medication only.

3. Weight reduction.

4. Exercise/walking.

5. Cessation of smoking & alcohol intake.

6. Yoga & relaxation also help.


6. HEART ATTACKHeart attack means

1. More pressure on heart.

2. Cessation of heart activity.

75

3. Chest pain on left side.

4. Can occurs when an individual is in stress.

5. Even consuming alcohol occasionally can lead to heart attack.

6. Smoking is also a risk factor.


b) Risk Factors -

Increase intake of saturated fat / oil

Increase smoking

Increase alcohol intake

Decrease physical activity

Stress & tension

6 Can be transmitted from parents to children.

High blood pressure can cause Heart attacks.

8. Any other specify:________________________________________________

c) Treatment, Prevention & Control -

1. Diet control

2. Weight reduction

3. Exercise

4. Can be controlled by drugs only

Bypass surgery may be required.

Yoga & relaxation also help

Any other specify:________________________________________________

7. DIABETES

a) Diabetes is:-

1. An infectious disease.

2. Charactrised by frequency of micturtion.

3. Feeling of weakness.

76

4. Increased appetite for food.

5. Affect other organs of the body e.g. eyes, kidneys etc.

Related with obesity

Only a diseases of elderly

Anybody can suffer from it

Any other specify:________________________________________________

b) Risk Factors: -

1. It passes on from parents to children.

It is a disease of old age only.

It is a disease of young age & old age both

It occurs in those who eat lot of sweets & sugar

Exercise has protective effect on diabetes


c) Treatment, Prevention and Control -

1. There is no treatment for diabetes.

2. It can be controlled by drugs only.

3. It can be controlled by dietary measures.

Weight control can help.

It can be controlled by vegetables like methi, karela, jammun etc.

Treatment & follow-up services available in Govt. Hospital

Health education regarding diabetes is helpful to patients

Foot care is very important in diabetes


77

INDIVIDUAL HEALTH

*Present Illness (last 15 days) (Write symptoms) Duration

1234

*Chronic disease : (Hypertension/Coronary artery disease/Diabietes mellitus /

COPD / Cataract / paralysis/other)

TREATMENT HISTORY: (CURRENT)

Medical/Surgical Medication Dose- (adequate Frequency Durationproblem inadequate) (Reg/Irreg.)

1.

2.

3.

4.

* Any other major ailment in life till date, if yes, please specify:_______________

i) Disease _________________________________________

ii) Any hospitalization _____________________________________

iii) Operations ____________________________________________

78

USE OF ANY AIDS & APPLIANCES

Aids Yes/No Duration (Months & Years)

Hearing

Dentures

Spectacles

Any other

PHYSICAL EXAMINATION

a) General Examination -

Pulse rate : / min. Respiratory rate: / min.

Blood pressure SBP mm Hg. Height cms.) Weight (Kg.)

DBP *Icterus JVP - Raised*

*Pallor : *Clubbing * Oedema feet

Oral cavity_______________________ *Lymphadenopathy Thyroid_____________________

Deficiency signs (Nutritional)__________________________________________________________

b) Systemic Examination -

Per Abdomen

1. Inspection -

*Movement with Respiration *Visible veins/Peristalsis

*Visible mass______________________ Hernial sites_______________________________

2. Palpation - *Guarding * Tenderness

Any mass___________________________________________________________________

Hernial sites_________________________________________________________________

Liver_______________________________Spleen___________________________________

*Please fill Yes - 01, No - 0279

3. Percussion

Resonance/Dullness___________________________________________________________

*Fluid thrill Shifting dullness

4. Auscultation

Bowel sounds

CIRCULATRY VASCULAR SYSTEM

1. Inspection

*Apex beat visible

2. Palpation

Apex beat (Localization/Character)________________________________________________

*Thrill *Parasternal Heave

3. Percussion (Area of cardiac dullness)

4. Auscultation

Heart sounds_________________________________________________________________

*Added sounds (Murmur/click/pericardial rub) if yes, please specify _________________

RESPIRATORY SYSTEM

1. Inspection - Shape of chest_________________Trachea_____________________________

2. Palpation - Chest expansion (cms.) Trachea__________________________________

3. Percussion - Note_______________________Liver dullness__________________________

Cardiac dullness_______________________________________________________________

4. Auscultation - Breath sounds______________________________________________

*Crepts/Rhonchi *Pleural rub

GENITO URINARY SYSTEM

1. Inspection - *Prolapse if yes, please specify______________________

Hernial sites_________________________________________________________________

2. Palpation - Hernial sites_______________________________________________

* Any Mass if yes, please specify________________________________________

*BPH:

80

CENTRAL NERVOUS SYSTEM

1. Higher mental functions____________________________________________

2. Autonomic functions ______________________________________________

3. Motor - Muscle mass__________________________________________

Tone/Strength_____________________________________________________

Reflexes__________________________________________________________

4. Sensory__________________________________________________________

5. Any other________________________________________________________

LABORATARY INVESTIGATION:

Hb. gm% Blood sugar F Cholestrol gm% Any other

PP FINAL DIAGNOSIS: ____________________________________________________

_______________________________________________________________________

FOLLOW UP

Sno.

Date Ailment (Monthly)

Weight(six monthly)

B.P. (six monthly)

Sugar (yearly)

81

Social and Health problems in Family: (Please enumerate)

1.

2.

3.

4.

82

INDIVIDUAL HEALTH

*Present Illness (last 15 days) (Write symptoms) Duration

1234

TREATMENT HISTORY: (CURRENT)

Medical/Surgical Medication Dose- adequate Frequency Durationproblem inadequate Reg/Irreg.

1.

2.

3.

4.

*Chronic disease : (Hypertension/Coronary artery disease/Diabietes mellitus /

COPD / Cataract / paralysis/other)

* Any other major ailment in life till date, if yes, please specify:_______________

i) Disease _________________________________________

ii) Any hospitalization _____________________________________

iii) Operations ____________________________________________

83

USE OF ANY AIDS & APPLIANCES

Aids Yes/No Duration (Months & Years)

Hearing

Dentures

Spectacles

Any other

PHYSICAL EXAMINATION

a) General Examination -

Pulse rate : / min. Respiratory rate: / min.

Blood pressure SBP mm Hg. Height cms.) Weight (Kg.)

Pallor :DBP *Icterus JVP - Raised*

Oral cavity_______________________ *Lymphadenopathy Thyroid_____________________

Deficiency signs (Nutritional)__________________________________________________________

*Clubbing * Oedema feet

b) Systemic Examination -

Per Abdomen

1. Inspection -

*Movement with Respiration *Visible veins/Peristalsis

*Visible mass______________________ Hernial sites_______________________________

2. Palpation - *Guarding

Any mass____________________________* Tenderness

Hernial sites_________________________________________________________________

Liver_______________________________Spleen___________________________________

Please fill Yes - 01, No - 0284

3. Percussion

Resonance/Dullness___________________________________________________________

*Fluid thrill Shifting dullness

5. Auscultation

Bowel sounds_________________________________________________________________

CIRCULATRY VASCULAR SYSTEM

1. Inspection

*Apex beat visible

2. Palpation

Apex beat (Localization/Character)________________________________________________

*Thrill *Parasternal Heave

3. Percussion (Area of cardiac dullness)

4. Auscultation

Heart sounds_________________________________________________________________

Added sounds (Murmur/click/pericardial rub) if yes, please specify _________________

RESPIRATORY SYSTEM

1. Inspection - Shape of chest_________________Trachea_____________________________

2. Palpation - Chest expansion (cms.) Trachea__________________________________

3. Percussion - Note_______________________Liver dullness__________________________

Cardiac dulness_______________________________________________________________

4. Auscultation - Breath sounds______________________________________________

*Crepts/Rhonchi *Pleural rub

GENITO URINARY SYSTEM

1. Inspection - *Prolapse if yes, please specify______________________

Hernial sites_________________________________________________________________

2. Palpation - Hernial sites_______________________________________________

* Any Mass if yes, please specify________________________________________

*BPH:

85

CENTRAL NERVOUS SYSTEM

1. Higher mental functions____________________________________________

2. Autonomic functions ______________________________________________

3. Motor - Muscle mass__________________________________________

Tone/Strength_____________________________________________________

Reflexes__________________________________________________________

4. Sensory__________________________________________________________

5. Any other________________________________________________________

LABORATARY INVESTIGATION:

Hb. gm% Blood sugar F Cholestrol gm% Any other

PP FINAL DIAGNOSIS: ____________________________________________________

_______________________________________________________________________

FOLLOW UP

Sno.

Date Ailment (Monthly)

Weight(six monthly)

B.P. (six monthly)

Sugar (yearly)

86

*DIET SURVEY AND NUTRITIONAL STATUSDIET SURVEY Vegetarian / Non-Vegetarian

Food Material 1st Day 2nd Day 3rd Day Daily average Daily intake per consumption unit

Cereals :1.2.3.4.

Pulses :1.2.3.

Roots and Tubers :1.2.3.

Leafy Veg. :1.2.3.

Non-Leafy Veg. :1.2.3.

Nuts :1.2.3.

Fruits :1.2.3.

Milk and Dairy Products:1.2.3.

Flesh food :1.2.3.

Miscellaneous :1.2.3.4.5.

* Note : Refer to Annexure IV to XI for details)

87

DIETARY COMPOSITION / NUTRIENTS OF INTAKE

2. COMPOSITION OF AVERAGE DAILY INTAKE PER CONSUMPTION UNIT:

Sno. Food material

Quantity gms.

Calories

Protein (Gms)

Fat (mg)

Calcium (mg)

Iron (mg)

Vitamin A (μg.)

Vitamin B1 (mg)

Nicotin. Acid(mg)

Riboflavin (mg)

Vitamin C (mg)

Vitamin D (I.U.)

a.

b.

c.

d.

e.

f.

g.

h.

i.

j.

Total

88

RECOMMENDED NUTRIENT INTAKE3. DAILY REQUIREMENTS :

S.No

Name Age Sex Occ. ECC Calories (K cal)

Proteins

(gm)

Fat(mg)

Calcium

(mg)

Iron(mg)

Vit.A

(μg)

Vit.B1

(mg)

Nicot. Acid (mg)

Riboflavin (Mg)

Vit.C (mg)

Vit. D

(mg)

Total consumptionTotal daily requirementsDeficiency Excess

Action taken:- 1.___________________________________________________________________________________________________ 2. ___________________________________________________________________________________________________ 3. ___________________________________________________________________________________________________

* ECC = Energy Consumption Coefficient

89

ANNEXURE – I

PREFERRED CLASSIFICATION FOR OVERCROWDING : GUIDELINES

RECOMMENDED FLOOR SPACE NO. PERSONS

> 110 sq feet 2 persons

90-100 sq feet 1½

70-90 sq feet 1

50-70 sq feet 1/2

> 50 Nil

Note :

Child < 1 year is not counted

Children 1-10 years of age are counted as ½ unit.

ANNEXURE - II

A) MODIFIED PRASAD'S CLASSIFICATION FOR SOCIO ECONOMIC STATUS

Income per Capitum / Month (Rs.) Social Class

>1800 I

900-1800 II

420- 900 III

180- 420 IV

<180 V

89

B) KUPPUSWAMY SCALE SOCIO-ECONOMIC STATUS IN URBAN AREA

OCCUPATION OF HEAD : SCORE

Professional 10Semi Professional 06Clerk, Shop Owner, Farm Owner etc. 05Skilled Worker 04Semi-Skilled Worker 03Unskilled Worker 02Unemployed 01

EDUCATION OF HEAD

Professional Degree 07Graduate & PG 06I.Sc./Post High School Diploma 05High School Certificate 04Middle School Completion 03Primary School and literate 02Illiterate 01

INCOME (Rs./m)

22734, and above 1211367 - 22733 10

8504 - 11366 065683 - 8503 043410 - 5682 031138 - 3409 021137, and below 01

Modified family income groups of the Kuppuswamy's socioeconomic status scale was obtained by multiplying conversion factor with the income groups for 1998. Conversion factor is determined by dividing the CPI-IW by 88.428. The CPI-IW of Chandigarh is 149 for September 2009. The income groups for 2009 were revised by applying a conversion factor of 1.684.*** CPI-IW = (Consumer Price Index for industrial worker)

SOCIO ECONOMIC CLASSIFICATION

Upper (I) 26-29

Upper Middle (II) 16-25

Lower Middle (III) 11-15

Upper Lower (IV) 05-10

Lower (V) <05

Ref.: Kuppuswamy B. Manual of Socio Economic Status Scale (Urbans) Manasayam - 32, Netaji

Subash Marg, Delhi (Indian journal of Pediatrics, vol 70-March,2003 )

90

ANNEXURE - III

EXAMPLES OF FAULTY COOKING PRACTICE

i) Cooking rice & throwing the rice water

ii) Cutting vegetable & then washing them

iii) Straining the flour & throwing the barn

iv) Peeling all types of vegetable before cooking

EXAMPLES OF BENEFICIAL COOKING PRACTICES

i) Cooking in iron pans

ii) Use of jaggery over sugar

iii) Soaking & germinating sprouts

iv) use of paraboiled rice

iv) Adding soyabean to wheat flour

v) Using rice water to cook the pulse

91

ANNEXURE - IVNUTRITIVE VALUE OF COMMON INDIAN FOOD

Sno. Common foods (per 100g) of edible

portion

Calories(K Cal)

1

Proteins G

2

Fats (g)

3

Calcium(mg)

4

Iron (mg)

5

Carotene (µg)

6

Vit B1(mg)

7

Nicotine Acid(mg)

8

Vit. B2(mg)

9

Vit C(mg)

10CEREALS :

Maize 342 11.1 3.6 10. 2.3 90 0.42 1.8 0.10 0Rice (Raw milled) 345 6.8 0.5 10 0.7 0 0.06 1.9 0.06 0Wheat flour 341 12.1 1.7 48 4.9 29 0.49 4.3 0.17 0Wheat flour refined(Maida)

341 11 0.9 23 2.7 25 0.12 2.4 0.07 0

PULSES :Bengal Gram dhal (Chana)

372 20.8 5.6 56 5.3 129 0.48 2.4 0.18 1

Black Gram (Urad) dhal

347 24 1.4 154 3.8 38 0.42 2 0.2 0

Green Gram (Moong) dhal

323 24.5 1.2 124 4.4 49 0.47 2.4 0.21 0

Peas (Green) 93 7.2 0.1 20 1.5 83 0.25 0.8 0.01 9Rajmah 346 22.9 1.3 260 5.1Red Gram dhal 335 22.3 1.7 73 2.7 132 0.45 2.9 0.33 25Soyabean 432 43.2 19.5 240 10.4 426 0.73 3.2 0.39 -

LEAFY VEGETABLE :Cabbage 27 1.8 0.1 39 0.8 120 0.06 0.4 0.09 124Cauliflower (Green) 66 5.9 1.3 626 40Coriander leaves 44 3.3 0.6 184 1.42 6918 0.05 0.8 0.06 12Mint 48 4.8 0.6 200 15.6 1620 0.05 1.0 0.26 27

ROOTS & TUBERS : 1 2 3 4 5 6 7 8 9 10Mustard leaves 34 4 0.6 155 16.3 2622 0.03 - - 33Spinach 26

2

0.7 73 1.14 5580 0.03 0.5 0.26 2892


portion

Calories(K Cal)

1

Proteins G

2

Fats (g)

3

Calcium(mg)

4

Iron (mg)

5

Carotene (µg)

6

Vit B1(mg)

7

Nicotine Acid(mg)

8

Vit. B2(mg)

9

Vit C(mg)

10Carrot 48 0.9 0.2 80 1.03 1890 0.04 0.6 0.02 3Onion (small) 59 1.8 0.1 40 1.2 15 0.08 0.5 0.02 2Potato 97 1.6 0.1 10 0.48 24 0.10 1.2 0.01 17Radish (white) 17 0.7 0.1 35 0.4 3 0.06 0.5 0.02 15Sweet potato 120 1.2 0.3 46 0.21 6 0.08 0.7 0.04 24Turnip 29 0.5 0.2 40 0.4 0 0.04 0.5 0.02 15

OTHER VEGETABLES :Brinjal 24 1.4 0.3 18 0.38 74 0.04 0.9 0.11 12Cauliflower 30 2.6 0.4 33 1.23 30 0.04 1 0.1 56Cucumber 13 0.4 0.1 10 0.6 0 0.03 0.2 0 7Ladies Finger 35 1.9 0.2 66 0.35 52 0.07 0.6 0.10 13Tinda 21 1.4 0.2 25 0.9 13 0.04 0.3 0.08 18Tomato (Green) 23 1.9 0.1 20 1.8 192 0.07 0.4 0.01 31

NUTS :Almond 655 20.8 58.9 230 5.09 0 0.24 4.4 0.57 0Cashewnut 596 21.2 46.9 50 5.81 60 0.63 1.2 0.19 0Coconut (Fresh) 444 4.5 41.6 10 1.7 0 0.05 0.8 0.10 1

CONDIMENTS & SPICES :Chillies (Green) 29 2.9 0.6 30 4.4 175 0.19 0.9 0.39 111Garlic (Dry) 145 6.3 0.1 30 1.2 0 0.06 0.4 0.23 13Ginger (Fresh) 67 2.3 0.9 20 3.5 40 0.06 0.6 0.03 6Turmeric Powder 349 6.3 5.1 150 67.8 30 0.03 2.3 0 0

FRUITS :Amla 58 0.5 0.1 50 1.2 9 0.03 0.2 0.01 600Apple 59 0.2 0.5 10 0.66 0 - 0 - 1Banana 116 1.2 0.3 17 0.36 78 0.05 0.5 0.08 7Dates (Fresh) 144 1.2 0.4 22 0.96Grapes 45

1

0.1 30 0.2 - 0.12 0.3 0.02 3193


portion

Calories(K Cal)

1

Proteins G

2

Fats (g)

3

Calcium(mg)

4

Iron (mg)

5

Carotene (µg)

6

Vit B1(mg)

7

Nicotine Acid(mg)

8

Vit. B2(mg)

9

Vit C(mg)

10Guava 51 0.9 0.3 10 0.27 0 0.03 0.4 0.03 212Lemon 57 1 0.9 70 0.26 0 0.02 0.1 0.01 39Lichi 61 1.1 0.2 10 0.7 0 0.02 0.4 0.06 31Mango 74 0.6 0.4 14 1.3 2743 0.08 0.9 0.09 16Melon 17 0.3 0.2 32 1.4 169 0.11 0.3 0.08 26Papaya 32 0.6 0.1 17 0.5 666 0.04 0.2 0.25 57Tomato 20 0.9 0.2 48 0.64 351 0.12 0.4 0.06 27

MEAT & POULTRY :Egg (Hen) 173 13.3 13.3 60 2.1 600 0.1 0.1 0.4 0Goat Meat 118 21.4 3.6 12 - - - - - -Mutton (Muscle) 194 18.5 13.3 100 2.5 0 0.18 6.8 0.14 -

MILK PRODUCT :Milk (Buffalo) 117 4.3 6.5 210 0.2 160 0.04 0.1 0.1 1Milk (Cow) 67 3.2 4.1 120 0.2 174 0.05 0.1 0.19 2Milk (Goat) 72 3.3 4.5 170 0.3 182 0.05 0.3 0.04 1Milk (Human) 65 1.1 3.4 28 - 137 0.02 - 0.02 3Cheese 348 24.1 25.1 790 2.1 273 - - - -Khoa (Whole buffalo milk)

421 14.6 31.2 650 5.8

FATS :Butter 729 - 81 - - 3200 - - - -Ghee (Cow) 900 - 100 - - 2000 - - - -Ghee (Buffalo) 900 - 100 - - 900 - - - -Cooking Oil 900 - 100 - - 2500 - - - -

SUGAR :Sugar cane 398 0.1 0 12 0.155Jaggery (Cane) 383 0.4 0.1 80 2.64

94

ANNEXURE - VCALORIFIC VALUE PER HOUSE HOLD MEASURE

Sno. Food Items Qty. CaloriesTea (Sugar 1 cup) 1 cup 200 ml 52Milk

a. Buffalob. Cowc. Toned milkd. Skimmed milk

1 glass1 glass1 glass1 glass

23413413258

CurdBuffaloCowToned milkSkimmed milk

1 glass1 glass1 glass1 glass

18212011069

EggBoiledRaw yolkRaw AlbumenFriedOmelette

OneOneOneOneOne

80-8560-6515-20

155-160155-160

Chapatia. Phulka (small)b. Chapati (med.)c. Roti (big)

One / 25 gm.One / 30 gm.One / 40 gm.

85100-105130-135

PuriAttaMaida

OneOne

180-185185-190

Nan Plain One 100-105Prantha Plain (medium) One 230-240Bhatura (medium) One 190-195Wheat dalia (Raw-4Tsp/20gm) One cup (cooked) 68Rice

a. Boiledb. Pullao

1 cup1 cup

170-185250-260

Cornflakes 1 cup / 20 gm / (raw) 77Porridge (oats) 1 cup cooked 75-80Bread

SmallBig

One (20 gm)One (30 gm)

4974

Dals and Beans One cup cooked 125-135Bread Pakora One 215-220Samosa One 155-160Vada One 140-150Bread butter sandwich One 140-145Cold drinks (sweet aerated) One bottle 100-115Milk chocolate a. Amul 100gm

b. Cadbury 100gm588530

95

ANNEXURE - VINUTRITIVE VALUE OF COOKED PREPARATIONS

Katori - 1 Volume - (150 ml) Diameter - 78 cm Depth - 4 cm.

SNo.

Cooked food stuff cooked

App. Wt.Qty.

Raw

(gm)

Protein

(gm)

Fats

(gm)

Carbo-hydrate

(gm)

Energy

(Kcal)

Sodium

(mg)Chapati (Thin) One 25 3.0 0.4 17.3 85 5.0

Chapati (Medium) One 30 3.6 0.5 20.8 102 6.0

Chapati (Big) One 40 4.8 0.6 27.7 136 8.0

Rice 1 katori 40 2.7 0.2 31.2 138 -

Wheat Porridge -do- 35 4.2 0.5 25.0 121 6.0

Oat Meal Porridge -do- 30 4.0 2.2 18.8 112 -

Dal Moong (with husk) -do- 30 7.2 0.3 17.0 100 8.4

Dal Moong (washed) -do- 50 12.2 0.6 30.0 174 13.6

Dal Moong (whole) -do- 45 10.8 0.5 25.5 150 14.0

Dal Urad (washed) -do- 45 11.0 0.6 27.0 156 20.0

Dal Urad &Channa (3+1) -do- 30+10 9.2 0.9 23.6 141 25.8

Dal Urad (whole) -do- 40 9.6 0.6 24.0 139 16.0

Dal Masoor -do- 50 12.6 0.3 29.5 171 -

Dal Malka Masoor -do- 40 10.0 0.3 28.6 157 10.0

Channa Dal -do- 55 11.4 3.0 32.7 204 24.8

Arhar Dal -do- 50 11.1 0.8 28.8 167 14.2

Rajmah -do- 35 8.0 0.4 41.2 121 -

Bengal Gram (whole) -do- 50 8.5 2.6 30.4 180 18.6

Coffee-milk 30 cc.

Sugar - 10 gm.

1 Cup 200 1.0 1.0 11.3 59 4.8

Tea-milk 20 cc.

Sugar - 10 gm.

1 Cup 200 0.7 0.7 108.0 53 3.2

96

ANNEXURE - VIICALORIES EXPENDITURE IN VARIOUS ACTIVITIES

Activity K. CaloriesConsumption / Minute

Activity K. Calories Consumption

Minute

Lying down 1.0 Sitting 1.5

Standing 2.6 Driving a car 2.8

Washing cloths 3.1 Walking (indoor) 3.1

Driving motorcycle 3.4 Mopping floors 4.9

Gardening and weeding 4.9 Farming and ploughing

(with bullocks)

6.7

Walking downstairs 7.1 Walking up-stairs 10.00 to 18.0

Dancing : Moderate 4.2

Vigrous 5.7

Sports

Skating 5.0 Table Tennis 4.9 to 7.0

Badminton : Recreation 5.0 Cycling 5.0 to 12.0

Competitive 10.0 Swimming 6.0

Mountain climbing 10.0 Judo & Karate 13.0

Running 10.0

97

ANNEXURE - VIII

ASSESSMENT OF ENERGY REQUIREMENT FOR FAMILY

Practical nutrition work often involves the assessment of the calories of groups of persons. It is

usual to assess the caloric needs of woman & children in terms of those of the average man by applying

various coefficients to the different age & sex groups. The following scale is used for assessing caloric

requirement of an individual as recommended by National Institute of Nutrition, Hyderabad, pioneer in this

field. The calorie consumption of an average adult male doing sedentary work is taken as ONE ENERGY

CONSUMPTION COEFFICIENT (ECC) and the other coefficients are worked out on the basis of gender

and the occupational status for adults and by age for children and adolescents. (Ref. Nutritive Value Indian

Foods-National Institute of Nutrition. Indian Council of Medical Research. Hyd. India. (1989).

COEFFICIENT FOR COMPUTING CALORIE REQUIREMENT OF DIFFERENT GROUPS

GROUP * Cu-UNITS

Adult male (sedentary worker) 1.0

Adult male (moderate worker) 1.2

Adult male (Heavy worker) 1.6

Adult female (sedentary worker) 0.8

Adult female (moderate worker) 0.9

Adult female (Heavy worker) 1.2

Adolescents - 12 to 21 years 1.0

Children - 9 to 12 years 0.8





* 1.0 Cu-Unit = 2400 K Cal.

98

ANNEXURE - IX

CLASSIFICATION OF ACTIVITIES BASED ON OCCUPATIONSSedentary :

Male : Teacher, Tailor, Barber, Executives, Shoemaker, Priest, Retired Personnel, Land-

Lord, Peon, Postman, etc.

Female : Teacher, Tailor, Executives, Housewife, Nurses, etc.

Moderate :

Male : Fisherman, Basket-maker, Potter, Goldsmith, Agricultural, Labour, Carpenter,

Mason, Rickshaw-puller, Electrician, Fitter, Turner, Welder, Industrial Labour,

Cooli, Weaver, Driver, etc.

Female : Servant-maid, Cooli, Basket-maker, Weaver, Agricultural Labour, Beedi-maker,

etc.

Heavy :

Male : Stone-cutter, Blacksmith, Mine-worker, Wood-cutter, Gang-man, etc.

Female : Stone-cutter.

99

ANNEXURE - X

BALANCED DIET

A balanced diet is one which contains different types of foods in such quantities and proportions so that the needs for

calories, proteins, minerals, vitamins and other nutrients is adequately met and a small provision is made for little bit extra

nutrients. The requirements of our body in terms of nutrients and energy for the various groups is known and on this basis our

daily diet can be planned. The requirement of individual items depends upon growth status (age, sex, height and weight),

physical activity and physical stress or illness keeping in view the recommendation of the nutrition expert group of the ICMR

for dietary allowances, balanced diet for different age groups are presented below :

Food Groups

Adult Men Adult Women Children

Sedentary work

Moderate work

Heavy work

Sedentary work

Moderate work

Heavy work

1-3 yrs.

4-6 yrs.

10-12 yrs.

Boys

10-12 yrs.

Girls

Cereals 460 520 670 410 440 675 175 270 420 380

Pulses 40 50 60 40 45 50 37 35 45 45

Leafy vegetables 50 40 40 100 100 50 40 50 50 50

Other vegetables 60 70 80 40 40 100 20 30 50 50

Roots and tubers 50 60 80 50 50 60 10 20 30 20

Milk 150 200 250 100 150 200 300 250 250 250

Oils and fats 40 45 65 20 25 40 15 25 40 35

Sugar and jaggery 30 35 55 20 20 40 30 10 45 45

SAMPLE MENU

7.00 A.M. 1 Cup water + 1/2 lemonor

1 Cup plain tea + 1/2 lemon (lemon tea)

Break Fast 1. Milk 1 Cup2. Toast 2

orMissi Roti 1 (20g. atta, 10gm. Gram Flour)Butter 1 tsp.

orPrantha 1

orDalia 1 Cup

100

3. Egg 1or

Paneer 25gm. (1 piece)or

Curd 125gms (1/2 katori)

This provides 420 kcal & approx, 13 gm protein

Lunch 1. Chapati 3-4 (90-120 gms.)or

Rice 2-3 Katories (80g.)2. Chicken curry 1 katori (200gms.)

orPaneer curry (50gms)

3. Alu 1, Green Vege 1 katori (250 gm)4. Curd 1/2 katori (125 gm.)

Cooking fat 4-5 tsp.

This provides 1000 kcal 35g. protein

Evening Tea Tea 1 CupSandwich 1

orBiscuits 2

This provides 150 kcal 35g. protein

Dinner 1. Chapati/Rice As in lunch2. Dall 1 katori (35gm)

orCurd 1 katori (150gm.)

3. Green & Leafy 1 katori (250g.)vegetableCooking oil 4-5 tsp.

This provides 900 kcal and 35g. protein

Fruits One serving at midmorning

Salad Alongwith regular meals.

101

ANNEXURE - XI

I. INCREASE IN WEIGHT AND HEIGHT

Birth Weight - 2.9kg Height - 50cm

1 - 6 years Wt. - Age (years) X 2+8 kg

Ht. - Age (years) X 6+77 cm

7 - 12 years Age (years) x 7 5------------------------ 2

INCREASE IN WEIGHT, LENGTH & HEAD CIRCUMFERENCE DURING INFANCY

Age in months Approximate daily Weight gain (g)

Growth in length (cm/month)

Change in head (circumference

cm/month)0-3 30 3.5 2.0

3-6 20 2.0 1.0

6-9 15 1.5 0.5

9-12 12 1.2 0.5

ENERGY & PROTEIN REQUIREMENT OF CHILDREN

Age Group Weight (Kg) Energy (K cal.) Protein (gms)

0-6 months 03-07 600 11

6-12 months 07-09 600-1200 13

1-3 years 09-13 1200 18

4-6 years 15-17 1500 22

102

ANNEXURE - XII

W.H.O. DAY THEMES

YEAR THEME

1950 Know your health services1951 Health for your Child and the World’s Children1952 Healthy surroundings make Healthy people1953 Health is Wealth1954 The Nurse: Pioneer of Health1955 Clean water means better health1956 Destroy disease carrying insects1957 Food and Health1958 Ten years of Health Progress1959 Mental Illness and Mental Health in the world today1960 Malaria Eradication: a World Challenge1961 Accidents need not happen1962 Preserve Sight: Prevent blindness1963 Hunger : Disease of millions1964 No trace of Tuberculosis1965 Smallpox : constant alert1966 Man and his cities1967 Partners in Health1968 Health in the World of Tomorrow1969 Health , Labour and Productivity1970 Early detection of Cancer saves lives1971 A full life despite Diabetes1972 Your Heart is your Health1973 Health begins at home1974 Better food for a Healthier World1975 Smallpox : Point of No Return1976 Foresight prevents Blindness1977 Immunize and protect your Child1978 Down with High Blood Pressure1979 A Healthy Child : A sure future1980 Smoking or Health : The choice is yours1981 Health for All by the year 2000 A.D.1982 Add years to life1983 Health for All by 2000 : The countdown has begun1984 Children’s Health : Tomorrow’s Wealth1985 Healthy Youth : Our Best Resource1986 Healthy Living : Everyone a winner1987 Immunization : A chance for every child1988 Health for All – All for Health1989

Let’s talk Health1990 Our Planet – Our Health; think Globally, Act Locally

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W.H.O. DAY THEMES (contd…)

YEAR THEME

1991 Should Disaster strike – Be prepared1992 Heart Beat – The rhythm of life1993 Handle Life with Care – Prevent violence and negligence1994 Oral Health for a Healthy Life1995 Target 2000 : A World without Polio1996 Healthy cities for Better Living1997 Emerging Infectious Diseases : Global Alert, Global Response1998 Pregnancy is Special – Let’s make it Safe1999 Active Aging makes the difference2000 Safe Blood starts with Me. Blood is Life2001 Mental Health – stop exclusion, dare to care2002 Move for Health2003 Shape the future of life2004 Road Safety – is no accident2005 Make every mother and child count2006 Working together for health2007 International Health Security2008 Protecting Health from climate change2009 Save lives. Make hospitals safe in emergencies.

104

ANNEXURE - XIII

NATIONAL HEALTH PROGRAMS

National Vector Borne Diseases Control Program

National Leprosy Eradication Program

Revised National Tuberculosis Control Program, (RNTCP)

National AIDS Control Program, (NACP)

National Program for Control of Blindness, (NPCB)

National Iodine Deficiency Disorders Control Program

Universal Immunization Program, (UIP)

National Rural Health Mission (NRHM)

National Urban Health Mission

National Program for Control and Treatment of Occupational Diseases

Reproductive and Child Health Program, (RCH)

Integrated Disease Surveillance Project 2004 – 2009

Integrated Child Development Service (IDSP) Scheme

Rabies Control Program

National Guinea – Worm Eradication Program

Yaws Eradication Program

National Cancer Control Program

National Family Welfare Program

National Water Supply and Sanitation Program

Minimum Needs Program

Mid – Day Meal Program

National Program for the Control of Diarroeal Diseases

National Program for Prevention and Control of Diabetes, Cardiovascular Diseases and

Stroke

National Vitamin – A Prophylaxis Program

National Nutritional Anemia Prophylaxis Program

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National Program for the Control of ARIs

ANNEXURE - XIV

IMPORTANT NATIONAL & INTERNATIONAL HEALTH RELATED DAYS

DAY AREA

30th January Anti – Leprosy Day8th March International Women Day15th March Consumer’s Protection Day24th March World TB Day7th April World Health Day8th May Red Cross Day17th May World Hypertension Day31st May World No – Tobacco Day5th June World Environment Day

National Filaria Day (India)14th June World Blood Donation Day26th June International Day against Drug Abuse & Illicit Trafficking27th June World Diabetes Day1st July Doctors Day (India)11th July World Population Day8th September World Rabies Day

Eye Donation Day28th September World Heart Day1st October International Day for Older Persons2nd October ICDS Day10th October World Mental Health Day

Human Rights Day11th October International Day for Natural Disaster Reduction7th November National Cancer Awareness Day10th November World Immunization Day1st December World AIDS Day3rd December International Day for Disabled / Handicapped person

IMPORTANT HEALTH RELATED WEEKS

1st – 7th August World Breast Feeding Week25th August – 8th September Eye Donation Fortnight1st – 7th September National Nutrition Week

106

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