Diarrhoea, A socio-clinical case presentation.

A socio clinical case presentation on Diarrhoea

1. Avijit Paul PGT, Dept. of Community Medicine Burdwan Medical College SOCIO-CLINICAL CASE PRESENTATION

2. PARTICULARS OF THE PATIENTS Name – Ritu Das Age - 3 years Sex - Female Address – Chotonilpur , Burdwan Religion – Hinduism Informant - Mother Place – Pediatric OPD Date of history taking - 30.11.2012

3. Chief complaints : 1. 8-10 times of watery stool for last 2 days 2. Two episodes of vomiting since last night

4. History of present illness : Child was apparently normal 2 days back as per mother’s information. Then she developed frequent attack of loose stool for last 2 days. Stool found watery in nature and at a frequency of 8-10 times per day. There is no history of blood stained stool or any fever. There is also history of vomiting twice since last night. Vomitus contains only food stuff. Appetite is reduced during the course of illness. Thirst is maintained and drinking eagerly.

5. History of past illness : There is a history of similar type of episode 6 months back. There is no history of any major illness in the past. Treatment history : The child was treated for the past episode of diarrhea with ORT at home. There was no history of hospitalization in the past.

6. Personal history Antenatal history of the mother No significant illness of the mother in the antenatal period. Took 2 antenatal check up, 2 doses of Tetanus toxoid and iron and folic acid tablets for 2 month only. Intranatal history Institutional ( B urdwan M edical C ollege and Hospital) Normal vaginal delivery Baby cried after birth Birth weight – 2.8 kg

7. Feeding history Colostrum not given History of prelacteal feeding with honey and water Not exclusively breast fed, cow milk and water was given to her occasionally Complementary feeding was started at 7 months with soft cooked rice, vegetables She is now on usual home diet but currently on soft cooked rice, smashed vegetables due to illness Breast feeding - Stopped Feeding - restricted during the periods of illness

8. Bowel habit – R egular Appetite – Loss of appetite Sleep – No abnormality Immunization history - All the vaccines were given at the proper time. Immunization card was not available at the time of examination. BCG scar mark is not seen. Developmental history - The child achieved all the developmental milestones in due time like other children of the same age sex.

9. Knowledge and practices regarding the disease Source of infection - contaminated food Mode of transmission – fly Mode of prevention - avoiding contaminated food Care seeking behavior – doctor’s advice or hospitals

10. Identification of the family Name of the head of the family – Dibyendu Das Type of family – Joint Total family members- 7 Social problem in the family – Father is having a habit of smoking and chewing tobacco. Grand Father is also addicted to bidi .

11. Socioeconomic characteristics of family 1. Education of the Head of the family (HOF) : High school completed (score -- 4) 2. Occupation of the HOF : Stationary shopkeeper (Unskilled worker) ( score -- 5) 3. Total monthly income : ≈ Rs . 15,000 (score -- 6) Total score 15 i.e. Socioeconomic status is lower middle class according to M odified Kuppuswamy Scale

12. ENVIRONMENTAL CONDITION 1. Type of house – Kuchha-pucca 2. Number of living rooms – 3 3. Source of drinking water – Tube well, situated just outside of their house They collect and store water for drinking and cooking purpose in an uncovered bucket

13. Personal food hygiene – Hand washing practice before taking food is not regular Practice of defecation – The family use sanitary latrine of their own. They often wash their hand with water only. Refuse disposal – They throw refuse indiscriminately out side the house.

14. PHYSICAL EXAMINATION 1. The child is conscious cooperative but restless 2. Anthropometry Height – 88 cm Weight - 11.5 kg Mid arm circumference – 14 cm 3. General Survey Pulse rate – 110/min Respiratory rate – 30/min Pallor, Icterus, Cyanosis - Absent Neck vein – Not engorged Temperature – not raised Tongue - Dry

15. SYSTEMIC EXAMINATION 1. Gastro-intestinal system – No superficial or deep tenderness No abdominal distension No superficial visible swelling or organomegaly Skin pinch on abdomen goes back slowly No other abnormality detected

16. SYSTEMIC EXAMINATION 2. Central nervous system – All superficial and deep reflexes were present No other abnormality detected 3. Cardiovascular system – S1 and S2 audible No added sound heard 4. Respiratory system – Bilateral vesicular breath sound audible No added sound

17. This is a case of acute diarrhea with some dehydration. PROVISIONAL DIAGNOSIS

18. MEDICO-SOCIAL DIAGNOSIS Ritu Das, a 3 yrs old female child of a lower middle class hindu -joint family is suffering from acute diarrhea with some dehydration. She is living in a kuchha-pucca house and the family members who don’t follow proper hand washing, food handling and defecation practices. They throw refuse indiscriminately. There is presence of tobacco smoking and chewing habits as a social problem in this family. There is lack of exclusive breast feeding, history of pre-lacteal feeding with honey and water. Colostrum was not given to the child. Complementary feeding was started at 7 months of age with soft cooked rice, vegetables.

19. Currently she is on soft cooked rice, smashed vegetables and her feeding is restricted during the periods of illness. Clinical examination of the child reveals she is restless, pulse rate - 110/min , dried tongue, drinks water eagerly and skin pinch goes back slowly. Anthropometric examination excludes any malnutrition.

20. ACTION TAKEN 1. ORS - 900ml within 4 hours 2. Zn Tablet 20 mg 1 tab OD for 14 days 3. Home available fluid 4. Feeding should be continued Khichri with oil R ice with milk or curd and sugar Mashed banana with milk or curd

21. ACTION TAKEN 5) Informed about danger signs and asked to seek health facilities if:- Many watery stools Repeated vomiting Marked thirst or not able to drink Fever Blood in the stool 6) Advised to take all the remaining doses of vaccines.

22. 7. IEC Collect, store and use water in a proper way. Proper hand washing practice Wash hand after defecation with soap water and maintain proper hygiene. Proper feeding of child during illness

23. RECOMMENDATION The mother has been counseled to give her child properly collected, stored and handled potable water. Father has been informed regarding the ill effects tobacco addiction to him and others so that he could quit the same and could motivate the other family members.

24. THANK YOU