FAMILY HEALTH CARE

FAMILY HEALTH CARE
STUDY UPON A FAMILY TO REACH A FAMILY DIAGNOSIS
1. SOCIO ECONOMIC
2. SOCIO DEMOGRAPHIC
3. SOCIO CULTURAL
4. HOUSING & ENVIRONMENT
5. HEALTH, KNOWLEDGE & ATTITUDE
6. IMMUNIZATION STATUS
7. NUTRITIONAL STATUS
8. HEALTH STATUS
9. FAMILY DIAGNOSIS
10. ACTIONS & RECOMMENDATIONS

1. HEALTH CARE Department of Community Medicine MIDNAPORE MEDICAL COLLEGE - BY SURAJ DHARA

2. This Project was carried out under the Guidance of : D r. AVISEK GUPTA 2

3. PRESENTED BY … Suraj Dhara (Group leader) Suvamita Mandal Subhadeep Kar Astha Modi Tanjila Khatun Ratneswar Sankhari Sanjay Char Madhura Majumdar Poulomi Saha 3

4. Nikita Ahamed Oishee Giri Madhumita Maity Shreyansh Jain Abida Sultana Rovin Singh Shubham Meena Sk Wasim Akram PRESENTED BY (Cont’d)… 4

5. INTRODUCTION TO F AMIL Y H EALT H C AR E 5

6. Definition of Community : According to WHO Expert Committee – “Community is a social group determined by geographical boundaries &/or common values & interests.” Its members know & interact with each other. It functions within a particular social structure and exhibits and creates certain norms, values & social institutions. The individual belongs to the broader society through his family & community. Definition of Family : A family is a group of people, who are related to each other either biologically or by marriage or by adoption, living under the same roof & eating food from same kitchen. 6

7. 7 Types of Family

8. Nuclear Family It consists of married couple & their dependent children. Joint Family It consists of two or more married couples & their children who lived together with the same household. Three Generation Family Three generations living together. 8

9. FUNCTIONS OF THE A FAMILY 9

10. OBJECTIVES OF FAMILY HEALTH CARE…. GENERAL OBJECTIVE : To learn how to make a family diagnosis within available health resources. SPECIFIC OBJECTIVES : To assess the socio-demographic, economic & socio-cultural factors influencing the health of the family. To identify health problems of members of the family, if any. To find out immunization, heath, nutritional status of under five children. To assess dietary intake (food & nutrition) through 24 hrs recall method by oral questionnaire . To make recommendations and to take actions for improving family conditions. 10

11. TOOLS OF THE STUDY HOSPITAL RECORDS GROWTH CHART MEASURING TAPE STETHOSCOPE SPHYGMOMANOMETER WEIGHING MACHINE MODIFIED KUPPUSWAMY SCALE, 2018 MOTHER & CHILD PROTECTION CARD NUTRITIVE VALUE OF INDIAN FOOD, ICMR PARK’S TEXTBOOK OF PREVENTIVE & SOCIAL MEDICINE, 25 TH ED PRACTICAL GUIDE BOOK 11

12. SALIENT FEATURS OF THE COMMUNITY Name of the community : Girja basti . Geographical location : Homeopathic college road Urban / Rural : Urban Name of the opinion leader : Nimai Singh Police station : Kotwali Nearest railway station : Midnapore Railway Station Nearest Govt. health facility : Midnapore Medical College & Hospital Other health facilities available : Spandan Nurshing Home 12

13. SALIENT FEATURS OF THE COMMUNITY Facilities for education : Primary & HS – Vidyasagar Vidyapith Boys’ HS, Nirmal Hriday Ashram Catholic Church High School Facilities for recreation : Play ground, Club Playground : College ground Roads : Hospital road Major source of drinking water : Tap water Drainage system : No specific structure Mode of refuse disposal : Waste products are dumped in a heap in a distant place. Municipal clearing is done weekly. 13

14. GEOGRAPHICAL LOCATION OF THE COMMUNITY 14

15. SOCIO – DEMOGRAPHIC CHARACTERISTICS OF THE FAMILY 15

16. IDENTIFICATION OF THE FAMILY AND ITS PARTICULARS Date of the interview : 02.02.2019 to 04.02.2019 Name of the head of the family : Nimai Singh Household No & Address : Homeopathic College Road, Girja Basti , 721101 Religion : Hindu Mother tongue : Bengali State of origin : West Bengal Caste : SC Length of residence : 50 years Family type : Joint Family Total family members : 6 Male – 2 Female – 4 Adults – 4 Under five – 1 Adolescent – Nil Persons aged > 60 yrs – Nil Pregnant mother – Nil Lactating mother – Nil 16

17. FAMILY TREE 17

18. NIMAI SINGH 55 YR (M) PARI SINGH 48 YR (F) AJAY SINGH 27 YR (M) MOUMITA SINGH 22 YR (F) MANISHA SINGH 5 YR 2M (F) MONALISHA SINGH 13 M (F) 18

19. NAME AGE SEX MARITAL STATUS RELATION TO HOF EDUCATIONAL LEVEL OCCUPATION PHYSIOLOGICAL STATUS 1. NIMAI SINGH 55y M Married HOF 8 Grocery shop _ 2. PARI SINGH 48y F Married Wife Illiterate Grocery shop _ 3. AJAY SINGH 27y M Married Son 7 Grocery shop _ 4. MOUMITA S INGH 22y F Married Daughter in law Illiterate Home maker NON-PREG NON-LACTATING 5. MANISHA SINGH 5yr 2 M F _ Grand daughter Pre-school _ _ 6. MONALISHA SINGH 13M F _ Grand daughter _ _ _ PARTICULARS OF FAMILY MEMBERS 19

20. SOCIO-ECONOMIC & SOCIO-CULTURAL CHARACTERISTICS OF THE FAMILY 20

21. MODIFIED KUPPUSWAMY SCALE (2018) 21

22. Earning members : 3 Male : 2 Female : 1 Source of Income : Grocery shop Occupation of the Head of the Family (HOF) : Grocery shop keeper Total income of the family per month : 12000 Per capita income : (12000/6) = 2000 Literacy status of the HOF : VIII th class Socio-economic class (As per MODIFIED KUPPUSWAMY SCALE, JAN 2018) : SCORE = (6 + 2 + 3) = 11 Lower Middle ( Socioeconomic class III) 22

23. TOTAL MONTHLY ECONOMIC BALANCE SHEET OF THE FAMILY CHARACTERS AMOUNT % (APPROX) FOOD 4000 33.33 FUEL 1000 8.33 CLOTHING 500 4.17 EDUCATION 250 2.08 HOUSING 700 5.83 ELECTRICITY 350 2.92 TRANSPORT 240 2 HEALTH & ILLNESS 2040 17 RECREATION 120 1 OTHERS 350 2.92 TOTAL 9550 79.58 SAVINGS 2450 20.42 23

24. 24

25. Available modern amenities : Bicycle Mobile Television Income and Expenditure : Savings 25

26. SOCIO-CULTURAL PROBLEMS Addictions : Alcohol (NIMAI SINGH), Smoking (AJAY SINGH), Chewing tobacco (PARI SINGH) No. of family members addicted : 3 M : 2 F : 1 Unemployed adult : No Orphans : No Working mother : No Children over 5 yrs not going to school : No School drop out : No Child labour : No Any handicapped (differently abled) or Chronically ill member : No Presence of divorced / widowed / unmarried adult female : No 26

27. SUMMARY The allotted Hindu joint family consisted of 6 members, of which 4 were adult & 2 were children (one underfive ). They residing at Girja Basti , Homeopathic college road, Paschim Medinipur . The source of income of the family was from the grocery shop, which was run by head of the family, his wife & son. According to Modified Kuppuswamy scale 2018, the family belonged to lower middle socioeconomic class (III). Maximum amount of expenditure is as follows : Food (33.33%), Health & illness (17%), fuel (8.33%) with a savings of 20.42%. Nimai Singh, Ajay Singh & Pari Singh were addicted in alcohol, smoking & chewing tobacco respectively. 27

28. HOUSING & ENVIRONMENTAL SANITATION OF THE FAMILY 28

29. A. HOUSING Type : Mixed Mode : Owned Setback area : Absent No. of living room : 2 Total Floor space area : (14 x 10) + (10 x 10) sq. ft. = 240 sq. ft. Per capita floor space area : (240 / 5 ) = 48 sq. ft. Total Door space area : (5 x 2) + (5 x 2) sq. ft. = 20 sq. ft. Window + Door space area : [{(1 x 1) + (1 x 1)} + 20] sq. ft. = 22 sq. ft. (Combined Door + Window area) / Floor area = (22 / 240) = 0.092 4 adult members + 2 children between 1 – 10 yr = 4 + (0.5 + 0.5) = 5 unit 29

30. MAP OF THE AREA WALL DOOR WINDOW HOMEOPATHY COLLEGE RD. 30 KITCHEN LIVING ROOM

31. TABLE SHOWING DIFFERENT CRITERIAS FOR OVERCROWDING PARAMETERS STANDARD FINDINGS INFERENCE PERSONS PER LIVING ROOM 3 rooms per 5 persons 2 rooms per 5 persons Overcrowding present PER CAPITA FLOOR SPACE 70 – 90 sq. ft. (Minimum 50 sq ft.) 48 sq. ft. Overcrowding present SEX SEPARATION Present Absent Overcrowding present 31

32. Dampness present : No Overcrowding present : Yes Separate kitchen present : No ( within one living room) Smoke nuisance : Present Fuel used : LPG Natural light : Inadequate Ventilation : Inadequate Cross ventilation : Present 32

33. B. WATER SUPPLY Sources of water for - Drinking : Tap water Cooking : Tap water Other domestic purpose : Tap water Type of water supply : Intermittent (9.30 AM – 11.30 AM) & (4.30 PM – 6.00 PM) Distance of drinking source from house : Near Amount : Adequate Method of storage : Bottle, Bucket Method of using withdrawal : Small handle mug Any special treatment taken for drinking water : No 33

34. C. EXCRETA DISPOSAL Latrine present : Yes Type : Sanitary Location : Outside premises Mode : Community Water supply : Adequate D. REFUSE DISPOSAL Waste water disposal : Outside premises Refuse disposal : Municipal service Fly nuisance : Absent Breeding places of mosquitoes : Present E. OTHERS Any household / pet animal present : No Kitchen garden : Absent 34

35. SUMMARY The allotted family had their owned mixed house; where cross ventilation is present but ventilation is inadequate Setback area is absent Dampness is absent Separate kitchen is absent Natural light is inadequate Overcrowding is present by all 3 criterias – persons per living room, per capita floor space & sex separation. The family uses water from municipality supplied pipe line which is intermittent. They collect water from the above source & collect into covered bucket & bottles for further uses such as – cooking, drinking, other domestic purposes. 35

36. SUMMARY During withdrawal of water hand dipping was present. Sanitary latrine is present which is community type & having adequate water supply. Waste water is allowed to flow through pucca drain which is outside the house premises. Wastes are thrown into common heap from where municipality service collect weekly. There was presence of mosquito breeding places but without fly nuisance. 36

37. HEALTH KNOWLEDGE AND TREATMENT SEEKING BEHAVIOR OF THE FAMILY 37

38. KNOWLEDGE MALARIA TB ARI DIARRHOEA LEPROSY STD AIDS HEARD THE NAME OF THE DISEASE Yes Yes Yes Yes No No No IF YES, CAUSE & MODE OF TRANSMISSION Mosquito bite Not known Dust, Smoke in air Not known Not known Not known Not known 2 – 3 IMPORTANT SYMPTOMS Fever Not known Sneezing, Cough, Breathing problem Frequent watery stool Not known Not known Not known PREVENTION & TREATMENT Mosquito net Not known Hospitalization ORS Not known Not known Not known HEALTH BEHAVIOR OF THE FAMILY Respondent : Mother 38

39. CHARACTERS KNOWLEDGE PRACTICE Ideal food for neonate Infant feeding formula Infant feeding formula Pre-lacteal feeding Nil Not done Colostrum feeding Not known Done Initiation of breast milk Not known 2 hrs after birth Exclusive breast feeding (in months) Not known 4 months Initiation of complementary feeding (in months) Not known 5 months Feeding during illness (Normal / Altered / Restricted) Normal Normal KNOWLEDGE & PRACTICES OF THE INFANT FEEDING Respondent : Mother 39

40. CHARACTERS KNOWLEDGE PRACTICE (LAST PREGNANCY) Importance of regular Antenatal check up Not known Monthly No. of visits at least required Not known Not remembered IFA prophylaxis needed : yes/no If yes , No. of tabs Yes Not known Yes Not remembered T. Toxoid required : yes/no If yes , Number Yes Not known Yes 2 doses Extra meal required : yes/no Yes Yes Rest during day time needed : y/n If yes , hours Yes Not known Yes 2 - 3 hours Preference for delivery Hospital Hospital Postnatal care needed : y/n If yes , No. of visits Yes Not known Yes 1 visit ANTENATAL & POSTNATAL CARE Respondent : Mother 40

41. IMMUNIZATION To be filled if the family has under five children. Heard the name of : Polio Tuberculosis Tetanus Measles Respondent : Mother 41

42. Is there any eligible couple in the family : Yes, Number : 1 Heard about family planning : Yes Methods known : Natural method & condom Source of knowledge : Health worker Does he/she think that the use of family planning method is necessary for him/her : Yes Method preferred : Temporary ( condom) Source : Hospital Since : After 1 st child birth No problem on use. No H/O abortion. FAMILY PLANNING 42

43. Respondent : Female Member KNOWLEDGE PRACTICE Ideal age for marriage : M F Not known 19 yrs 16 yrs Age at 1 st pregnancy : for female Not known 17 yrs No. of children the family should have : (Boys / Girls) 1 Boy & 1 Girl 2 Girls Suitable spacing between last two consecutive children Not known 4 yrs FAMILY PLANNING 43

44. TREATMENT SEEKING BEHAVIOR OF THE FAMILY For minor ailments the family members go to : Pharmacist For serious ailments the family members go to : Govt. Hospital (MMCH) For immunization of children : Govt. Hospital For antenatal care : Govt. Hospital 44

45. SUMMARY The family had heard about malaria, TB, ARI & diarrhoea . They had inadequate knowledge about TB. They had inadequate knowledge of IFA prophylaxis , tetanus toxoid, extra meal during pregnancy, rest during day time & postnatal check up. The knowledge of mother regarding infant feeding practices were inadequate, though colostrum feeding was done & they fed their child normal during illness. Family had inadequate knowledge of family planning. For minor health issues they preferred pharmacist but for immunization & serious health problems they preferred Govt. hospital. 45

46. NUTRITIONAL PROFILE OF THE FAMILY 46

47. Importance of assessment of nutritional profile of the family : To plan for nutrition related attention to improve health status of the family. To provide information regarding prevalence of the nutritional problems in the family. Early detection of malnutrition state. Objective of assessing the nutritional profile of the family : To identify nutritional status of the family members by applying various methods. To suggest the measures to improve dietary profile and nutrition. 47

48. Methods adapted to assess the nutritional profile : Dietary survey by means of 24 hours recall method by oral questionnaire Anthropometry Clinical examination 48

49. SCHEDULE FOR DIET SURVEY METHOD APPLIED : 24 HOURS DIETARY RECALL METHOD BY ORAL QUESTIONNAIRE FOOD GROUPS FOOD STUFF INTAKE IN GRAMS TOTAL INTAKE PER GROUP (GRAMS) Cereals Rice Wheat 750 250 1000 Pulses & Legumes Lentil 100 100 Roots & Tubers Potato Onion 500 200 700 TABLE 1: INTAKE OF FOOD 49

50. FOOD GROUPS FOOD STUFF INTAKE IN GRAMS TOTAL INTAKE PER GROUP (GRAMS) Fats & Oils Mustard oil 58.50 (65 ml) 58.50 Milk & Milk Products Cow milk 500 500 Flesh Foods Egg 150 (3 pieces) 150 Fruits Pomegranate Sweet lemon 100 (1 piece) 100 (1 piece) 200 Others Biscuits Tea Sugar Green chilli 40 100 100 5 245 Provided ρ = 0.9 gm /cc Provided 1 pc = 50 gm Wheather the family is using Iodized salt : Yes 1 packet biscuit of Rs 5/- Considering 40 gm 50

51. COMMENTS The family consumes – 1000 gms of cereals 100 gms of pulses & legumes 700 gms of roots & tubers 58.50 gms of fats & oils 500 gms of milk & milk products 150 gms of flesh foods 200 gms of fruits 245 gms of other food. And iodinized salt 51

52. TABLE 2 : INTAKE OF FOOD STUFFS (NUTRIENT WISE) NAME OF FOODS INTAKE ( gm ) CALORIES (Kcal) PROTEIN ( gm ) FAT ( gm ) IRON (mg) β – CAROTENE (µg) Rice 750 2595 48 3 7.5 _ Wheat 250 852.5 30.25 1.75 12.25 72.5 Lentil 100 343 25.1 0.6 7.6 270 Onion 200 100 2.4 0.2 1.2 _ Potato 500 485 8 0.5 2.4 120 Mustard oil 58.5 496.08 _ 58.5 _ _ Egg 150 259.5 19.95 19.95 1.5 _ 52

53. NAME OF FOODS INTAKE ( gm ) CALORIES (Kcal) PROTEIN ( gm ) FAT ( gm ) IRON (mg) β – CAROTENE (µg) Pomegranate 100 83 1.7 1.2 1 _ Sweet lime 100 43.02 0.8 0.3 .7 1.2 Biscuits 40 195.9 0.216 5.16 _ _ Tea 100 1 0.1 _ _ _ Sugar 100 488 5.4 19.8 _ _ Milk (Cow) 500 335 16 20.5 20.5 870 Green chilli 5 1.45 0.145 0.03 _ 8.75 Total 2953.5 6278.45 158.061 131.49 54.65 1342.45 53

54. COMMENTS 6278.45 Kcal of calories 158.061 gms of protein 131.49 gms of fat 54.65 mgs of iron 1342.45 µ gs β – carotene The family consumed 2953.5 gms of total food stuffs & of which they got - 54

55. TABLE 3 : DAILY NUTRITIONAL REQUIREMENTS OF THE FAMILY Name Nimai Singh Pari Singh Ajay Singh Moumita Singh Manisha Singh Monalisha Singh Age Sex 55y M 48y F 27y M 22y F 5 yr 2 M F 13m F Phy . Status Phy . Activity _ Sedentary _ Sedentary _ Sedentary NPNL * Sedentary _ _ _ _ *NPNL : Non-pregnant & Non-lactating B. Wt (kg) 54 60 45 34 14 9 Calorie (Kcal) 2320 1900 2320 1900 1350 1060 Protein ( gm ) 54 60 45 34 15.63 11.65 Fat ( gm ) 25 20 25 20 25 27 Total 10850 220.28 142 98 25600 β -C (µg) 4800 4800 4800 4800 3200 3200 Fe (mg) 17 21 17 21 13 9 55

56. Name Nimai Singh Pari Singh Ajay Singh Moumita Singh Monisha Singh Monalisha Singh Age Sex 55y M 48y F 27y M 22y F 5 y 2M F 13m F TABLE 4 : DAILY REQUIREMENTS OF FOOD STUFFS FOR THE FAMILY Phy . Status _ _ _ NPNL * _ _ Cereals ( gm ) 460 410 460 410 270 175 Pulses 40 40 40 40 35 35 R & T * 50 50 50 50 20 10 GLV * 40 100 40 100 50 40 Other veg 60 40 60 40 30 20 Fruits 50 30 50 30 100 90 Flesh food 40 30 40 30 25 20 Milk & M p * 150 100 150 100 250 300 Fats & Oils 40 20 40 20 25 15 * NPNL : Non-pregnant & Non-lactating * R&T : Roots & Tubers * GLV : Green leafy veg * M p : Milk products Total 2185 230 230 370 250 350 185 1050 160 56

57. TABLE 5 : FOOD STUFF WISE CONSUMPTION BASED ON DAILY REQUIREMENTS Food stuffs Total consumption ( gm ) Requirements ( gm ) Deficiency(%) Excess(%) Cereals 1000 2185 54.23 _ Pulses 100 230 56.52 _ R & T * 700 230 _ 204.35 GLV * _ 370 100 _ Other Veg _ 250 100 _ Fruits 200 350 42.86 _ Milk & M p * 500 1050 52.38 _ Flesh food 150 185 18.92 _ Fats & oils 58.5 160 63.44 _ * R&T : Roots & Tubers * GLV : Green leafy veg * M p : Milk products 57

58. COMMENTS The family consumed all of the food stuffs in a deficient amount except Roots & Tubers , which is an excess of 204.35 % 58

59. COMPARATIVE STUDY OF REQUIREMENT VS CONSUMPTION OF FOOD STUFFS UNITS IN GRAMS ALONG Y - AXIS 59

60. 60 CONSUMPTION UNIT OF THE FAMILY NAME AGE PHYSIOLOGICAL ACTIVITY CONSUMPTION UNIT NIMAI SINGH 55 Y SEDENTARY MALE 1.0 PARI SINGH 48 Y SEDENTARY FEMALE 0.8 AJAY SINGH 27 Y SEDENTARY MALE 1.0 MOUMITA SINGH 22 Y SEDENTARY FEMALE 0.8 MONISHA SINGH 5 Y 2 M _ 0.6 MONALISHA SINGH 13 MONTHS _ 0.2 TOTAL C. U. 4.4

61. TABLE 6 : RESULT BASED ON NUTRIENTS CONSUMED 61 Nutrients Calorie (Kcal) Protein ( gm ) Fat ( gm ) Iron (mg) β - carotene ( µ g) Total consumption 6278.45 158.061 131.49 54.65 1342.45 Consumption per C.U. 1426.92 35.92 29.88 12.42 305.10 Requirements 10850 220.28 142 98 25600 Deficiency (%) 42.13 28.24 7.4 44.23 94.76 Excess (%) _ _ _ _ _

62. comments The family consumed all the nutrients ( Calorie, Protein, Fat, Iron & β - Carotene ) in a deficient amount . Calorie : 42.13 % Protein : 28.24 % Fat : 7.4 % Iron : 44.23 % β - Carotene : 94.76 % 62

63. COMPARATIVE STUDY OF REQUIREMENT VS CONSUMPTION OF NUTRIENTS RESPECTIVE UNITS ALONG Y - AXIS 63

64. SUMMARY According to 24 hours recall method the family diet was deficient in cereals, pulses, green leafy veg & other veg, fruits, flesh food, milk & milk products and fats & oils. But it was excess in roots & tubers. Based on nutrient consumed the diet was deficient in calorie, protein, fat, iron & β – carotene. 64

65. NUTRITIONAL & HEALTH PROFILE OF UNDER FIVE CHILD 65

66. INDIVIDUAL CHILDREN AGE (MONTHS) LENGTH (CM) WEIGHT (KG) MUAC (CM) NUTRITIONAL STATUS MONALISHA SINGH 13 76 9 13.5 Normal COMMENTS : It reveals that under five child Monalisha Singh had a normal nutritional status. ANTHROPOMETRY FOR ASSESSING THE NUTRITIONAL STATUS 66

67. . WEIGHT FOR AGE PLOTTING ON MOTHER & CHILD PROTECTION CARD 67

68. CLINICAL EXAMINATION OF MONALISHA SINGH FOR ASSESSING NUTRITIONAL STATUS PARAMETERS STATUS OF MONALISHA PARAMETERS STATUS OF MONALISHA General appearance Thin Skin Normal Hair Normal Nails Normal Face Normal Edema Not there Eyes Normal Rachitic changes Not there Lips Normal Hepatomegaly Not there Tongue Normal Calf tenderness Normal Teeth Normal Ankle & knee jerks Normal Gums Normal Psychological changes Irritability glands Normal 68

69. SL. NO. HEALTH ASPECT STATUS OF MONALISHA SINGH 1. Present illness Asthma 2. H/O past illness Fever & Cough 3. Birth history Date of birth Birth weight Type & place of delivery Neonatal history 18.12.17 Not mentioned on MCPC Normal delivery (at MMCH) Uneventful 4. Developmental history Social smile Holds head erect Sits without support Crawling Stands with support 3 months 3 months 7 months 9 months 11 months HEALTH PROFILE OF MONALISHA SINGH 69

70. SL. NO. HEALTH ASPECT STATUS OF MONALISHA SINGH 5. Feeding history Breast feeding Initiation of breast feeding Colostrum feeding (Y/N) Exclusive breast milk feeding how long b) Pre-lacteal feeding (Y/N) c) When started complementary feeding d) Type of food e) Current diet f) Feeding during illness ( Inc / Same / Dec) Within 2 hrs Yes 4 months No 5 months Infant feeding formula Khichdi & Suji Same CONT’D 70

71. SL. NO. HEALTH ASPECT STATUS OF MONALISHA SINGH 6. A. Physical examination General examination Length Weight MUAC Head circumference Malnutrition Congenital malformation Pulse rate Respiratory rate Pallor Cyanosis Jaundice Edema Clubbing Vitamin deficiency sign Dental condition 76 cm 9 kg 13.5 cm 45 cm Not Present No 100 / min 22 / min Not present Not present Not present Not present Not present Not present Normal CONT’D 71

72. SL. NO. HEALTH ASPECT STATUS OF MONALISHA SINGH 6. B. Systemic examination GI CVS CNS Respiratory system Others NAD 6. C. Laboratory investigation Not done 6. D. Provisional diagnosis Normal CONT’D 72

73. IMMUNIZATION STATUS OF MONALISHA SINGH VACCINES MONALISHA SINGH DOB : 18.12.17 AGE : 13 months BCG 18.12.17 PENTAVALENT – I 07.02.18 PENTAVALENT – II 04.04.18 PENTAVALENT – III 09.05.18 DPT – B _ OPV – 0 18.12.17 OPV – I 07.02.18 OPV – II 04.04.18 OPV – III 09.05.18 73

74. VACCINES MONALISHA SINGH DOB : 18.12.17 AGE : 13 months Hep -B – 0 18.12.17 Measles – I 19.12.18 Measles – II _ JE – I _ JE – II _ Others _ 74

75. IMMUNIZATION CARD OF MONALISHA SINGH 75

76. Source of Immunization : immunization clinic of MMCH Immunization card available : Yes Remarks : Fully immunized Vitamin – A supplementation : Yes Number of doses : 1 st dose on 02.11.18 Whether attended ICDS : No Reasons for that : No nearby center 76

77. SUMMARY Monalisha Singh, the under five girl child of the allotted family was normally delivered at MMCH. She had received exclusive breast feeding for last 4 months. According to nutritional status she was found to be normal. She had a past history of fever & cough. She was a patient of asthma and taking medication for the same. She had an fully immunization status. 77

78. NUTRITIONAL & HEALTH PROFILE OF OTHER FAMILY MEMBERS 78

79. NAME AGE SEX WEIGHT (KG) HEIGHT (METER) BMI STATUS Nimai Singh 55y M 54 1.62 20.58 Normal Pari Singh 48y F 60 1.59 23.70 Normal Ajay Singh 27y M 45 1.6 17.58 CED Moumita Singh 22y F 34 1.48 15.52 CED Monisha Singh 5y 2m F 14 1.01 13.72 Normal BMI ASSESSMENT TO DETECT NUTRITIONAL STATUS COMMENT : Ajay singh & Moumita Singh are chronic energy deficient (CED). 79

80. HEALTH ASPECTS NIMAI SINGH PARI SINGH AJAY SINGH MOUMITA SINGH H/O present illness Hypertension with vomiting Nothing significant Nothing significant Nothing significant Past history Addiction to alcohol Chewing tobacco Smoking Nothing significant Physical examination Height (cm) Weight (kg) B.P. (mmHg) Pulse rate Resp. rate Pallor Jaundice Cyanosis Edema Clubbing Deformity Dental & mouth cond. Skin cond. Thyroid gland 162 54 122 / 98 75 / min 15 / min Absent Present Absent Periorbital puffiness Absent Absent Poor oral hygiene Normal Normal 159 60 118 / 84 72 / min 12 / min Absent Absent Absent Absent Absent Absent Poor oral hygiene Normal Normal 160 45 120 / 84 72 / min 16 / min Absent Absent Absent Absent Absent Absent Poor oral hygiene Normal Normal 148 34 116 / 78 68 / min 15 / min Absent Absent Absent Absent Absent Absent Normal Normal Normal HEALTH PROFILE OF ADULT MEMBERS OF THE FAMILY 80

81. 81 HEALTH ASPECTS NIMAI SINGH PARI SINGH AJAY SINGH MOUMITA SINGH Systemic examination CVS CNS GIT RESP. SYS OTHERS Hypertension NAD NAD NAD NAD NAD NAD NAD Lab findings LFT done Not done Not done Not done Provisional diagnosis Alcoholic liver disease Normal Normal Normal HEALTH PROFILE OF ADULT MEMBERS OF THE FAMILY

82. SUMMARY Presently all the adult members were healthy, Mr. Nimai Singh was suffering from hypertension & alcoholic liver disease. Nimai , Pari & Ajay Singh had history of addiction to alcohol, chewing tobacco & smoking respectively. Peri -orbital puffiness was detected on Nimai Singh & poor oral hygiene was detected on Pari Singh, Nimai Singh & Ajay Singh. We saw reports of Nimai Singh declaring his alcoholic liver disease. 82

83. 83 As a whole

84. SUMMARY The allotted family of 6 members (4 adult, 1 above 5yr & 1 under 5 yr ) residing in urban area – Homeopathic college road, Girja basti , paschim medinipur , 721101, WB for past 50 yrs was a joint family belonging to hindu religion & SC caste. Head of the family was Nimai Singh. According to Modified Kuppuswamy Scale 2018 family belonged to lower middle class (III) & maintain balance between income & expenditure. 3 out of 4 adult members of family were addicted to alcohol, smoking & chewing tobacco. The girl child above 5 yrs was admitted to school. 84

85. SUMMARY Overcrowding was present, ventilation inadequate, setback area absent. Family members used to withdraw drinking water by hand dipping from the storage. They did not do any special treatment for the drinking water. They had no proper drainage system within the house premises and housing is very near to mosquito breeding places. The family had inadequate knowledge about feeding the infant, family planning & some diseases like TB, measles. For immunization of the children they preferred Govt. hospital & for health issues they preferred both medicine shop & hospital. The under five child was fully immunized & above five child was completely immunized. 85

86. SUMMARY The family was deficient from all the food stuffs consumed except roots & tubers. They were deficient in the nutritional elements like calorie, protein, fat, iron & beta carotene. Under five child had normal nutritional status but was suffering from asthma. 2 out of 4 adults were suffering from CED. Nimai Singh, head of the family was suffering from alcoholic liver disease and its complications like hypertension, jaundice, fatty liver. Ajay Singh & Pari S ingh had poor oral hygiene. No abnormality detected on physical examination. 86

87. 87 FAMILY DIAGNOSIS

88. FAMILY DIAGNOSIS The overcrowded, lower middle class of 6 membered family, living in urban community, lacks proper ventilation & natural lighting & had mosquito breeding places nearby. Family had inadequate knowledge about TB, infant feeding practices & family planning. Family had deficiencies of all the nutrients ( β -carotene, iron, calorie, protein & fat) in their diet. S on of HOF Ajay & daughter-in-law Moumita Singh were chronic energy deficient. HOF Mr. Nimai Singh was diagnosed as alcoholic liver diseased patient & his grand daughter Monalisha had asthma. Monalisha & Manisha had fully & completely immunization status respectively. Some family members had an addiction history of alcohol intake, smoking & tobacco chewing. 88

89. 89 S T A K E N & S

90. 90 INDIVIDUAL LEVEL

91. AT INDIVIDUAL LEVEL Mr. Nimai Singh was sensitized to stop alcohol consumption & to continue the treatment of alcoholic liver disease & fatty liver with consulting a doctor. He was told regarding the complication of alcohol intake. Mrs. Pari Singh was specially sensitized to stop tobacco chewing. She was explained about the hazards of the same. Mrs. Moumita Singh was sensitized for her underfive baby to get in touch with physician & to continue the dosage of medication provided to her baby as prescribed by doctor. 91

92. 92 Mrs. Moumita Singh was also informed about proper infant feeding practices . Mr. Ajay Singh was advised to stop smoking & was explained about the hazards of the same . Mr. Ajay & Mrs. Moumita Singh were advised to adopt permanent methods of family planning & contraceptions , as they already have two children. AT INDIVIDUAL LEVEL

93. 93 FAMILY LEVEL

94. 94 AT THE FAMILY LEVEL They were taught about the basics & hazards of overcrowding. Improper ventilation & lighting may affect the health of the individuals – was discussed also. Family members were advised to use mosquito nets, repellents & was informed about the mosquito borne diseases with their symptoms. Family members were advised not to dip their hands in buckets during water withdrawal & for the same the hazards of it was also discussed. Cause, sign – symptoms & basic treatment of the communicable diseases like TB, leprosy, STD were discussed.

95. 95 AT THE FAMILY LEVEL A suitable dietary modification was suggested to the family members. They were sensitized to take balanced diet & discussed about the importance of the same. They were specially described about the deficiency disorders of the food stuffs . They were advised to seek the medical help from M idnapore Medical College & Hospital for their current health status. Dangers of smoking, alcohol intake & its impression over the children were also discussed. Importance of physical exercise was also explained to them.

96. 96 COMMUNITY LEVEL

97. 97 AT THE COMMUNITY LEVEL Pucca , covered drains should be made in that area for proper disposal of waste water. Garbage cleaning service from the municipality should be more regular. Covered dustbins should be placed in that locality for more hygienic refuse disposal. Respective authority should arrange awareness camps, about communicable diseases in association with department of Community Medicine of Midnapore Medical College & Hospital.

98. 98 Group at the spot

99. 99