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Prakash

1. DEPARTMENT OF COMMUNITY MEDICIE FAMILY VISIT PRESENTATION NIMISHA JAKKA - 18052 RAKSHYA RAMAN – 18064 PRAKASH SHARMA - 18074

2. GENERAL INFORMATIONS: House hold number: 31, Kalika chowk, Bharatpur 10. Name of the head of the family: Loknath Bhattarai Type of the family: Joint family Religion: Hindu Caste: Brahmin Family members: 5 Name of the respondent: Subash Bhattarai

3. Name Relationship with head of the family Age/Sex Marital status Literacy Occupation Addiction Health issue (Mortality/Morbidity) Loknath Bhattarai Head of the family 54/ Male Married 6 class Business X X Bimala Bhattarai Wife 52 / Female Married 6 class homemaker X Prolapse disc Subash Bhattarai Son 30 / Male married Bachelor Business X X Shanti Bhattarai Daughter in law 27 / Female married Bachelor shopekeeper X X Shivya Bhattarai Grand daughter 38 month/Female unmarried X X X Vaccinated

4. 8. Family Income: 71,500. A) Source of income: B) Per capital income: Rs.14,300 per month C) Expenditure: Business shop 50,000 b. Others c,. Abroad work House rent Remittence 15,000 20,000 1. Household Food Fuel Clothing Medical Rs. 30,000/month Rs. 2,000/month Rs. 6,000/month Rs. 2000/month 2. Education Rs. 2000/month 3. Social and Religious functions Rs. 2000/month 4. Miscellaneous

5. D. Does income meet expenditure? Yes E. Debt if any? No G. If any saving per month (Specify the amount): Yes. Rs. 15000 is saved per month * Saving is utilized during need (any kind of medical emergency). It is saved for future studies of their children. H. Socio-Economic Status: According to Revised Kuppuswamy Scale for Nepal: So, they belong to Upper Middle Class of Family.(total score 18) Income of the family 10 Education of the head of family Middle school(3) Occupation of the head of family Shop (5)

6. STUDY OF ENVIRONMENTAL FACTORS

7. Housing: * House: Pucca * No. of rooms: 4 * Per capita space: 93.6 sq ft * Any over crowding present: No. No physical crowding, no sexual crowding * Built up area: 675 sq ft * Set back: not present * Floor: pucca * Roof: cemented * Height of ceiling: 9 ft

8. * Ventilation: Adequate * Cross ventilation: Present * Lighting: Adequate * Kitchen: Separate * Smoke out lets: absent * Water supply: => Sources: Municipality supply (for both drinking and other purposes.) => Water treatment before drinking: boiling * Refusal disposal: => Solid wastes: collected by Municipality => Organic wastes: used as compost manure

9. * Excreta disposal : In sanitary latrine connected to septic tank. * Livestock: absent

10. B. Drainage: Adequate underground drainage present around the house C. Insects and Rodents: Flies, mosquitoes, bugs and rodents present. D. Suggestions regarding environmental sanitation: - Avoid any collection of water to prevent mosquito breeding - Use rodent trap and repairs holes and burrows. - Keep the environment clean.

11. SOCIAL ASPECTS OF NUTRITION

12. Food adequacy : They have cultivable land and they grow vegetables and cereals. Food is purchased in shop in the community. Quantity of food purchased: Rice: 3.5 kg/ week Vegetable: 6 kg /week Dal:2 kg/week Oil: 700 ml/week

13. Diet survey 24 hour recall method

14. Food stuff Item Quantity Calories Protein Vit. A(mcg) Iron( mgm ) Vit-B( mgm ) Calcium( mgm ) Vit. C ( mgm ) Cereals Rice 500gm 1725 34 3.5 11 50 Wheat 300 gm 1023 36.3 87 14.7 12.6 144 Pulse Dal (Lentil) 300 gm 1041 75 375 18.9 10.5 270 Milk and Milk products Milk 2 L 1500 70 3400 4 8 3400 20 Meat/ chiken /egg Chicken meat Egg 500 gm 300 gm 590 519 107 39.9 2880 6.3 1.8 60 180

15. Food stuff Item Quantity Calories Protein Vit. A Iron Vit-B Calcium Vit. C Oil and Fats Mustard Oil 100ml 900 2000 Green Leafy vegetables mustard 500gm 170 20 13110 81.5 1.5 775 165 Root and Tuber Potato 250gm 242.5 4 60 1 3.47 25 42.5 Onion 50gm 56 1.2 25 0.7 80 180 Fruits Apple banana 500 gm 600 gm 295 696 1 7.2 468 3.3 1.8 3.78 50 102 5 42 Spices Chilly 40 gm Total 8757.5 388.4 Total consumption unit: 4.1(1+0.8+1+0.8+0.5) Protein consumption unit / day = 94.73 Calorie consumption unit / day = 2135.97

16. II. Food preparation and Cooking methods: They clean rice and dal after purchasing. They wash rice and dal thrice. They wash vegetables both before and after cutting. They cut vegetables into medium pieces and fry it with oil. Advice to reduce the loss of nutrients while cooking: Don’t wash vegetables after cutting. Don’t wash rice and daal thrice and avoid overcooking or frying it in excessive oil.

17. III. Food storage: They store their food grains in kitchen in plastic cans with lid. Salt is stored in air tight plastic container. IV. Food safety: They keep the prepared foods covered. They wash their hand before handling food. They safely store their both cooked and uncooked food .

18. V. Availability of Food: Cereals: Bought Pulses: Bought Vegetables : Bought Meat, Eggs: Bought Milk: Bought Milk is present in adequate quantity (2litre) to all the members. VI. Eating habit : They eat 4 times daily. VII. She took extra food during pregnancy and lactation because she thinks it is necessary for the good health of mother and children.

19. Infant feeding and weaning practices in the family

20. How many hrs after delivery, breast feeding should be started? After 1 hour Did you give colostrum ? Yes Do you know breastfeeding is important for child ? Yes Do you know about exclusive breastfeeding ? Yes Is your breast milk adequate ? No How long did you continue breast feeding ? 6 months along with lactogen Frequency of breast feeding? whenever child wants. Around 8 to 10 times/day

21. Do you clean your breast before feeding ? No Do you burp after each feed ? Yes Do you know about weaning ? Yes From which age weaning should be started ? 6 months What are the foods you consider suitable for weaning? Lito , dal Whether breast feeding should be continued along with weaning ? Yes If Yes, how long ? 3 years Frequency of weaning food? 4 to 5 times Do you know about the important of supplementary food ? Yes

22. Nutrition of pregnant and lactating women Do you know the importance of increased food intake during pregnancy and lactation ? Yes What type of food do You Consider necessary? Meat, eggs, milk, fruits, green leafy vegetables. (food rich in protein, minerals and vitamins) Do you know that increased food intake is necessary for good Intra-uterine growth of fetus? Yes Do you think that impaired growth of the baby will create problem in delivery? Yes Did you increase diet when became pregnant / after delivery ? Yes Do you have taboo for some food ?No Any particular social religious believes associated with eating practice? No

23. Study of knowledge attitude & practice towards health & diseases and attitude towards health care

24. Name of respondent : Bimala Bhattarai Relationship to head of the family : wife Assessment of knowledge regarding causes of diseases: believes that cause of disease is due to : * Bad weather * Due to sin * Infection * Ill health/nutritional deficiency

25. Attitude towards health Do you consider health as a valued asset : YES Do you believe that most of the diseases are preventable? YES Do you believe that most of the disease are curable ? YES Do you think any intervention required for recovery from diseases ? YES

26. Practices Do you practice any preventive / promotive health care? Yes PERSONAL HYGIENE Do you take bath every day? Yes Do you keep your nails clean ? Yes Do you wash your hands with soap and water before taking food / after coming from toilet? Yes Do you brush your teeth every morning ? Yes

27. IMMUNIZATION Do you consider immunization is important for prevention of diseases? Yes Do you know the important of complete immunization ? Yes Are you children completely immunized? Yes

28. Environmental sanitation From where do you collect drinking water? Municipality water supply Do you disinfect drinking water ? Yes by boiling Do you use sanitary latrine? Yes Where do you dispose off refuse? Solid waste: Municipal waste management Biodegradable waste: compost manure

29. Care during illness A) DIARRHOEA: Do you with draw food and water during diarrhea ? No Do you give more water during diarrhea ? Yes B) BREAST FEEDING / WEANING: Do you give colostrum? Yes When do you start weaning? 6 months

30. C) ACUTE RESPIRATORY ILLNESS (ARI): Do you know about symptoms of ARI ? Yes. Symptoms like runny nose, sore throat, sneezing, cough. Do you know where to go when you suspect ARI ? Yes. Usually to government hospital.

31. Where do you go for medical relief? Usually go to government hospital. Do you find any problem in seeking Medical Relief : No Attitude towards Govt. Health services : There is crowding and lack of doctor. Have you ever met the local health worker : Yes Do you find him/her useful : Yes

32. STUDY OF UNDER 5 CHILDREN

33. NUTRITIONAL ASSESSMENT/GROWTH CHART Name Age Height Weight Right MUAC Left MUAC HC CC Shivya Bhattarai 38 month /female 89cm 12kg 14.5cm 14.5cm 49cm 49.5cm

34. CLINICAL ASSESSMENT General appearance : Thin built Normal hair, face, eyes, lips, tongue, gums, glands, skin nails, legs, skull, chest Edema absent Teeth caries Nutritional Status of child According to WHO growth chart, W/A : 0 TO -2 =Mild underweight H/A : 0 to -2 = Mild stunted W/H : 0 to -2= Mild wasted HC : Normal CC : Normal Dental caries : Present

35. IMMUNIZATION STATUS OF UNDER 5 CHILDREN VACCINES BCG Rota DPT,Hep B, Hib OPV PCV fIPV MR JE Typhoid (TCV) Remark TAKEN TIME At birth Taken Not taken 6 , 10 14 week Taken 6, 10, 14 week Taken 6 , 10 week, 9 month Taken 6 , 14 week Taken 9, 15 month Taken 12 month Taken 3 years Taken Incomplete vaccination (Rota vaccine not taken)

36. SOCIO CLINICAL CASE PRESENTATION

37. Name : Bimala Bhattarai Age : 52 yrs Sex : F Locality : Urban District : Chitwan Zone : Narayani Name of the head of the family: Lokhnath Bhattarai Religion : Hindu Type of the Family : Joint Caste: Brahmin

38. Economic aspect of the family i ) Total income of the family : 71,500 per month ii) Per capita income of the family : 14,300 per month iii)Expenditure per month : iv) Amount of debt : None 1. Household Food Fuel Clothing Medical Rs. 30000/month Rs. 2000/month Rs. 6000/month Rs. 2000/month 2. Education Rs. 2000/month 3. Social and Religious functions Rs. 2000/month 4. Miscellaneous

39. Dietary habit of the family: Non–vegetarian Environmental Sanitation: a. Housing : Pukka house b. Refuse disposal : manure pit and municipality waste management c. Water supply: Municipality supply d. Drainage : Adequate e. Excreta disposal : Sanitary latrine f. Livestock & poultry: None

40. Chief complaint: Back pain x 5 years History of present illness : According to mrs. Bimala Bhattarai, she was in her usual state of health 5 years back when she started developing lower back pain which increased its severity since 1 year, insidious in onset, dull aching in character, gradually progressive, non- radiating, continuous, relieved with rest and medication and exaggerated with movements. It was severe enough to hamper her daily life. Negative history She has no history of trauma, cancer, weight loss, fecal and urinary incontinence, sensory and motor deficit, night sweats and fever.

41. Past history : She has treatment history for back pain in CMS and CMC Diagnosed as disc prolapse. Sha was consulted to go to gym for mild exercise but problems worsened then she went to Kathmandu for treatment and was adviced for physiotherapy. She has no past history of chronic illness like HTN, DM, TB, thyroid problems, malignancy, asthma, COPD, CAD. She has no history of other illnesses and infections. Personal history : Bowel and Bladder habit: Normal Diet : non vegetarian. Takes mixed diet. Appetite: Normal Sleep: Normal Addiction: Non alcoholic and non smoker. Exercise: she do mild exercise and physiotherapy

42. General Examination: > Appearance : A verage built , Medium-height, fair in colour and councious and well oriented to time , place and person. >No pallor, icterus ,lymphadenopathy ,cyanosis, clubbing , oedema and hydration status is good. Vitals : Pulse : 88 beats /min Bp : 125/80 mmHg Temperature: 98.6 degree F (Respiratory Rate not calculated due to inconvenience)

43. Advice given to patient: Avoid heavy weight lifting. Avoid any heavy work. Don’t do strenuous exercise. Continue physiotherapy Correct your walking, sitting and sleeping posture. Sit with your back straight. Eat diets rich in Calcium like Green leafy vegetables, milk and milk products, meat, fish.

44. Thank you