Under 5 age, community medicine Group - 4.pptx

community medicine

1. Under 5 case 139 S. Shravanthishaa 140 Sindhu 141 Sourabh Khyalia 142 Sourabh Yadav 143 M. Sravanti 144 S ree Vathsun

2. OUTLINE INDEX CASE Information General information of the locality Family profile Family tree Income Chief Complaints History of present illness Past history Treatment history Antenatal history Intra-natal history Post-natal history Immunization history Developmental history Personal history Family history Psychosocial History Socio cultural history Dietary history Environmental history Knowledge, attitude & practice General examination Head to toe examination Anthropometry Systematic examination Clinical Diagnosis Family Diagnosis

3. INDEX CASE Information Name : Harshath Age : 4yrs 5 months Gender : Male Religion : Hindu Informant : Grandmother (Paternal) Reliability : Good Colour of ration card : Red

4. General information of the locality Area : URBAN Address : No.2, Ram Nagar, Cement Road, Shanmugapuram , Puducherry - 605009. Duration of stay : 9 years Nearby health facilities with distance : PHC Reason for preference : JIPMER (Lack of facilities in PHC)

5. Family profile Name Relation to HOF Age/Sex ( yrs ) Education Occupation Income (Rs.) Medical illness Pazhani HOF 63 5 th Std Salesman 7000/- Hypertension Kamakshi Wife 58 5 th Std Housewife - - Sundar Son 37 B.Sc (Maths) Hotel Manager 15,000/- - Dhavamani Daughter-in-law 30 B.Tech IT Employee 15,000/- - Prajan Grandson 2yrs 3 months - - - - Mohan Son 35 B.Tech Supervisor 20,000/- - Sangeetha Daughter-in-law 31 B.Sc Data Analyst 15,000/- - Harshath Grandson 4yrs 5 months UKG Student - -

6. Family tree Type of family : Extended No. of family members : 8 HOF Index case

7. Income Total income per month : 72,000/- Total no of family members : 8 Per capita income : Rs.9,000/- Social class : Upper middle class (B.G. Prasad scale) Health care expenditure in last month: Nil Debts/Loans: Nil Health Insurance: PMJAY

8. Chief Complaints No Chief complaints

9. History of present illness No H/o fever/rashes No H/o ear discharge, ear pain No H/o fast breathing/ chest indrawing/ stridor No H/o lethargy/ poor feeding / vomiting / convulsions No H/o chest pain No H/o breathlessness / cyanosis No H/o diarrhoea, vomiting / worm infestations/abdominal pain

10. Past history In November 2023, Harshath developed severe breathlessness, fever and cough with white watery sputum for which he was hospitalised for 1 day When he was 2 years, he was hospitalised for 3 days due to fever and convulsions From 1 to 4 years(till December 2023), he has history of nebulisation for atleast once a month No H/o any surgeries done No H/o TB/Jaundice

11. Treatment history In December 2023, he had 3 doses of IM injection(drug unknown) after which he has not had breathlessness problem.

12. Antenatal history Birth order : 1 st born Unplanned pregnancy Registered birth at JIPMER No. of ANC visits : 9 (PHC & JIPMER) No H/o hyperemesis gravidarum No H/o bleeding PV No H/o burning micturition

13. No H/o PIH & GDM No H/o fever with rashes / radiation exposure IFA & Calcium supplementation taken Quickening from 5 th month TT inj. 2 doses received Anemia : No Overall weight gain : 7kg

14. Intra-natal history Place of delivery : JIPMER Caesarean section (due to decreased amniotic fluid) Gender of baby : Male Term : 39 weeks DOB : 15/12/2019 Birth weight : 3kg Baby cried immediately after birth : Yes

15. Post-natal history Breastfeed - within 2hrs (Colostrum given ) Pre-lacteal feeds : Nil Immunized : Yes No h/o NICU admission (roomed in with mother ) Baby passed meconium & urine within 24 hours No h/o neonatal jaundice, umbilical sepsis, cyanosis, fast breathing, chest in-drawing, convulsions, feeding difficulty No h/o traditional substance application over umbilical cord stump Fall of umbilical cord stump– 7th day

16. KMC was practiced H/o 1st bath : 6 th day PNC visit : 1 Home visits by ANM : Nil(As mother was at her hometown after childbirth) Exclusive breastfeeding for 9 months Continuation of iron & calcium tablets : Yes Utilization of AWW services : Yes

17. Immunization history Immunized till date Developmental history Fine motor, gross motor, social milestones, language skills : developed Developmental retardation : absent Milestone attained : Running, hoping, throwing and kicking balls, climbing and swinging with ease

18. Immunization history Age Vaccines given Birth BCG,OPV-0, Hep.B Birth dose 6 weeks OPV-1, Pentavalent-1, fIPV-1, Rotavirus-1 10 weeks OPV-2, Pentavalent-2, RVV-2 14 weeks OPV-3, Pentavalent-3, fIPV-2, RVV-3 9-12 months MR-1, Vit.A drops 16-24 months MR-2, DPT booster 1, OPV booster, Vit.A drops Vitamin A drops taken from 9 th month till now for every 6 months DPT booster 2 vaccine not administered yet.

19. Developmental history Features Newborn 6 months 15-16 months 2 years 3 years 4 years Gross motor Stepping Sits with support Walking Runs, uses stairs Rides tricycle Hops Fine motor Grasping Reaching for objects Scribbles, 2 block tower 6 block tower, circular strokes 9 block tower, draws circle Copies cross block bridge Speech and language Reflex to sound Coo’s (musical vowel sound) 8 to 10 words 2 to 3 word sentence Asks questions Says song, tells story Social milestones Blinking Recognize strangers Copies parents’ tasks Asks for food/drink Shares toys Group play

20. Personal history Mixed diet No h/o sleep disturbance Normal bowel/bladder habits No h/o any drug allergy No h/o behaviour problems No h/o pica No h/o thumb sucking Has bed wetting habit

21. Family history Non – consanguineous marriage Any similar episodes in family members : Nil

22. Dietary history (Qualitative) Exclusive breastfeeding : 9 months When stopped breastfeeding : 2yrs Bottle feeding given Pre-lacteal feeds not given Cow’s milk fed after 2 nd year Bottle fed milk was boiled No change in bowel habits when a new food item is introduced in the diet

23. Details regarding complementary feeds When started : 10 th month Food items : semi solid (Started with Dal rice) Frequency : 3 times a day Hygienic No h/o food allergies. No faulty cooking practices No food faddism/taboos in the family

24. Diet history (Quantitative) Time Foods Consumed Calories(kcal) Proteins(g) Breakfast Idly – 2 Coconut chutney 150 32.5 5 0.5 Snacks Channa (1 serving) Banana – 1 195 28 20 1.2 Lunch Rice Prawn Carrot 115 178.7 25 2.56 19 0.5 Snacks Ragi malt 336 7.7 Dinner Idly – 2 Veg Rice Milk 150 363 180 5 5.5 10 (24hr recall method)

25. Diet history (Quantitative) Consumed Recommended (Holiday Segar Formula) Excess/deficit Calories (kcal) 1753.2 1330 423.2 ( excess ) Proteins(gm) 76.96 15.77 61.19 (excess) Weight of index case = 19 kg Protein requirement = (19 x 0.83g/kg/day) = 15.77g/day

26. Diet history in family Salt consumption/person/day : 3g Oil consumption/person/day : 38ml (groundnut oil)

27. Environmental history External environment: Road : Clean Street lights : Adequate Common dustbins : Present Stray dogs : Present but do not enter the house Breeding sites for mosquito : Nil

28. Internal environment: Type of house : Pucca No of living rooms : 2 Usage of latrine H/o boiling water : Yes Drinking water Method of storage : Closed vessel Collection : Corporation water tap at home Purification : Boiling

29. H/o indoor air pollution - No usage of firewood for cooking - Adequate ventilation in the kitchen(window present) - No burning of wastes - LPG used - Separate kitchen Overcrowding: Yes by room person ratio No by floor space area and sex separation No h/o smoking in the family members No pets in the family Food Sanitation : Hygienic

30. Ventilation Natural light: Not adequate Artificial light used Lighting No. of windows : 3 & kept open : 3 No. of doors : 4 Cross ventilation : Present

31. Knowledge, attitude & practice Knowledge Attitude Practice Aware of EBF & complementary feeding Approaches her elders mostly mother-in-law Male condoms are used as contraceptives Aware of IFA supplementation after delivery for 6 months Trusts nearby PHC regarding illness & health care Seeks treatment for her child at JIPMER Aware of services provided in Anganwadi for lactating mother & children including visits She thinks vaccinating will protect her child from diseases Child is immunized till date, immunization done at JIPMER Aware of JSY & PMMVY benefits (through AW teacher) Ready to avail the benefits She receives AW services

32. Knowledge, attitude & practice Knowledge Attitude Practice Aware of basic developmental milestones and deworming Till 2yrs child was in breastfeeding Aware of HBM of common childhood illnesses/ORS preparation No food items are being avoided for the child Aware of Spacing Methods Washed hands before & after food intake There is recognition of danger signs

33. General examination Child is alert & active Periphery : warm CRT : <3secs The subject was conscious, cooperative and well oriented to time, place and person Pallor: No pallor Icterus: No icterus Cyanosis: No cyanosis Clubbing : No clubbing Lymphadenopathy: No lymphadenopathy Edema : No pedal edema

34. General examination BCG scar present Fontanella closed Vitals –HR : 112 beats/min (Regular rhythm) -RR : 22 breaths per minute -TEMPERATURE : Afebrile Signs of dehydration : Nil Signs of electrolyte imbalance: Nil

35. Head to toe examination Hair Appears normal, No depigmentation, no flag sign Face No prominent bones/ depigmentation/ seborrheic dermatitis Eyes Moist, no bitot’s spots, No SCH Lips No cheilosis/angular stomatitis Tongue Normal Ears Normal Nose No deformity/ discharge Nails No pallor/ koilonychia Skin No pigmentations/ peeling/ rashes/ pustules Chest Ribs not prominent Abdomen Flat Legs No edema

36. Anthropometry Anthropometry Observed Expected Comments Length 98 cm 93.98 – 107.95 cm Normal Weight 19 kg 18 – 24 kg Normal Head circumference 50cm 49 – 52 cm Normal Chest circumference 56cm 56 – 58 cm Normal Mid-arm circumference 16cm >13.5cm Normal

37. Systematic examination CVS : S1, S2 heard; No murmurs RS : Normal vesicular breath sounds heard, no added sounds Bilateral AE assessment - Normal Abdomen : Soft, non tender, flat CNS : Alert and active, NFND (neurocognitive function non-decline)

38. Weight-for-age BOYS – No undernutrition

39. Height-for-age BOYS – No stunting

40. Weight-for-height BOYS – No wasting

41. BMI-for-age BOYS – Healthy weight Weight: 19kg Height: 0.98m BMI= 19/(o.98) ² = 19.78

42. Head circumference-for-age Boys - Normal

43. Arm circumference-for-age BOYS - Normal

44. Clinical Diagnosis A 4 year old male child of 1 st order birth, born to non consanguineous parents, delivered by term LSCS with birth weight 3 kg. Suboptimal IYCF practices Interpretation of Growth chart : Normal No acute malnutrition or AGE without dehydration (as per IMNCI) No cough or cold (No pneumonia as per IMNCI) Immunized till date with no developmental delay

45. Family Diagnosis This is the family of Pazhani which is a extended family consisting of 8 members belonging to upper-middle class socio-economic status (Modified BG prasad scale) residing in Shanmugapuram . Any false feeding practices to child : Nil Utilisation of MCH and AWW services : Yes The Vulnerable individuals of the family are Under 5 child - 2 Eligible couple - 2 Geriatric age group – Mr.Pazhani

46. Thank You