Family presentation corrected

CONDUCTED BY Team Members

Mithilesh Mriduchhanda

Mosharaf Mrinmay

Mousumi Das Nazrul

Mousumi Ghosh Naba Kumar

Moumita Naushad

Our Guide

Dr Kakali Boral Maam

INTRODUCTION

Family :-It is a primary unit of society consisting of individuals related biologically or by marriage or adoption, living under the same room and consuming food from a common kitchen.

The term family differs from a household due to the fact that all members of a household may not be related.

TYPES OF FAMILY

Nuclear Family

Joint / Extended Family

Three Generation Family

ROLE OF FAMILY

To provide a decent home to its members

It serves as a platform of division of labour of household works

Provides a legal platform to share property for inheritance and helps in social care and socialization

It also serves as a medium for economic functions

INTRODUCTION CONT.

IMPLICATIONS OF FAMILY STUDY

Family serves as a primary unit of society

Reflects the important aspects of a community like role in diseases and health

Helps to identify, prevent and treat individual illnesses

Plays an important role as an biological unit and also focuses on the care of children and dependent adults.

INTRODUCTION CONT.

OBJECTIVES

GENERAL OBJECTIVES

To make a Medico social Diagnosis of the Family

Objectives Continued

Specific Objectives

a) To study the demographic, socioeconomic and environmental conditions of the family.

b) To assess the health status of individual family members

c) To assess maternal health, antenatal and post natal care

OBJECTIVES CONTINUED

d) To determine the immunization status, feeding practices, health and nutritional status of under 5 children

e)To estimate Dietary Practices of the family

f) To take appropriate remedial measures for the problem identified.

MATERIALS AND METHODS

●Type of study: Descriptive type of epidemiological study

●Study Area: Faridpur village near Mallickpur, South 24 Paraganas

●Duration of study: One month (10th

Feb – 8th March)

FARIDPUR

MATERIALS AND METHODS CONT..

●Tools used –

1.Predesigned, Pretested schedule

2.Measuring tapes

3.Weighing machine

4.Sphygmomanometer

5.Stethoscope

6.Torchlight

7.Medical records

A.BRIEFING- Briefing about the family study was done by the faculty members of the department


PROCEDURE


B.CRITERIA FIXATION: Criteria fixation is done for the following-

1. Type of family

2. Literacy

3. Ventilation

4. Lighting

5. Adult Consumption Unit

6. School Dropout

7. Unemployed Youth


C.FAMILY ALLOTMENT : One family was allotted to our group

D.INTERVIEW-With the help of Predesigned, Pretested schedule, Hasna Banu Bibi was interviewed

INTERVIEW-With the help of Predesigned, Pretested schedule, Banu bibi was interviewed

E.OBSERVATION- The housing and environmental conditions of the family were observed

F.ANTHROPOMETRIC MEASUREMENT-Using measuring tape and weighing machine, the following parameters were measured :

For mother- Height, WeightFor child-Height, Weight, Mid upper arm circumference


H.DIETARY SURVEY- The Dietary survey was done by 24 hour recall method

I.RECORD ANALYSIS- The findings were recorded and subsequently analysed.

G.CLINICAL EXAMINATION-Examination was done for pallor, cyanosis, icterus, oedema, neck glands and vesicles.


SCHEMATIC DIAGRAM OF PROCEDURE OF FAMILY STUDY

Presentation

Data Compilation and Analysis

Data Collection

Interview ObservationAnthropometric Measurements

Clinical Examination

Dietary Survey

Allotment Of Family

Criteria Fixation

Briefing

Family Identification Head of Family: Jamal Laskar

Address: Village-Faridpur, P.O-Mallickpur, P.S-Baruipur,Dist-South 24 Paraganas

Type of Family: Nuclear Family

Religion: Islam

Caste:Sunni

Place Of Origin:Faridpur

Length of Stay: From Birth

Mother tongue: Bengali

Other Languages:Hindi, Arabic

Main Source Of Income: Salary of head of the family and wife.

TABLE NO 1- DETAILS OF FAMILY MEMBERS

Names Relation With HOF

Age Sex Marital Status

Education Level

Occupation

Jamal Laskar

Self 26yr Male Married Six Unskilled workerBelt factory Worker

Hasna Banu Bibi

Wife 22yr Female Married Eight Unskilled workerBidi Binder

Hasib Ali Laskar

Son 45 months

Male NA Pre-School

Family Identification

FAMILY TREE

Jamal LaskarHasna Banu

Bibi

Hasib Ali Laskar

•HOUSING

•WATER SUPPLY AND STORAGE

•EXCRETA AND REFUSE DISPOSAL

HOUSING

•Site – Elevated

•Type – Kuccha

•Ownership – Owned

•No of living room – 1

•Total area of living rooms – 15 x 9 sq.ft

•Per unit floor space – 54 sq.ft

•Sex separation – NA

•Person per room – 2.5

•Comment on overcrowding – Not overcrowded

•Area other than living rooms utilized for living purposes – 19x 6 sq.ft

•Combined windows and door space – Is less than 2/5th of the floor space of the living room

•Ventilation – Inadequate

HOUSING CONT..

•Cross-ventilation – absent

•Lighting – Inadequate

•Kitchen – on Veranda

•Type of fuel used – Wood

•Smoke nuisance – Present

•Storage of food – improper

HOUSING CONT..

•Separate cattle shed – Absent

•Drainage system around the house –Absent

•Kitchen garden – absent

•Drainage of household wastewater – In the pond

•Breeding place of mosquitoes – present

•Fly nuisance – present

HOUSING CONT..

SCHEMATIC DIAGRAM OF ALLOTED HOUSE

LIVING ROOM

LATRINE

STORE

VERANDA

KITCHEN

WATER SUPPLY• Source of water – 1.Drinking purposes : Tube

well2.Cooking purpose : Tube

well3.Washing-bathing purpose :

Tube well

• Distance of drinking water source – 10m

• Nature of supply – continuous

• Adequacy of supply – Adequate

• Comment on how people draw, carry, store water in house and how they draw water from containers – water is drawn in buckets

• Special treatment of drinking water at house hold - No

EXCRETA DISPOSAL•Sanitary Latrine present outside house

•Family members including children go to defecate in Sanitary latrine

•Regular cleaning - Yes

REFUSE DISPOSAL

•How do people dispose of refuse – collected in a container

•How is Kitchen waste disposed – Solid waste in common container, which is then disposed off in the pond • Sullage in pond

SOCIOECONOMIC STATUS Both the adult male and female members are earning.

The child is the dependant member.

There is no other source of economic help from outside.

Family income per month:6000.

Per capita income of the family:2000.

SOCIOECONOMIC STATUS contd. Monthly expenditure of the family: ITEM EXPENDITURE Food 3000(51.28%) Fuel 150(2.56%) Clothing 250(4.27%) Electricity 150(2.56%) Substance abuse 150(2.56%) Mobile Phone 200(3.42%) Social functions 500(8.54%) Health and illness 250(4.27%) Travel and transport 100(1.7%) Recreation 100(1.7%) Loan 1000(17.09%) Total expenditure of the family-5850 (100%) Balance of income over expenditure-150

SOCIOECONOMIC STATUS contd. Modified Prasad scale: Based on per capita monthly

income:

Social class Income(Rs.)

Upper high 10000 and above

High 5000-9999

Upper middle 3000-4999

Lower middle 1500-2999

Poor 500-1499

Very poor or BPL Below 500

Thus according to Prasad scale the family belongs to lower middle class.

PIE CHART SHOWING TOTAL MONTHLY EXPENDITURE

51%

3%4%3%3%

8%

4%

2%2%

17%

3%

.Food FuelClothing ElectricitySubstance abuse Social functionsHealth and illness Travel,transportRecreation Loan

PIE CHART NO 1

SOCIOCULTURAL PROBLEM The head of the family is a smoker.

There is no orphan, school dropout and no problem of child labour.

No presence of any handicapped or chronically ill member in the family.

No history of broken family.

No other sociocultural problem identified.

Problem of early marriage and teenage pregnancies in the family.

AMENITIES AND RECREATIONAL FACILITIES The head of the family possesses a bicycle .

The family enjoys amenities of electrical appliances like lights, fans and television

The family uses mobile phone as a mode of communication.

HEALTH KNOWLEDGE ON COMMUNICABLE DISEASES

Disease CAUSATION Mode of

transmission

Prevention Availability of

services

Diarrhoea Contaminated food

&water

No idea To take proper

food & water

PHC

Malaria Mosquito Bite Mosquito Bite Mosquito net

& coil

Private

Practitioner

Tuberculosis No idea No idea No idea _

ARI Exposure to cold No idea Warm clothes

& avoid

exposure to

cold

_

RTI No idea No idea No idea _

HIV/AIDS No idea No idea No idea _

Leprosy

No idea

No idea No idea _

TABLE NO 2- COMMUNICABLE DISEASES

Health knowledge of non communicable diseases

DISEASE CAUSATION PREVENTION AVAILABILITY OF SERVICES

DIABETES INCREASEINTAKE OF SUGAR

SUGARRESTRICTION

NONE

HYPERTENSION NO IDEA SALTRESTRICTION

NONE

CORONARY HEART DISEASE

NO IDEA NO IDEA NONE

CANCER NO IDEA NO IDEA NONE

MENTAL DISEASE

NO IDEA NO IDEA NONE

TABLE NO 3- NON COMMUNICABLE DISEASES

CHILD HEALTH CHECKUP Name- Hasib Ali Laskar

Age- 45 months Sex- Male

Chief Complaints – Cough and Cold

H/O present illness- Cough and Cold for 3 days with running nose and no fever

H/O of Past Illness – Diarrhoea- At 2 years of age

Birth HistoryDATE OF BIRTH 31.05.2010

BIRTH WEIGHT 2.5 KG

GESTATIONAL AGE TERM

PLACE OF DELIVERY INSTITUTIONAL

TYPE OF DELIVERY NORMAL

BIRTH ATTENDANT DOCTOR

ANY CONGENITALMALFORMATION

NO

CONDITION OF BABYAT BIRTH

NORMAL

NEED OF RESUSCITATION

NO

TABLE NO. 5

FEEDING HISTORY Time of initiation of Breast Milk –Half an hour after Delivery

Colostrum - Given

Prelacteal feed given- Yes , Honey as a Social Custom once only.

Exclusive Breast Feeding- Yes up to 6 months

Age of initiation of complementary feeding- After 6 months

Type of Food Offered- Semi Solid

Name of Food offered – Khichdi , Cooked Rice , Eggs

Amount of Food Given During Illness- Same as above

CURRENT FEEDING PRACTICE(24HRS RECALL) Morning- Tea, Biscuits, Parched Rice

Noon- Rice, fish

Evening- Fruits, Biscuits

Night- Rice, Pulses, vegetables

Amount of Food Taken by child presently

No of Katori(150 ml) – 1

No of times - 4

CONT… Visit to ICDS : Yes

Deworming: Not Done

IMMUNIZATION STATUS

VACCINE DATE OF VACCINATION

PLACE OF VACCINATION

REMARKS

BCGOPV 0HEPATITIS B

31.5.1031.5.10NOT GIVEN

NURSING HOME PARTIALLY IMMUNISED AT PAR WITH AGE

DPT 1DPT 2DPT 3DPT BOOSTER (1ST)DPT BOOSTER(2ND)

28.7.1008.9.106.10.10NOT GIVENNOT GIVEN

HARIHARPURPRIMARY HEALTH CENTRE

OPV 1OPV 2OPV 3OPV BOOSTER

28.7.1008.9.106.10.10NOT GIVEN


HEPATITIS B1HEPATITIS B2HEPATITIS B3

28.7.10NOT GIVENNOT GIVEN


MEASLES NOT GIVEN

VITAMIN APPI

NOT GIVENALL DOSES TAKEN

TABLE 6- IMMUNIZATION HISTORY

FINAL IMMUNISATION STATUS All OPV doses were taken except the booster dose.

Pulse Polio doses are complete.

BCG Scar present thus signifying that the vaccine was taken at birth.

Measles, Hepatitis B full course and Vitamin A are not given.

Child is Partially Immunized.

CLINICAL FINDINGSVitals :

Temperature- 98.3 F Resp. Rate-24/min Heart Rate- 75/min Pulse- 84/min

Pallor

Cyanosis/Clubbing/

Pedal edema/Generalized lymphadenopathy

Jaundice

Respiratory Distress

Ear Discharge

ABSENT

CLINICAL FINDINGS CONTND. Eye-Normal

Pustules- Absent

Umbilical Discharge- Absent

Skin pigmentation- Normal

Abdominal Distension- Absent

CVS - Normal

GROWTH CHART

Anthropometric measurement:

Height- 36 cms

Weight-11 Kg

Mid Upper Arm Circumference- 13 cms

Malnutrition

According to WHO growth chart the child was found to be Moderately Underweight

Lab Investigations- Not performed

From the above parameters it is found that the child is moderately underweight and is PRESENTLY SUFFERING FROM COUGH AND COLD.

CONT..

RECORD OF INDIVIDUAL Name : Hasna banu bibiAge : 22 yrsSex: femalePresenting complains: indigestion & acidity for last 2

monthsHistory of present illness: The problem is aggravated in empty stomach and

relieved after taking food.No history of malaena and heart-burn.Abdominal fullness & discomfort after taking the food

was present.History of past illness :no significant past illness

MATERNITY RECORD

Married for: 6 years

Age at menarche : 12 years

Age of marriage : 15 years

Para: 1 Pre term and 1 term.

HISTORY OF PREGNANCIESORDER OFPREGANANCY

AGE O PREGNANCY

OUTCOME ABORTION /STILLBIRTH/LIVEBIRTH

TYPE OF DELIVERY

PLACE OF DELIVERY

CONDUCTED BY D/N/TBA/OTHER

COMPLICATIONS IF ANYa

FIRST 16 YRS LIVE BIRTH NORMAL HOME TBA PRETERM BABY DELIVERED AFTER 7 MONTHS, DIED 1 DAY AFTER BIRTH

SECOND 18 YRS LIVE BIRTH NORMAL NURSING HOME SUBHASGRAM

DOCTOR N.A.

TABLE NO 4- HISTORY OF PREGNANCIES

OBSTETRIC HISTORY She has not taken any antenatal care for the 1st

baby.

The baby was delivered at home by trained birth attendant after 7th month of gestation, i.e.; Preterm baby

Baby was alive for one day only, and she died at home.

ANTENATAL CARE During second pregnancy she made three visits,

during which the following investigations were done.

1) Blood for Hb%

2) Blood group ABO & Rh

3) Blood for sugar

4) Blood for VDRL

5) Urine examination

SERVICES RECEIVEDTT immunization:1st dose: at 1st month of gestation

2nd dose : One month after the first dose

IRON FOLIC ACID tablets:

received

90 tablets for last 3 month

1 tab/day

PHYSICAL EXAMINATION

HEIGHT : 150 cm

WEIGHT : 36Kgs

BMI: 16

AS BMI IS LESS THAN 18.5, SHE IS UNDERWEIGHT

GENERAL SURVEYPallor: Clubbing:Jaundice: absentOedema:Cyanosis:

Pulse:74/minBP:110/70 mm of Hg Respiratory Rate- 19/minTemperature: normalNeck veins : not engorgedNeck glands: not palpable

SYSTEMIC EXAMINATIONCVS: No abnormality found

Respiratory system: no abnormality found

GI system: no abdominal fullness & no tender point is found on examination

CNS : No abnormality found

GENITOURINARY: No abnormality found

PROVISIONAL DIAGNOSIS :- Wife of the head of the family is underweight and presented with Indigestion and Acidity.

FOOD CONSUMED BY THE FAMILY MEMBERS IN LAST 24 HOURS

FOOD GROUPS FOOD ITEMS QUANTITY(gm/dl)

Cereals 1. Rice

2. Puffed rice

250

100

Pulses 1. Lentil 100

Green leafy vegetables 1.Cabbage 200

Other vegetables

Roots and tubers 1. Potato

2. onion

100

100

Fruits 1. guava 100

Milk and milk products

Animal foods 1. egg 250

Fats and oils Mustard oil 100

Sugars 50

TABLE NO 7

NUTRIENT CONSUMPTION SHEET

Foodstuff Amount(g

m)

Calories(Kca

l)

Protei

n (gm)

Fat(gm

)

Fe(mg

)

Ca(mg

)

Vit.A(microgra

m)

Vit.B1(m

g)

Vit.B2(m

g)

Vit.C(mg

)

1.Rice 250 865 16 1 2.5 22.5 _ 0.525 0.125 _

2.Puffed

rice

100 325 7.5 0.1 6.6 23 0 0.21 0.01 _

3.Lentil 100 343 25.1 0.6 7.6 69 270 0.45 0.20 _

4.Cabbage 200 54 3.6 0.2 1.6 78 240 0.12 0.18 248

5.Potato 100 97 1.6 0.1 0.48 10 24 0.10 0.01 17

6.Onion 100 50 1.2 0.1 0.60 47 0 0.08 0.01 11

7.Guava 100 51 0.9 0.3 0.27 10 0 0.03 0.03 212

8.Egg 100 173 13.3 13.3 2.10 60 420 0.10 0.40 _

9.Mustard

oil

100 900 _ 100 _ _ __ _ _ _

10.Sugar 50 199 - _ - - _ _ _ _

Total

Consumpti

on

1200 3057 69.20 115.7 21.83 319.5 954 1.615 0.965 488

TABLE NO 8

COMPARISON OF CONSUMPTION AND DAILY REQUIREMENT OF NUTRIENTS

Nutrients Calories(Kc

al)

Protein(g

m)

Fat(gm) Fe(mg) Ca(mg) Vit.A(MICR

OGRAM)

VitB1(mg) VitB2(mg) Vit.C(mg)

RDA(Reco

mmended

Dietary

Allowance)

2960 71.7 47 30 1200 8000 1.5 1.7 80

Consumpti

on

3057 69.25 100 21.83 325.5 954 1.615 0.965 488

Excess 97 53 0.115 408

Deficit 2.45 9.83 874.5 7046 0.735

TABLE NO 9

0

100

200

300

400

500

600

700

RDA

AMOUNTTAKEN

100 103.27 100 96.6 100 111 100 67.24 100 27.13 100 11.93 100 107.67 100 56.77

100 610

MULTIPLE BAR DIAGRAM SHOWING COMPARISON BETWEEN DAILY REQUIREMENTS AND CONSUMPTION

BAR DIAGRAM 1WITH RDA TAKEN AS 100

CONSUMPTION OF DIFFERENT NUTRIENTS

SUMMARY Three membered Bengali speaking nuclear Muslim family

residing in Faridpur Village, Mallickpur for the last 30 years.

Main source of income is salary of head of family i.e. Jamal Laskar and his wife Hasna Banu Bibi

Live in a kuccha house with no overcrowding but inadequate ventilation, lighting and absence of a drainage system

SUMMARY CONT..

Improper method of drawing drinking water by buckets

Mosquitoes and fly nuisance also present.

No drainage system with sullage and garbage being dumped into the pond.

Per capita income of Rs 2000/month

Belongs to lower middle group according to Modified Prasad’s Scale.

SUMMARY CONT. There are no school dropouts or orphans.

Jamal Laskar , head of the family is a smoker

Early marriage of the lady, Hasna Banu Bibi at 15 years.

Two TEENAGE pregnancies, the first being pre term and surviving only for a day after delivery

CONT.. Wife of HOF suffers from bouts of indigestion and

acidity and is also moderately underweight.

The child, Hasib Ali Laskar is moderately underweight according to WHO growth curve for boys and suffers from repeated cough and cold infections.

Measles Vaccine, Hepatitis B full course vaccine and Vitamin A injections are not given to the child and he is hence partially immunized.

CONT.. The family has minimal knowledge about diseases like

Malaria, Diarrhoea, Hypertension, Diabetes.

Diet had excess of Fat and Vitamin C

Diet lacked in Iron, Ca, Vit A , Protein and Vit B2.

PROBLEMS IDENTIFIED

The house has inadequate ventilation, lighting and has fly nuisance.

The house lacks a proper drainage system

The method of drawing drinking water is improper

PHYSICAL ENVIRONMENT

HOUSING

REFUSE DISPOSAL

WATER SUPPLY

SOCIO CULTURAL PROBLEM

The head of the family is a smoker.

Wife of HOF had two teenage pregnancies.

The family has no knowledge regarding diseases like TB, HIV etc.

HEALTH KNOWLEDGE

CONT…

CONT…

The mother is underweight and frequently suffers from indigestion

The child is underweight and suffers from repeated episodes of cough and cold

Child is partially immunized.

MATERNAL HEALTH

UNDER 5 HEALTH

CONT..

Their diet lacks in Calcium, Vitamin A,B2, Protein, Iron.

DIETARY ASSESSMENT

FAMILY DIAGNOSIS This is a three membered Bengali speaking Muslim family,

residing in Faridpur for last 30 years, in a kuccha house with no overcrowding but inadequate ventilation and lighting. The family belongs to Lower Income Group by Modified Prasad’s Scale. The adult woman is underweight and has frequent episodes of acidity and indigestion. The child is also moderately underweight and had cough and cold during the time of visit. The family diet contains excess Fat, Vitamin C and is deficient in Protein, vitamin A,B2.

RECOMMENDATIONS

To family :-

1) To use filtered water provided by municipality and use long handled mugs for taking out water

2) To complete the immunization of the child from the nearest sub centre

Diet

3) As the diet was deficient in protein, iron, calcium, vitamin A & B2, hence they were advised to consume green leafy vegetables, cereals, milk products, pulses, fruits, eggs, and soya bean.

RECOMMENDATIONS

To Individuals :

1) Hasna Banu Bibi –

a) Advised to take frequent small meals daily and consume plenty of water

b) Avoid Spicy Food

c) To take meals according to time

d) To use barrier method of contraception

e) Being a bidi binder she should use a mask during work.

2) Hasib Ali Laskar

a) Avoid Exposure to Cold

ACTIONS TAKEN The family were asked to immediately discard water that was

stored in containers for more than 7 days.

They were advised to avoid dipping fingers while drawing water from containers.

The family was described causation and modes of transmission of various communicable diseases and their modes of prevention like TB, Malaria etc

She was made aware of the different occupational hazards related to Bidi binding.

•Hand washing with soap and water was advised before taking food.

•The wife was advised to motivate her husband to quit smoking.

•The mother is motivated to complete the immunization of the child ( i.e. two doses of Measles, OPV and DPT Boosters.)

•The wife was asked to consume higher amounts of locally available high calorie indigenous food and also feed her child properly as they both are moderately underweight.

CONT..

LIMITATIONS Head of the family was absent at the time of visit.

Study was conducted in a very short duration of just a single visit.

Diet survey ideally be taken for one dietary cycle which is 7 days whereas the assessment was made for only 24 hours

Fallacies:

Recall Bias.

The amount of food items taken were approximated in many cases.

Individual dietary patterns could not be assessed.

ACKNOWLEDGEMENTS We would like to convey our deep sense of gratitude to

Dr Anima Haldar ( HOD, Dept of Community Medicine)

We would like to thank our guide Dr Kakali Boral, for helping us throughout the project.

We are also grateful to the other teachers of the Department and also the families at Faridpur to help us complete this project.

Technology

Family presentation corrected