family presentation corrected
TRANSCRIPT
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
MATERIALS AND METHODS CONT..
PROCEDURE
MATERIALS AND METHODS CONT..
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
MATERIALS AND METHODS CONT..
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
MATERIALS AND METHODS CONT..
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.
MATERIALS AND METHODS CONT..
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
HARIHARPURPRIMARY HEALTH CENTRE
HEPATITIS B1HEPATITIS B2HEPATITIS B3
28.7.10NOT GIVENNOT GIVEN
HARIHARPURPRIMARY HEALTH CENTRE
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.