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Sociodemographic Profile of a Family - Community Medicine History Taking

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SECTION 1: IDENTIFICATION DATA (Address and Contact)

• Name of the head of family (with title: Mr./Mrs./Smt.)
• House number / Door number
• Street / Lane name
• Ward / Village / Town
• District, State, Pin code
• Nearest landmark
• Contact number (mobile/landline)
• Date of visit
• Name of the interviewer / student

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SECTION 2: FAMILY IDENTIFICATION

A. Type of Family

B. Family Size

• Total number of family members: ____
• Number of males: ____ | Number of females: ____
• Dependency ratio = (Non-working members / Working members) x 100

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SECTION 3: FAMILY COMPOSITION TABLE

• Sex: Male / Female / Transgender
• Marital status: Unmarried / Married / Widowed / Divorced / Separated
• Education: Illiterate / Primary (up to Class 5) / Middle (Class 6-8) / High school (9-10) / Intermediate / Graduate / Postgraduate / Professional
• Occupation: Unskilled worker / Semi-skilled / Skilled / Clerical/shop/farm / Semi-professional / Professional (use Kuppuswamy scale categories)

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SECTION 4: SOCIOECONOMIC STATUS (SES)

Kuppuswamy's Socioeconomic Scale (urban) / BG Prasad Scale (rural)

Kuppuswamy Scale - Three Parameters:

For rural families, use BG Prasad Classification (based on per capita monthly income, also updated periodically with CPI).

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SECTION 5: RELIGION AND CASTE

• Religion: Hindu / Muslim / Christian / Sikh / Buddhist / Jain / Others
• Caste / Community: General / OBC / SC / ST / Others
• Mother tongue / Language spoken at home

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SECTION 6: EDUCATIONAL STATUS OF THE FAMILY

• Literacy rate of family = (Number of literate members / Total members ≥ 7 yrs) × 100
• Highest educated member and their qualification
• School-going children: How many? Are they attending regularly?
• Dropout children: Age and reason for dropout

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SECTION 7: OCCUPATIONAL PROFILE

• Type of occupation: Agriculture / Daily wage / Government service / Private service / Business / Housewife / Student / Retired / Unemployed
• Nature of work: Sedentary / Moderate / Heavy physical
• Working hours per day: ____
• Any occupational hazard: (dust, chemicals, noise, heavy lifting, etc.)
• Number of earning members: ____
• Number of dependents: ____

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SECTION 8: INCOME DETAILS

• Per capita income = Total monthly family income / Total family members
• Per capita daily income = Per capita monthly income / 30
• Source(s) of income: Salary / Daily wage / Agricultural produce / Business / Pension / Remittances
• Any other source: BPL card / Government welfare benefits / NREGA income

Note: Always record monthly family income (not annual) for SES classification.

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SECTION 9: HOUSING CONDITIONS

Type of House

Overcrowding Index

• Persons per room = Total persons / Number of sleeping rooms
• Overcrowded if > 2 persons per room (Park's criterion)

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SECTION 10: WATER SUPPLY AND SANITATION

Water Supply

• Source: Municipal tap / Hand pump / Borewell / Open well / River/pond / Tanker
• Storage method: Open pot / Closed vessel / Tank with lid
• Treatment before drinking: Boiling / Chlorination / Filtration / None
• Adequacy: Litres per capita per day (LPCD) - minimum 40 LPCD (rural), 70-150 LPCD (urban)

Sanitation

• Type of latrine: Water seal / Pit latrine / Open defecation / Community toilet
• Availability of toilet in house: Yes / No
• Handwashing facility near toilet: Yes / No
• Soap/ash use for handwashing: Yes / No
• Bathing frequency: Daily / Alternate days / Weekly

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SECTION 11: FUEL AND COOKING

• Cooking fuel: Firewood / Dung cake / Kerosene / LPG / PNG / Electric / Solar
• Cooking area: Separate kitchen / Common room / Outside
• Ventilation in kitchen: Adequate / Inadequate (smoke in kitchen = indoor air pollution risk)

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SECTION 12: WASTE DISPOSAL

• Garbage disposal: Municipal bin / Pit in compound / Roadside dump / Open burning
• Drainage system: Covered drains / Open drains / No drainage
• Presence of stagnant water nearby: Yes / No (mosquito breeding risk)

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SECTION 13: FAMILY HEALTH PROFILE - PAST AND PRESENT

Specific health inquiries:

• Chronic diseases: Hypertension, Diabetes, Tuberculosis, Asthma, Cancer, Heart disease, Epilepsy
• Communicable diseases: Any recent fever, diarrhoea, skin infections, jaundice, malaria
• Mental health: Any member with psychiatric illness, addiction
• Disability: Physical / Sensory / Intellectual / Multiple - with nature and duration
• Deaths in the family in past 5 years: Age, cause, place of death

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SECTION 14: MATERNAL AND CHILD HEALTH (MCH)

For women:

• Number of pregnancies (G_P_A_L_): Gravida / Para / Abortions / Living children
• ANC (Antenatal care): Number of visits, where, any complications
• Place of last delivery: Home / Sub-centre / PHC / CHC / Private hospital
• Conducted by: TBA (dai) / ANM / Nurse / Doctor
• Postnatal check-ups: Done / Not done
• Use of family planning: Method used (OCP, IUCD, sterilisation, condom, natural), satisfied / not
• Age at marriage: ____ years (note if below 18 = child marriage)

For children under 5:

• Birth weight: ____ kg (< 2.5 kg = LBW)
• Breastfeeding: Exclusive breastfeeding for 6 months? Yes / No
• Complementary feeding: Started at 6 months? Yes / No
• Nutritional status: Weight for age / Height for age / Weight for height (use IAP charts)
• Any acute illness in past 2 weeks: Fever / Diarrhoea / ARI / Others

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SECTION 15: IMMUNIZATION STATUS

Children (0-5 years) - National Immunization Schedule:

• Immunization card available: Yes / No
• Defaulter: reason for missing vaccines

Adults:

• TT immunization for women of childbearing age
• COVID-19 vaccination status

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SECTION 16: DIETARY HABITS

• Type of diet: Vegetarian / Non-vegetarian / Eggetarian / Mixed
• Number of meals per day: ____
• Meal frequency and timing: Regular / Irregular
• Nutritional adequacy:
  • Cereals, pulses, vegetables, fruits, milk/dairy, fats/oils - consumed daily?
  • Use of iodized salt: Yes / No
  • Use of fortified foods: Yes / No
• Food storage: Proper covered storage / Open storage
• Cooking methods: Boiling / Frying / Pressure cooking / Others
• Use of preserved/packaged food: Frequency?

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SECTION 17: PERSONAL HABITS AND LIFESTYLE

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SECTION 18: HEALTH SEEKING BEHAVIOUR

• Where does the family usually go for treatment?
  • Government hospital / PHC / CHC / District hospital / Private clinic / Private hospital / Quack / Self-medication / Traditional healer / No treatment
• Distance to nearest health facility: ____ km
• Mode of transport used to reach facility: Walk / Two-wheeler / Auto/bus / Own vehicle
• Time taken: ____ minutes
• Reason for preference: Cost / Proximity / Trust / Quality
• Health insurance coverage: PMJAY (Ayushman Bharat) / ESIC / CGHS / Private insurance / None
• BPL card: Yes / No (card number if yes)

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SECTION 19: SOCIAL FACTORS

• Awareness of government schemes: ICDS / Janani Suraksha Yojana / PM Matru Vandana Yojana / NHM / Poshan Abhiyan - aware/not aware
• Access to Anganwadi: Distance, frequency of visit
• Access to ASHA worker: Contact known / Regular visits
• Migration history: Any seasonal migration for work? Duration? Impact on health services access?
• Discrimination or stigma (relevant in TB, HIV, leprosy families): Any faced?

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SECTION 20: ENVIRONMENTAL PROFILE

• Urban / Peri-urban / Rural / Tribal area
• Slum / Non-slum
• Distance to nearest:
  • Sub-Centre: ____ km
  • PHC: ____ km
  • CHC / Taluka hospital: ____ km
  • District hospital: ____ km
• Presence of vector breeding sites nearby: Yes / No (stagnant water, waste dumps)
• Air quality: Industrial area / Traffic-heavy area / Clean area
• Noise pollution: Present / Absent

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SECTION 21: FAMILY PEDIGREE / GENOGRAM (Optional but Impressive)

• Squares = males, circles = females
• Horizontal line = marriage, vertical line = offspring
• Shaded = affected, dot = carrier
• Crossed = deceased

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HOW TO PRESENT/WRITE-UP THE SOCIODEMOGRAPHIC PROFILE

"The index family is a [nuclear/joint/extended] family residing at [address]. The family consists of [number] members - [number] males and [number] females. The head of the family is Mr. ____, aged ___ years, working as a [occupation]. The family belongs to [religion], [caste category] community. The monthly family income is Rs. ____ and the per capita monthly income is Rs. ____. As per Kuppuswamy's socioeconomic classification, the family belongs to Class __ (Upper/Upper Middle/Lower Middle/Upper Lower/Lower). The family resides in a [pucca/semi-pucca/kutcha] house with [number] rooms. Water supply is obtained from [source] and the family uses a [type] latrine. The diet is [vegetarian/non-vegetarian]. Immunization of children is [complete/incomplete]. The nearest health facility is [facility name], located [distance] km away."

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QUICK CHECKLIST FOR PROFESSORS

• Family type and composition table
• SES classification with total score (Kuppuswamy / BG Prasad)
• Education and occupation of each member
• Monthly income and per capita income
• Housing type, number of rooms, overcrowding index
• Water source, storage, treatment
• Latrine type and sanitation
• Immunization status with chart
• MCH details (if applicable)
• Diet type and adequacy
• Personal habits (smoking, alcohol, tobacco)
• Health seeking behaviour and nearest facility
• Government scheme awareness
• Pedigree (if any hereditary condition)
• Summary paragraph

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Geriatric Case - Community Medicine History Taking & Write-Up

Definition: Geriatrics is the branch of medicine dealing with health and diseases of old age. A person is defined as elderly/geriatric if aged ≥ 60 years (India / WHO developing countries) or ≥ 65 years (WHO developed countries).

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PART 1: BIODATA / IDENTIFICATION DATA

• Name: Mr./Mrs. __________
• Age: ___ years (must be ≥ 60 for geriatric case)
• Sex: Male / Female
• Marital status: Married / Widowed / Divorced / Unmarried
• Religion: ______
• Caste / Community: General / OBC / SC / ST
• Education: ______
• Occupation (current / previous): ______
• Address: House no., street, ward, town, district
• Informant: Self / Spouse / Son / Daughter / Caregiver (and reliability of informant)
• Date of interview: ______

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PART 2: CHIEF COMPLAINTS

e.g., Difficulty in walking for 2 years, Forgetfulness for 1 year, Knee pain for 6 months, Difficulty in passing urine for 3 months

• Pain (location, onset, type)
• Falls
• Memory problems
• Bladder/bowel changes
• Vision/hearing changes
• Weight loss / poor appetite

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PART 3: HISTORY OF PRESENT ILLNESS (HPI)

• Onset: Sudden / Gradual
• Duration: ____
• Progression: Static / Progressive / Regressive / Episodic
• Severity: Mild / Moderate / Severe
• Aggravating and relieving factors
• Associated symptoms (for each system affected)
• Treatment taken so far (where, what, for how long, compliance)

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PART 4: PAST MEDICAL HISTORY

• Past surgeries: Type, year, complications
• Past hospitalizations: When, where, reason
• Past trauma: Fractures, head injury

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PART 5: DRUG HISTORY (POLYPHARMACY - KEY IN GERIATRICS)

Elderly patients on ≥5 drugs = polypharmacy (high risk for adverse drug reactions and drug-drug interactions)

• Self-medication: Any OTC drugs, herbal/Ayurvedic medicines, vitamin supplements?
• Allergies: Drug name + type of reaction
• Beers Criteria drugs (drugs inappropriate in elderly): Ask specifically about benzodiazepines, anticholinergics, NSAIDs, certain antihypertensives
• Adherence: Does patient take medications regularly? Who dispenses medicines?

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PART 6: FAMILY HISTORY

• Hypertension, Diabetes, CAD (premature), stroke in parents/siblings
• Cancer (hereditary types - breast, colon)
• Dementia / Alzheimer's in family members
• Any hereditary or genetic disorders
• Draw pedigree if relevant

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PART 7: PERSONAL HISTORY

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PART 8: SOCIOECONOMIC & FAMILY BACKGROUND

• Type of family: Nuclear / Joint / Living alone (note: living alone = major vulnerability in elderly)
• With whom does the patient live? (self / spouse / children / caregiver / institution)
• Family members who support patient: ____
• Monthly income: Own pension / Dependent on children / No income
• Socioeconomic status: Kuppuswamy / BG Prasad class
• Any financial stressors?: Yes / No
• Caregiver: Identified? Available 24 hours? Any caregiver burden?
• Power of Attorney / Advance directive: Made / Not made

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PART 9: GERIATRIC GIANTS (THE "5 I's" + Additional Syndromes)

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PART 10: COMPREHENSIVE GERIATRIC ASSESSMENT (CGA)

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A. FUNCTIONAL ASSESSMENT

Basic Activities of Daily Living (ADL) - Katz Index

• 6 = Fully independent
• 4 = Moderate impairment
• 2 or less = Severe impairment

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Instrumental Activities of Daily Living (IADL) - Lawton Scale

• Higher score = more independent

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Falls Assessment

• Timed Up and Go (TUG) Test: Ask patient to rise from chair, walk 3 metres, turn, walk back, sit down
  • < 10 seconds: Normal
  • 10-20 seconds: Borderline (needs monitoring)

  • 20 seconds: High fall risk - refer physiotherapy

• Previous falls in past 12 months: Yes / No
• Fear of falling: Yes / No (itself causes immobility)
• Causes to look for: Postural hypotension, poor vision, polypharmacy, unsafe environment, muscle weakness

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B. COGNITIVE ASSESSMENT

Mini-Mental State Examination (MMSE) - Folstein

• 24-30: Normal cognition
• 18-23: Mild cognitive impairment
• 10-17: Moderate dementia
• < 10: Severe dementia

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Montreal Cognitive Assessment (MoCA) - if MMSE is normal but suspicion remains

• More sensitive for mild cognitive impairment
• Score ≥ 26 / 30 = Normal (add 1 point if education < 12 years)

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C. PSYCHOLOGICAL / MOOD ASSESSMENT

Geriatric Depression Scale (GDS) - 5-Item Short Form

• Anxiety: Excessive worrying, restlessness, palpitations
• Delirium: Acute confusion, fluctuating consciousness (use CAM - Confusion Assessment Method)
• Delirium vs Dementia vs Depression ("3 D's") - must distinguish

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D. NUTRITIONAL ASSESSMENT

Mini Nutritional Assessment - Short Form (MNA-SF)

• 12-14: Normal nutritional status
• 8-11: At risk of malnutrition
• 0-7: Malnourished

• BMI = Weight (kg) / Height (m)²; < 18.5 in elderly = undernutrition
• Mid-arm circumference (MAC)
• Calf circumference: < 31 cm = sarcopenia risk
• Chewing difficulty (dental status, ill-fitting dentures)
• Swallowing difficulty (dysphagia)

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E. SENSORY ASSESSMENT

• Visual acuity using Snellen's chart (distance) / Jaeger's chart (near)
• Conditions to ask: Cataract (cloudy vision) / Glaucoma (tunnel vision) / Age-related macular degeneration (central vision loss)
• Last eye examination: ____
• Use of spectacles: Yes / No

• Whisper test or finger rub test
• HHIE-S (Hearing Handicap Inventory for Elderly - Short version): 10 items; score > 8 = significant handicap
• Use of hearing aid: Yes / No
• Type of hearing loss: Presbycusis (age-related, sensorineural, bilateral, high-frequency first)

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F. CONTINENCE ASSESSMENT

• Type: Stress (leaks on coughing/straining) / Urge (cannot reach toilet in time) / Overflow (dribbling, enlarged prostate) / Functional (cannot get to toilet due to mobility)
• Duration, severity, impact on daily life
• Use of pads: Yes / No

• Constipation: Frequency, straining, laxative use
• Faecal incontinence: Yes / No

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G. FRAILTY ASSESSMENT

FRAIL Scale (Simple screening)

• 0 = Robust (not frail)
• 1-2 = Pre-frail
• 3-5 = Frail

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H. SOCIAL ASSESSMENT

• Living situation: Independent at home / With family / Old age home / Nursing home
• Social support: Spouse alive? Children present? Friends / community contacts?
• Caregiver details: Who? Relationship? Time spent? Any caregiver burnout?
• Transportation: Can reach hospital independently?
• Financial independence: Own income / Dependent / Government pension
• Elder abuse screen: Physical (unexplained bruises), emotional (shouting, threats), financial (money taken), sexual, neglect
  • Ask directly but sensitively: "Does anyone at home hurt you or make you feel afraid?"
• Advance directives / Living will: Has the patient documented end-of-life wishes?
• Legal: Power of attorney assigned?

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PART 11: SYSTEMS REVIEW (Brief)

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PART 12: PHYSICAL EXAMINATION (Key Points)

Vital Signs (Age-Specific Targets)

• BP: Record both arms; note postural hypotension (drop ≥20 mmHg systolic on standing = fall risk)
• Pulse: Rate, rhythm (AF is common in elderly)
• Respiratory rate: Tachypnoea even at rest is abnormal
• Temperature: Elderly may not mount fever - even 37.5°C may indicate serious infection
• BMI: Weight (kg) / Height (m)²; note: height decreases 1-2 cm/decade after 50 yrs
• Grip strength: Measured with dynamometer; low = sarcopenia marker

General Examination

• Appearance: Well-nourished / Cachectic / Thin
• Pallor, icterus, clubbing, cyanosis, lymphadenopathy, oedema
• Skin: Wrinkling, pigmentation, pressure areas (sacrum, heels, trochanters)
• Eyes: Arcus senilis, cataract visible, xanthelasma
• Mouth: Dentition (own/dentures), oral hygiene, xerostomia
• Posture: Kyphosis (dorsal), forward head posture

Gait Assessment

• Ask patient to walk short distance
• Note: Speed, step length, stability, use of aid (stick / walker / wheelchair)
• Abnormal gaits: Shuffling (Parkinsonism), wide-based (cerebellar), hemiplegic (stroke), antalgic (pain)

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PART 13: INVESTIGATIONS TO MENTION

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PART 14: SUMMARY WRITE-UP PARAGRAPH

"Mr./Mrs. ____, a ___-year-old [male/female], [widowed/married], residing at [address], was seen on [date] for community geriatric assessment. The patient presented with [chief complaints]. Past history is significant for [hypertension/DM/etc.] of [duration]. The patient is currently on [number] medications [list major ones], indicating [polypharmacy / no polypharmacy]. Socioeconomically, the patient belongs to Class ___ (Kuppuswamy), lives [alone / with family / in old age home], and [is / is not] financially dependent on family. Functional assessment using Katz ADL score is ___ /6 indicating [full independence / mild / moderate / severe] impairment; IADL score is ___/8. Cognitive assessment by MMSE score is ___/30, suggestive of [normal / mild / moderate / severe] cognitive impairment. Geriatric Depression Scale (5-item) score is ___, which is [negative / positive] for depression. Nutritional assessment by MNA-SF reveals [normal nutritional status / risk of malnutrition / malnutrition]. Frailty assessment (FRAIL scale) score is ___, classifying the patient as [robust / pre-frail / frail]. The patient [has / has not] had falls in the past 12 months. Elder abuse screening was [negative / positive]. Priority concerns identified are ____, and the following referrals are recommended: [physiotherapy / ophthalmology / psychiatry / dietitian / social worker]."

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PART 15: MANAGEMENT PLAN (5-Pronged)

1. Medical: Treat active diseases, review and rationalise polypharmacy (use Beers Criteria to identify inappropriate drugs in elderly), prevent complications
2. Functional rehabilitation: Physiotherapy for mobility/falls, occupational therapy for ADL training, assistive devices (walking stick, walker, hearing aid, spectacles)
3. Psychological: Treat depression, cognitive stimulation activities, caregiver counselling
4. Social: Social worker referral, government schemes (Indira Gandhi Old Age Pension, Varishtha Pension Bima Yojana, National Programme for Health Care of the Elderly - NPHCE), old age home if needed
5. Preventive: Immunization (Influenza annually, Pneumococcal vaccine, Td booster), fall prevention (home hazard assessment), osteoporosis prevention (calcium + Vitamin D), regular health check-ups

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QUICK EXAM CHECKLIST

• Age ≥ 60 confirmed and documented
• All comorbidities listed with duration
• Polypharmacy documented (count drugs, list Beers Criteria drugs if any)
• Geriatric Giants screened (falls, incontinence, dementia, depression, immobility, iatrogenesis)
• Katz ADL Score (with /6)
• Lawton IADL Score (with /8 or /5)
• MMSE Score (with /30 and interpretation)
• GDS 5-item score (with cutoff interpretation)
• MNA-SF nutritional screen
• FRAIL scale score
• TUG test result
• Vision and hearing screening documented
• Urinary/bowel continence status
• Elder abuse screen
• Caregiver identification
• Summary paragraph written
• Management plan with referrals

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Under-Five Child Case - Community Medicine History Taking & Write-Up

Definition: An "Under-Five" or "Under-5" case in community medicine refers to any child from birth up to 5 years (0-59 months). This is the most vulnerable age group for malnutrition, infections, developmental delays, and vaccine-preventable diseases.

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PART 1: BIODATA / IDENTIFICATION DATA

• Name of child: __________
• Age: ___ months / years (write in months if < 2 years, e.g., 14 months)
• Sex: Male / Female
• Date of birth: ______
• Birth order: 1st / 2nd / 3rd / etc. child
• Religion: ______
• Caste: General / OBC / SC / ST
• Address: House no., street, ward, town, district
• Name of father: ______ | Age: ___ | Education: ____ | Occupation: ____
• Name of mother: ______ | Age: ___ | Education: ____ | Occupation: ____
• Informant: Mother / Father / Grandparent (state reliability)
• Date of interview: ______

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PART 2: CHIEF COMPLAINTS

e.g., "Child not eating well for 2 months, losing weight for 1 month, frequent loose stools for 2 weeks"

• Weight gain / weight loss
• Feeding difficulty
• Loose stools / vomiting
• Recurrent fever / cough
• Any developmental concern (not sitting, not talking, etc.)
• Any swelling on body

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PART 3: HISTORY OF PRESENT ILLNESS (HPI)

• Onset: Sudden / Gradual
• Duration
• Severity and progression
• Aggravating / relieving factors
• Associated symptoms (fever, cough, diarrhoea, rash, vomiting, convulsions)
• Treatment taken: Where, what medicines, for how long, any improvement?
• Sick contacts: Any similar illness in siblings / family?

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PART 4: ANTENATAL HISTORY (ANC)

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PART 5: NATAL (BIRTH) HISTORY

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PART 6: POSTNATAL / NEONATAL HISTORY (First 28 days)

• Neonatal jaundice: Yes / No (treatment required?)
• Neonatal seizures: Yes / No
• Neonatal sepsis / infections: Yes / No
• Feeding in neonatal period: Breastfed / Formula / Both
• Time of first breastfeed after birth: Within 1 hour / After 1 hour (colostrum given?)
• Any hospitalisation in neonatal period: Yes / No

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PART 7: FEEDING HISTORY

A. Breastfeeding

B. Complementary Feeding (Weaning)

C. Dietary Assessment

• Calculate calorie intake (compare to RDA for age)
• Protein intake (compare to RDA)
• RDA Reference:
  • 0-6 months: Breast milk only = 550 kcal/day
  • 6-12 months: ~700 kcal/day
  • 1-3 years: ~1060 kcal/day
  • 3-5 years: ~1350 kcal/day

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PART 8: IMMUNIZATION HISTORY

MANDATORY TABLE - Refer to the National Immunization Schedule (India):

Child is fully immunized if has received: BCG + OPV (3 doses) + DPT (3 doses) + Measles/MR by 12 months of age

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PART 9: DEVELOPMENTAL HISTORY

Developmental Milestones Chart - Ask and Check

• If Yes: Which domain(s)?
• Global developmental delay (all domains) vs Specific domain delay

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PART 10: PAST MEDICAL HISTORY

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PART 11: PERSONAL HISTORY

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PART 12: FAMILY HISTORY

• Siblings: Number, ages, health status
• Any sibling deaths? Age and cause (esp. diarrhoea, malnutrition, pneumonia)
• Congenital / genetic diseases in family
• Tuberculosis in any family member (key - risk to child)
• Father / mother health status
• Parents' consanguinity (cousin marriage increases genetic disorder risk)

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PART 13: SOCIOECONOMIC & FAMILY PROFILE

• Type of family, family size
• SES (Kuppuswamy / BG Prasad class)
• Mother's education (MOST important determinant of child health)
• Father's occupation and income
• Per capita income
• BPL card: Yes / No (entitled to ICDS, NHM, JSY benefits)

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PART 14: ENVIRONMENTAL HISTORY

• Water source and treatment
• Latrine availability and type
• Open defecation: Yes / No (major risk for diarrhoea/worm infestations)
• Hand washing with soap: practiced? Before feeding child? After defecation?
• Overcrowding (persons per room)
• Cooking fuel (indoor air pollution from biomass = recurrent ARI risk)
• Animal/poultry sharing household space: Yes / No (zoonotic disease risk)
• Anganwadi centre nearby: Yes / No (distance: ___ km)
• Is child enrolled at Anganwadi? Yes / No

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PART 15: ICDS (Integrated Child Development Services) Utilisation

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PART 16: ANTHROPOMETRIC ASSESSMENT (PHYSICAL EXAMINATION)

Measurements

MUAC Interpretation (children 6-59 months)

Weight-for-Age (Underweight) - IAP / WHO Z-score

Nutritional Status Classification (WHO)

Rule of Thumb for Expected Weight (quick check)

• Birth weight: ~3 kg
• 5 months: doubles birth weight (~6 kg)
• 1 year: triples birth weight (~9 kg)
• 2 years: quadruples birth weight (~12 kg)
• After 2 years: add 2 kg per year
• Formula: Weight (kg) = Age (years) × 2 + 8 (for 2-12 years)

Rule of Thumb for Expected Height

• Birth: ~50 cm
• 1 year: ~75 cm
• 2 years: ~85 cm
• 4 years: doubles birth length (~100 cm)
• Formula: Height (cm) = Age (years) × 6 + 77 (for 2-12 years)

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PART 17: GENERAL PHYSICAL EXAMINATION

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PART 18: CLINICAL SIGNS OF NUTRITIONAL DEFICIENCIES TO LOOK FOR

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PART 19: SYSTEMIC EXAMINATION (Key Points)

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PART 20: INVESTIGATIONS TO MENTION

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PART 21: GROWTH MONITORING

• Plot all three measurements on WHO Growth Chart (Weight-for-Age, Height-for-Age, Weight-for-Height)
• Road-to-Health card / Growth monitoring card: Available? Regularly updated?
• Direction of growth curve: Going up (adequate) / Flat (faltering) / Going down (failure to thrive)
• Failure to Thrive: Child crosses down two major percentile lines on growth chart

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PART 22: SUMMARY WRITE-UP PARAGRAPH

"The index case is [Child's name], a [age in months/years] old [male/female] child, [birth order] born to [mother's name] aged [mother's age], a [mother's education] [mother's occupation], and [father's name] aged [father's age], a [father's occupation], belonging to [religion, caste], residing at [address]. The family belongs to socioeconomic Class ___ as per Kuppuswamy's scale. The child was born at term / preterm by normal delivery / LSCS at [place of delivery] with a birth weight of ___ kg. Antenatal care was [adequate/inadequate] with ___ visits. Breastfeeding was initiated [within 1 hour / after 1 hour] of birth; exclusive breastfeeding was [maintained / not maintained] for [duration]. Complementary feeding was started at [age] months. The child is [fully / partially / not] immunized as per National Immunization Schedule. On developmental assessment, the child has achieved milestones appropriate for age / shows delay in [domain(s)]. Anthropometrically, the child weighs ___ kg (Z-score: ___) and has a height of ___ cm (Z-score: ___) and MUAC of ___ cm, indicating [normal nutrition / underweight / stunting / wasting / SAM / MAM]. Clinically, the child shows [pallor / oedema / Bitot's spots / skin changes / nil significant findings]. The primary diagnosis is [e.g., moderate acute malnutrition with iron deficiency anaemia]. The family is enrolled / not enrolled at the local Anganwadi centre."

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PART 23: MANAGEMENT PLAN

1. Nutritional Rehabilitation

• MAM: Enhanced feeding at Anganwadi / home-based care; therapeutic foods (Ready-to-Use Food / local preparations)
• SAM (uncomplicated): Community-based management with RUTF (Ready-to-Use Therapeutic Food) - Bal Arogya Poshan Mela; NRC referral if needed
• SAM (complicated - oedema, medical complications): Admit to Nutrition Rehabilitation Centre (NRC) for inpatient management (F-75 then F-100 milk formula → RUTF)

2. Micronutrient supplementation

• Iron (Anaemia): Elemental iron 3 mg/kg/day for 3 months
• Vitamin A: Supplementation every 6 months (national program)
• Vitamin D / Calcium: If deficiency present
• Deworming: Albendazole 400 mg (single dose) for children ≥ 12 months (National Deworming Day)
• Zinc: 10-20 mg/day for 14 days during diarrhoea (national ORS + Zinc policy)

3. Immunization catch-up

• Complete any missed vaccines as per catch-up schedule

4. Treatment of infections

• ORS + Zinc for diarrhoea, Amoxicillin for non-severe pneumonia per IMNCI guidelines

5. Preventive and promotive

• Growth monitoring every month at Anganwadi
• Promote exclusive breastfeeding + timely complementary feeding
• Hand hygiene, safe water, latrine use counselling to mother
• Enrolment in ICDS / Anganwadi
• Government schemes: POSHAN Abhiyan, ICDS, PM POSHAN (Mid-Day Meal), Janani Suraksha Yojana, Mission Indradhanush (immunization)

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QUICK EXAM CHECKLIST

• Age in months stated clearly
• Mother's age, education, and occupation documented (most critical determinants)
• Antenatal, natal, postnatal history complete
• Feeding history: initiation of BF, exclusive BF duration, complementary feeding age and type
• 24-hour dietary recall done
• Full immunization table with dates
• Developmental milestones in all 4 domains (GM, FM, Language, Personal-Social)
• Anthropometry: Weight, Height, MUAC - with Z-scores
• Growth chart plotted
• Nutritional status classified: Underweight / Stunting / Wasting / SAM / MAM
• Clinical signs of deficiency noted
• Anganwadi enrolment and ICDS services utilised
• Summary paragraph written
• Management with NRC referral if SAM

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Environmental Status - Community Medicine Case

This section is also called the "Sanitary Assessment of the House and Environment" in clinico-social case write-ups. It is assessed during a home visit and covers 8 major areas. Every point must be observed directly, not just asked.

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HOW TO APPROACH IT

1. Location and type of area
2. Type of house and physical structure
3. Ventilation and lighting
4. Kitchen assessment
5. Water supply
6. Excreta / latrine disposal
7. Refuse (garbage) disposal
8. Drainage
9. Vector and pest control
10. Surrounding environment

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SECTION 1: LOCATION AND TYPE OF AREA

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SECTION 2: TYPE OF HOUSE AND PHYSICAL STRUCTURE

A. Overall Type of House

B. Rooms and Space

Overcrowding definition (Park's): More than 2 persons per sleeping room, OR less than 4.5 m² (50 sq. ft) floor area per person

C. Construction Details

D. Ownership

• Own house / Rented / Government allotted / Slum dwelling / Living with relatives

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SECTION 3: VENTILATION AND LIGHTING

Ventilation

Standard: Window area should be at least 1/10th of floor area for adequate ventilation

Lighting

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SECTION 4: KITCHEN ASSESSMENT

Key concern: Biomass fuel + no chimney = indoor air pollution → major risk for ARI in children and COPD/chronic bronchitis in women who cook

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SECTION 5: WATER SUPPLY

A. Source of Water

• Primary source for drinking: ______
• Source for other purposes (cooking, bathing, washing): ______
• Same or different source for drinking vs other uses? ______

B. Adequacy of Water Supply

Per capita water requirements (Park's standards):

• Rural (minimum): 40 LPCD
• Urban (desirable): 70-150 LPCD
• Urban (minimum): 70 LPCD

C. Storage of Drinking Water

D. Water Treatment at Home

• Overall water treatment: Adequate / Inadequate / None

E. Water Quality Observations

• Colour: Colourless / Yellowish / Turbid
• Odour: Odourless / Foul / Chlorine smell
• Any complaints of waterborne illness in family: Yes / No
• Any pipe running near drain/sewage (cross-contamination risk): Yes / No

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SECTION 6: EXCRETA DISPOSAL / LATRINE

A. Availability

• Toilet in household: Yes / No
• If No: Uses community toilet / Open defecation in fields/open ground
• Open defecation = highest risk for diarrhoeal diseases, worm infestations, soil-transmitted helminths, and cholera

B. Type of Latrine

C. Latrine Condition

Swachh Bharat Mission (SBM): India's program to achieve ODF (Open Defecation Free) status. Ask if family received toilet under SBM / Swachh Bharat scheme.

D. Disposal of Children's Stools (If Under-5 case)

• Children's stools disposed in toilet: Yes / No
• Disposed in open: Yes (major diarrhoea and worm risk) / No
• Open defecation by children = major entry point for soil-transmitted helminths

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SECTION 7: REFUSE / GARBAGE DISPOSAL

A. Inside the House

B. Outside / Disposal from House

Hazard: Roadside dumping and open garbage = breeding ground for flies, mosquitoes, rodents, and stray dogs → disease transmission risk

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SECTION 8: DRAINAGE

Stagnant water = mosquito breeding (Anopheles → Malaria; Aedes → Dengue/Chikungunya; Culex → Filariasis/JE)

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SECTION 9: VECTOR AND PEST CONTROL

Mosquito Control

Fly Control

Rodents and Pests

Animals

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SECTION 10: SURROUNDING ENVIRONMENT

Proximity to Health Facilities

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SECTION 11: HYGIENE PRACTICES (Personal and Domestic)

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SECTION 12: ENVIRONMENTAL SANITATION SCORE (Summary Table)

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SUMMARY PARAGRAPH FOR ENVIRONMENTAL STATUS

"The family resides in a [pucca / semi-pucca / kutcha] house located in a [urban / rural / slum] area of [address]. The house has [___] rooms for [___] family members, giving [___] persons per room, indicating [overcrowding / no overcrowding]. Ventilation is [adequate / inadequate] with [___ windows] and [cross-ventilation / no cross-ventilation]. Natural and artificial lighting are [adequate / inadequate]. Cooking is done on [LPG / firewood / dung cake] in a [separate kitchen / common room]; [a smoke outlet is present / no chimney, leading to indoor air pollution risk]. Water is obtained from [municipal tap / hand pump / open well / borewell], stored in [covered / open] containers; [water is / is not] treated before drinking by [boiling / chlorination / none]. Per capita water supply is approximately [___] LPCD, which is [adequate / inadequate] by [rural / urban] standards. The family uses a [water-seal latrine / pit latrine / flush toilet / no toilet - open defecation]. The latrine is [clean / dirty], [fly-free / fly-infested], and is located [___] metres from the water source. Handwashing with soap [is / is not] practiced before eating and after defecation. Garbage is disposed via [municipal collection / open dumping / burning]. Drainage near the house is [covered and flowing / open and stagnant], with [no / potential / actual] mosquito breeding sites observed. [Rodents are / are not] present. Overall, the environmental sanitation is [satisfactory / unsatisfactory], with the following specific deficiencies: [list]."

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ENVIRONMENTAL DIAGNOSIS (For Clinico-Social Diagnosis Section)

1. Overcrowding present (3.5 persons/room)
2. Inadequate ventilation (only 1 window, no cross-ventilation)
3. Water stored in open containers without treatment
4. No toilet - open defecation practised
5. Kitchen shared with living area; biomass fuel used with no chimney
6. Stagnant water within 50 metres (mosquito breeding risk)
7. Garbage dumped on roadside
8. Handwashing not practised with soap after defecation

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KEY STANDARDS TO REMEMBER (For Viva)

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