Pages: 134 --- Page 1 --- Medical College & Hospital Mathura STUDENT'S PRACTICAL MANUAL (SOCIO-CLINICAL CASE, CLINICO-SOCIAL CASE, SPOTTERS, FIELD VISITS, EPIDEMIOLOGY AND NUTRITION) --- Page 2 --- Name : Roll No. : Batch Year : From To Signature & Date: (cid:0) INDEX SL.NO TITLE & EXERCISE PAGE NO. SIGNATURE VILLAGE/LOCALITY SURVEY Family No. 1. 1. Family No. 2. Family No. 3. CLINICAL-SOCIAL CASE STUDIES a. Case No.1 b. Case No.2 c. Case No.3 d. Case No.4 2. e. Case No.5 --- Page 3 --- FIELD VISITS a. Hospital visit b. Water filtration plant c. Primary Health Centre d. Sub-Centre visit e. Anganwadi Centre f. District Tuberculosis Centre g. Leprosy Centre h. District Malaria Centre i. District CMO Office j. School Health visit 3. k. Occupational Health visit 1. Sewage treatment plant m. Any other (cid:0) SL.NO TITLE & EXERCISE PAGE NO. SIGNATURE SPECIMENS FOR DEMONSTRATION & SPOTTERS a. Entomology b. Parasites of public health importance c. Insecticides & Disinfectants d. Nutrition 4. e. Immunobiological f. Family Planning Devices g. Laboratory equipment NATIONAL HEALTH PROGRAMS 5. OPERATIONAL ASPECTS 6. STUDENTS OWN HEALTH RECORD ANNEXURE a. Definitions b. Useful indices 7. c. Nutritive Value of Common Foods d. Height & Weight for Indian Children (cid:0) --- Page 4 --- Certificate It is practical that this is the bonafide record of the practical work done in Community Medicine by Mr./Miss for the examination he/she is appearing in the year . The work is found satisfactory. University Registration Numiver Concerned Teacher Professor and Head Department of Community Medicine (Name ) Place: Date: (cid:0) --- Page 5 --- STUDENT PRACTICAL MANUAL Rationale Community settings work as field laboratory to learn about the Health and Diseases phenomenon among the human population. Department of community Medicine K.M. Medical College Hospital and Research Centre, Mathura is having the following four laboratories where students will develop their skills by doing practical exercises. 1. Public health laboratory in the Department 2. Research laboratory in the Department 3. Rural health training centre,SRC hospital, Mathura District 4. Urban health training centre at Goverdhan Chawk, Mathura. , Undergraduate students have to gain knowledge, develop and sharpen their skills in Biostatistics & Epidemiology, Community diagnosis, Planning & management, Communication and operational aspects of various National Health Programs, Practical Demonstrations and field visits will equip them with the skills required for the community physician, practicing epidemiologist, Health manager and Health team leader. Through this manual undergraduate students will be exposed to the basics of community medicine and learn how these principles could be translated into practice. This manual will help the students to learn practical work by doing the various exercises. An attempt has also been made to make this manual more self explanatory in nature and students can learn much more just by following the instructions and guidelines. This manual will also help the students to prepare themselves for examinations.(cid:0) STUDENT PRACTICAL MANUAL INSTRUCTIONS TO THE STUDENTS 1. Students should come in time, with practical manual & apron worn on, in their clinical postings and practical. 2. Students must be equipped for family survey with torch, inch tape, stethoscope. HB pencil, rubber, sharpener, paper & pen. 3. Students should come prepared by reading about the topic that is going to be taught in clinical posting & practical classes. --- Page 6 --- 4. After posting each student should fill the practical manual and getting it signed & checked periodically by concerned teacher. 5. Legible handwriting of students in manual, will be appreciated. 6. While going to the families during the clinical posting, first of all a rapport should be developed with the head of household and other family members as per techniques explained by teachers." 7. Record your observations. 8. Draw relevant diagrams, do calculations if necessary, and get checked by the teacher on the same day. 9. Discipline is to be maintained at every time when student comes in the department and while functioning in the community. Whenever they go to the families they have to work with human dignity, decency and have respect for the family members. While communicating with family members, please always remember that you are dealing with a fellow human being at his own residence! Also think always that community members have got their own thinking & perceptions.(cid:0) VILLAGE/LOCALITY SURVEY 1. Name of the Village/Locality : 2. Population : 3. Distance from headquarters (Kms) : 4. Connectivity. Connected by Bus/Train/Type of transport Post office: Present/Absent Phone facility: Mobile/ Landline/ Internet facility 5. Water supply Type: Wells, River/Lakes/ other (specify) Frequency of disinfections. Monthly/Quarterly/Half yearly/Yearly/ none 6. Sanitary facilities : Present/Absent Refuse disposal : Dumping/Manure pit/others (specify) Biogas plants : Yes/No. Drainage facility : Yes/No. Water logging : Yes/No. 7. Medical & Health facilities: Health centre/ subcentre / Anganwadi/other(specify)(cid:0) Local dais: Who conduct deliveries: Visits by Health staff: How frequent: Trained/Untrained Relatives/Trained Dai/Untrained Dai/Institutional Regular/Irregular(cid:0) 8. School : Present/Absent Playground : Present / Absent 9. Food establishments: Tea shops/Hotels : Present/Absent 10. Fair Price Shops : Present/Absent --- Page 7 --- 11. Recreational facilities: a) Community playground Present/Absent(cid:0) b) Library c) Parks d) Stage for recreation activities Present / Absent Present/Absent Yes/No(cid:0) e) Temple/ Mosque/ any other place for prayers 12. Birth & Death registrations a) Who will be informed? b) Who will record? c) Crude birth rate d) Crude death rate 13. Type of Climate: Temp. as on date 14. Electricity Present/Absent 15. Facilities for obtaining Ration Card/Voters Card/ Aadhar Card/Passport(cid:0) 16. Offensive trades Metal brushes/paints /quarry/brick kilns/others(specify) 17. Predominant community 18. Major occupation Agriculture/Business/Labour/others (specify) 19. List of formal leaders and informal leaders 1. 2. 3. 4. 20. Voluntary organization a). Youth clubs b). Mahila Mandals c). Others 21. Societal strata: Vertical (Doctors, Lawyers etc) Horizontal (Caste wise) 22. Local self govt.: Panchayats/Municipalities/Others 23. Any Other Observations:(cid:0) SPOT MAP OF VILLAGE / LOCALITY --- Page 8 --- VILLAGE SURVEY ANALYSIS 1. Name of the Village : 2. District : 3. Location : 4. Total population Males No. % Females No. % Children (0-5 yrs) No. % Children (6-14 yrs) No. % --- Page 9 --- 5. Health Facilities available in village 1. 2. 3. 6. Literacy status Males Females No. % Children (6-14) No. % No. % 7. Socio-economic Status Low income families No. % Middle income families No. % High income families No. % 8. Occupations Employed No. % Unemployed No. % Cultivators No. % Agri. Laborers No. % Others No. % 9. Human resources Voluntary Organizations Youth clubs Mahila mandals Leaders 1. Formal 2. Informal Others (specify) 10. Recreation facilities/Cultural centers 11. Name/s of endemic diseases present (cid:0) 12. History of epidemic outbreaks in last five years if any: Sl. Epidemic Disease Date / Year of Approx No. Deaths No. onset of cases 1. 2. 3. 4. --- Page 10 --- 5. 6. 7. 8. 9. 13. Educational institutions present:(cid:0) VILLAGE SURVEY QUESTIONAIRE Define the following terms 1. Society 2. Type of society 3. Community 4. Association 5. Stratification a). Horizontal stratification b). Vertical stratification 6. Socio-economic scales --- Page 11 --- a). Modified Kuppuswamy scale b). Modified B.G. Prasad scale (cid:0) FOR NOTES --- Page 12 --- FAMILY VISIT FAMILY No. GENERAL INFORMATION 1. Name of locality : 2. Family Registration no. : 3. Head of family : 4. Type of family :Nuclear/Joint/Extended family/ Three generation 5. Total family income monthly : 6. Total family members : 7. Per capita per month income : 8. Any one "Divyang" or Mentally Challenged: Numbers : --- Page 13 --- 9. Any Suicide or accidental death in family: : 10. Superstitions : (cid:0) FAMILY COMPOSITION (cid:0) Family No. Village / Town / Locality: (cid:0) Head of the family (HOF): Total family monthly income: Type of family : Nuclear / Joint / Extended family / Three generation(Tick -√) Family Composition Table Relation Monthly Literac Morbidity Sex/Age Occupation Name with. Income y Status H.O.F status (cid:0) INDIVIDUAL SCHEDULE - 1 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income --- Page 14 --- 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship --- Page 15 --- 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 2 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. --- Page 16 --- Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 3 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not --- Page 17 --- If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 4 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits --- Page 18 --- : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 5 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) --- Page 19 --- 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 6 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. --- Page 20 --- : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 7 1. Name of the individual : --- Page 21 --- 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts --- Page 22 --- Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) ANTENATAL SCHEDULE 1. Name of the pregnant woman 2. Husband name 3. Address 4. Eligible couple no. 5. Family monthly income 6. Weight in Kgs 7. Height in Cms 8. Present complaints (if any) 9. Obstetric history: (Gravida Para Abortions ) 10. Period of Amenorrhoea Status Place of Order of Warning Wt. Normal/ Type of risk delivery pregnancy Signs gain/week. High Risk chosen 1 st 2 nd 3 rd 4 th 5 11. Any systemic disease (details): 12. Any other risk factor(eg. Short stature /BOH/etc) 13. Services received before and during pregnancy No. of Iron & TT Place where Antenatal folic acid Others Remarks doses received visits tablets 1 st 2 nd 3 rd 14. Urine Test: Urine: Alb/Sugar / Microscopy(cid:0) 15. Blood test- DC HB% Blood Group VDRL (cid:0) --- Page 23 --- (cid:0) 17. Other Inv. BP: Weight at 1 / 2 /3 Trimesters 1 2 3 st nd rd st nd rd (cid:0) 18. FP Adoption history- OCP/Copper-T/ others (specify) 19. Visits by AWW/ASHA/ Any other personnel (cid:0) POSTNATAL SCHEDULE 1. Date of present delivery : 1.a Full term/Pre term : 1.b Mode of Delivery : Normal/ Caesarian 1.c Place of Delivery : Institutional/Home If home delivery, then who conducted it : Trained Dai/ Untrained Dai/ ANM/other 2. Temperature of mother : 3. Pulse rate : /minute 4. Onset of breast milk secretion : hours after delivery 5. Quantity of breast milk : Poor/Average/Good 6. Uterine involution : Poor/Average/good 7. Time taken for involution : 8. Bleeding : Primary (Blood loss during first 48 hours) Secondary (Blood loss after 48 hours) 9. Lochia Yellow/Dark/Pink 10. Post Natal services for mother 11. Bathing : 12. Nutrition : 13. FP motivation : 14. Mother craft : About feeding of child About exclusive breast feeding About weaning foods About colostrum feeding 15. If Mother not breast feeding baby then reasons : 16. Evidence of any infection in new born : (cid:0) INFANT SCHEDULE 1. Age S ex --- Page 24 --- 2. Birth order : 3. Birth Wt.(kgs) : 4. Full term/Premature/LBW/Jaundice 5. Apgar score : 6. Caput : Present / Not 7. Any birth injury : 8. Umbilical cord status : 9. Any congenital defects/diseases : 10. Feeding in first 6 months Colostrum feeding given/not given Time of commencement of breast feeding : No. of feeds per day. : Artificial feeds if any (details) : 11. BCG at birth : Given/Not given OPV at birth : Hepatitis at birth : Given/Not given Given/Not given (cid:0) PRE-SCHOOL AGE CHILD SCHEDULE (1 TO 4 YEARS) 1. Name of Child : 2. Father's name : 3. Birth order : 4. Height and weight : 5. Observation of personal hygiene : a) Clothes - Clean/Dirty b) Hair - Clean & cut/long and dirty c) Bath - Regular/Irregular d) Nails - Trimmed/Not trimmed e) Footwear - Using / Not using f) Ear/ Nose discharge - Present/ Absent g) Throat/Teeth 6. Behavioural disorders --- Page 25 --- a) Bed wetting - Present/Absent b) Nail biting - Present/Absent c) Thumb sucking - Present/Absent 7. Attending nursery school / Anganwadi : Yes/No 8. Remarks on play : 9. Remarks on dict : 10. Present state of health : Healthy/Non healthy if not healthy : Sickness during the 12 months 11. Six monthly deworming practice : done/ not done 12. Pica : Present/Absent NAME OF THE SOURCE OF S.NO. DURATION RESULT DISEASE TREATMENT 1. 2. 3. 4. 5. 13. Follow up : Date of visit : Complaints : Advice : (cid:0) ENVIRONMENT HEALTH SCHEDULE 1. Housing Pucca/Kaccha/ Semi pucca 2. Number of rooms 3. Floor. muddy/not muddy/filed 4. Roof. thatched or not 5. Cross ventilation Present/Not present 6. No of persons living in a room No. 7. No of eligible couples present No. 8. Kitchen separate Yes/No 9. Overcrowding Yes/No Infestation of house by pests: Rats/Cockroaches/Ticks/Flies/Mite Health condition of the Date Advice Remarks Signature 10. Surrounding environment 1. Presence of animals : Cattle/Goats/Pigs/Dogs/Cats/others (Specify) 2. Presence of insects : Flies/Mosquitoes/Ticks etc 3. Presence of breeding places: Their number --- Page 26 --- Type of breeding-mosquito/fly/others Distance from house 11. Garbage disposal 12. Compost pits : Present/absent 13. Sewage disposal 14. Latrine : Sanitary/Insanitary/Practice of open field defecation 15. Fogging/Vector Control Measures taken by local bodies/ individual or family 16. Water Supply : 17. Source of Drinking Water : 18. Disinfection of water : Done/ Not done 19. Method of disinfection of drinking water : 20. T.V Tower/ Mobile tower : Your opinion about environment in few lines SUMMARY OF FAMILY HEALTH SURVEY REPORT FOR FAMILY No. 1 1. Summary of overall health status of family: --- Page 27 --- 2. Action recommended to improve the health status of the family:(cid:0) FOLLOW UP CHART OF THE FAMILY family(cid:0) DIET SURVEY Date of survey : Family No. : Family income : Head of the family : Family members : Man Veg/Non Sl.No Name Age Sex Occupation value/Consumption veg units --- Page 28 --- Total Man Value Ration card details (cid:0) CALORIE CALCULATION Yester Survey Carboh Sl. Food Daily Protein Energy day day Fat ydrate Remarks No item average (gms) (gms) (CHO) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Tot ACC= al ECC (Expected Calorie Consumption) = Total man Value x 2400 ECC (Expected Calorie Consumption) = ACC (Actual Calorie Consumption from survey) = IF ACC = ECC = Nutritional status good ACC < ECC = Nutritional status poor = Nutritional deficiency (Correlate with clinical findings of deficiency) Recommendations: If nutritional deficiency is present, find out whether it is Protein, Fat or CHO deficiency and advise cheap & low cost foods accordingly (CHO, Fats and Proteins should provide approximately 60%, 10-15% and --- Page 29 --- 25-30% of calories in diet).(cid:0) NUTRITION ASSESSMENT SCHEDULE (Pre-School Child) (Clinical Examination) 1. General appearance - Normal built/Thin built/Sickly 2. Hair - Normal/ dull & dry/depigmented/thin and sparse / easily pluckable / flag sign. 3. Face - Diffuse depigmentation/naso-labial dyssebacea /moon face 4. Eyes Conjunctivae Normal/dry & wrinkled / bitot's spots / brown pigmentation / angular conjunctive/ pale conjunctiva/ Cornea - normal/dryness/hazy/opaque. 5. Lips - Normal/angular stomatitis/cheilosis 6. Tongue - Normal pale & flabby / red & raw / fissured / geographic 7. Teeth - Mottled enamel/caries/attrition 8. Gums - Normal/bleeding 9. Glands - Thyroid enlargement/parotid enlargement 10. Skin - Normal/dry and scaly / follicular hyperkeratosis 11. Nails - Koilonychia 12. Oedema - In dependent parts 13. Rachitic changes - Knock-knee or bow legs/ epiphyseal enlargement / beading of the ribs/pigeon chest. 14. Other systems - Hepatomegaly / psychomotor change / mental confusion / sensory loss / motor weakness / loss of position sense / loss of ankle and knee jerks / calf tenderness / cardiac enlargement / tachycardia. 15. Anthropometry Weight (kg) : Height (cm) : Mid Upper arm circumference (cm): (cid:0) Head Circumference (cm): Chest circumference (cm) Inspiration: Expiration: Upper segment/lower seg. Ratio: (cid:0) --- Page 30 --- GUIDELINES FOR DIET SURVEY Diet survey is one of the practical methods of assessing the nutritional status of a community. Objectives: 1. To assess whether the family is consuming recommended number of calories or not i.e. to know its nutritional status. 2. If not, to identify the nutritional deficiency states / diseases in family members. 3. To know about the dietary patterns and the locally available foods in the community. 4. To compare with ICMR recommendations. Methods: 1. By oral questionnaire method. 2. By weighing raw or cooked foods. 3. By inventory method. Each student will conduct diet survey for 3 families as a part of family health survey. As a student exercise, oral questionnaire method is practiced and information is obtained only for 2 days (Yesterday is day one and survey date is day two). Here the students will collect all the information about various food items consumed by the family and convert them into Carbohydrates, fats, proteins and energy while doing so, they will learn easily the nutritive values of foods. This knowledge will be very useful for them during practical exam for spotters and viva. He/She will be able to calculate expected calories consumption (ECC) and actual calorie consumption (ACC) to decide whether the family is consuming enough number of calories as recommended by ICMR. He/ She will also be able to recommend low cost foods according to the need of the family. As a whole, this exercise will enable the student to remember the nutritive values more easny as he is converting each food into calories practically using the conversion tables. It will also improve his skill of communication and data collection. Students will also try to "Balance" the diet of the given family by advising them changes required in diet under guidance of concerned dietician.(cid:0) FOLLOW UP CHART OF THE FAMILY Health condition of the Date Advice Remarks Signature family(cid:0) FOR NOTES --- Page 31 --- FAMILY No. GENERAL INFORMATION --- Page 32 --- 1. Name of locality : 2. Family Registration no. : 3. Head of family : 4. Type of family :Nuclear/Joint/Extended family/ Three generation 5. Total family income monthly : 6. Total family members : 7. Per capita per month income : 8. Any one "Divyang" or Mentally Challenged: NO : 9. Any Suicide or accidental death in family: : 10. Superstitions : (cid:0) FAMILY COMPOSITION (cid:0) Family No. Village / Town / Locality: (cid:0) Head of the family (HOF): Total family monthly income: Type of family : Nuclear / Joint / Extended family / Three generation(Tick -√) Family Composition Table --- Page 33 --- Relation Monthly Literac Morbidity Sex/Age Occupation Name with. Income y Gen/Chr. H.O.F status (cid:0) INDIVIDUAL SCHEDULE - 1 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : Rs. : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) --- Page 34 --- 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 2 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : --- Page 35 --- : Rs. : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Planning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 3 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation --- Page 36 --- 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : Rs. : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship --- Page 37 --- 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 4 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : Rs. : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management --- Page 38 --- 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 5 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : Rs. : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease --- Page 39 --- Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 6 1. Name of the individual : 2. Sex Age : Male/Female 3. Religion : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : Rs. : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. --- Page 40 --- Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : Status Place of 14. IntOrarfadmeri loiafl relati W on a sh rn ip i ng Wt. Normal/ Type of delivery pregnancy Signs gain/week. 15. Interfamilial relationship High Risk risk chosen 16. Family1 Planning adoption: Con dom/OCP/Copp er-T/Vasectom y/Tubectomy(cid:0) 2 INDIVIDU AL SCHED ULE - 7 rd 3 1. Name of the individual : th 4 2. Sex Age : Male/Female th 3. Religion5 : (cid:0) 4. Occupation 5. Monthly income 6. Height (Cms) 7. Weight (Kgs) 8. Educational status 9. : Hindu/Muslim/Christian/Buddhism/other : : Rs. : --- Page 41 --- : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 10. Marital status : Married or not if married, number of children : (cid:0) 11. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 12. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 13. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 14. Intrafamilial relationship 15. Interfamilial relationship 16. Family Planning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) ANTENATAL SCHEDULE 1. Name of the pregnant woman 2. Husband name 3. Address 4. Eligible couple no. --- Page 42 --- 5. Family monthly income 6. Weight in Kgs 7. Height in Cms 8. Present complaints (if any) 9. Obstetric history: (Gravida Para Abortions ) 10. Period of Amenorrhoea st nd 11. Any systemic disease (details): 12. Any other risk factor(eg. Short stature /BOH/etc) 13. Services received before and during pregnancy No. of Iron & TT Place where Antenatal folic acid Others remarks doses received visits tablets st 1 nd 2 rd 3 14. Urine Test: Urine: Alb/Sugar / Microscopy(cid:0) 15. Blood test- DC HB% Blood Group VDRL (cid:0) (cid:0) 17. Other Inv. BP: Weight at 1 / 2 /3 Trimesters 1 2 3 st nd rd st nd rd (cid:0) --- Page 43 --- 18. FP Adoption history- OCP/Copper-T/ others (specify) 19. Visits by AWW/ASHA/ Any other personnel (cid:0) POSTNATAL SCHEDULE 1. Date of present delivery : 1.a Full term/Pre term : 1.b Mode of Delivery : Normal/ Caesarian 1.c Place of Delivery : Institutional/Home If home delivery, then who conducted it : Trained Dai/ Untrained Dai/ ANM/other 2. Temperature of mother : 3. Pulse rate : /minute 4. Onset of breast milk secretion : hours after delivery 5. Quantity of breast milk : Poor/Average/Good 6. Uterine involution : Poor/Average/good 7. Time taken for involution : 8. Bleeding : Primary (Blood loss during first 48 hours) Secondary (Blood loss after 48 hours) 9. Lochia Yellow/Dark/Pink 10. Post Natal services for mother 11. Bathing : 12. Nutrition : 13. FP motivation : 14. Mother craft : About feeding of child About exclusive breast feeding About weaning foods About colostrum feeding 15. If Mother not breast feeding baby then reasons : 16. Evidence of any infection in new born : (cid:0) INFANT SCHEDULE 1. Age Sex S 2. Birth order : 3. Birth Wt.(kgs) : 4. Full term/Premature/LBW/Jaundice --- Page 44 --- 5. Apgar score : 6. Caput : Present / Not 7. Any birth injury : 8. Umbilical cord status : 9. Any congenital defects/diseases : 10. Feeding in first 6 months Colostrum feeding given/not given Time of commencement of breast feeding : No. of feeds per day. : Artificial feeds if any (details) : 11. BCG at birth : Given/Not given OPV at birth : Hepatitis at birth : Given/Not given Given/Not given (cid:0) PRE-SCHOOL AGE CHILD SCHEDULE (1 TO 4 YEARS) 1. Name of Child : 2. Father's name : 3. Birth order : 4. Height and weight : 5. Observation of personal hygiene : a) Clothes - Clean/Dirty b) Hair - Clean & cut/long and dirty c) Bath - Regular/Irregular d) Nails - Trimmed/Not trimmed e) Footwear - Using / Not using f) Ear/ Nose discharge - Present/ Absent g) Throat/Teeth 6. Behavioural disorders a) Bed wetting - Present/Absent b) Nail biting - Present/Absent c) Thumb sucking - Present/Absent 7. Attending nursery school / Anganwadi : Yes/No 8. Remarks on play : 9. Remarks on dict : --- Page 45 --- 10. Present state of health : Healthy/Non healthy if not healthy : Sickness during the 12 months 11. Six monthly deworming practice : done/ not done 12. Pica : Present/Absent NAME OF THE SOURCE OF S.NO. DURATION RESULT DISEASE TREATMENT 1. 2. 3. 4. 5. 13. Follow up : Date of visit : Complaints : Advice : (cid:0) ENVIRONMENT HEALTH SCHEDULE 1. Housing Pucca/Kaccha/ Semi pucca 2. Number of rooms 3. Floor. muddy/not muddy/filed 4. Roof. thatched or not 5. Cross ventilation Present/Not present 6. No of persons living in a room No. 7. No of eligible couples present No. Health condition of the 8. KitchDeant eseparate Yes/No Advice Remarks Signature 9. Overcrowding Yes/No Infestation of house by pests: Rats/Cockroaches/Ticks/Flies/Mite 10. Surrounding environment 1. Presence of animals : Cattle/Goats/Pigs/Dogs/Cats/others (Specify) 2. Presence of insects : Flies/Mosquitoes/Ticks etc 3. Presence of breeding places: Their number Type of breeding-mosquito/fly/others Distance from house 11. Garbage disposal 12. Compost pits : Present/absent 13. Sewage disposal --- Page 46 --- 14. Latrine : Sanitary/Insanitary/Practice of open field defecation 15. Fogging/Vector Control Measures taken by local bodies/ individual or family 16. Water Supply : 17. Source of Drinking Water : 18. Disinfection of water : Done/ Not done 19. Method of disinfection of drinking water : 20. T.V Tower/ Mobile tower : Your opinion about environment in few lines SUMMARY OF FAMILY HEALTH SURVEY REPORT FOR FAMILY No. 1. Summary of overall health status of family: --- Page 47 --- 2. Action recommended to improve the health status of the family:(cid:0) FOLLOW UP CHART OF THE FAMILY family(cid:0) DIET SURVEY Date of survey : Family No. : Family income : Head of the family : Family members : Man Veg/Non Sl.No Name Age Sex Occupation value/Consumption veg units Total Man Value Ration card details (cid:0) --- Page 48 --- CALORIE CALCULATION Yeste Survey Carboh Sl. Food Daily Protein Energ -rday day Fat ydrates Remarks No item average y (gms) (gms) (CHO) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Tot ACC= al ECC (Expected Calorie Consumption) = Total man Value x 2400 ECC (Expected Calorie Consumption) = ACC (Actual Calorie Consumption from survey) = IF ACC = ECC = Nutritional status good ACC < ECC = Nutritional status poor = Nutritional deficiency (Correlate with clinical findings of deficiency) Recommendations: If nutritional deficiency is present, find out whether it is Protein, Fat or CHO deficiency and advise cheap & low cost foods accordingly (CHO, Fats and Proteins should provide approximately 60%, 10-15% and 25-30% of calories in diet).(cid:0) NUTRITION ASSESSMENT SCHEDULE (Pre-School Child) (Clinical Examination) 1. General appearance - Normal built/Thin built/Sickly --- Page 49 --- 2. Hair - Normal/ dull & dry/depigmented/thin and sparse / easily pluckable / flag sign. 3. Face - Diffuse depigmentation/naso-labial dyssebacia /moon face 4. Eyes Conjunctivae Normal/dry & wrinkled / bitot's spots / brown pigmentation / angular conjunctive/ pale conjunctiva/ Cornea - normal/dryness/hazy/opaque. 5. Lips - Normal/angular stomatitis/cheilosis 6. Tongue - Normal pale & flabby / red & raw / fissured / geographic 7. Teeth - Mottled enamel/caries/attrition 8. Gums - Normal/bleeding 9. Glands - Thyroid enlargement/parotid enlargement 10. Skin - Normal/dry and scaly / follicular hyperkeratosis 11. Nails - Koilonychia 12. Oedema - In dependent parts 13. Rachitic changes - Knock-knee or bow legs/ epiphyseal enlargement Health condition of the Date / beading A of d t v h ic e e ribs/pigeon c R h e e m st a . rks Signature 14. Other systems - Hepatomegaly / psychomotor change / mental confusion / sensory loss / motor weakness / loss of position sense / loss of ankle and knee jerks / calf tenderness / cardiac enlargement / tachycardia. 15. Anthropometry Weight (kg) : Height (cm) : Mid Upper arm circumference (cm): (cid:0) Head Circumference (cm): Chest circumference (cm) Inspiration: Expiration: Upper segment/lower seg. Ratio: (cid:0) FOLLOW UP CHART OF THE FAMILY family(cid:0) --- Page 50 --- FAMILY VISIT FAMILY No. GENERAL INFORMATION 11. Name of locality : 12. Family Registration no. : 13. Head of family : 14. Type of family :Nuclear/Joint/Extended family/ Three generation 15. Total family income monthly : 16. Total family members : 17. Per capita per month income : 18. Any one "Divyang" or Mentally Challenged: Numbers : 19. Any Suicide or accidental death in family: : 20. Superstitions : (cid:0) FAMILY COMPOSITION (cid:0) --- Page 51 --- Family No. Village / Town / Locality: (cid:0) Head of the family (HOF): Total family monthly income: Type of family : Nuclear / Joint / Extended family / Three generation(Tick -√) Family Composition Table Relation Monthly Literac Morbidity Sex/Age Occupation Name with. Income y Status H.O.F status (cid:0) INDIVIDUAL SCHEDULE - 1 17. Name of the individual : 18. Sex Age : Male/Female 19. Religion : (cid:0) 20. Occupation 21. Monthly income 22. Height (Cms) 23. Weight (Kgs) 24. Educational status 25. : Hindu/Muslim/Christian/Buddhism/other : --- Page 52 --- : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 26. Marital status : Married or not if married, number of children : (cid:0) 27. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 28. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 29. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 30. Intrafamilial relationship 31. Interfamilial relationship 32. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 2 17. Name of the individual : 18. Sex Age : Male/Female 19. Religion : (cid:0) 20. Occupation --- Page 53 --- 21. Monthly income 22. Height (Cms) 23. Weight (Kgs) 24. Educational status 25. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 26. Marital status : Married or not if married, number of children : (cid:0) 27. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 28. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 29. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 30. Intrafamilial relationship --- Page 54 --- 31. Interfamilial relationship 32. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 3 17. Name of the individual : 18. Sex Age : Male/Female 19. Religion : (cid:0) 20. Occupation 21. Monthly income 22. Height (Cms) 23. Weight (Kgs) 24. Educational status 25. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 26. Marital status : Married or not if married, number of children : (cid:0) 27. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 28. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management --- Page 55 --- 29. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 30. Intrafamilial relationship 31. Interfamilial relationship 32. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 4 17. Name of the individual : 18. Sex Age : Male/Female 19. Religion : (cid:0) 20. Occupation 21. Monthly income 22. Height (Cms) 23. Weight (Kgs) 24. Educational status 25. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 26. Marital status : Married or not if married, number of children : (cid:0) 27. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 28. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease --- Page 56 --- Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 29. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 30. Intrafamilial relationship 31. Interfamilial relationship 32. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 5 17. Name of the individual : 18. Sex Age : Male/Female 19. Religion : (cid:0) 20. Occupation 21. Monthly income 22. Height (Cms) 23. Weight (Kgs) 24. Educational status 25. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 26. Marital status : Married or not if married, number of children : (cid:0) 27. --- Page 57 --- Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 28. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 29. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 30. Intrafamilial relationship 31. Interfamilial relationship 32. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 6 17. Name of the individual : 18. Sex Age : Male/Female 19. Religion : (cid:0) 20. Occupation 21. Monthly income 22. Height (Cms) 23. Weight (Kgs) 24. Educational status 25. : Hindu/Muslim/Christian/Buddhism/other : : . : --- Page 58 --- : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 26. Marital status : Married or not if married, number of children : (cid:0) 27. Age of last child Personal habits : : Nil/smoking/alcoholic/tobacco chewing/puff/others (specify)(cid:0) 28. Health status: Well/acutely ill/chronically ill/ (specify the disease) If ill, details: Disease(s) suffering from Duration of disease Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 29. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 30. Intrafamilial relationship 31. Interfamilial relationship 32. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) INDIVIDUAL SCHEDULE - 7 17. Name of the individual : 18. Sex Age : Male/Female 19. Religion : (cid:0) 20. Occupation 21. Monthly income 22. Height (Cms) --- Page 59 --- 23. Weight (Kgs) 24. Educational status 25. : Hindu/Muslim/Christian/Buddhism/other : : . : : : Illiterate/primary/secondary/Higher Secondary/Graduate/post-graduate(cid:0) 26. Marital status : Married or not if married, number of children : (cid:0) 27. Age of la st child Status Place of Order of Warning Wt. Normal/ Type of delivery Personal habits pregnancy Signs gain/week. High Risk risk chosen 1 : 2 : Nil/smoking/alcoholic/tobacco chewing/puff/others rd (specify)(cid:0) 3 28. Hea4l t t h h status : Well/acutely ill/chronically il l/ (specify the di sease) If ill, de tails: Disease(s) suffering from Duration of disease 5 Awareness about disease prevention What type of prevention presently following Taking treatment or not If yes from where Any other information about the disease and its course & management 29. Investigation: B.P. mmHg. Urine: albumin/sugar/others (specify) Stool: not examined / examined If examined then ova / cyst - Present / Absent specify type ankylostoma /ascaris /E.H.cysts/other cysts Blood test: Not examined/nil/M.P/others (specify) Any other investigations: : 30. Intrafamilial relationship 31. Interfamilial relationship 32. Family Plannning adoption: Condom/OCP/Copper-T/Vasectomy/Tubectomy(cid:0) --- Page 60 --- ANTENATAL SCHEDULE 20. Name of the pregnant woman 21. Husband name 22. Address 23. Eligible couple no. 24. Family monthly income 25. Weight in Kgs 26. Height in Cms 27. Present complaints (if any) 28. Obstetric history: (Gravida Para Abortions ) 29. Period of Amenorrhoea st nd 30. Any systemic disease (details): 31. Any other risk factor(eg. Short stature /BOH/etc) 32. Services received before and during pregnancy No. of Iron & TT Place where Antenatal folic acid Others remarks doses received visits tablets st 1 nd 2 rd 3 33. Urine Test: Urine: Alb/Sugar / Microscopy(cid:0) 34. Blood test- DC HB% --- Page 61 --- Blood Group VDRL (cid:0) (cid:0) 36. Other Inv. BP: Weight at 1 / 2 /3 Trimesters 1 2 3 st nd rd st nd rd (cid:0) 37. FP Adoption history- OCP/Copper-T/ others (specify) 38. Visits by AWW/ASHA/ Any other personnel (cid:0) POSTNATAL SCHEDULE 1. Date of present delivery : 1.a Full term/Pre term : 1.b Mode of Delivery : Normal/ Caesarian 1.c Place of Delivery : Institutional/Home If home delivery, then who conducted it : Trained Dai/ Untrained Dai/ ANM/other 5. Temperature of mother : 6. Pulse rate : /minute 7. Onset of breast milk secretion : hours after delivery 5. Quantity of breast milk : Poor/Average/Good 6. Uterine involution : Poor/Average/good 7. Time taken for involution : 8. Bleeding : Primary (Blood loss during first 48 hours) Secondary (Blood loss after 48 hours) 9. Lochia Yellow/Dark/Pink 10. Post Natal services for mother 11. Bathing : 12. Nutrition : 13. FP motivation : 14. Mother craft : About feeding of child About exclusive breast feeding About weaning foods About colostrum feeding 17. If Mother not breast feeding baby then reasons : 18. Evidence of any infection in new born : (cid:0) INFANT SCHEDULE 1. Age S ex --- Page 62 --- 2. Birth order : 3. Birth Wt.(kgs) : 4. Full term/Premature/LBW/Jaundice 5. Apgar score : 6. Caput : Present / Not 7. Any birth injury : 8. Umbilical cord status : 9. Any congenital defects/diseases : 10. Feeding in first 6 months Colostrum feeding given/not given Time of commencement of breast feeding : No. of feeds per day. : Artificial feeds if any (details) : 11. BCG at birth : Given/Not given OPV at birth : Hepatitis at birth : Given/Not given Given/Not given (cid:0) PRE-SCHOOL AGE CHILD SCHEDULE (1 TO 4 YEARS) 1. Name of Child : 2. Father's name : 3. Birth order : 4. Height and weight : 5. Observation of personal hygiene : a) Clothes - Clean/Dirty b) Hair - Clean & cut/long and dirty c) Bath - Regular/Irregular d) Nails - Trimmed/Not trimmed e) Footwear - Using / Not using f) Ear/ Nose discharge - Present/ Absent g) Throat/Teeth 6. Behavioural disorders a) Bed wetting - Present/Absent --- Page 63 --- b) Nail biting - Present/Absent c) Thumb sucking - Present/Absent 7. Attending nursery school / Anganwadi : Yes/No 8. Remarks on play : 9. Remarks on dict : 10. Present state of health : Healthy/Non healthy if not healthy : Sickness during the 12 months 11. Six monthly deworming practice : done/ not done 12. Pica : Present/Absent NAME OF THE SOURCE OF S.NO. DURATION RESULT DISEASE TREATMENT 1. 2. 3. 4. 5. 13. Follow up : Date of visit : Complaints : Advice : (cid:0) ENVIRONMENT HEALTH SCHEDULE 1. Housing Pucca/Kaccha/ Semi pucca 2. Number of rooms 3. Floor. muddy/not muddy/filed 4. Roof. thatched or not 5. Cross ventilation Present/Not present 6. No of persons living in a room No. 7. No of eligible couples present No. 8. Kitchen separate Yes/No 9. Overcrowding Yes/No Infestation of house by pests: Rats/Cockroaches/Ticks/Flies/Mite 10. Surrounding environment 1. Presence of animals : Cattle/Goats/Pigs/Dogs/Cats/others (Specify) 2. Presence of insects : Flies/Mosquitoes/Ticks etc 3. Presence of breeding places: Their number Type of breeding-mosquito/fly/others --- Page 64 --- Distance from house 11. Garbage disposal 12. Compost pits : Present/absent 13. Sewage disposal 14. Latrine : Sanitary/Insanitary/Practice of open field defecation 15. Fogging/Vector Control Measures taken by local bodies/ individual or family 16. Water Supply : 17. Source of Drinking Water : 18. Disinfection of water : Done/ Not done 19. Method of disinfection of drinking water : 20. T.V Tower/ Mobile tower : Your opinion about environment in few lines (cid:0) SUMMARY OF FAMILY HEALTH SURVEY REPORT FOR FAMILY No. 3. Summary of overall health status of family: --- Page 65 --- 4. Action recommended to improve the health status of the family:(cid:0) FOLLOW UP CHART OF THE FAMILY family(cid:0) DIET SURVEY Date of survey : Health condition of the Family No D . a t e : Advice Remarks Signature Family income : Head of the family : Family members : Man Veg/Non Sl.No Name Age Sex Occupation value/Consumption veg units Total Man Value Ration card details (cid:0) --- Page 66 --- CALORIE CALCULATION Yester Survey Carboh Sl. Food Daily Protein Energy day day Fat ydrate Remarks No item average (gms) (gms) (CHO) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Tot ACC= al ECC (Expected Calorie Consumption) = Total man Value x 2400 ECC (Expected Calorie Consumption) = ACC (Actual Calorie Consumption from survey) = IF ACC = ECC = Nutritional status good ACC < ECC = Nutritional status poor = Nutritional deficiency (Correlate with clinical findings of deficiency) Recommendations: If nutritional deficiency is present, find out whether it is Protein, Fat or CHO deficiency and advise cheap & low cost foods accordingly (CHO, Fats and Proteins should provide approximately 60%, 10-15% and 25-30% of calories in diet).(cid:0) NUTRITION ASSESSMENT SCHEDULE (Pre-School Child) (Clinical Examination) 16. General appearance - Normal built/Thin built/Sickly --- Page 67 --- 17. Hair - Normal/ dull & dry/depigmented/thin and sparse / easily pluckable / flag sign. 18. Face - Diffuse depigmentation/naso-labial dyssebacea /moon face 19. Eyes Conjunctivae Normal/dry & wrinkled / bitot's spots / brown pigmentation / angular conjunctive/ pale conjunctiva/ Cornea - normal/dryness/hazy/opaque. 20. Lips - Normal/angular stomatitis/cheilosis 21. Tongue - Normal pale & flabby / red & raw / fissured / geographic 22. Teeth - Mottled enamel/caries/attrition 23. Gums - Normal/bleeding 24. Glands - Thyroid enlargement/parotid enlargement 25. Skin - Normal/dry and scaly / follicular hyperkeratosis 26. Nails - Koilonychia 27. Oedema - In dependent parts 28. Rachitic changes - Knock-knee or bow legs/ epiphyseal enlargement / beading of the ribs/pigeon chest. 29. Other systems - Hepatomegaly / psychomotor change / mental confusion / sensory loss / motor weakness / loss of position sense / loss of ankle and knee jerks / calf tenderness / cardiac enlargement / tachycardia. 30. Anthropometry Weight (kg) : Height (cm) : Mid Upper arm circumference (cm): (cid:0) Head Circumference (cm): Chest circumference (cm) Inspiration: Expiration: Upper segment/lower seg. Ratio: (cid:0) FOLLOW UP CHART OF THE FAMILY family(cid:0) --- Page 68 --- FOR NOTES --- Page 69 --- Date Health condition of the Advice Remarks Signature CLINICO-SOCIAL CASE STUDIES (cid:0) GUIDELINES FOR CLINICO-SOCIAL CASE STUDIES Clinicosocial case study is an epidemiological or an in-depth study and includes study of prepathogenic, pathogenic and follow up phases to elicit natural history of disease. It is not confined to the limits of time of admission and time of discharge as in clinical case sheet. It extends beyond these limits to the study of residential environment and society and is more useful for prevention and management. It elicits not only clinical and biological factors as is usually done in clinical case sheet but also into the social factors (Host & Environmental) of the disease. Unless the agent, host and environmental factors interact the disease will not occur. The disease is usually multifactorial and it is essential to elicit about the all these biological & social factors, otherwise it is difficult to understand and manage the disease. Case study format consists of: 1. General information: --- Page 70 --- 2. Clinical examination 3. Family composition table (For host factors) 4. Agent factors/Host factors/Environment factors/their interactions 5. Source/Reservoir Mode of transmission incubation period period of communicability 6. Application of levels of prevention 7. Treatment 8. Follow-up 9. Student's advices It is an integrated approach (both clinical & social factors combined). Clinical workup helps us to establish the case-definition, biological factors of disease and its stage while the social factors have direct bearing on health and disease. Hence in an integrated manner, both the biological (Agent factors) and social factors are elicited and studied. It is a scientific document. Whatever the student writes, he has to substantiate it with relevant findings. Each question in this case study format has its own Public Health significance. Student has to elicit maximum number of both positive and negative factors relevant to the case to formulate hypothesis. All the points have to be obtained in detail and at the end of his work up, entire case has to be summarized to show that he has understood the health problem and able to forma hypothesis.(cid:0) Eg., so and so patient- belonging to a place (urban & rural) is having problem due to interaction of the following Agent. Host and Environment factors. The source of infection is the mode of transmission is . He can be managed (Treated): and the disease can be prevented at Primary level at Secondary level at Tertiary level individual level at at family level community level NB: Factors vary with the Health problem. Hence appropriately guidelines have to be modified. Students will earn maximum number of marks if he elicits the follo wing information about the health problem in a sequence to form a hypothesis and its management (Prevention, Control & treatment). 1. Agent Individual (cid:0) Source/reservoir Mode of(cid:0) (cid:0) Transmission Host Environment. IP & PC --- Page 71 --- Susceptible Host(cid:0) 2. Management - prevention: At individual level : Family level : Community level : Treatment : How to write a Case Study? Each student has to write at least 5 cases, Tuberculosis, Leprosy, PEM, Scabies, ANC, PNC, Under 5 child. Hypertension, Anaemia. STD, Diabetes, Diarrhoeas, Hepatitis, etc. Sometimes student will come across a patient having multiple problems, For ex HIV & TB. Five proforma to conduct the case studies in an integrated clinico-social approach are given. These can be modified according to the needs of the health problem under study. Case study is a scientific exercise and writing it is an art. Every point has got its own public health importance. Student should never think that it is a just another form to fill up the blanks. It is a scientific aid for the student to understand comprehensively (natural history of the disease to the maximum extent) the health problem that he has encountered in his/her patient for its proper management.(cid:0) As already stated, it is essential for the student to understand the public health significance of each question in it. Both the positive and negative findings will help to understand better. Sometimes, though not asked in the proforma, the student has to write the important relevant findings. Student should always keep in his mind that case study is a philosophical study of the health problem. Student should act like a medical detective to find out all the possible agent. host and environmental factors to know about and to solve the health problem. Student should avoid the use of adjectives (unless he can substantiate) as they will invite unnecessary discussions (at the time of examination). Presentation in figures (eg., patches, nerves and loss of sensation can be shown in a figures in leprosy case) will bring more marks to the student. Public Health Importance a. Address: i. Essential for follow-up ii Some diseases will have place predilection, helping to identify easily. Ex: Kala-azar at West Bengal. b. Income: Conventionally, total family monthly income should be obtained. In poor families several family members will earn and hence, while enquiring, all individual earnings should be obtained. Usually, some patients, say agriculturists cannot tell their income in cash but only in kind. Student should know how to find out the income approximately in those circumstances. Most essential is to know how much of the total income is spent towards the patient. c. Clinical examination: Though very essential as it is an entry point to conduct the case study and establish case- definition, it is advised to make it brief and optimum enough to know about the health problem. student should not copy the entire clinical case sheet as it differs from the epidemiological case sheet where more stress will be given to social (host and environment) factors. --- Page 72 --- d. Family composition - Number one must be the patient himself in contrast to the Head of the family in Family in Family survey. It is the heart of the case study, if written carefully, as it gives lot of information about: 1. Reservoir/source of infection 2. Spread of infection 3. Mode of transmission 4. Number of secondary/ tertiary cases 5. Prevention to the other family members and 6. All the host factors like: Age, Sex, Occupation, Education, Income etc.(cid:0) e. Environment: Physical structure and surroundings of the house include the residential environment. Its details should be taken as the environmental factors play a great role, especially in causing infectious, diseases. Usually the cause of the disease will be in the environment. Presence of poor sanitation, overcrowding, poor nutrition, pet animals, breeding places will help us to know the cause of the disease. f. Nutritional work up: Nutritional status is one of the essential factors and should be thoroughly assessed as it has got direct bearing in health and disease of an individual, particularly in case of Protein Energy Malnutrition, nutritional assessment should be done systematically to prove that the deficiency is nutritional terms of quantity, proteins, fats and carbohydrates, vitamins for eg Vit. A. Vit. D etc. g. Socio-economic status (S.E.S): Occupation, income, education will decide the socio-economic status of a family as per kuppuswamy/B.G. Prasad scales of S.E.S. As S.E.S has direct influence on disease and health, its details should be fully obtained. Particularly the break up of income and expenditure on patient has to be known. If it is a girl child, is there any discrimination?If yes Why? All these financial implications of the problem should be gathered. h. Attitude (knowledge + feeling): Students are habituated to write attitudes as positive or negative. What is pösitive for student may be negative for the examiner. Student has to spell and write it in clear descriptive words, particularly about the attitudes at the onset of the disease. So also while writing interfamilial and intrafamilial relationships, he should be verythorough in his enquiry. 1. Applying levels of prevention. (Most vital points of case study) i) Primordial Prevention (Health education and awareness) : St udent will enqu ir e regarding the primordial prevention practiced or knowledge regarding it in family. Primordial prevention helps in elimination and modification of risk factors of disease. It is of special importance in non communicable diseases. ii) Primary prevention (Health education and specific protection): Students are of erroneous opinion that primary preventive measures (Health education, specific protection) will not apply this patient as the disease already occurred. No doubt the disease has occurred --- Page 73 --- and primary level has failed but primary measures like education (Health advices) can still be applied. There is nothing wrong in giving advices i.e., health education regarding drugs, diet etc. primary level failed does not mean that it is not applicable in future as it is mainly health education and is safest, cheapest and most powerful method.(cid:0) ii) Secondary prevention (Early diagnosis and compt treatment): Early diagnostic techniques and all treatment details (in brief) should be noted. Student will explain in his notes about advantage of secondaryprevention in given case. iii) Tertiary prevention (Disability limitation and Rehabilitation): Follow-up: Case study does not stop after studying the patient. It includes the study of other family members. Follow-up by clinical examination, laboratory tests etc particularly while treating chronic diseases like Tuberculosis, DM and Leprosy. (cid:0) CLINICO-SOCIAL CASE STUDY CASE NO.1 (NB- Write specifically to your patient not in general from text book) (cid:0) Name : Age/Sex : Address : Part-A Bed No. : Date of Admission : Date of Examinaition:(cid:0) Sl. No. Complaints Onset Duration Progression 1 2 3 4 5 History of Past illness (if any) All positive and relevant negative findings should be written --- Page 74 --- 1. Presence of discase in any other member of family 2. Have they been protected against this? 3. Any hereditary history Systemic examination: Investigations: a. Patient b. Family c. Epidemiological Provisional Diagnosis:-(cid:0) Part-B 1. Agent Factors: a) Causative agent b) Reservoir c) Mode of Transmission d) Incubation Period e) Period of Communicability 1. Risk Factors (for non communicable discase) 2. Host Factors: 3. Family composition 4. Total monthly Income: No. Name Age Occu. Educ. Health Relationship Immunization /Sex status to patient status if < 5 yrs 1. 2. 3. 4. 5. 6. 7. --- Page 75 --- 8. 9. 5. Family Economy: 6. Expenditure: a. Education of children b. Clothing с. Medical d. Loans 7. Attitude of patient towards Health & Disease:(cid:0) 8. Attitude of family towards the illness of patient 9. Effect of patient on: a. Economy b. Social Equilibrium 10. Interfamilial Relationship: 11. Has he any treatment before: a. Allopathic b. Ayurvedic or any other system of medicine 12. Any Adverse Domestic factor: 13 Food habits: a. Any restrictions b. Staple diet, and c. Cooking 14. Environmental Factors: A) Housing a) Type: Katcha/Pacca b) No. of Rooms c) No. of Persons/Rooms d) Rented/Own c) Ventilation-cross ventilation f) Kitchen separate/Not separate g) Type of fuel used for cooking: wood/ LPG/ Any other h) Water Supply i) Electricity --- Page 76 --- (cid:0) Part-C Preventive Measure Discussion 1. What are the factors that are responsible for this stage of disease? 2. What are the measures to be taken to prevent recurrence of this condition? 3. Discuss the Natural History of disease and levels of prevention as applicable to this case? Nature of advice with regard to: a. Patient b. Family c. community Management a. Treatment (in brief) b. Other investigations c. Diet: d. Rest e. Follow-up f. Rehabilitation: --- Page 77 --- g. Any other(cid:0) CLINICO-SOCIAL CASE STUDY CASE NO.2 NB- Write specifically to your patient not in general from text book) (cid:0) Name : Age/Sex : Address : Part-A Bed No. : Date of Admission : Date of Examinaition:(cid:0) Sl. No. Complaints Onset Duration Progression 1 2 3 4 5 History of Past illness (if any) All positive and relevant negative findings should be written 1. Presence of discase in any other member of family 2. Have they been protected against this? 3. Any hereditary history Systemic examination: Investigations: a. Patient b. Family --- Page 78 --- c. Epidemiological Provisional Diagnosis:-(cid:0) Part-B 1. Agent Factors: a) Causative agent b) Reservoir c) Mode of Transmission d) Incubation Period e) Period of Communicability 1.a. Risk Factors (for non communicable discase) 2. Host Factors: 3. Family composition 4. Total monthly Income: No. Name Age Occu. Educ. Health Relationship Immunization /Sex status to patient status if < 5 yrs 1. 2. 3. 4. 5. 6. 7. 8. 9. 5. Family Economy: 6. Expenditure: a. Education of children b. Clothing с. Medical d. Loans --- Page 79 --- 7. Attitude of patient towards Health & Disease:(cid:0) 8. Attitude of family towards the illness of patient 9. Effect of patient on: a. Economy b. Social Equilibrium 10. Interfamilial Relationship: 11. Has he any treatment before: a. Allopathic b. Ayurvedic or any other system of medicine 12. Any Adverse Domestic factor: 13 Food habits: a. Any restrictions b. Staple diet, and c. Cooking 14. Environmental Factors: A) Housing a) Type: Katcha/Pacca b) No. of Rooms c) No. of Persons/Rooms d) Rented/Own c) Ventilation-cross ventilation f) Kitchen separate/Not separate g) Type of fuel used for cooking: wood/ LPG/ Any other h) Water Supply i) Electricity (cid:0) Part-C Preventive Measure Discussion 1. What are the factors that are responsible for this stage of disease? --- Page 80 --- 2. What are the measures to be taken to prevent recurrence of this condition? 3. Discuss the Natural History of disease and levels of prevention as applicable to this case? Nature of advice with regard to: a. Patient b. Family c. community Management a. Treatment (in brief) b. Other investigations c. Diet: d. Rest e. Follow-up f. Rehabilitation: g. Any other (cid:0) CLINICO-SOCIAL CASE STUDY CASE NO.3 (NB- Write specifically to your patient not in general from text book) (cid:0) Name : Age/Sex : Address : Part-A Bed No. : Date of Admission : Date of Examinaition:(cid:0) --- Page 81 --- Sl. No. Complaints Onset Duration Progression 1 2 3 4 5 History of Past illness (if any) All positive and relevant negative findings should be written 1. Presence of discase in any other member of family 2. Have they been protected against this? 3. Any hereditary history Systemic examination: Investigations: a. Patient b. Family c. Epidemiological Provisional Diagnosis:-(cid:0) Part-B 1. Agent Factors: a) Causative agent b) Reservoir c) Mode of Transmission d) Incubation Period e) Period of Communicability 1.a. Risk Factors (for non communicable discase) 2. Host Factors: 3. Family composition 4. Total monthly Income: --- Page 82 --- No. Name Age Occu. Educ. Health Relationship Immunization /Sex status to patient status if < 5 yrs 1. 2. 3. 4. 5. 6. 7. 8. 9. 5. Family Economy: 6. Expenditure: a. Education of children b. Clothing с. Medical d. Loans 7. Attitude of patient towards Health & Disease:(cid:0) 8. Attitude of family towards the illness of patient 9. Effect of patient on: a. Economy b. Social Equilibrium 10. Interfamilial Relationship: 11. Has he any treatment before: a. Allopathic b. Ayurvedic or any other system of medicine 12. Any Adverse Domestic factor: --- Page 83 --- 13 Food habits: a. Any restrictions b. Staple diet, and c. Cooking 14. Environmental Factors: A) Housing a) Type: Katcha/Pacca b) No. of Rooms c) No. of Persons/Rooms d) Rented/Own c) Ventilation-cross ventilation f) Kitchen separate/Not separate g) Type of fuel used for cooking: wood/ LPG/ Any other h) Water Supply i) Electricity (cid:0) Part-C Preventive Measure Discussion 1. What are the factors that are responsible for this stage of disease? 2. What are the measures to be taken to prevent recurrence of this condition? 3. Discuss the Natural History of disease and levels of prevention as applicable to this case? Nature of advice with regard to: --- Page 84 --- a. Patient b. Family c. community Management a. Treatment (in brief) b. Other investigations c. Diet: d. Rest e. Follow-up f. Rehabilitation: g. Any other:(cid:0) CLINICO-SOCIAL CASE STUDY CASE NO.4 (NB- Write specifically to your patient not in general from text book) (cid:0) Name : Age/Sex : Address : Part-A Bed No. : Date of Admission : Date of Examinaition:(cid:0) Sl. No. Complaints Onset Duration Progression 1 2 3 4 5 --- Page 85 --- History of Past illness (if any) All positive and relevant negative findings should be written 1. Presence of discase in any other member of family 2. Have they been protected against this? 3. Any hereditary history Systemic examination: Investigations: a. Patient b. Family c. Epidemiological Provisional Diagnosis:-(cid:0) Part-B 1. Agent Factors: a) Causative agent b) Reservoir c) Mode of Transmission d) Incubation Period e) Period of Communicability 1.a. Risk Factors (for non communicable discase) 2. Host Factors: 3. Family composition 4. Total monthly Income: No. Name Age Occu. Educ. Health Relationship Immunization /Sex status to patient status if < 5 yrs 1. 2. 3. 4. 5. 6. --- Page 86 --- 7. 8. 9. 5. Family Economy: 6. Expenditure: a. Education of children b. Clothing с. Medical d. Loans 7. Attitude of patient towards Health & Disease:(cid:0) 8. Attitude of family towards the illness of patient 9. Effect of patient on: a. Economy b. Social Equilibrium 10. Interfamilial Relationship: 11. Has he any treatment before: a. Allopathic b. Ayurvedic or any other system of medicine 12. Any Adverse Domestic factor: 13 Food habits: a. Any restrictions b. Staple diet, and c. Cooking 14. Environmental Factors: A) Housing a) Type: Katcha/Pacca b) No. of Rooms c) No. of Persons/Rooms d) Rented/Own c) Ventilation-cross ventilation f) Kitchen separate/Not separate g) Type of fuel used for cooking: wood/ LPG/ Any other h) Water Supply --- Page 87 --- i) Electricity (cid:0) Part-C Preventive Measure Discussion 1. What are the factors that are responsible for this stage of disease? 2. What are the measures to be taken to prevent recurrence of this condition? 3. Discuss the Natural History of disease and levels of prevention as applicable to this case? Nature of advice with regard to: a. Patient b. Family c. community Management a. Treatment (in brief) b. Other investigations c. Diet: d. Rest e. Follow-up f. Rehabilitation: --- Page 88 --- g. Any other:(cid:0) CLINICO-SOCIAL CASE STUDY CASE NO.5 (NB- Write specifically to your patient not in general from text book) (cid:0) Name : Age/Sex : Address : Part-A Bed No. : Date of Admission : Date of Examinaition:(cid:0) Sl. No. Complaints Onset Duration Progression 1 2 3 4 5 History of Past illness (if any) All positive and relevant negative findings should be written 4. Presence of discase in any other member of family 5. Have they been protected against this? 6. Any hereditary history Systemic examination: Investigations: a. Patient b. Family --- Page 89 --- c. Epidemiological Provisional Diagnosis:-(cid:0) Part-B 4. Agent Factors: f) Causative agent g) Reservoir h) Mode of Transmission i) Incubation Period j) Period of Communicability 1.a. Risk Factors (for non communicable discase) 5. Host Factors: 6. Family composition 4. Total monthly Income: No. Name Age Occu. Educ. Health Relationship Immunization /Sex status to patient status if < 5 yrs 1. 2. 3. 4. 5. 6. 7. 8. 9. 13. Family Economy: 14. Expenditure: a. Education of children b. Clothing с. Medical d. Loans --- Page 90 --- 15. Attitude of patient towards Health & Disease:(cid:0) 16. Attitude of family towards the illness of patient 17. Effect of patient on: a. Economy b. Social Equilibrium 18. Interfamilial Relationship: 19. Has he any treatment before: a. Allopathic b. Ayurvedic or any other system of medicine 20. Any Adverse Domestic factor: 13 Food habits: a. Any restrictions b. Staple diet, and c. Cooking 15. Environmental Factors: A) Housing a) Type: Katcha/Pacca b) No. of Rooms c) No. of Persons/Rooms d) Rented/Own c) Ventilation-cross ventilation f) Kitchen separate/Not separate g) Type of fuel used for cooking: wood/ LPG/ Any other h) Water Supply i) Electricity (cid:0) Part-C Preventive Measure Discussion 4. What are the factors that are responsible for this stage of disease? --- Page 91 --- 5. What are the measures to be taken to prevent recurrence of this condition? 6. Discuss the Natural History of disease and levels of prevention as applicable to this case? Nature of advice with regard to: a. Patient b. Family c. community Management h. Treatment (in brief) i. Other investigations j. Diet: k. Rest l. Follow-up m. Rehabilitation: n. Any other:(cid:0) --- Page 92 --- FIELD VISITS(cid:0) Date of visit : HOSPITAL VISIT(cid:0) Type of hospital : Primary/Secondary/Tertiary/Private/Semi Govt./Teaching When established : Direct catchment population : Indirect catchment population : Different functional units: A. OPD: 1. No. of OPDS: Average daily OPD : 2. Waiting place : Adequate/Not 3. Toilets : Present/Absent 4. Average waiting time for the patient in OPD : 5. Q-system : Present/Absent. : 6. Separate for males and females : 7. Management of referred cases: Separate/Not separate --- Page 93 --- 8. Feed back : Yes/No B Acute medical care unit : Separate/Not separate C IPD 1. Bed strength : 2. Bed population ratio: 3. Facilities: Adequate/Not adequate 4. Cooking Facilities for attendants - Present/not present D. Personnel: 1. Doctor : Pop. ratio 2. Nurse : Pop. ratio 3. Student : Bed ratio E. Medical care: Fully paid/Subsidized/Free (Tick) F. Medical records cell: 1. Maintenance : Average/Good/Best 2. Hospital in patient analysis : + ve / - ve 3. Medical audit : Done/Not done G Material management; 1. Drugs Bin card system : Yes/No 2. Equipment- Preventive maintenance : Yes/No(cid:0) H. Transport Management Ambulance : Present/Not I Nursing Section 1. Nurse- Bed ratio : 2. Trained/Untrained : 3. No. of nurses : 4. Theater trained : 5. ANMs/ Paramedics ASHA : J. Central Sterilization and Supply Department (CSSD)(cid:0) a. Staff (No. of Persons) : b. Trained : No. No.(cid:0) c. No of autoclaves (which type) : d. Sterilization procedures - Gloves,: Sharps, Blunts. Linen e. Disinfectants used: Disinfectant Purpose Dose 1) 2) --- Page 94 --- 3) 4) 5) f. House keeping : 1) How frequently done : 2) Floor mopping : Frequency : Disinfectants used : 3) Concurrent disinfections: Soiled linen : Faeces : Vomits : Urine : 4) Terminal disinfection (after death) : Clothes : Other material : 5) Visit if there is incimerator : beehive type/open/ other : g. Nursing procedure: 1). Bed making procedures : 2). How thermometer is sterilized : 3). Nursing charts: Temp./Pulse/BP/Respi. : Urine output/input : (cid:0) Date of visit : Place : WATER FILTRATION PLANT(cid:0) To be observed and recorded : A. Catchment area : Source : Reservoir : Size : Capacity : Type of pumping system : B. Water sedimentation : type (details) Sedimentation tanks present/not Number of sedimentation tank Capacity per tank C. Water filtration: Type of filters present : Rapid sand filters / slow sand filters Number of filters : Size : Filtration rate : --- Page 95 --- Coagulants used : Dose of coagulants : D. Water disinfection Type of disinfectant used : Chlorine gas/bleaching powder/ozone/others Dose of disinfectant : Type of chlorination : Prechlorination / post / double chlorination Contact time : Instruments used : E. Water distribution system: Extent of coverage : Residual chorine present : Separate/combine : F. Water quality standards Monitoring for water quality : Periodical/Continous Biological : Chemical : Organic : Viral : Record the latest details for water quality G. Cleansing of filters (Observe while doing) How often done Manual/mechanical Details of filter cleansing: (cid:0) PRIMARY HEALTH CENTRE VISIT Students have to record the details after enquiry: 1 Introduction by Medical Officer-Regarding a). Staff Pattern b). Population covered c). No. of subcentres d). National Health Programmes carried out at P.1.C. e). OPD registers. 2. Pharmacist - Drug Indenting & Maintenance - Maintenance of TB Cards/Defaulter Action 3. Health Supervisor - Demonstration of cold chain equipment - Indenting of vaccination from District Immunization Officer - Issuing of vaccines to workers. - Epidemic control activities 4. Headquarters ANM - Demonstration of Registers & Records 5. Health Visitor - F.P Methods Demonstration of all FP Methods - Incentives - Sector meeting etc. 6. Lab Tech. - Registers - Receipt of slides --- Page 96 --- - Reporting of slides - Radical Treatment - Passive surveillance of O.P.D.cases 1. L.D. Computer - Births & Deaths Registration / Statistician - Monthly Reports - Onward Transmission to DM & HO 8. Operation Theatre Nurse i). Fumigation of O.T ii). Sterilization of Gloves & Instruments(cid:0) SUB - CENTRE VISIT Name of the sub-centre : P.H.C Population covered : No. of villages in subcentre : Name of multi purpose Health worker- Female (ANM) : Name of multi purpose Health worker- Male : A. Safe motherhood activities: a) No. of eligible couples (EC) expected : b) No. of eligible couples registered: No. % c) No. of pregnant women (PW) expected (Pop x BR =PW): No.: % d) No. of pregnant women registered No. : % e) Pregnant women with at least: 4 Antenatal visits : No. % 3 Antenatal visits : No. % 2 Antenatal visits : No. % 1 Antenatal visit : No. % k) Pregnant women taken Tetanus Toxoid: TTI : No. % TT2 : No. % TT booster : No. % l) Pregnant women received Iron folic acid tablets (100) No. % m) Eligible Couple using F.P methods : No. % O.C.P : No. % Copper-T : No. % Condom : No. % Tubectomized : No. % Vasectomies : No. % i). Total deliveries conducted: At home : No. % At hospital : No. % By relatives : No. % By trained dai : No. % By untrained dai : No. % Others (specify) : No. %(cid:0) B. Child survival activities: 1) Growth monitoring : Done/Not done --- Page 97 --- 2) Immunization : No. % Infants: [(Pop. BR (1-IMR))] Fully immunized : No. % Partially immunized : No. % Not immunized : No. % Children used ORS : No. % 3) 4) Vitamin A prophylaxis : No. % 5) Iron Folic acid tablets : No. % C. Epidemic control: 1) Water sources present : No. Chlorinated : 2) No. of smears for malarial parasite taken : 3) Birth & Death register: No. of Births registered : No. of Deaths registered : 4) Group talks conducted : (cid:0) ANGANWADI VISIT 1) Name of the Anganwadi (AW) : ICDS Project : 2) Name of the AWW (Anganwadi worker) : Ÿ Qualification : Ÿ Period of training : Ÿ Place : Ÿ Stipend : 3) No. of beneficiaries Ÿ 1 to 6 years : Ÿ Pregnant women : Ÿ Adolescent girls : Ÿ Reproductive age women : 4) Services delivered: a) Non formal pre-school education (NFPSE): Ÿ Children attending : Ÿ Methods of NFPSE : --- Page 98 --- b) Supplementary Nutrition(SN): Ÿ Quality of supplementary food: Ÿ Quality (Protein content) : Ÿ Food type : Ÿ Time : Ÿ Hygienic or not : Ÿ Single ration or double : Ÿ Given to children only / child & mother : Ÿ Growth monitoring : done/not done. Ÿ Growth charts maintained or not : Ÿ Children with malnutrition : No. % Gr-I Gr-II Gr-III Gr-IV SAM/MAM: Ÿ Children with filing growth: No. % (Growth curve flattened) Ÿ Children losing growth : No. % (Growth curve coming down) Ÿ Reasons for growth decline : ARI / DD / Food gap / other (specify) Ÿ What type of action taken : Ÿ Results : (cid:0) c) Immunization(cid:0) DISTRICT TUBERCULOSIS CENTRE 1. Population served: District: 2. No. of Peripheral Health Institutions covered : (PHC / UHC / CHC / Dispensaries): 3. Location of district T. B. control unit: 4. Name of DOT centre in T.U. 4. Staff in position Training Status i) ii) iii) iv) v) vi) vii) viii) 5. Total patients detected this year: --- Page 99 --- 6.(cid:0) c. Case treatment: Ÿ SCC/Conventional Treatment : Operating Not operating(cid:0) Ÿ Non-DOTS Ÿ DOTS : No. % : No. %(cid:0) Category-I Category-II Category- III 1. Regimen used for DOTS 2. Number of patients 3. Cured No. % No. % No. % 4. Treatment completed No. % No. % No. % 5. Compliance (Poor/Average/good) 6. Non compliance No. % No. % No. % Performance of the Unit Ÿ Cure rate for the unit : Ÿ Treatment completion rate for the unit : Ÿ Defaulter rate for the unit : Ÿ Died : Ÿ Transfer in : Ÿ Transfer out : d. Training activities : SL.NO. PERSONAL TYPE OF NUMBER REMARKS TRAINING TRAINED 1. 2. 3. 4. e. Evaluation of the services:(cid:0) A. Type of leprosy unit: LEPROSY UNIT(cid:0) --- Page 100 --- 1. Leprosy control unit 2. Urban leprosy unit 3. Survey-education & Treatment centre 4. PHC 5. Temporary Hospitalization Ward 6. Clinic A.1 Location/Place: Staff in position Ask about their duties See their records 1). 2). 3). 4). 5). 6). 7). 8). (Students has to conduct case studies for at least 2 patients here.) B. Laboratory: 1). Technique of skin smear 2). Staining of smear 3). Calculation of bacteriological index (131) 4). Calculation of morphological index (MI) 5). Learn field classification of leprosy C. Services: 1). No. of cases registered in the year : PB : MB : Total : 2). No. of cases under M.D.T : PB : MB : Total : 3). M.D.T coverage : 4). No. of cases cured with M.D.T : PB : MB : Total : 5). Defaulters : 6). No. of cases with leprosy reactiors : 7). No. hospitalized : 8). No. of cases with deformities : (cid:0) 9). Type of deformities Deformity Corrective action 1). 2). 3). --- Page 101 --- 10). Rehabilitation services: a). Medical:- No. & Details : b). Surgical:- No. & Details : c). Vocational:- No. & Date : d). Care of hands & feet (Physiotherapy) : 11). Voluntary organization (V.O) involved: (Technical Support Teams) Voluntary organization Their role in brief a). b). c). d). e). (cid:0) 12). SIS (Simplified Information System) followed or not Yes/No 13). Accompanied M.D.T Present/Not Present 14). I.E.C Activities - (Enquire) --- Page 102 --- 15). Cleansing (regular deletion of cured cases) done Yes/No regularly or not 16). MDT blister packs- MB(A), MB(C), PB(A), PB(C), (Look for their does & condition) a). Multi. Bacillary (Adult) : b). Multi. Bacillary (Child) : c). Pauci.Bacillary (Adult) : d). Pauci. Bacillary (Child) :(cid:0) Notes(cid:0) DISTRICT MALARIA UNIT 1. Population covered : District : 2. No. of villages covered : 3. Staff working Number District malaria officer Assistant malaria officers Biologists Health supervisors Health assistants Field workers Lab technicians Insect collectors 4). Cross check laboratory details in brief : 5). Services: a). Surveillance: Ÿ Active centers : No. --- Page 103 --- Ÿ Passive centers : No. Ÿ Microscopy center : No. No. Ÿ Annual Blood Examination Rate (ABER) : b). Spraying policy : API (Annual parasite incidence) : Ÿ Ÿ No. of areas 2 API : Ÿ No. of areas 2API : Ÿ No. of areas for general spraying : Ÿ No. of areas for focal spraying : Ÿ Insecticide used for spraying : Ÿ Its dosage : (cid:0) c). Ÿ Chemotherapy : Total blood smears positive for M.P : (cid:0) Ÿ Plasmodium Vivax positive (PV) : Ÿ Plasmodium Falciparum positive (PF) : Ÿ Infant parasite incidence : Ÿ No. of patients who had presumptive treatment : Ÿ No. of patients who had radical treatment : d). Vector control: Ÿ Vector density ratio : Ÿ Principal vector found : Anti larval measures:- Ÿ No. of breeding places present : Ÿ No, treated : Ÿ Larvicide used and dose : Anti adult measures:- Ÿ Bioenvironmental method : e). No. of drug distribution centers (DDC) : f). No. of fever treatment depots "FTDS" : g). Is there PFCP unit. If so, brief details : h). Type of drug resistance observed : Type of chloroquine resistance found : Stratification recording to resistance : i). Use of bed nets etc : (cid:0) DISTRICT CHIEF MEDICAL OFFICER OFFICE --- Page 104 --- 1). Name of the district : Population : 2). Technical staff in position Duty and responsibilities in brief No. of children fully immunized : a). CMOŸ b). DHO/CNivoi.l oSfu crgheilodnre /n M paerdtiicaallly S iumpmeruinntieznedde n t c :). Distric t Ÿ malaria officer Ÿ No. of children not immunized : d). Mass education & information officer e). AWW doing alone/or with ANM/ASHA : No. % Statistical uŸnit f). Hea Ÿ lthV eidtaumcaitnio 'An 'u inmitm gu).n i z a tion : No. % Epidemic control unit h). Service engineer d) Health checkups: Ÿ Frequency : 3). Division of work and area between deputies (in brief): Ÿ Place : Who is doing : Ÿ Ÿ No. of sick children. : Ÿ Common type of illness found : Ÿ Children with P.E.M : Ÿ Treatment : 4). Functional hospitals under control of CMO e) Health referrals: No. of PHC's : Ÿ Ÿ No. of children referred : Ÿ No. of CHCs : Ÿ Referred to hospital/Nutritional Ÿ No. of dispensaries : Rehabilitation centre (NRC) : Ÿ No. of sub-centers : Ÿ Type of treatment at referral centre : Ÿ No. of taluk hospitals : Ÿ Type of feed back from centre : Ÿ No. of area hospitals : Ÿ No. of distr ict headquarter hospitals : Ÿ No. of mobfi)le m e Ndiuctarl iutinoints e d u c a t i o n f o r r e p r o d :uctive wom en: Ÿ Content & type of education : 5). Family welfare achievements during the year : Ÿ Place : Ÿ No. o f ElŸigibIsle F CLoAuWpl e(sF uenxcpteicotneadl L i t e r a c y : Ÿ No. registefroerd Afodru slet rwvoicmese n ) i n o p e r a t i o n : : % Safe mogt)herhAooddo laecstcievnitti egsir :ls programme : Ÿ(cid:0) AN carŸe (4Is t iimt iens o) p e r a t i o n : : Y e s / N o % Ÿ If yes how many girls are involvTedT : Iron folic acid Type of income generating activities : Ÿ Ÿ : % Ÿ(cid:0) : % M.T.P : %(cid:0) Child survival activities: Ÿ Full Immunization (FI) : No. % Ÿ Partial Immunization (PI) : No. % Non Immunized Ÿ (NI) : No. % Used ORS for Diarrheal Diseases --- Page 105 --- Ÿ : No. % Ÿ Use of Zinc for diSarpruhteuaml d +isveeass e : N o . : No. % % Sputum-ves : No. % Ÿ Treated for ARI : No. % Clinical suspects : No. % Iron folic Acid small : No. % X-ray positives : No. % T. B./HIV : No. % District Performance Report Services: Ÿ District maternal mortality rate : a. Case finding : Ÿ District infant mortality rate : Ÿ Case finding at DTC : No. % Ÿ District child mortality rate : Ÿ Case finding from PHI : No. % Ÿ District crude birth rate : Total : No. % Ÿ District crude death rate : b. Case holding: Ÿ Defaulters : No. % 6). Other progrŸammDeesf:aulter rate : No. % Ÿ Defaultering reasons. (Excluding NMEPi), N FLinEaPn &cia Rl N T C P a s t h :ey Nwoe.r e specially d i s c u %ssed separately):(cid:0) SC HOiiO) SLid eH efEfeActsL oTf dHru gSsU : RNVoE. Y SCH E D U %LE iii) Transport problems : No. % iv) Other reasons : No. % 1. Name of the school : 2. Locality : 3. Type of school: (Tick all the appropriate) Govt./Private/Municipality/ Elementary/ Middle / High/ Boys/Girls-Co- education 4. No. of teachers 5. No. of non-teaching staff: 6. No. of scholars: Ÿ Boys: no % Ÿ Girls: no % 7. Is it away from traffic: Yes / No 8. Is it constructed in sandy soil: Yes / No 9. Physical facilities: Class rooms (one room for 40 scholars) : No. Ÿ adequate/inadquate Ÿ Over crowding (40 in one roomrecommended) : No. Present/Absent Ÿ Type of roof: Pucca / Not Ÿ Window area : Ÿ Mosquito screening: Present / Absent Ÿ Floor: Muddy / Cemented Ÿ Floor area : Ÿ Lighting: --- Page 106 --- Not adequate / adequate Falling from left side / Right side Glare: Present / Absent Ÿ Cross ventilation: Present/Absent Ÿ Audibility: Poor/Adequate / Resounding Ÿ Furniture: Chairs / Benches With back rest/Without back rest Blackboard: Distance from first row of student Ÿ Teacher's room: Separate/Not Adequate / Not Clean / Not (cid:0) 10. Sanitation facilities: Ÿ Latrine : No. Ratio: Separate for boys/girls/teachers/no Ÿ Urinals : No. Ratio: Separate for boys/girls/teachers/no Ÿ Maintenance: Well maintained/Poor Ÿ Water supply: Type: Well/Tap/ Others (specify) Protected/Not protected Ÿ Refuse disposal: Open & indiscriminate: Yes / No Dustbin: Used / Not Dustbin: Covered/Uncovered Fly breeding: Present Absent Ÿ Eating facilities: Cloak room for boys: Present/Absent Vendors allowed inside: Allowed / Not allowed Is midday meal procedure going on in the school: Yes / No (if yes, brief details) Ÿ Recreation facilities: Play ground: Present / Absent Area: Distance : Parks/Garden: Present/Absent 11. Health aspects: Ÿ No. of medical inspections done so far : Ÿ frequency : Ÿ Are the teachers trained in health aspects: Yes / No Ÿ Health topics included in students syllabus: i). ii). iii). iv). Ÿ First Aid equipment: Present/Absent 12. Results of previous medical examinations (in brief) : (cid:0) OCCUPATIONAL HEALTH SCHEDULE --- Page 107 --- Part - A (General information) I. Name of Factory / Unit : Date of Establishment : Location of Factory : Government / Private / Quassi Type of Management : Government II. Manufacturing unit details : 1. No. of person working : Skilled Unskilled Males : Females : Total : 2. Machine used : Manual / Automatic / Both Condition : Old / New / Good / Bad 3. Type of power used : Electrical / Coal / Diesel / Solar / Other source (Mention) 4. Yearly Income : Expenditure : 5. Type of Chemicals used : 6. Shift System : Present / Absent 7. Design of Factory : No. of Halls No. of Rooms Ventilation 8. Brief description of manufacturing process :(cid:0) PART - B (Public Health Measures) 1. Preplacement examination : Yes / No. 2. Is right person placed in right job : Yes / No. 3. Periodical examination : Yes / No. If done 4. Are the details of manufacturing process : and its dangers exhibited to the workers in important places (Factory Act Regulation 5. Common diseases noticed in the workers (in order of Frequency of occurrence) a. b. c. d. 6. Dust control Measure Adopted a. House keeping : Satisfactory / Good / Bad b. Manufacturing : Wet / Dry/ Other --- Page 108 --- c. Machines : (specify) Enclosed / Open d. Emission of dust : Controlled / Not controlled if controlled How? : e. Dust control is by : 1. Dilution 2. Source reduction 3. Both 7. Safety Measures a. Is there a safety officer or not : Yes / No b. Air space for each workers : Adequate / inadequate c. Is any machine having protruding parts : Yes / No d How fresh air is supplied to workers : Ducts / Open Hall e. Exhaust fans & tube : Present / Absent f. Any accident occurred in this year : Yes / No if yes, reasons : : 1. Machine factor 2. Human factor 3. Both g. Types of personal protective devices used : a). Helmet b). Dark glasses c. Ear plugs d. Apron e. Long boots f. Gloves g. Masks h. Other ( specify) h. Method for disposal of waste and effluent : (cid:0) 8. Welfare measures: a. Is there a welfare officer : Yes / No b. Canteen present : Yes / No c. Creche for children of working mothers present : Yes / No d. Washing facilities : Yes / No For washing : Yes / No For bath : Yes / No e. Dining hall available : Yes / No f. Drinking water available : Yes / No g. Are the toilets available separately for : Male & Female. If present, number of urinal for each sex Male Female number of latrine for each sex Male Female 9. Effects on surrounding populations : a. No. of humans affected : b. Common complaints : Fever / Cough / Burning of eyes/Joint pains / others (specify) 10. Any other relevant information: --- Page 109 --- 11. Your advice: Student's Name : Year : Date : (cid:0) SEWAGE TREATMENT PLANT Date of visit Place : To be observed and recorded : A. Catchment area : a. Source of sewage : b. Reservoir : c. Capacity : d. Type of pumping system : B. Sewage sedimentation a. Sedimentation tanks : Present/Not b. Number of sedimentation tanks : c. Capacity per tank : d. Type of sedimentation tank : Primary/Secondary C. Sewage disinfections : a. Disinfectant used : Chlorine gas / bleaching powder/ozone/others (specify) b. Dose of disinfectant : c. Type of chlorination : Prechlorination/post/double chlorination d. Contact time : e. Instruments used for chlorination : D. Water distribution system : a. Extent of coverage : b. Residual chlorine present : c. Separate/combine : E. Sewage quality standards a. Monitoring for sewage quality : Periodical/Continuou s b. Biological : c. Chemical : --- Page 110 --- d. Organic : e. Viral : F. Cleansing of filters (observe while doing) a. Frequency of cleansing : b. Method of cleansing : Manual/Mechanical G. Other relevant information: (cid:0) ANY OTHER FIELD VISIT / REMARKS / NOTES(cid:0) ANY OTHER FIELD VISIT / REMARKS / NOTES(cid:0) ANY OTHER FIELD VISIT / REMARKS / NOTES(cid:0) ANY OTHER FIELD VISIT / REMARKS / NOTES(cid:0) Epidemiology of Disease(cid:0) Epidemiology of Disease(cid:0) India(cid:0) SPECIMENS FOR DEMONSTRATION & SPOTTERS ENTOMOLOGY(cid:0) --- Page 111 --- SPECIMENS FOR DEMONSTRATION & SPOTTERS ENTOMOLOGY(cid:0) SPECIMENS FOR DEMONSTRATION & SPOTTERS ENTOMOLOGY(cid:0) INSECTICIDES & DISINFECTANTS(cid:0) INSECTICIDES & DISINFECTANTS(cid:0) PARASITES OF PUBLIC HEALTH IMPORTANCE(cid:0) PARASITES OF PUBLIC HEALTH IMPORTANCE(cid:0) NUTRITION(cid:0) NUTRITION(cid:0) NUTRITION(cid:0) VACCINES(cid:0) VACCINES(cid:0) VACCINES(cid:0) VACCINES(cid:0) FAMILY PLANNING DEVICES(cid:0) FAMILY PLANNING DEVICES(cid:0) FAMILY PLANNING DEVICES(cid:0) FAMILY PLANNING DEVICES(cid:0) NATIONAL HEALTH PROGRAMMES (OPERATIONAL ASPECT)(cid:0) NATIONAL HEALTH PROGRAMMES (OPERATIONAL ASPECT)(cid:0) NATIONAL HEALTH PROGRAMMES (OPERATIONAL ASPECT)(cid:0) NATIONAL HEALTH PROGRAMMES (OPERATIONAL ASPECT)(cid:0) NATIONAL HEALTH PROGRAMMES (OPERATIONAL ASPECT)(cid:0) NATIONAL HEALTH PROGRAMMES (OPERATIONAL ASPECT)(cid:0) NATIONAL HEALTH PROGRAMMES (OPERATIONAL ASPECT)(cid:0) --- Page 112 --- NATIONAL HEALTH PROGRAMMES (OPERATIONAL ASPECT)(cid:0) DEMONSTRATIONS(cid:0) DEMONSTRATIONS(cid:0) DEMONSTRATIONS(cid:0) STUDENTS OWN HEALTH RECORD (HEALTH IS WEALTH) "PRACTICE WHAT YOU PREACH" Name ...................................................................................................................................... Age .......................................... Date of Birth .............................. Birth order ....................... Father's occupation ..............................................................Income ....................................... Father's Address ...................................................................................................................... ...................................................................................................................... Identification Marks ................................................................................................................ a) Date of admission in KMMC ............................................................................... b) Date of appearing in last MBBS Examination .................................................... c) Drug Sensitivity ................................................................................................... d) Special information if any .................................................................................... 1. Habits:- Exercise (Nature & frequency) ....................................................................... Cleaning of teeth (how and when)......................................................................... 2. Diet Vegetarian/Non Vegetarian / Eggetarian Addictions:- Tobacco (Smoking/Chewing/Gutkha) frequency. Liquor (Country/Foreign) frequency Bhang (CANABIS) Other drugs (Specify) frequency 3. Immunization:- Vaccine First Date's Subsequency Tetanus Hepatitis Others --- Page 113 --- (cid:0) 4. History of past illness Treatment : From : Private Practitioner / Civil Hospital. Vaidya / Hakim / Homeopath / Others 5. For Female Member only Menstrual history : Date of onset Regularity Periodicity 6. Physical Measurements (CMS) 1) Physique : Well built/ Average/Below average/Emaciated/Obese 2) Physical deformity of any type (describe) 3) Measurements: Height ........................... Weight....................Waist.............. Chest: full exp........................................ full insp. ........................................ On Subsequent Date 7. General Examination 1) Nutritional status (specify deficiency if any) 2) Skin & Hair 3) Lymph Nodes 4) Bone & joints 5) General organs & cleanliness, hydrocele 6) Hernia 7) Ear, Nose. Throat Examination. Rt Lt Ears: Hearing Otorrhea Wax Nose: Discharge Throat: Oral Septic Tonsils (cid:0) 8. Dental Examination: Teeth, Cavities, and Pyorrhea etc. Ist Examination --- Page 114 --- 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 Subsequent examination 9. Eye Examination Ist Subsequent Rt Lt Rt Lt Distance vision without glasses with glasses Near vision Color vision Other disease of the eye Remarks b. Systematic Examination Ist Subsequent 1. Pulse 2. B.P. 3. Heart 4. Circulatory System Respiratory System Abdomen Liver Spleen Nervous System : Psychiatric examination :(cid:0) 12. Laboratory Examination Hematologic al Sputu Dt. Stool Urin Other m for e s AFB Peripheral Smear HB Bloo VDR % d L Gr. DLC M.P. Others --- Page 115 --- P L E M 13. Advice & follow up progress (Date wise) Date Progress Treatment & advice (cid:0) Annexure- A DEFINATIONS 1. Health:- Health is a state of complete physical, Mental and Social well being and not merely an absence of disease or infirmity (WHO). 2. Preventive Medicine:- The Science and art of preventing diseases prolonging. life and promoting physical, mental health and efficiency (Leavell and Clerk) 3. Social Medicine:- It is the study of man in his total environment Physical, biological, pathological and socioeconomic and deals with man in relation to society and with health in masses. 4. Community Medicine:- The field concerned with the study of health and disease in the population of a defined community or group. Its goal is to identify the health problems and needs of --- Page 116 --- the defined population (Community Diagnosis) and to plan, implement and evaluate the extent to which health measures effectively meet their needs. 5. Community Diagnosis:- The diagnosis of disease in an individuals patient is a fundamental idea in medicine. It is based on signs and symptoms and the making of inference from them. When this is applied to Community, is known as Community diagnosis. 6. Epidemiology:- Epidemiology is the study of distribution and determinants of health related states or events in specified populations, and the application of this study to the control of health problems. (By John M. Last) It is divided in to two parts :- i) Descriptive Epidemiology: - That is the studyof disease or health status limited to description of occurrence of the disease in the human population. ii) Analytical Epidemiology: - That is the study of the determinants or risk factor of diseases. It analyses the relationship between disease and other variables. 7. Epidemic:- Epidemic is the occurrence of unusual number of cases of an illness clearly excess of natural expectancy in any particular time in a community or specific geographic area. 8. Endemic:- It is the habitual presence of a disease or infections agent within a given geographic area without importation from outsides or usual prevalence of a disease within such area.(cid:0) 9. Pandemic:- Disease is said to be pandemic when it spreads from one country to another in a short time or occur at the same time in different countries. (Usually when disease affects more than two continents) 10. Sporadic:- It means scattered out. The cases occur irregularly, haphazardly from time to time and generally infrequently. 11. IMMUNITY:- Older Concept:- Immunity is "Resistance of the host to an infecting organism". Modern Concept:- Ability of body to recognize to destroy and to eliminate antigenic material foreign to its own. 12. Incubation Period:- It is the time interval between the entry of the disease agent in the bodyand manifestation of clinical signs and symptoms 13. Extrinsic Incubation Period:- The period or time necessary for the development of the disease agent outside the human host till it become infectious is called extrinsic incubation period. 14. Disease Control:- Means to reduce the incidence / prevalence of a disease to an acceptable level but the disease agent is permitted to persist according to the tolerance of the population. 15. Eradication:- Literally means to take out by roots "or extinction of responsible pathogens. Eradication is an absolute process not a relative goal. It is an "all or none" phenomenon (e.g. smallpox eradication). The word eradication should be restricted to cessation of infection and disease from the world. 16. Disinfection:- Disinfection is the killing of infectious agents outside the body by direct exposure to chemical or physical agents. It can refer to the action of antiseptics as well as disinfectants. 17. Surveillance :- Connotes the maintenance of an ongoing watch over the status of a group or a community. Awatch may be kept bothon its health status in terms of mortality & morbidity, nutritional status or other factors that mayaffect health. --- Page 117 --- Thus we have epidemiological surveillance, demographic surveillance, nutritional surveillance, etc. 18. Monitoring:- Monitoring is the making of routine observations on health and environmental parameters and recording and transmission of these data. It is an ongoing or continuous activity. 19. Incidence Rate:- It is defined as the frequency of occurrence of new illness in a population. It refers to only new cases during a given period of time.(cid:0) 20. Prevalence Rate:- It is the total number of cases (old and new) at given period of time. It can be expressed either as: a). Point Prevalence Rte b). Period Prevalence Rate. 21. Pollution:- Means degradation in the composition of a substance to such an extent that it deteriorates the quality to such an extent that it may be injurious to health. 22. Contamination:- It implies the presence of an infectious agent on the body surface on or in clothes, bedding, toys, surgical instruments or dressing or other inanimate articles or substances including water, milk and food. These articles do not respond to the disease agent in the way, the human bodyresponds. 23. Vital Statistics:- May be defined as the facts, systematically collected and compiled in numerical form related to or derived fromrecords of vital events. 24. Demography: - Demography is the science, which studies population. Its size character and composition along with change therein. 25. Family Planning:- A way of thinking and living that is adopted voluntarily, upon the basis of knowledge attitude and responsible decision by any individual and couples in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country. 26. Eligible Couples:- This terms is applied to couples in which female is in the reproductive age group i.e. 15-45 years & neither has undergone sterilization. 27. Couple Protection Rate: - It is derived fromthe formula. Couple Production rate = Total No. of Sterilization + IUDUsers + OralPilsUser + CondomUsers 3 9 18 Total No. of eligible couples. 28. Primary Health Care:- Primary Health Care is an essential health care made universally accessible to individuals and families in the community by means, acceptable to them through their full participation and at a cost that community and country can afford. It forms an integral part both of the country's health system of which it is the nucleus and of the overall social and economic development of the community.(cid:0) 29. Health Planning:- Careful, intelligent. interpretation and orderly development of health services in accordance with modern knowledge and experience to meet health needs of nation within its resource (W.H.O). National Health Planning is defined as the orderly process of defining community health problems, identifying unmet needs and surveying resources to most of them, establishing priority goals that --- Page 118 --- are realistic and feasible and projecting administrative action to accomplish the purpose of the reposed programme. 30. Risk Approach:- It is a managerial tool aimed at providing better health services for all but with special attention to those who need them most e.g:, at risk mother, at risk children, chronically ill, elderly & handicapped. Inherent in this approach is optimal utilization of all resources in a judicious manner. 31. Voluntary Health Agency:- Avoluntary health agency may be defined as an organization that is administered by an autonomous board, which holds meeting collects funds for its support chiefly from private services, and expends money whether with or without paid workers in conducting a programme directed primarily to furthering the public health by providing health services or health education or by advancing research registration for health or bycombination or these activities. 32. Panchayati Raj:- The Panchayati Raj is a three-tier structure of rural local self government in India, linking the village to the district. The three institutions are 1. Panchayat at village level. 2. Panchayat Samiti at the block level. 3. Zila Panchayat at the district level. 33. Health Education:- Health education is the process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health. 34. Extension Education: - Extending the knowledge from known person in order to change their knowledge and behavior. 35. Communication:- Communication is transmission of information from one person or group of persons to other persons or group of persons with a view to bring about behavioural changes. 36. Family:- It is a group of biologically related individuals living together and eating from a common kitchen,(cid:0) 37. Slum:- Slum is a particular over-crowded residential area, unfit for human habitating due to services, structural defects, incurable damp, poor lighting and ventilation. absence of water supply & baths, inadequate provision for storage and cooking of foods. 38. Urban areas including Urban Agglomerations All places with a municipality, corporation, cantonment board or notified town area committee, etc. Aplace satisfying the following three criteria simultaneously: i). Aminimum population of 5,000; ii). At least 75 percent of male working population engaged in non-agricultural pursuits; and iii) Adensity of population of at least 400 per sq. km. (1,000 per sq. mile) Urban Agglomerations:- e.g:, railway colonies, university campus, port areas, military camps etc, that which may have come up near a town or city but within the revenue limits of a village/s contiguous to the town or city. Rural:- Area not fulfilling above criteria are rural. 39. City:- Towns with population of 1,00,000 and above are called cities. 40. Household:- A household is usually a group of persons who normally live together and take their meals from a common kitchen unless the exigencies of work prevent any of them fromdoing --- Page 119 --- so. Persons in a household may be related or unrelated or a mix of both.(cid:0) Annexure- B USEFUL INDICES IN COMMUNITY MEDICINE & VITAL STATISTICS A. Measurement of Mortality 1. Crude Death Rate: Number of deaths during the year Crude Death Rate = x 1000 Mid-year population(cid:0) 2. Specific Death Rate i) Specific death rate due during the year No. of deaths fromspecific disease(cid:0) to specific diseases = x 1000 Mid-year population No. of deaths among male ii) Specific death rate during the year for Male = x 1000 Mid-year population of males No. of deaths of persons aged 15-20 iii) Specific death rate during the year in age group 15-20 = x 1000 yrs Mid-year population of persons Aged 15-20 Deaths in January x 12 iv) Death rate for January = x 1000 Mid-year population Deaths in the week x 52 v) Weekly death rate = x 1000 Mid-year population 3. Proportional Mortality Rate: a) Proportional mortality rate No. of deaths due to cancer from cancer = x 100 All Deaths(cid:0) No. of deaths due to particular disease b) Case fatality rate = x 100 Number of cases of that ds.(cid:0) --- Page 120 --- 4. Maternal Mortality Rate: Number of deaths directly due to pregnancy or child birth and occurs during pregnancy or within 42 days of the delivery(cid:0) M.M. R. = x 1000 Total live births in the year(cid:0) 5. Infant Mortality Rate: No. of deaths under one year of age(cid:0) I.M. R. = x 1000 Total live births in the year(cid:0) 6. Neonatal Mortality Rate: No. of deaths under 28 days of age(cid:0) N.M.R. = x 1000 Total live births in the same year(cid:0) 7. Post-Neonatal Mortality Rate: No. of deaths of infants after 28 days to under one year(cid:0) P.N.M.R. = x 1000 Total live births in same year(cid:0) 8. Perinatal Mortality rate: Deaths between 28 wks of intrauterine life to 7th day of life after birth (Late fetal deaths + deaths under 1 week weighing over 1000 g at birth)(cid:0) Perinatal mortality rate= x 1000 Total live births(cid:0) 9. Still Birth Rate: No. of fetal deaths of 28 or more completed weeks of gestation(cid:0) Still Birth Rate = x 1000 No. of live births(cid:0) B. Measurement of Morbidity 1. Incidence No. of persons having illness(cid:0) a) Incidence rate persons = x 1000 Population at risk No. of new spells of illness --- Page 121 --- b) Incidence rate spells = x 1000 Population at risk(cid:0) 2. Prevalence Rate: The no. of persons who are sick(cid:0) a) Point prevalence rate (old & new cases) at a given time (Persons) = x 1000 Population exposed to risk at that time No. of persons who are sick b) Period Prevalence Rate during a definite period (Persons) = x 1000 Average no. of persons exposed to risk during that period(cid:0) C. Measurement of Fertility 1. The crude birth rate No. of live births during the year(cid:0) Birth rate = x 1000 Estimated Mid-year population(cid:0) 2. The General Fertility Rate: No. of live births(cid:0) General fertility rate = x 1000 No. of females in the age group of 15-44 years 3. The Total Fertility Rate: It indicates how many children would be born to 1000 women passing through and surviving the entire reproductive span of their life.(cid:0) 4. Gross Reproduction Rate: It indicates the average number of girls that would be born to a women during her reproductive age, if she experiences the current fertility rate, without dying. 5. Net Reproduction Rate: This rate indicates the average number of female children a newborn gir l will bear during her reproductive age, assuming fixed age specific fertility and mortality rates. 6. Child Woman Ratio: The child women ratio is also known as fertility ratio. It is the number of children 0-4 years of age per 1000 women of child bearing age (15-44 or 49 years). It is estimated through data derived from censuses. C. General Epidemiology --- Page 122 --- 1) Relative risk: It is the ratio of the incidence Incidence of disease or death (I ) E of the disease or death among among exposed exposed and the incidence R.R. = ------------------------------------------------ among non- exposed. Incidence of disease or death (I ) NE among non-exposed 2) Attributable risk: It is difference in incidence rates Incidence of disease rate among of disease or death between an exposed-incidence of disease rate exposed group and non exposed among non-exposed group. It is often expressed in A.R. = ------------------------------------------------ percentage. Incidence rate among exposed 3) Exposure Rates: A case control study provides direct No. of cases who have been exposed estimation of the exposure rates to the causative factor of a disease (frequency of exposure) to a E.R. = ------------------------------------------------ suspected factor in disease and Total No. of patients with the disease non-disease group.(cid:0) 4) Odds Radio (Cross production Ratio) In case control study, odds Ratio (OR) measures the strength of the association O.R = ad / bc between risk factor and outcome. It is Cross-product ratio. E. Evaluation of Screening: 1) Validity: It expresses the ability of test to separate or distinguish those who have the disease from those who do not. Validity has two components sensitivity and specificity. a) Sensitivity: An ability of test to identify correctly all those who have the disease (Percentage of true positives) b)Specificity: An ability of test to identify correctly those who do not have the disease (Percentage of true negatives) 2) Predictive Values: It reflects the diagnostic power of the test. It is calculated for positive test & for negative test. (cid:0) A. Tuberculosis COMMUNICABLE DISEASES No. of individual showing +ve reaction To tuberculin test in specific age group(cid:0) i) Prevalence of infection: = x 100 Population of same age group who have been tested for tuberculin test(cid:0) --- Page 123 --- ii) Incidence of infection: (Infection Rate) or (No. of tuberculin +ve, during study- No. of Tuberculin +ve one year back)(cid:0) Tuberculin Conversion = x 100 Population under study(cid:0) iii) Prevalence of disease No. of individuals show sputum +ve x 100 = x 100 Total No. of People under study(cid:0) (cid:0) iv) Incidence of disease No. of cases sputum +ve during - No. of cases sputum +ve, 1 year back = x 100 Population studies (No. of people Should be followed same in both study)(cid:0) (cid:0) v) Prevalence of Drug No. of patients excreting tubercular bacilli resistant = x 100(cid:0) Resistant cases. Total No. of confirmed cases under study (cid:0) --- Page 124 --- vi) Tuberculosis Mortality No. of deaths due to Tb in a year = x 100(cid:0) Rate Total No. of population surveyed (cid:0) B. Cholera Endemicity of Cholera: No. of weeks reporting incidence(cid:0) i) Persistence Level (PL) = x 100 Total No. of weeks during study period(cid:0) a) Non endemic for cholera : b) Low Endemicity : c) Hyper Endemicity : d) Intermediate Endemicity : Where PL is less than 10 PL < 10 & MMIR < 0.1 PL 20, MMIR > 0.1 Areas which are not coming under: a), b) and c) criteria.(cid:0) B. Ankylostomiasıs Endemic index for Ankylostomiasis (Chandlers Index) (Eggs Index) = Average no. of hookworm eggs per gram of faeces. Endemicity Average no. of eggs Per gm. Of feces i) Not much significant Below-200 ii) Potential danger iii) Minor public health problem 200-250 iv) Important public healtlı problem 250-300 --- Page 125 --- Above - 300 D. Yellow Fever Vector indices related to yellow fever No. of breeding places of Aedes aegypti Found in the houses(cid:0) i) Aedes Aegypti index ii) Breteau index: = x 100 No. of houses examined in an Area No. of houses where containers were found +ve for Larva = x 100 No. of houses examined(cid:0) E. Malaria i) Incidence (cid:0) a) Annual Parasitic Incidence Rate: Confirmed cases during one year(cid:0) Α.Ρ.Ι. = x 100 Population under surveillance (cid:0) b) Annual Blood Examination Rate: --- Page 126 --- No. of slides examined(cid:0) A.B.E.R. iii) Prevalence a) Infant Parasite Rate = x 100 Population Blood slides +ve for malaria of the age groups of 0-12 months = x 100 Total no. of slides of ar 0-12 months age examined(cid:0) (cid:0) b) Proportional Case Rate No. of cases confirmed by blood exam = x 100 No. of cases diagnosed clinically(cid:0) (cid:0) F. Filaria (Filarial Indices) 1) Microfilaria Rate 2) Filarial Disease Rate No. of individuals carrying microfilaria in their peripheral blood = x 100 No. of people examined --- Page 127 --- No. of persons showing visible Manifestation = x 100 Total No. of population examined No. of individuals clinically showing(cid:0) E. Malaria 3) Filarial Endemicity Rate Filariasis or no. of cases +ve for Microfilaria or both = x 100 Total no. of population examined(cid:0) (cid:0) 4) Microfilarial density Rate No. of microfilaria presen. n the slide =---------------------------------------------------------- 100 No. of unit volume (20c.cm of blood) examined(cid:0) (cid:0) G. Obesity 1. Broca's Index = Ht (in cms)100(cid:0) Weight (Kg) 2. Body mass index ------------------ = (BMI) Height (m) 2 Quetelets Index Height (cm) 3. Ponderal Index = Cube root of body weight (kg) --- Page 128 --- Assessment of Protein Quality Retained Nitrogen 1. Net Protein Utilization (NPU) = ---------------------------------- 100 Nitrogen intake Assessment of Protein Quality Energy from protein 1. Protein Energy Ratio = ---------------------------------- 100 Total Energy in diet(cid:0) Vaccination (cid:0) 1. Vaccine Efficacy Ratio: V.E.R. U - V = -------------- x 100 U(cid:0) Where U = Attack rate among unvaccinated group. V = Attack rate among vaccinated group. Family Welfare 1. Evaluation of Contraceptive Methods Failure rate per hundred women years of exposure. Total accidental pregnancies Failure Rate per HWY = ------------------------------------------ x 1200 Total months of exposures. 2. Annual obstetric coverage in a community --- Page 129 --- No. of deliveries attended by qualified midwives or obstetrician = Expected no. of deliveries during the year in a given community (cid:0) Sullivan's Index: Disability(cid:0) It is known as expectation of life free of disability S.I. = Life expectancy-probable duration of bed disability to perform Major activities. Measurement of Coronary Heart Disease Burden No. of deaths due to CHD(cid:0) 1. Proportional Mortality Rate 2. Loss of expectation of life = ------------------------------------------ x 100 Total no. of deaths occurred Life expectancy-reduction of life due to CHD.(cid:0) 3. C.H.D. Incidence Rate 4. Age Specific Death Rate --- Page 130 --- 5. CHD Frevalence Rate Sum of total cases of CHD in a year = ------------------------------------------------- Population surveyed No. of people of specific age group dies due to CHD = ------------------------------------------ x 100 Total No. of cases dies due to CHD ECG evidence of infraction + No. of People have prolonged chest pain = ---------------------------------------------- x 100 No. of people surveyed General(cid:0) 1. Socio-economic birth weight quotient The mean birth weight in lower S.E. group SBQ = x 100 The mean birth weight in upper S.E. group 2. Physical quality of life index PQLI includes Life expectancy at one year age, Infant mortality rated and adult literacy rate. Each one has given score between 0-100. Average of three scores is used to calculate PQLI. (Range 0- 100) 3. Human Development Index HDI = Life expectancy at birth, literacy in the form of mean years of schooling and --- Page 131 --- expected years of schooling, and purchasing power of people expressed as per capita GNI Adjusted real income).(cid:0) Low HDI countries Medium HDI countries High HDI countries = HDI less than 0.5 = HDI 0.5-0.799 = HDI more than 0.8(cid:0) Annexure- C NUTRITIVE VALUES OF COMMON FOODS (Per 100 gms) Name of the food item Proteins Fat Carbo- Energy Calcium Iron Vit-A Vit-B Vit-C Dietary (100 gms) gm% gm% hydrate Kcal mg mg mg mg mg gm% Cereals: 1. Rice 6.8 0.5 78.2 345 10 0.7 0 0.06 0 0.2 2. Wheat 12.1 1.7 69.4 341 48 4.9 29 0.45 0 1.9 3. Rice (parboiled) 8.5 0.6 77.4 349 10 2.8 9 0.27 0 Millets 1. Jowar 10. 1.9 72.6 349 25 4.1 47 3.1 0 1.6 2. Maize 11.1 3.6 66.2 342 10 2.3 90 1.8 0 2.7 Pulses: 1. Black gram 24 1.4 59.6 347 154 3.8 38 0.2 0 0.9 2. Bengal gram 20.8 5.6 59.8 372 56 5.3 129 2.4 1 1.2 3. Green gran 24.5 1.2 50.9 348 75 3.9 49 2.4 0 0.8 4. Red gram 9.8 1 16.9 336 57 1.1 132 2.9 0 1.5 5. Khesari dhal 28.2 0.6 5.36 545 73 6.3 120 2.9 1 .5 Green leafy veg.: 1. Amarnath 3 0.7 2 26 200 5520 1.2 99 1 2. Palak 2 0.7 2.9 26 73 1.14 5580 0.5 28 0.6 3. Cauliflower 5.9 1.3 7.6 66 626 40 2 4. Ruddish 0.7 0.1 3.4 17 35 0.4 3 0.5 15 0.8 5. Potato 1.6 0.1 22.6 97 10 0.48 24 1.2 17 0.4 6. Beetroot 1.7 0.1 8.8 4.3 18.3 1.19 0 0.4 10 0.9 7. Carrot 0.9 0.2 10.6 48 80 1.03 1167 0.6 3 1.2 8. Onion 1.2 0.1 11.1 50 46.9 0.6 0 0.4 11 0.6 9. Brinjal 1.4 0.3 4 12 20 0.46 74 0.04 12 1.3 --- Page 132 --- (cid:0) NUTRITIVE VALUES OF COMMON FOODS (Per 100 gms) Name of the food item Proteins Fat Carbo- Energy Calcium Iron Vit-A Vit-B Vit-C Dietary (100 gms) gm% gm% hydrate Kcal mg mg mg mg mg gm% Apple 0.2 0.5 13.4 59 10 0.660 - - 1 1 Banana 1.2 0.3 27.2 116 17 0.36 39 0.5 7 0.4 Grapes 0.5 0.3 16.5 71 20 0.52 15 0.2 1 2.9 Tomato 0.9 0.2 5.6 20 48 0.64 175 0.12 27 0.8 Lemon 1 0.9 11.1 57 70 0.26 - 0.1 39 1.7 Orange 0.7 0.2 10.9 48 26 0.32 552 - 30 0.3 Cashewnut 21.2 46.9 22.3 596 50 5.81 30 1.2 0 1.3 Ground nut 25.3 40.1 26.1 567 90 2.5 18.5 19.9 0 3.1 Coconut 6.8 62.3 18.4 662 400 7.8 - 3.00 7 6.6 Milk-Human 1.1 3.4 7.4 65 28 - 68 0.02 3 - Milk-Cow 3.2 4.1 4.4 67 120 0.2 87 0.19 2 - Milk-Bufffalo 3.3 4.5 4.6 72 170 0.3 80 0.10 1 - Cheese 24.1 25.1 63 348 790 2.1 350 - - - Ghee - 100 - 900 - - - - - - Butter Milk 0.8 1.1 0.5 15 30 0.1 - - - - Butter - 81.0 - 729 - - 825 - - - Egg (hen) 13.3 13.3 - 173 60 2.1 0.40 0 - Mutton 18.5 - - 194 150 2.5 - 0.14 - - Liver 19.3 1.3 1.3 150 10 6.3 - 1.70 20 - Fish 19.5 - - 100 1.5 0.73. 140 50mg - - (cid:0) MAN VALUES: Annexure- D(cid:0) Group Coefficients (units) Adult male (Sedentary worker) 1.0 Adult male (Moderate worker) Adult male (Heavy worker) 1.2 Adult female (Sedentary worker) Adult female (Moderate worker) 1.6 Adult female (Heavy worker) 0.8 --- Page 133 --- Adolescents ---------------- 12 to 21 years Children -------------------- 9 to 12 years 0.9 Children -------------------- 7 to 9 years Children -------------------- 5 to 7 years 1.2 Children -------------------- 3 to 5 years 1.0 Children -------------------- 1 to 3 years 0.8 0.7 0.6 0.5 0.4 (cid:0) Annexure- G Approximate Calorific Value of Some Cooked Preparations Preparation Quantity for Calones Preparation Quantity for Calones One serving (Kcal) One serving (Kcal) 1. Cereal 7. Sweets & Desseris Rice Besan barfi 1 cup 170 2 pieces 400 Phulka Chikki Fruit 1 No. 80 2 pieces 20 Paratha cake Rice 1 No. 150 1 piece 270 Puri puttu 1 No. 100 ½ cup 280 Bread Sandesh 2 slices 170 2 Nos. 140 Poha Doubleka meetha 1 cup 270 ½ cup 280 Upma Halwa (Kesari) 1 cup 270 ½ cup 320 Idli Jelly/Jam 2 Nos. 150 1 tbsp 20 Dosa Custard (aramel) 1 No. 125 ½ cup 160 Kichidi Shrikhand 1 cup 200 ½ cup 380 Wheat porridege Milk Chocolate 1 cup 220 25 g 140 Semolina Porridge Ice-cream 1 cup 220 ½ cup 200 Cereal flakes with 1 cup 220 8. Beverages (corn/wheat/rice) Tea (2tsp sugar + 1 cup 75 2. Pulse 50 ml toned Plain dhal Milk) Sambar Coffee (2tsp sugar + ½ cup 100 3. Vegetable 1 cup 110 10 ml toned 1 cup 110 With gravy Milk) Dry Cow's milk (2 tsp sugar) 1 cup 170 Buffalo's milk (2 tsp sugar) 4. Non-Vegetarian 1 cup 150 Lassi (2tsp sugar) 1 cup 180 Boiled egg 1 cup 320 Ommelette 1 glass 110 Squash Fried egg 1 No. 90 (200 ml) Mutton curry 1 No. 160 Syrups Sherbat) 1 glass 75 Chicken curry 1 No. 160 Cold Drinks (200 ml) Fish fried ¾ cup 260 Fresh lime juice 1 glass Fish cutlet Prawn ¾ cup 240 Nuts Almonds (200 ml) 200 curry Keema kofta 2 big pieces 220 Cashewnuts 1 bottle curry 2 Nos. 190 Coconut (fresh) (200 ml) 150 ¾ cup 220 Coconut (dry) 1 glass ¾ cup 240 Peanuts (200 ml) 60 5. Savoury snacks (6 small koftas) Bajji or pakora Fresh Fruits 10 Nos. Besan ka pura Apple 10 Nos. Chat (Dahi-pakori) Banana 85 Cheese balls 8 Nos. 280 Grapes ¼ 95 Dahi vada 1 No. 220 Guava ¼ 130 Vada 5 Pieces 220 Jackfruit 50 Nos. 140 Masala vada 2 Nos. 250 Mango 90 Masala dosa 2 Nos. 180 Mosambi/orange 1 medium Pea-kachori 2 Nos. 140 Papaya 1 medium Potato bonda 2 Nos. 150 Pineapple 30 Nos. 65 Sago vada 1 No. 200 Sapota Custard apple 1 Medium 90 Samosa 2 Nos. 380 watermelon/muskmelon 4 Pieces 70 2 Nos. 50 --- Page 134 --- Sandwhches (butter-2 tsp) 2 Nos. 200 Salads 1 medium 90 Vegetable puff 1 No. 210 Beetroot 1 medium 180 Pizza (Cheese and tomato) 2 Nos. 200 Carrot 1 piece 40 6. Chutneys 1 No. 200 Cucumber 1 piece 80 Coconut/ground/till 1 Slics 170 Onion 1 medium 50 Tomato 200 Radish 1 medium 80 Tamarind (with jaggery) Tomato 1 slice 130 2 tbsp 15 1 tbsp 120 1 tbsp 10 1 medium 60 1 medium 30 1 medium 20 1 medium 15 1 medium 25 1 medium 10 10 (cid:0) .. [Command succeeded with exit code 0]