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DEPARTMENT OF COMMUNITY MEDICINE

GOVERNMENT MEDICAL COLLEGE


CHANDIGARH

FAMILY STUDY MANUAL

VOLUME - II

ROLL NO.

BATCH

NAME

FROM "HIPPOCRATIC OATH"

"Into whatever house I enter, I will go with the object of helping the sick, holding aloof from all voluntary and
all other hurtful wrong doing, and from licentious practices whether with women or men free or bound, and
regarding the things, I see or hear, in the exercise of my art, or outsides its exercise, in my intercourse with
men, which ought not to be divulged, I will keep silent regarding them as inviolable secrets".
I certify that I have read the " Hippocratic Oath", and understand that the family records to be entered
in the note book are of a confidential nature.

---------------------------------------------(Student's Signature)

CERTIFICATE

This is to certify that Mr. / Ms. ___________________________has completed his/her assignment of family
study satisfactorily / unsatisfactorily.

Professor & Head,


Deptt. of Community Medicine,
Govt. Medical College,
Chandigarh-160047
Dated :____________
2

FIELD WORK & ASSESSMENT


S.
NO.

DATE OF VISIT

FAMILY ASPECT STUDIED

GRADE

PAGE

FACULTY

REMARKS

PART-A
1.

GUIDELINES FOR FAMILY STUDY

2.

VITAL STATISTICS OF THE AREA

3.

COMMUNITY SURVEY

4.

ENVIRONMENTAL SURVEY

5.

FAMILY RECORD

6.

ECONOMIC SURVEY

7.

IMMUNIZATION RECORD

8.

PERSONAL HYGIENE

9.

FAMILY WELFARE SURVEY

10.

HEALTH KNOWLEDGE

11.

SURVEY FOR SOCIAL PROBLEMS

12.

DIET

SURVEY

&

NUTRITION

STATUS
13.

ANTENATAL CARE

14.

POSTNATAL CARE

15.

INFANT HEALTH CARE

16.

UNDERFIVE HEALTH CARE

17.

ADOLESCENT HEALTH CARE

18.

INDIVIDUAL HEALTH CARE

19.

GERIATRIC HEALTH CARE

20.

SUMMARY & CONCLUSION

21.

ANNEXURES I-XI
PART-B

22.

STUDENT OWN FAMILY STUDY


OVERALL GRADING:
GRADE
A- >70%
C- 50-60%

B- 60-70%
D- <50%
I/C Academics
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GUIDELINES FOR FAMILY STUDY


Each student will be assigned two families-one at RHTC Palsora and another his /her own family at
home.

FAMILY:
A family is a social unit of biologically related people sharing from the same kitchen and living under
one roof.

SPECIFIC INSTRUCTIONAL OBJECTIVES:


To enable each student:
1. To understand that the family is the basic and social unit of the community.
2. To obtain first hand experience of application of principles of Preventive Medicine for the welfare of
the family, i.e health promotion and specific protection, earliest diagnosis and prompt treatment and
limitation of disability and rehabilitation (if required).
3. To orient them so that they can help the families as family physician.
4. To help them in learning about general medical practice at family / household level. In addition to
these, the other objectives are:
i. To observe and study the environmental factors responsible for good health, for
causation and transmission of diseases in the family.
ii. To learn the importance of observing the person in his natural environment i.e, in
prepathogenic phase affected by multiplicity of factors and their importance in
causation of

disease.

iii. To study the socio-economic factors responsible for the good health and disease as well,
in the family.
iv. To assess the nutritional status of the family and dietary pattern of community as a
whole and

advise them accordingly.

v. To study the health status of each individual in family and advise accordingly.
vi. To study and observe the psychosocial or emotional factors having their relation and
impact on

the health and disease of the family.

vii. To suggest feasible, practical and affordable (cost effective) improvements in the
environment
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viii. to take part / in the health education program organised from time to time / for the
promotion / actively of health and prevention of diseases in future.
ix. To ascertain the need of family welfare measures of the family and motivate them to
select the

family planning devices as per their felt needs (cafeteria approach) and

the availability under National Family Welfare Program (NFWP).


x. To get first hand experience of various social and cultural practices prevalent in the
community with the help of Medico-social worker and apply this knowledge for
providing the comprehensive health care to the family.
FAMILY STUDY

CASE STUDY

Family study aims at the complete health study of the


family.

It aims at the health of an individual only.

All the aspect of health i.e. promotive, preventive,


curative are given importance.

Mainly curative aspect is dealt with


Only deals with the treatment of diseased part.

Aims at all the five levels of prevention.


To study the epidemiology of disease in respect of
agent, host and environment.

To study the disease in question and its


treatment only i.e. mainly the host part is kept
in view. Environment and social factors are
ignored and not given any importance.

Case or patient in chronic/acute illness has to take


domicillary treatment. So study of socioeconomic
status, physical, biological & Psycho-social
environment, habits and customs related with health
practices of family are also done.

Hospital is the place of stay and its


environment is only a temporary phase which
may not help ultimately for complete cure.

RESPONSIBILITIES OF STUDENTS:
It is envisaged that the students, are friends, guides and health advisors to the assigned families and
shall act as family Physician during the whole period of their training at the centres. Medical services needed
by the members of the families are being provided through the Rural Health Training Centre (RHTC), Palsora,
Urban Health Training Centre (UHTC), Sector 44, and referral is done to OPDs of various Departments of the
Govt. Medical College & Hospital (GMCH), Chandigarh.
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The students must imbibe the missionary spirit and adopt a humane approach. You should always
remember your duty and responsibilities (Hippocratic oath). In obtaining the information from the family
always attempt to convey the idea that we are truly interested in their overall welfare and all the information
gathered will remain confidential especially about their income, marital life and interfamilial relations.
You shall visit your families as and when allotted as part of your practical work and maintain their
records. You are free to visit your families at any other time if you or your family so desires. In addition you
have to carry out the environmental and socio-economic survey of the house and the family and conduct the
physical examination of all members of your families with appropriate recommendations for improvement of
the socio-economic status, environmental conditions and treatment of illness if any. The faculty / staff of the
department of community medicine is always available for regular guidance.
You must wear your apron and always carry your stethoscope, tape and torch with you, whenever you
visit your families. All other equipments required are made available from the concerned Health Centre.
You shall present your family to the whole class bringing out all the important features on socioeconomic status, the dietary factors, environment on one hand, the growth and development of the children in
the family, antenatal mother, geriatric person, common disease in the family, their problems on the other hand
and how you tried to help them. The outlines for guidance are also provided.

VITAL STATISTICS OF THE STUDY AREA


Date:__________

STUDY AREA

INDIA

Total Births :
Live Births :
Still Births/Abortions
Crude Birth Rate
Total Death
Crude Death Rate
Total Infant Deaths
Infant Mortality Rate
Total Maternal Deaths
Maternal Mortality Rate
Total Population

Male:
Female:

Antenatal Mothers
Infants
<5yrs
>60yrs
Total Number of Eligible Couples
Total Number of Eligible Protected
Condom users
Cu-T Insertions
OCP - Users
Tubectomies Done
Vasectomies Done
i)

Couple Protection Rate

(Contraceptive Prevalence)
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COMMUNITY SURVEY
Date:__________
1.

Name of Place:

Union Territory Chandigarh.

2.

Name of Study Area: Urban Area/Peri-Urban Area/Urban Slums/Rural Area:_______________.

3.

Main Religion represented in the population:Sikhs

4.

Important Community / Social organizations

Hindus

Others

Govt.:1.____________.2._______________
NGOs: 1.____________.2._______________
__________________________________________

Principal industries/means of livelihood: ___________________________________.


Method of Village/Urban Government:
Recording births & deaths:

Gram Panchayat/NAC/MCC

Gram Pradhan/Panchayat Secretary/Chowkidar/ANM/TBA/Any other

Educational facilities available:

No. of Schools : Govt.____________.Public__________


No. of Colleges : Govt.____________.Public__________

Health facilities available:


Medical Care: _________________________________
Medical practitioners (No.) Modern Medicine/Ayurveds/Homeopaths/other indigenous:______.
TBAs: _______________AWS/AWW/AWH______________VHG_____________
6.

Water Supply:

Tap/Well/Other Specify: continuous/intermittent supply

7.

Excreta disposal:

Sanitary Latrine

Personal
Community

Any other, specify: __________________________.


8.

Waste water disposal: Open drain/closed


drain/water logging
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9.

Refuse disposal:

Dumping/Composting/ Bins (Municipal Corporation)

10.

Disposal of dead:

Ritual burning/Crematorium/other, specify___________.

11.

Channels of Communication in the community:


Interpersonal:
Mass Media:
Folk Media:

TV/Radio/Newspaper
_______________________________.

Important customs prevalent in community:

Birth

________________________________

Marriage

________________________________

Others

________________________________

Main health problems in community

1.

________________________________

(Interview opinion leaders/ Panchayat members)

2.

________________________________

3.

_________________________________

4.

_______________________________

1.

_______________________________

2.

_______________________________

3.

______________________________

Unmet needs of community

COMMUNITY DIAGNOSIS:

1. _________________________.
2. _________________________.
3. _________________________.

QUESTIONS:

What is the significance of conducting community survey?

What are the different ways of conducting community survey?

What is Community Diagnosis?

How can community diagnosis help in health planning and management?


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ENVIRONMENTAL SURVEY
Date:__________

LEARNING OBJECTIVES: To enable medical students


To assess the Environmental Status.
To understand the influence of environmental factors on health of the family.

To suggest suitable modifications in the environment to alleviate/prevent health problems in the family within th
given constraints.
Name of Ward / Mohalla /Street:

Sector

House No.

HOUSING CONDITION:

House:

Owned / Rented

Roof:

Thatched / Tin or Cement Sheets / Bricks / Cemented & Plastered.

Walls:

Mud / Bricks

Floor:

Mud with cowdung / Cemented / Tiled.

Number of Doors

Area

sq. ft.

Number of Windows

Area

sq. ft.

*Open space around the house:

Numbers of Rooms

*Separate kitchen:

*Separate bath room:

Latrine:

Total floor space area of living rooms

**Overcrowding

*Cross Ventilation

Lighting:

*Dampness

Water Supply: Tap water / Hand pump / Well

Type: Kuchha / Pucca / Mixed

Own / Community / Indiscriminate defecation.


sq.ft. Floor space/Area/person

(see annexure I)
10Adequate

/ Inadequate

sq.ft.

If tap water:
*

Own tap / Community tap

Continuous / Intermittent

Water storage:

Drums/Buckets/Utensils/Any other, specify_____________________.

Stored water :

Covered / Uncovered

Method of drawing water from pot : Mug/Ladle/Steel Glass / Tumbler / Other specify___________

Sullage disposal : Kuchha drains / Pucca drains/ None / Any other, specify____________________

Cooking : Gas / Stove / Chula / Electric Plate

Refuse disposal : Own bin / Community bin / Indiscriminate throwing / Dumping / Any other, specify

If Bins used, Whether Covered / Uncovered

**Animals/Birds in the house

Animals kept in the house / separate shed

Insects / Rodents / Mosquitoes / Houseflies of medical importance seen

Smoke vent : Present / Absent

If yes, distance of shed from the house

ft.
If yes,

specify________.
*

Preventive measures used

Measures Used: Mosquito Nets / Repellants / Sprays / Rat traps / Flytraps / Any other, specify._____

**Good cleanliness inside the house

GENERAL REMARKS:

Environment:

Please write

Good cleanliness outside the house

Disease Breeding

Why: ______________________________________

Health Promoting

Why: ______________________________________

* Yes - 01,

** Present - 01,

* No - 02

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** Absent 02

QUESTIONS:

Enumerate criteria for overcrowding.

Enumerate diseases associated with overcrowding.

What are the diseases transmitted by Mosquitoes?

Classify various water borne diseases.

Enumerate the household methods for disinfection of water.

How can you find out whether water being supplied through municipal corporation is potable and fit for
drinking or not?

What are diseases associated with cattles and pets?

What is manure pit and soakage pit?

What is sanitary landfill and composting? Differentiate between sewage, sewerage and sullage.

Comment upon physical and biological environment of the family allotted to you.

Comment on adequacy of ventilation and lighting in family allotted to you?

What do you mean by kitchen hygiene?

What do you mean by VIP latrine?

SKETCH OF THE HOUSE OF ALLOTED FAMILY:

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FAMILY RECORD
LEARNING OBJECTIVES:

Date:__________

The student should be able


To conduct the Interview as per steps in interview technique.
To learn the importance of each variable in relation to the identification and family record collected below.
-

To learn types, functions, advantages & disadvantages of particular type of family and

To learn the role of family in health and disease.

Total family members

Type of family:

Joint/Nuclear/Extended/ Three generation

Religion: Hindu/sikh/muslim

FAMILY COMPOSITION
S.
No.

Name

Age

Sex

Relation to
head of family

Education

Occupation

Income/
month

Immunization
Status

Any
Health
Problems

Head of family comes first. Rest in chronological (order of age), including deaths / still births.
**
Any birth / death during clinical posting to be recorded and to be updated in flying posting before examination.
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Rema
rk If
any

QUESTIONS:

What are the steps of interview technique?


Difference between family and household.
Enumerate functions of family.
Enumerate merits and demerits of nuclear and joint family.
How much should be the spacing between two children? Why?
Name the diseases associated with the occupations of the family members
Explain the following terms:
Broken family
Extended family
Problem family
New familiy

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SOCIO-ECONOMIC SURVEY
Date: __________

LEARNING OBJECTIVES: To enable medical students:

To learn the methods of assessment of socio-economic status and significance of different classifications t
various set-ups
To learn the concept of poverty line
To learn association of socio-economic status with health.

To be able to advice the family members for modification of expenditure pattern to improve health status in th
available economic resources
INCOME SOURCE AND EXPENDITURE PATTERN:
6.2.1
Land

Monthly income (in rupees)


House

Shop

Wages/Salary
Of all members

Cottage
Industry

6.2.2 Per capita income per month: ______________


2.
A.

EXPENDITURE (Monthly):
Food
Housing
Clothing
Transport
Education
Medical aid
Electricity / Water
Communication (Telephone/Mobile)
Fuel
Ceremonies
Any other, specify
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Others

Total

Total expenditure (monthly) ___________________


C.
Assessment:
(a) Above/below poverty line
(b) Socio-economic status based on Modified Kuppuswamy scale ( See Annexure IIA & B):
- Score : Income ____ + Occupation ____ + Education ______ : Total ______
- Socio-economic status based on the score obtained: _________

QUESTIONS:

Name the different scales used to measure the socio- economic status.

What are the limitations of Kuppuswamy classification?

How much is the per capita per month income in India at present?

What is the economic criteria for poverty line and name the other criteria?

Enumerate the diseases associated with upper socio-economic status.

Enumerate the diseases associated with lower socio-economic status.

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IMMUNIZATION RECORD (For Under Five Children & Antenatal Mothers only)
LEARNING OBJECTIVES: To enable medical students:

Date:__________

To learn methods of eliciting information about immunization status of the individuals.


To learn eligibility, contraindications, precautions, dosages, route of administration, vaccination schedule, side effects of the vaccines,
cold chain maintenance etc. regarding vaccines used under National Immunization Program.
To be able to perform immunisation.
S.
No.

Name

Age

B
C
G

DPT
I

II

III

OPV
B

II

C
1
2
3
4
M
I
II

17

III

Measles
B

TT
I

Hepatitis
A/B
II

Chickenpox /
MMR/ Typhoid
etc.

Immunization
Complete /
Partial / Nil

Reasons for failure


of Immunization

QUESTIONS:

What is the National Immunization Schedule?

What are the common complications of vaccines?

Discuss specific complications of vaccines used in national immunization schedule.

What are dosages, routes and sites of administration of vaccines used in UIP?

What advice you will give to mother after DPT & BCG vaccination of the child?

Why Measles vaccine is recommended at the age of nine months?

What is toxic shock syndrome?

If a child has been vaccinated just one day before PPI under NIS, whether that child be vaccinated agai
during PPI? Discuss reasons.

Suggest Immunization schedule for a two years, four years and six years old unimmunized child.

What are the newer vaccines?

Differentiate between EPI and UIP.

What is cold chain? Name the different equipments used in maintaining cold chain

What is Reverse Cold Chain? Give examples.

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PERSONAL HYGIENE
LEARNING OBJECTIVES: To enable the medical students:

Date:__________

To do assessment of personal hygiene of individual and family.


To learn the influence of poor personal hygiene on health status.
To learn how to impart health education regarding personal hygiene to individual and family
** S.No. OF FAMILY MEMBERS

CLEANLINESS:

Bath: Daily/Occasional
Use of soap : Daily/Occasional
Washing of hands : before taking food
After going to toilet
CLOTHING :

*Clean
How often exchanged?
How often washed?
SKIN :

*Clean
*Any skin disease
If yes, specify:
If, present : Under Tt/Cured/Not Tt /Others
NAILS

*Trimmed
HAIR :

*Combed
Washed :Regularly/irregularly
*Soap / Shampoo used
*Presence of lice
If yes, specify-Tt taken or not.
EYES

*Presence of discharge
*Presence of congestion
If yes, specify status
EARS

*Presence of wax
*Presence of discharge
If yes, specify status
LIPS:

Normal /Chapped/Angular/ Stomatitis


TEETH:

Brushed :Regularly/irregularly
*Presence of tartar/caries
*Use of brush/datoon
TONGUE:

Clean/coated
*Presence of ulcers
If yes, advice given-specify
MOUTH:

*Washed after meals


*Presence of bad odour
*Presence of gingivitis / stomatitis
*Please fill: Yes - 01, No - 02

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**S.No.
is according to Family Record

QUESTIONS:
What are the different types of hygiene you know?
What is the difference between hygiene and sanitation.
What are the diseases transmitted/associated with application of Kajal?
What are the diseases associated with poor genital hygiene?
Which disease is likely to be transmitted by walking bare foot?
What do you mean by effective handwashing?
What is occular hygiene? How is it different from visual hygiene?
Enumerate diseases cause by poor personal hygiene?
What is the correct method of brushing? What is the life of toothbrush?
How will you assess the quality of soap and which soap you will recommend for washing and bathing purpose?

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FAMILY WELFARE SURVEY


Date:__________

LEARNING OBJECTIVES: To enable the medical students:


1.To learn the problem of population explosion and its reasons.
2. To learn about the various family planning devices under cafeteria approach.
3.To learn the attitude of people towards National family welfare program (NFWP).

KNOWLEDGE:
*India is facing the problem of population explosion :
Reasons for population explosion :

___________________
_________________
___________________
_________________
In your opinion, how many children a couple should have: ___________
Family planning methods known :
Barrier methods/ OCP / Cu-T / Saheli / Tubectomy / Vasectomy / Any other, specify :
v)

What in your view should be the spacing between 2 children : ___________________.

ATTITUDE:
Attitude towards use of family planning methods : Using / Willing to use;
If cant use, why; specify________________________________________________.
Attitude towards spacing of children: Doing / willing to do; If not, why; specify______________.
Ideal number of children in their view: _________________________.
*Is a male child must:
*Preference of son to daughter:
If yes, give reason: _______________________________________________.
vi)

Which permanent sterilization methods (Tubectomy/vasectomy) you will prefer and why?

______________________________________________

PRACTICE:
i)

FP methods: Used / Not used

S.no.
Contraceptive
Duration
1.
Condoms
2.
Cu-T
3.
OCP / Saheli
4.
Tubectomy Done
5.
Vasectomy Done
* Please fill : Yes - 01, No - 02

Using/Withdrawn

Side effect/any other problem

**Unmet need of Contraception


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QUESTIONS:
1. What are different kinds of family planning devices available in the National family welfare
program?
2. What do you mean by cafeteria approach under NFWP?
3. Who is an ideal candidate for Cu T?
4. Is it essential to know about attitude of elderly in the house regarding family planning methods?
5. What is PNDT act?
6. What are conventional contraceptive? What is an ideal contraceptive?
7. Define Sex Ratio. Enumerate reasons for the decline in sex ratio.
8. What is meant by Unmet Need for family planning?
9. Define the following terms: a) Target Couple

b) Eligible Couple c) Couple Protection Rate

10. What are the Natural family planning methods?


11. Explain scope of family planning services.

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SOCIO-CULTURAL ENVIRONMENT
Date:__________

LEARNING OBJECTIVES: To enable the medical students:To learn the importance of socio-cultural factors in health and disease
To learn the level of knowledge, attitude, customs, beliefs and practices of the family in health and
disease
To learn the benefits and harmful effects of the customs and practices scientifically and advise the
family accordingly.

Information regarding customs and health practices


Name of the respondent: _____________________

Marriage
What is the legal age for marriage in India for boys: ___ , for girls __
At what age you were married ? _____
In your opinion, what should be the age at marriage for boys __ , & girls ___

Child bearing
1. Age at first pregnancy of the respondent (if applicable) _____
2. Number of children born: __________
3. Age at last pregnancy: ____________
4. Details regarding the last pregnancy and its outcome:
- Registered in antenatal clinic : Yes/No _________ Or Period of gestation at the
time of registration in Antenatal Clinic ______ weeks/not registered.
- Received antenatal care: Yes/No _______ Number of antenatal visits _____
- Food intake : Whether food intake increased : Yes/No since second trimester?
- Any food restriction:

Yes/No,

If yes,

- For which food item? ___________________________ , Why _____


_______________________________________________________
- Any special/additional food item given ? Yes/No, Names:______________
Reasons _____________________________________________________
- Number of hours of rest in daytime : Nil/ __________
- Any complications during pregnancy: Yes/No _______________________
- Anemia : Present/ Absent (as per record/history)
- Outcome of pregnancy: Abortion/still birth/ preterm/full term
- Delivery: Institutional/ Home

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Delivered by : Doctor/Nurse/Trained

Dai/Untrained Dai/Relatives or neighbours/self

- Cord applicants : ash/cowdung/ghee/ antiseptic/other _________none applied


- No. of days of isolation during puerperium: _____

Child rearing
1. Should colostrum be given to the newborn child ? Yes/No and why ? _____
______________________________and have you given it to your baby ? Y/N
After how many hours/days of birth, breast feeding should be given ? ____
And why ? ______________________________________ and when have you started breast
feeding ? ______
Any prelacteal feeds given to the child? ___________________________
Do you give any other food than breast milk before six months of age? Yes/No ______________
Do you give water to a child who is getting only breast feed? Yes/No _____
At what age supplementary feeding should be started ? ____
When did you start supplementary foods for your child ? _____
Which foods should be introduced at 6 m ____________________________ _______________,
8 m __________________________________________.
Have you registered your child with well baby clinic/under five clinic ? Y/N
Against what diseases, vaccines should be given for an infant ?
_________, __________, _________, _________, ________, __________
Is your child vaccinated for the vaccines due for date ? Y/N, If no, reasons
______________________________________________________
Apart from vaccine preventable diseases, which diseases commonly occur during first year ?
_____________________________________________
Did your child ever suffer from diarrhoea ? Y/N. If Yes, what actions did you take: a) ORS given :
Y/N, b) Home Available Fluids given : Y/N, if Yes, specify ________________________ c)
Any other action, specify: _____________.
Did your child ever suffer from pneumonia? Y/N, If yes, could you recognize it? Y/N, What were
the signs and symptoms? _________________________,
What actions did you take: ________________________________________.

Other child rearing practices


1. Application of kajal.

Y/N, If yes, with common applicator Y/N

2. Massage with oil

Y/N
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3. Exposure to sunlight

Y/N

4. Use of ghutti

Y/N

5. Food prohibited during fever:

Y/N

6. Restrictions of fluids during diarrhea : Y/N

Concept of disease causation:


i)

"Evil eye"

ii)

Karma"

iii)

Punishment by God

iv)

Bad weather

v)

Dirty water / food

vi)

Any other, specify

Are diseases preventable?

Knowledge, attitude and practices in some common diseases


(Students should impart health education)
1. Tuberculosis
Is tuberculosis curable ? Y/N
What measures should be taken to prevent transmission of the disease ?
___________________________________________________________
___________________________________________________________
Should the patient of T.B. be isolated ? Y/N
What is the duration of treatment ? ________ If complete treatment is not taken, what will
happen to the patient ? _______________________
2. Measles
Can it be prevented ? Y/N, If yes, how ? __________________________
What do you do in case a child gets measles? _____________________
___________________________________________________________
What is the cause of measles ? __________________________________
3. Poliomyelitis
(a) Can it be prevented? Y/N, If yes, how ___________________________
4. KAP regarding any other disease existing in the family? (e.g. Hypertension. Diabetes etc.
Attach separate sheets.)

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Nutrition
Which are the faulty cooking practices in the family? Enlist them (See Annexure III)

2)

i)

______________________________________________________________

ii)

______________________________________________________________

iii)

______________________________________________________________

Which are the beneficial cooking practices in the family? Enlist them (See Annex. III)
i)

______________________________________________________________

ii)

______________________________________________________________

iii)

______________________________________________________________

Health services utilization:


Which are the health centers /agencies serving in your village/ locality?
________________________________________________________________________
Are you availing benefits regularly? Yes / No,

If No, please specify:

________________________________________________________________________
Are you satisfied with the health services provided? Yes / No,

If No, please specify:

________________________________________________________________________
Are you visited by the medical social/health workers/ANM regularly? Yes/No
Where do you go in case of emergency?

________________

_________________

Analysis and interpretation


Customs and practices conducive to health _________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Customs and practices harmful for health
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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Customs and practices having no bearing on health


_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

QUESTIONS:

What are the various socio-cultural factors affecting health and diseases of the community?

What is social pathology?

What are the customs you have observed in the community which do not have a bearing on
health of the community?

Enlist the diseases to which social stigma is attached?

Define custom, culture, mores and folkways.

28

SURVEY FOR SOCIAL PROBLEMS


Date:__________

LEARNING OBJECTIVES: To enable the medical students:


To learn regarding various social problems in the family and the community
To suggest suitable measures to tackle those problems
Unemployed adult:

Yes

No

Poverty:

Yes

No

Overcrowding:

Yes

No

Gambling:

Yes

No

Marital conflicts / Abuse / Divorce or Separation:

Yes

No

Any unmarried mother:

Yes

No

In case of working mother, who takes care of the children: _____________________


Orphans in the family:

Yes

No

Children >6 years, not going to school:

Yes

No

If yes, state the reason _________________________.


Children <14 years, working: (Child Labour)

Yes

No

If yes, place of work __________________________.


11.

Any Delinquent Child in the Family:

Illness in the family:

Yes

No

If yes, effect of illness on:


i)

Individual Patient:
At Psychosocial / Emotional Level:_________________________
At Economic Level: ___________________________________

ii)

Family:
Psychosocial_______________________________________
Economic ________________________________________

iii)

Attitude of family members:

Positive & Caring


Co-operative & Sympathetic /Empathetic
Indifferent & Non Co-operative
Attitude of Neighbours :________________________________.
Indifferent & Non Co-operative

Emphathetic / Sympathetic & Co-operative


29

QUESTIONS:

What are the various social problems in the family and at the community level?

Suggest suitable measures to manage social problem in your family?

Explain various factors responsible for social problems?

Name the different social institutions existing in your field practice area. In what ways do these
impact the health status of the people ?

30

DIETARY ASSESSMENT
(To Be Completed In Three Visits)

Date:__________

LEARNING OBJECTIVES: To enable medical students:


To analyze the concept & importance of balanced diet.
Merits and demerits of various methods of dietary survey.
To collect the accurate information regarding food consumption of both the household and individual
member.
To understand the concept of energy consumption unit (ECU) and calculation of dietary intake per
consumption unit, detect deficiencies/excesses and correlate them to the nutritional status of the
family members.
To advise the family regarding required change in diet in case of deficiency/excess.
To calculate food intake according to various food items and nutrients relevant to that particular area and
the group.
Collection, analysis, interpretation and advice regarding diet to the individual suffering from nutritional
disorder/needing special nutrition to the vulnerable groups.

Visit I:
Recommended daily allowance of family members

Date:_______________

The following information is aimed to find out the dietary requirement of family members as per
recommendation. This will help students to understand what is required for the family members of the
family allotted to them and then compare that with what they are actually taking (See annexure X).
Name

Age

Sex

Occupation

Cereals

Pulses

31

GLV

Other
vegetables

Roots
&
tubers

Sugar
Milk

Fat
&
oil

DAILY DIET CONSUMPTION BY THE FAMILY IN GRAMS


(MODIFIED QUESTIONNAIRE METHOD)
Method for assessment of average daily consumption:
Find out fortnightly/monthly consumption for items procured fortnightly/monthly e.g. rice, wheat,
pulses, oil etc. and calculate average daily consumption
Find out weekly consumption for items such as fish, meat, eggs, fruits etc. and calculate average
daily consumption
Find out daily consumption of regularly used items such as milk, vegetables etc.
Find out consumption of any occasionally used items during last 24 hours e.g. chocolates, biscuits,
sweets, ice-cream etc.
Take into account if any member has not taken meal during the 24 hrs. period of taking history
Deduct the consumption of food by guests, if any
Dont take the diet consumed on the occasion of fast, feast and festival.
Now, calculate the average daily consumption (last 24 hrs.) by the family and enter below(See annexure
IV, V, VI, VII & IX):

S. No.

item

gms.

S. No.

item

1.

Wheat

2.

Rice

3.

Pulses

4.

Sugar / jaggery

5.

Oil/Ghee (total)

6.

Saturated fat

7.

Un-saturated fat

8.

Fish

9.

Meat

10.

Poultry

11.

Eggs

12.

Fruits

13.

Vegetables green leafy

14.

Vegetables, non-leafy

15.

Tuber

16.

Milk

17.

Milk product (specify)

18.

Any other, specify

Calculation of Consumption units:


. Total number of family members:___________________________.
. Total number of consumption units *: _________________________.
* Key for calculating consumption units(ANNEXURE VIII)
32

gms.

Visit II:

Date____________

Intake of foodstuffs per consumption unit (C.U.): (Prepare bar diagram)


Foodstuff

Average intake

Recommended
(for 1 C.U.)

Cereal

gms

460 gms.

Pulses

gms

40 gms.

Milk

gms

150 gms.

Fruits

gms

80 gms.

Green Vegetables

gms

40 gms.

Other vegetables

gms

60 gms.

Tubers

gms

50 gms.

Fats & Oils

gms

40 gms.

Sugar & Jaggery

gms

30 gms.

Eggs

gms

50 gms.

Meat/Fish

gms

30 gms.

9.3

% Deficit/Excess

Average Daily Consumption Of Individual Suffering From Nutritional Disorder/Needing Special

Nutrition (Dietary intake should be studied for all individuals qualifying this condition. Format given
below to be copied for each of them)
Name of the individual : _______________ Age ______

Sex ___

Physiological/pathological condition needing special nutrition : _______________________


Foodstuff

Average intake*

Recommended
(for the individual)

Cereal

gms

gms.

Pulses

gms

gms.

Milk

gms

gms.

Fruits

gms

gms.

Green Vegetables

gms

gms.

Other vegetables

gms

gms.

Tubers

gms

gms.

Fats & Oils

gms

gms.

Sugar & Jaggery

gms

gms.

Eggs

gms.

gms.

Meat/Fish

gms

gms.

% Deficit/excess

Average means usual intake as informed by respondent.


33

CONSUMPTION OF FOOD ITEMS & NUTRIENTS (PER CONSUMPTION UNIT)


(Construct bar diagram):
Sr.
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Food items

Qty.
gms

Calories Proteins Fat Vit. A* Thiamine Riboflavin


(gms.) gms (g)
(mg)
(mg)

Niacin Ascorbic Iron


(mg) Acid (mg) (mg)

Calcium
(mg)

Cereals
Pulses
Milk
Fruits
Green leafyVegetables
Other Vegetables
Roots & Tubers
Fats & Oils
Sugar & Jaggery
Eggs
Meat & Fish
Any other (nuts etc.)

Specify
Total per consumption
Unit
Recommended value
daily intake per C. U.
Percentage
* in terms of carotene

2425

60

34

20

2400

1.2

1.4

16

40

28

400

Deficiencies in the Diet & advice given:


Family diet according to per consumption unit
Deficiencies:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Advice given:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

35

Visit III:

Date____________

Nutritional Status Of Family


Sr.
No.

Name

Age

Nutritional assessment based


on anthropometrics/clinical
examination *

Dietary
deficiencies

Action taken

* Mention values for anthropometry and clinical findings and your diagnosis based on these.

36

QUESTIONS:

What are the various methods of assessing nutritional status of an individual?

What are the different methods of conducting diet survey? What are the advantages and
disadvantages of various methods of conducting diet survey?

What is the objective of conducting diet survey?

What dietary advice and treatment you will give to a three-year child suffering from Vit. A
deficiency?

What dietary advice you will give to a patient of Diabetes Mellitus?

What dietary advice you will give to a pregnant and lactating mother?

What is the protein requirement of a one-year old normal child?

What are the parameters for assessing protein quality in foodstuffs?

What are clinical features and management of rickets?

What is D.A.S.H. diet?

Classify malnutrition and discuss management of various types of malnutrition.

What is therapeutic diet?

37

PREVENTIVE CHECK-UP
Date:__________

LEARNING OBJECTIVES:

To enable medical students:

To learn about common health conditions in the various age groups.


To learn the concept of high risks and screening.
Importance of screening/preventive check-up in relation to health status. Identification of target groups for
preventive check up and individuals to be screened for the diseases relevant to their age and various
tests to be used for screening.
Early diagnosis of risk factors and health problems, timely referral, management at domestic and institutional
level and health education.

ANTENATAL CARE (ANC)


Date:__________
Name
Religion

Age
Occupation

Address
LMP

EDD

Registered/unregistered: ______________If registered, name the centre:____________.


Date of first visit (check-up)
*Planned pregnancy

Number of visits paid


If unplanned: Wanted/Unwanted.

Present complaints:
1.________________________________

3._____________________________________

2.________________________________

4._____________________________________

Onset duration & progress(ODP) of presenting illness:


________________________________________________________________________________________
________________________________________________________________________________________
38

Menstrual history_________________________________

Age at menarche

Obstetric history: _________________________________

Age of marriage

Sno.

No. of
pregnancies

Any
complications

Please fill

Age

Sex

Place of
delivery

Yes - 01,

Conducted
by

Live/Still
birth/IUD

No - 02

H/o Past illness:___________________________________________________________________


_______________________________________________________________________________
Family history :___________________________________________________________________
Personal history :__________________________________________________________________
*

Appetite

Bowel & bladder

Sleep

Habits

Diet history :_____________________________________________________________________


Contraceptive history:______________________________________________________________
Care provided for present pregnancy:
*T.T given :
If yes, no. of doses : reqd. _________ given: ________.
*Folic Acid & iron tablets given :
If yes, no. of tablets __________ since _____________.
If no, specify reason : ___________________________.
Economic / Environmental history :
GENERAL EXAMINATION
Height :
cm
Weight:
kg
Blood Pressure:_____ mmHg
Resp Rate
min
Pulse Rate
min
Pallor
Oedema
Clubbing:
Cyanosis
Icterus
Breast examination:___________________________________________________________

39

SYSTEMIC EXAMINATION
*P/A Inspection:
Abd distension

Visible pulsations

Visible movements

Linea Nigra

Striae gravidarum

Fundal Ht
*Foetal movements

Presentation:_____________ Lie:__________

Palpation:

Auscultation:

Foetal Heart Sound

Respiratory Distress

INVESTIGATIONS:
5. 1) Blood group: Self: _______ Husband: ________ Compatible: Yes/No
2)

VDRL : +
gm%

3)

Hb

4)

5)

USG:______________

Urinary Albumin

gm%

Urinary Sugar

RISK ASSESSMENT:
*High Risk:

If yes, reasons 1.__________2.___________3.___________

ADVICE / ACTION TAKEN BY STUDENT


1. Personal hygiene

______________________

_______________________

Physical activity

______________________

_______________________

Rest

______________________

_______________________

Diet

______________________

_______________________

Drugs

______________________

_______________________

Regular check-up ______________________

_______________________

T.T./Folic acid+ F.S. tablet ________________ _______________________


Any Other :_____________________________
S.No.

DATE OF
VISIT

ANTE NATAL FOLLOW UP


COMPLAINTS DIAGNOSIS & TREATMENT

40

REMARKS

Questions:

Enumerate high-risk pregnancy criteria. What is meant by the term high risk newborn?

How many minimum visits should be made at ANC clinic and what actions should be taken at each visit?

What additional nutrients should be provided during pregnancy?

What are the drugs contraindicated during pregnancy?

What are the facilities for ANC care in the area?

What do you mean by TORCH infection?

How will you prepare a lady for safe delivery? What do you mean by five cleans?

Define a) Maternal death b) Maternal mortality rate (MMR) c) Late maternal death d) pregnancy related
death.

Enumerate the causes contributing towards maternal mortality and what steps can be taken to counter them.

41

POSTNATAL CARE (PNC)


Date:__________
Name

Age

Religion

Occupation

Address
H/O Delivery:
Complaints at present:
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: ________________________________________________
______________________________________________________________________
Menstrual history: ______________________Obstetric history: __________________
Past history.: ___________________________________________________________
______________________________________________________________________
Family history: __________________________________________________________
Personal history: ________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________
________________________________________________________________________
Contraceptive History: ____________________________________________________
Economic/Environmental History in brief: ______________________________________
________________________________________________________________________
GENERAL EXAMINATION
Height :

cm

Weight:

kg

Blood Pressure:_____ mmHg

Resp Rate

min

Pulse Rate

min

Pallor

Clubbing:

Cyanosis

Oedema

Icterus

Breast examination:___________________________________________________________

42

SYSTEMIC EXAMINATION
*P/A Inspection:

Abd distension

Visible pulsations

Linea Nigra

Striae gravidarum

Visible movements

Palpation:
Fundal Ht

QUESTIONS:

What are the contraceptive methods for such a case?

What is the minimum number of postnatal visits required?

What are the common complications during postnatal period?

What are the facilities for PNC in the area studied by you?

Define : Perinatal mortality rate. Enlist the various causes contributing towards perinatal mortality.

43

EXAMINATION OF NEWBORN
Date:__________
H/o Delivery : _________________________________________________________________
Any complaints
1. ___________________________________________________________________________
2. ___________________________________________________________________________
ODP of presenting illness: _______________________________________________________
_____________________________________________________________________________
Family tree: ___________________________________________________________________
_____________________________________________________________________________
Feeding history (right from birth): _________________________________________________
______________________________________________________________________________
Immunization: _________________________________________________________________
Height :
Resp Rate

cm
min

Weight:
Pulse Rate

kg
min

Cyanosis
Pallor
Icterus

Anthropometry : Length :
Head :

Chest:

Weight:

Mid-arm:

Foot to toe examination (for congenital malformations)


If any abnormality detected please specify, otherwise write NAD / WNL
Anterior fontanelle:

__________.

Chest:

__________.

Umbilical cord:

__________.

Hip:

__________.

Ears:

__________.

Genitalia:

__________.

Eyes:

__________.

Legs:

__________.

Mouth:

__________.

Feet:

__________.

Nose:

__________.

Nails:

__________.

Neck:

__________.

Rectum:

__________.

Examination of Reflexes: Normal / Abnormal, If any Abnormal reflex detected, please specify:
______________________________________________________________________________
Diagnosis: _____________________________________________________________________
Investigation:
1)

Blood group

2) Hb

gm%

3) Any other : ________________________.

Treatment, If any :_______________________________________________________________


44

Advice:

Feeding: ________________________________________________________________
Immunization: ___________________________________________________________
Follow-up: growth monitoring by growth chart
Cord care : _____________________________________________________________
No Application of kajal
Advice / Action taken by Student:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
POST NATAL FOLLOW UP
S.No.

DATE OF
VISIT

COMPLAINTS

DIAGNOSIS & TREATMENT

45

REMARKS

INFANT HEALTH CARE


Date:__________
Informant: _______________________. Name: __________________________________.
Any complaints:
1._______________________________________________________________________
2._______________________________________________________________________
3._______________________________________________________________________
ODP of present illness: _____________________________________________________
________________________________________________________________________
H/o delivery in brief: _______________________________________________________
Family tree: ______________________________________________________________
*Working mother:
Nutrition history:
Breast feeding/Top feeding/Weaning __________________________________________
Food Items
Calories
Proteins
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
Total: ____________________________________________________________________
Required: ________________________________________________________________
Deficit/Excess: ____________________________________________________________
Immunization history: complete / incomplete, If incomplete specify reason_____________
_________________________________________________________________________
Milestones: (Record actual months)
1.
Social smile (2 months)_________ 2.
3.
Turning over (4-5months)________ 4.
5.
Teething (6months)______________ 6.
7.
Crawling (9-10mths)_____________8.
Walking with support (10-11months)

Head holding (3months)_________________


Sitting with support (5-6mths)____________
Sitting without support (6-8mths)__________
First words (10-11mths)__________________

Customs & beliefs related to infant care in this infant:____________________________________


_______________________________________________________________________________
Economic/Environmental History in brief: _____________________________________________
________________________________________________________________________________
GENERAL EXAMINATION
Height:
Resp Rate

cm
min

Clubbing:

Cyanosis

Weight:
Pulse Rate

46

Icterus

kg
min

Blood Pressure:_____ mmHg


Pallor
Oedema

Signs of nutritional deficiencies: ___________________________________________________


Anthropometry: _________________________________________________________________
Head :

Chest:

Weight:

Mid-arm:

Systemic Examination:
Respiratory system

Central nervous system

Cardiovascular system

Musculo skeletal system

Diagnosis:________________________________________________________________
Investigation, If any :_______________________________________________________
Treatment, If any:__________________________________________________________
Advice / Action taken by Student:
1.

Personal hygiene:____________________________________________________

2.

Diet: ______________________________________________________________

3.

Immunization as per National Immunization Schedule:


Follow-up(Growth monitoring) according to growth chart
Family planning:

Yes / No, please specify ______________________________

Removing misconceptions in child care if any ; specify:


A)
B)
C)
D)

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
*

S.No.

DATE OF VISIT

Please fill

Yes - 01,

No - 02

INFANT HEALTH FOLLOW UP


COMPLAINTS
DIAGNOSIS & TREATMENT

47

REMARKS

UNDERFIVE CHILD CARE


Date:__________
Informant: _______________________. Name: __________________________________.
Any complaints:
1._______________________________________________________________________
2._______________________________________________________________________
3._______________________________________________________________________
ODP of present illness: ______________________________________________________
_________________________________________________________________________
H/o delivery in brief: ________________________________________________________
Family tree: _______________________________________________________________
*Working mother :
Nutrition history:
Breast feeding/Top feeding/Weaning ___________________________________________
Food Items
Calories
Proteins
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
Total: ____________________________________________________________________
Required: _________________________________________________________________
Deficit/Excess: ____________________________________________________________
Immunization history: complete / incomplete, If incomplete specify reason_____________
_________________________________________________________________________
Milestones: (Record actual months)
1.
Social smile (2 months)_________ 2.
3.
Turning over (4-5months)________ 4.
5.
Teething (6months)______________ 6.
7.
Crawling (9-10mths)_____________8.
Walking with support (10-11months)

Head holding (3months)________________


Sitting with support (5-6mths)____________
Sitting without support (6-8mths)__________
First words (10-11mths)_________________

Customs & beliefs related to underfive care in this child:__________________________________


_______________________________________________________________________________
Economic/Environmental History in brief: _____________________________________________
________________________________________________________________________________
GENERAL EXAMINATION
Height :
cm
Resp Rate
min
Clubbing:

Weight:
Pulse Rate
Cyanosis

kg
min
48

Blood Pressure:_____ mmHg


Pallor
Oedema
Icterus

Signs of nutritional deficiencies: ___________________________________________________


Anthropometry: _________________________________________________________________
Head :

Chest:

Weight:

Mid-arm:

Systemic Examination:

If any abnormally detected please specify, otherwise write NAD / WNL


Respiratory system

_____________ Central nervous system____________________

Cardiovascular system

GIT __________________Eye___________________Ear_______________________

_____________ Musculo skeletal system_____________

Diagnosis:______________________________________________________________________
Investigation, If any :______________________________________________________________
Treatment, If any:___________________________________________________________ _____
Advice / Action by Student:
1.

Personal hygiene:___________________________________________________________

2.

Diet: _____________________________________________________________________

3.

Immunization as per National Immunization Schedule:


Follow-up(Growth monitoring) according to growth chart
Family planning:

Yes / No, please specify ___________________________________

Removing misconceptions in child care if any ; specify:


A)
B)
C)
D)

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
*

S.No.

DATE OF
VISIT

Please fill

Yes - 01,

No - 02

UNDERFIVE HEALTH FOLLOW UP


COMPLAINTS DIAGNOSIS & TREATMENT

49

REMARKS

QUESTIONS:

What are the common health problems of the under five children?

Name the medical conditions for which the child is normally asymptomatic?

What are the components of newborn care?

What are the different health care targets related to under five children in the national health policy?

What information can you get from the road to health card? Who prepared this card?

What are the effects of eating junk food?

What are the various national health programs associated with health of under five children?

How will you keep a healthy child healthy?

50

ADOLESCENT HEALTH CARE


Date:__________
Name

Age

Religion
Marital Status :

Occupation
Married / Unmarried

Address
Complaints (If any):
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: _______________________________________________
______________________________________________________________________
Past history: ____________________________________________________________________
_______________________________________________________________________________
Family history: __________________________________________________________________
Personal history: ________________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________________
Habits: ____________________________ Sleep : ______________________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: ______________
Menstrual hygiene practiced :
Yes / No
H/O of passage of white discharge per vaginum:
Yes / No
Economic/Environmental History in brief: _____________________________________________
________________________________________________________________________________
GENERAL EXAMINATION
Built & Nourishment: Well / Poor
Height :
Resp Rate

cm
min

Weight:
Pulse Rate

kg
min

Blood Pressure:_____ mmHg


Pallor
Oedema

Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify:_________________________________________
Any signs of nutritional deficiencies: Yes / No, If yes,
please specify:___________________________
51

SYSTEMIC EXAMINATION :
If any abnormally detected please specify, otherwise write NAD / WNL
Respiratory system

_____________ Central nervous system____________________

Cardiovascular system

GIT __________________Eye___________________Ear_______________________

_____________ Musculo skeletal system_____________

SIGNS OF PUBERTY:
1. __________________________________6.____________________________________
2. ___________________________________7.____________________________________
3. ___________________________________8.____________________________________
4. ___________________________________9.____________________________________
5. ___________________________________10.___________________________________
Is there any role model in your life: Yes / No, If yes, please specify____________________
___________________________________________________________________________
If givan a choice what would you like to become in your life?__________________________
___________________________________________________________________________
If givan a choice what would your parents want you to become?________________________
___________________________________________________________________________
Do you have good and trustworthy friends? Yes / No
Have you ever tried to use any of the following:
1.

Alcohol:

2.

Cigarette :

3.

Drugs :

4.

Any other:

Are you addicted to any of the above?


If yes, type

Duration

Yes / No
Years

Have you heard about HIV / AIDS? Yes / No


Who are the persons who may get HIV / AIDS?
1.___________________2._____________________3._______________4._____________
What are you doing to protect & promote your health?
_____________________________________________________________________________
________________________________________________________________________________
52

Diagnosis of health status: Healthy / Not Healthy if not, please specify_____________________


________________________________________________________________________________
Health advice given:_______________________________________________________________
ADOLESCENT HEALTH FOLLOW UP
S.No.

DATE OF
VISIT

COMPLAINTS

DIAGNOSIS & TREATMENT

QUESTIONS:

Who is an adolescent?

Is it a vulnerable period of life? Why?

What are the common health problems seen in adolescent age groups?

What are the national health programs associated with health of adolescents?

53

REMARKS

GERIATRIC HEALTH CARE


Date:__________
Name

Age

Religion

Occupation

Address
Working / Not working, If not working, specify the source of income________________________
Chief Complains including Psychosocial Problems (If any):
1.
____________________________________________________________________
2.

____________________________________________________________________

3.

____________________________________________________________________

4.

____________________________________________________________________

ODP of presenting illness: __________________________________________________________


________________________________________________________________________________
Past history.: _____________________________________________________________________
________________________________________________________________________________
Family history: ___________________________________________________________________
Personal history: ________________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________________
Habits: ____________________________ Sleep : ______________________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN FEMALES : H/o menopause:____________________________________________________
Psychosocial and Environmental History in brief: _______________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Built & Nourishment: Well / Poor
Height :
Resp Rate
Clubbing:

cm
min

Weight:
Pulse Rate

kg
min

Cyanosis

Blood Pressure:_____ mmHg


Pallor
Oedema
Icterus

Lymphadenopathy: Yes / No, If yes, please specify:_________________________________________


Any signs of nutritional deficiencies: Yes / No, If yes, please specify:___________________________
54

SYSTEMIC EXAMINATION:
If any abnormally detected please specify, otherwise write NAD / WNL
Locomotor system (joints) :_____________________________________________
Respiratory system

_____________ Central nervous system__________________

Cardiovascular system

GIT __________________Eye___________________Ear____________________

______________________________________________

Diagnosis:___________________________________________________________________
Investigation, If any :__________________________________________________________
Treatment, If any:_____________________________________________________________
ADVICE/ACTION TAKEN BY STUDENT

Attitude towards illness

Effect of illness on patient & family members

Problems in the family due to illness.________________________________________

S.No.

DATE OF
VISIT

______________________________________________
____________________________

GERIATRIC HEALTH FOLLOW UP


COMPLAINTS DIAGNOSIS & TREATMENT

REMARKS

QUESTIONS:

Enumerate the common health problems of geriatric age group.

For which problems the middle-aged people must be screened?

Name the lifestyle related diseases and how will you apply behaviour change communication
(BCC) for their prevention?

What is geriatrics? How can you classify old age people? Differentiate between geriatrics and
gerontology?
What are the services being provided to this age group?
What are the normal dietary modifications required after the age of 40 yrs, 50 yrs and 60 years?
55
Why?
Name some non- government organizations (NGOs) working actively for the welfare of the
elderly.

56

INDIVIDUAL HEALTH
Date:__________
Name

Age

Religion

Occupation

Address
Chief Complaints (If any):
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: _______________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: _________________________________________________________
Personal history:________________________________________________________
Bowel/Bladder: _____________________ Appetite : __________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ___________________________________________________________
_______________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: __________________
Contraceptive History: _______________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
Immunization History:____________________________________________________________
Economic/Environmental History in brief: ____________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Built & Nourishment: Well / Poor
Height :
Resp Rate

cm
min

Weight:
Pulse Rate

kg
min

Blood Pressure:_____ mmHg


Pallor
Oedema

Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify: _________________________________________
Any signs of nutritional deficiencies: Yes / No, If yes, please specify:___________________________
57

SYSTEMIC EXAMINATION :
If any abnormally detected please specify, otherwise write NAD / WNL
Respiratory system

_____________ Central nervous system____________________

Cardiovascular system

GIT __________________Eye___________________Ear______________________

_____________ Musculo skeletal system_____________

Diagnosis: _____________________________________________________________________
Investigation, If any :_____________________________________________________________
Treatment, If any:________________________________________________________________
ADVICE/ACTION TAKEN BY THE STUDENT

Attitude towards illness

Effect of illness on patient & family members

Problems in the family due to illness.__________________________________________

S.No.

DATE OF
VISIT

________________________________________________
______________________________

INDIVIDUAL HEALTH FOLLOW UP


COMPLAINTS DIAGNOSIS & TREATMENT

58

REMARKS

INDIVIDUAL HEALTH
Date:__________
Name

Age

Religion

Occupation

Address
Chief Complaints (If any):
1. ____________________________________________________________________
2. ____________________________________________________________________
3. __________________________________________________________________________________

4. ____________________________________________________________________
ODP of presenting illness: ________________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: ________________________________________________________
Personal history: ________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________
________________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: ______________
Contraceptive History: ___________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
Immunization History_____________________________________________________________
Economic/Environmental History in brief: ____________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Built & Nourishment: Well / Poor
Height :
Resp Rate

cm
min

Weight:
Pulse Rate

kg
min

Blood Pressure:_____ mmHg


Pallor
Oedema

Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify:___________________________________
Any signs of nutritional deficiencies: Yes / No, If yes,
59 please specify:___________________________

SYSTEMIC EXAMINATION :
If any abnormally detected please specify, otherwise write NAD / WNL
Respiratory system

_____________ Central nervous system_____________

Cardiovascular system

GIT __________________Eye___________________Ear____________________

_____________ Musculo skeletal system_____________

Diagnosis:________________________________________________________________
Investigation, If any :_______________________________________________________
Treatment, If any:___________________________________________________________
ADVICE/ACTION TAKEN BY THE STUDENT

Attitude towards illness

Effect of illness on patient & family members

Problems in the family due to illness._________________________________________

S.No.

DATE OF
VISIT

_____________________________________________
______________________________

INDIVIDUAL HEALTH FOLLOW UP


COMPLAINTS DIAGNOSIS & TREATMENT

60

REMARKS

INDIVIDUAL HEALTH
Date:__________
Name

Age

Religion

Occupation

Address
Chief Complaints (If any):
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: ________________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: __________________________________________________________
Personal history: ________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: __________________
Contraceptive History: ___________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
Immunization History:_____________________________________________________________
Economic/Environmental History in brief: __________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Built & Nourishment: Well / Poor
Height :
Resp Rate

cm
min

Weight:
Pulse Rate

kg
min

Blood Pressure:_____ mmHg


Pallor
Oedema

Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify:___________________________________
61

Any signs of nutritional deficiencies: Yes / No, If yes, please specify:___________________________

SYSTEMIC EXAMINATION :
If any abnormally detected please specify, otherwise write NAD / WNL
Respiratory system

_____________ Central nervous system_____________

Cardiovascular system

GIT __________________Eye___________________Ear____________________

_____________ Musculo skeletal system_____________

Diagnosis:________________________________________________________________
Investigation, If any :_______________________________________________________
Treatment, If any:___________________________________________________________
ADVICE/ACTION TAKEN BY THE STUDENT

Attitude towards illness

Effect of illness on patient & family members

Problems in the family due to illness._________________________________________

S.No.

DATE OF
VISIT

_____________________________________________
______________________________

INDIVIDUAL HEALTH FOLLOW UP


COMPLAINTS DIAGNOSIS & TREATMENT

62

REMARKS

INDIVIDUAL HEALTH
Date:__________
Name

Age

Religion

Occupation

Address
Chief Complaints (If any):
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: ________________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: __________________________________________________________
Personal history: ________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: __________________
Contraceptive History: ___________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
Immunization History:_____________________________________________________________
Economic/Environmental History in brief: __________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Built & Nourishment: Well / Poor
Height :
Resp Rate

cm
min

Weight:
Pulse Rate

kg
min

Blood Pressure:_____ mmHg


Pallor
Oedema

Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify:___________________________________
63

Any signs of nutritional deficiencies: Yes / No, If yes, please specify:___________________________

SYSTEMIC EXAMINATION :
If any abnormally detected please specify, otherwise write NAD / WNL
Respiratory system

_____________ Central nervous system_____________

Cardiovascular system

GIT __________________Eye___________________Ear____________________

_____________ Musculo skeletal system_____________

Diagnosis:________________________________________________________________
Investigation, If any :_______________________________________________________
Treatment, If any:___________________________________________________________
ADVICE/ACTION TAKEN BY THE STUDENT

Attitude towards illness

_____________________________________________

Effect of illness on patient & family members

Problems in the family due to illness._________________________________________

______________________________

INDIVIDUAL HEALTH FOLLOW UP


S.No.

DATE OF
VISIT

COMPLAINTS

DIAGNOSIS & TREATMENT

64

REMARKS

INDIVIDUAL HEALTH
Date:__________
Name

Age

Religion

Occupation

Address
Chief Complaints (If any):
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: ________________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: __________________________________________________________
Personal history: ________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: __________________
Contraceptive History: ___________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
Immunization History:_____________________________________________________________
Economic/Environmental History in brief: __________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Built & Nourishment: Well / Poor
Height :
Resp Rate

cm
min

Weight:
Pulse Rate

kg
min

Blood Pressure:_____ mmHg


Pallor
Oedema

Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify:___________________________________
65

Any signs of nutritional deficiencies: Yes / No, If yes, please specify:___________________________

SYSTEMIC EXAMINATION :
If any abnormally detected please specify, otherwise write NAD / WNL
Respiratory system

_____________ Central nervous system_____________

Cardiovascular system

GIT __________________Eye___________________Ear____________________

_____________ Musculo skeletal system_____________

Diagnosis:________________________________________________________________
Investigation, If any :_______________________________________________________
Treatment, If any:___________________________________________________________
ADVICE/ACTION TAKEN BY THE STUDENT

Attitude towards illness

_____________________________________________

Effect of illness on patient & family members

Problems in the family due to illness._________________________________________

______________________________

INDIVIDUAL HEALTH FOLLOW UP


S.No.

DATE OF
VISIT

COMPLAINTS

DIAGNOSIS & TREATMENT

66

REMARKS

SUMMARY & CONCLUSION OF THE FAMILY STUDY


Date:__________
1. Specify the health problems in the family:
Medical ______________________________________________________________
Nutritional ___________________________________________________________
Environmental ________________________________________________________
Social ________________________________________________________________
2. Enlist the medico-social problems as felt by the family:
_________________________________________________________________________
_________________________________________________________________________
Name

Age

Conditions for which


individual needs to
be screened

Methods of
screening

Findings/
Results of the test

Action taken

List the medical problems detected:


________________________________________________________________________________________
-_______________________________________________________________________________________
Which of the above problems could have been prevented?
________________________________________________________________________________________
67
__

DEPARTMENT OF COMMUNITY MEDICINE


GOVERNMENT MEDICAL COLLEGE, CHANDIGARH
STUDENT'S OWN FAMILY STUDY

Date:__________
Name of student

Batch

Address
Population of the area/sector

Religion

Facilities in your area/sector :


Education :

Medical:

Social :

Primary

Middle/High School

Secondary

College

Doctors : Private

Govt.

Govt. Dispensary

Hospital

Organisation

Clubs

Nursing Home

FAMILY RECORD
S
No.

Name

Age/
DOB

Sex

Marital
Status

Relation

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
68

Education

Occup
-ation

Height
(mtrs)

Weight
(Kg)

Illness
(if any)

IMMUNIZATION STATUS
S.No.

BCG Scar
Present/Absent

TT
(Mention
Year)

Hepatitis

Any other
(eg MMR)

Immunization
Status

1
2
3
4
ENVIRONMENTAL STATUS
Total area

Drinking Water

Sq. ft.
Tap water

Overcrowding :

Any other
(Specify) _______
Mode of refuse disposal (House to Public bin): _________________________________
Animals/Birds (Pets):

Aqua Guard

Present/Absent

Filter/Zero B

_______________________________________________

Y/N, If yes, please (specify) _________________________________________


Immunization status: Nil/Given, specify_________________________________
Insect/ Mosquito repellents :

Not used/Mat/Ointment/Spray/Any other_________

ECONOMIC STATUS:
Total Family Income :
(monthly)

Rs.

Per Capita Income (PCI) : Rs.

SOCIAL STATUS
Habits: (Father/Head)
Yes/No

Frequency

Smoking
Alcohol
Beetal chewing
Any other
69

Duration

A.

KAP OF MOTHER REGARDING COMMUNICABLE DISEASES


(Please encircle the correct options)
Multiple option possible
Yes - 1, No - 2

HIV/AIDS
a)

b)

It is:
1.
2.

A sexually Transmitted disease and occur by sexual contact.


Caused by HIV

3.

A curable disease.

4.

Once infected, the person will be infected for life.

5.

Leads to development of many other diseases.

6.

A disease of only Foreigner.

7.

A diseases of high risk groups

8.

Any other specify:______________________________________________

High Risk Groups are:Commercial sex worker


Health professional
Truckers
Migrant labourers
Street children

c)

It is transmitted by:1.

Transfusion of infected blood.

2.

Contaminated needles & syringes

3.

Touching the patient.

4.

Most commonly by sexual intercourse.

5.

Sharing food same utensils and towels.

Coughing and sneezing


Mother to child
Bite of mosquito and utensils
9.

Any other specify:______________________________________________

70

d)

e)

2.

Treatment 1.

No treatment available

2.

No vaccine available

3.

Use of strong antibiotic / injection

4.

No treatment but prevention possible

5.

Any other specify:_______________________________________________

Prevention & control is possible by : 1.

Use of condoms during intercourse.

2.

To keep away from patients suffering from AIDS.

3.

Using Disposable syringes / needles.

4.

Screening of Blood for HIV before its transfusion.

5.

Any other specify:_________________________________________________

TUBERCULOSIS
a)

Tuberculosis is an infectious diseases:It affects lungs only.


It affects lungs and any other part of body

b)

3.

Patient becomes weak.

4.

Cough persists for more than three weeks

5.

Occurs because of evil forces / past sins

6.

Any other specify:_________________________________________________

How does it spread?


1.

By sputum

2.

By drinking contaminated water

3.

By sharing towels

4.

By drinking contaminated milk

5.

Any other specify:_________________________________________________

71

c)

Treatment It is curable
DOTS treatment is available
It is available free at Govt. Hospital
3.

Treatment is costly.

Treatment is to be taken for (i) <6 months,


(ii) 6-9 months
(iii) 1 year
Drugs have severe side effects.
Any other specify:_________________________________________________
d)

DOTS provider is :Voluntary worker


School teacher
MPW / ANM
Any other specify:_________________________________________________

e)

Prevention & Control is possible 1.

Patients should cover mouth while coughing.

2.

Family contacts should be given ATT drugs.

Patients should be isolated.


BCG vaccine should be given to children <2 years
Infection can still spread even if patient is taking treatment
Any other specify:_________________________________________________
3.

DIARROHEA
a)

Diarrhoea means :1.

More number of stools than usual.

2.

Stools may have blood.

3.

Stools are watery.

4.

No deficiency of water can occur.

5.

Any other specify:_________________________________________________


72

b)

Mode of spread 1.
Caused by some curse or evil eyes.
2.
Caused by wrong feeding habits
3.

Spreads by eating uncovered foods in market.

4.

Dirty hands and flies also spread it

By consuming unsafe water


Any other specify:_________________________________________________
c)

Treatment 1.
2

Breast feeding should be continued


Feeding should be stopped.

3.

Person should avoid milk and other fluids.

4.

Plenty of fluids (ORS) should be given.

5.

Consult a doctor.

6.

Cannot be controlled without medicines

7.

Any other specify:_________________________________________________

Prevention & control is possible -

B.

1.

By keeping your environment clean.

By protecting foods from flies.

3.

By washing hands regularly.

4.

By storing water in covered buckets

5.

By using tumbler with long handle for taking out water

6.

Any other specify:_________________________________________________

KAP OF MOTHER REGARDING MCH / RCH SERVICES:


a)
Pregnancy: Pregnant mother should not
1.

Take non-vegetarian food.

2.

Take drugs without medical advice.

3.

Eat extra food than her daily average intake.

Smoke or take alcohol


Take papaya, black gram, bengal gram etc.
Any other specify:_________________________________________________
73

Pregnant mother should take:


1.

More energy dense food.

2.

More iron & calcium during her pregnancy.

3.

Take more spicy food.

4.

More sleep & rest

5.

Go for check-up regularly

6.

Take vaccine for tetanus

7.

Gain weight around 11 kg

8.

Any other specify:_________________________________________________

Place of delivery should be i) home based


ii)institutional delivery
High risk pregnancy are:
Abnormal presentation
Bleeding PV
Mothers age >30
Teenage pregnancy
High blood pressure during pregnancy
Diabetes during pregnancy
Any other specify:_________________________________________________
b)

Child:
1.
Should bathe child immediately
2

Janam ghuti and honey should be given

Baby should be kept in separate cot


Breast milk is the only thing that should be given to child for
first 6 months
Colostrum (first thick milk after delivery) should not be given
to the child.
Top feeds/milk should be started after 6 months.
Milk should be diluted before giving it to the child.
Kajal should be applied in eyes
Should anything be applied on umblical stump
74
Any other specify:_________________________________________________

C.

KAP OF MOTHER REGARDING NON-COMMUNICABLE DISEASES

HYPERTENSION (HIGH BLOOD PRESSURE)


a)

What happens in high blood pressure?


1.

Palpitation in chest

2.

Weakness in body.

3.

Increased pressure in blood vessels.

Headache
Any other specify:_________________________________________________
b)

Risk Factors 1.

Can be transmitted from parents to children.

2.

Increases by consuming more salt.

3.

Increases by taking more oily food, alcohol & smoking

Can occur in young people.


Only a diseases of elderly
Any other specify:_________________________________________________
c)

6.

Treatment, Prevention & Control is possible 1.

Diet control - low fat, high fiber diet

2.

Can be controlled by medication only.

3.

Weight reduction.

4.

Exercise/walking.

5.

Cessation of smoking & alcohol intake.

6.

Yoga & relaxation also help.

7.

Any other specify:_________________________________________________

HEART ATTACK
Heart attack means
1.

More pressure on heart.

2.

Cessation of heart activity.

75

b)

3.

Chest pain on left side.

4.

Can occurs when an individual is in stress.

5.

Even consuming alcohol occasionally can lead to heart attack.

6.

Smoking is also a risk factor.

7.

Any other specify:_________________________________________________

Risk Factors Increase intake of saturated fat / oil


Increase smoking
Increase alcohol intake
Decrease physical activity
Stress & tension
6

Can be transmitted from parents to children.

High blood pressure can cause Heart attacks.


8.
c)

Any other specify:________________________________________________

Treatment, Prevention & Control 1.

Diet control

2.

Weight reduction

3.

Exercise

4.

Can be controlled by drugs only


Bypass surgery may be required.
Yoga & relaxation also help
Any other specify:________________________________________________

7.

DIABETES
a)

Diabetes is:1.

An infectious disease.

2.

Charactrised by frequency of micturtion.

3.

Feeling of weakness.
76

4.

Increased appetite for food.

5.

Affect other organs of the body e.g. eyes, kidneys etc.

Related with obesity


Only a diseases of elderly
Anybody can suffer from it
Any other specify:________________________________________________
b)

Risk Factors: 1.

It passes on from parents to children.

It is a disease of old age only.


It is a disease of young age & old age both
It occurs in those who eat lot of sweets & sugar
Exercise has protective effect on diabetes
Any other specify:_________________________________________________
c)

Treatment, Prevention and Control 1.

There is no treatment for diabetes.

2.

It can be controlled by drugs only.

3.

It can be controlled by dietary measures.

Weight control can help.


It can be controlled by vegetables like methi, karela, jammun etc.
Treatment & follow-up services available in Govt. Hospital
Health education regarding diabetes is helpful to patients
Foot care is very important in diabetes
Any other specify:_________________________________________________

77

INDIVIDUAL HEALTH
*Present Illness (last 15 days)

(Write symptoms)

Duration

1
2
3
4

*Chronic disease

(Hypertension/Coronary artery disease/Diabietes mellitus /

COPD / Cataract / paralysis/other)

TREATMENT HISTORY: (CURRENT)


Medical/Surgical
problem

Medication

Dose- (adequate
inadequate)

Frequency
(Reg/Irreg.)

Duration

1.
2.
3.
4.

Any other major ailment in life till date, if yes, please specify:_______________
i)

Disease

_________________________________________

ii)

Any hospitalization _____________________________________

iii)

Operations ____________________________________________

78

USE OF ANY AIDS & APPLIANCES


Aids

Yes/No

Duration (Months & Years)

Hearing
Dentures
Spectacles
Any other
PHYSICAL EXAMINATION
a)

General Examination -

Pulse rate :

/ min.

Blood pressure SBP

mm Hg.

DBP
*Pallor :

Respiratory rate:
Height

/ min.

cms.) Weight

*Icterus

JVP - Raised*

*Clubbing

* Oedema feet

Oral cavity_______________________ *Lymphadenopathy

(Kg.)

Thyroid_____________________

Deficiency signs (Nutritional)__________________________________________________________


b)

Systemic Examination -

Per Abdomen
1.

Inspection

*Movement with Respiration

*Visible veins/Peristalsis

*Visible mass______________________ Hernial sites_______________________________


2.

Palpation

*Guarding

* Tenderness

Any mass___________________________________________________________________
Hernial sites_________________________________________________________________
Liver_______________________________Spleen___________________________________
*Please fill Yes - 01, No - 02
79

3.

Percussion
Resonance/Dullness___________________________________________________________
*Fluid thrill

4.

Shifting dullness

Auscultation
Bowel sounds

CIRCULATRY VASCULAR SYSTEM


1.

Inspection
*Apex beat visible

2.

Palpation
Apex beat (Localization/Character)________________________________________________
*Thrill

*Parasternal Heave

3.

Percussion (Area of cardiac dullness)

4.

Auscultation
Heart sounds_________________________________________________________________
*Added sounds (Murmur/click/pericardial rub)

if yes, please specify _________________

RESPIRATORY SYSTEM
1.

Inspection - Shape of chest_________________Trachea_____________________________

2.

Palpation - Chest expansion

3.

Percussion - Note_______________________Liver dullness__________________________

(cms.) Trachea__________________________________

Cardiac dullness_______________________________________________________________
4.

Auscultation -

Breath sounds______________________________________________

*Crepts/Rhonchi

*Pleural rub

GENITO URINARY SYSTEM


1.

Inspection

*Prolapse

if yes, please specify______________________

Hernial sites_________________________________________________________________
2.

Palpation
* Any Mass
*BPH:

Hernial sites_______________________________________________
if yes, please specify________________________________________
80

CENTRAL NERVOUS SYSTEM


1.

Higher mental functions____________________________________________

2.

Autonomic functions ______________________________________________

3.

Motor -

Muscle mass__________________________________________

Tone/Strength_____________________________________________________
Reflexes__________________________________________________________
4.

Sensory__________________________________________________________

5.

Any other________________________________________________________

LABORATARY INVESTIGATION:
Hb.

gm%

Blood sugar F

Cholestrol

gm% Any other

PP
FINAL DIAGNOSIS: ____________________________________________________
_______________________________________________________________________
FOLLOW UP
Sno
.

Date

Ailment
(Monthly)

Weight
(six monthly)

81

B.P.
(six monthly)

Sugar
(yearly)

Social and Health problems in Family:

(Please enumerate)

1.
2.
3.
4.

82

INDIVIDUAL HEALTH
*Present Illness (last 15 days)

(Write symptoms)

Duration

1
2
3
4

TREATMENT HISTORY: (CURRENT)


Medical/Surgical
problem

Medication

Dose- adequate
inadequate

Frequency
Reg/Irreg.

Duration

1.
2.
3.
4.
*Chronic disease

(Hypertension/Coronary artery disease/Diabietes mellitus /

COPD / Cataract / paralysis/other)


*

Any other major ailment in life till date, if yes, please specify:_______________
i)

Disease

_________________________________________

ii)

Any hospitalization _____________________________________

iii)

Operations ____________________________________________

83

USE OF ANY AIDS & APPLIANCES


Aids

Yes/No

Duration (Months & Years)

Hearing
Dentures
Spectacles
Any other
PHYSICAL EXAMINATION
a)

General Examination -

Pulse rate :

/ min.

Blood pressure SBP

mm Hg.

Pallor :DBP

*Icterus

Respiratory rate:
Height

/ min.

cms.) Weight

(Kg.)

JVP - Raised*

Oral cavity_______________________ *Lymphadenopathy

Thyroid_____________________

Deficiency signs (Nutritional)__________________________________________________________


*Clubbing
b)

* Oedema feet

Systemic Examination -

Per Abdomen
1.

Inspection

*Movement with Respiration

*Visible veins/Peristalsis

*Visible mass______________________ Hernial sites_______________________________


2.

Palpation

*Guarding

Any mass____________________________* Tenderness


Hernial sites_________________________________________________________________
Liver_______________________________Spleen___________________________________
Please fill Yes - 01,
84

No - 02

3.

Percussion
Resonance/Dullness___________________________________________________________
*Fluid thrill

5.

Shifting dullness

Auscultation
Bowel sounds_________________________________________________________________

CIRCULATRY VASCULAR SYSTEM


1.

Inspection
*Apex beat visible

2.

Palpation
Apex beat (Localization/Character)________________________________________________
*Thrill

*Parasternal Heave

3.

Percussion (Area of cardiac dullness)

4.

Auscultation
Heart sounds_________________________________________________________________
Added sounds (Murmur/click/pericardial rub)

if yes, please specify _________________

RESPIRATORY SYSTEM
1.

Inspection - Shape of chest_________________Trachea_____________________________

2.

Palpation - Chest expansion

3.

Percussion - Note_______________________Liver dullness__________________________

(cms.) Trachea__________________________________

Cardiac dulness_______________________________________________________________
4.

Auscultation -

Breath sounds______________________________________________

*Crepts/Rhonchi

*Pleural rub

GENITO URINARY SYSTEM


1.

Inspection

*Prolapse

if yes, please specify______________________

Hernial sites_________________________________________________________________
2.

Palpation
* Any Mass
*BPH:

Hernial sites_______________________________________________
if yes, please specify________________________________________
85

CENTRAL NERVOUS SYSTEM


1.

Higher mental functions____________________________________________

2.

Autonomic functions ______________________________________________

3.

Motor -

Muscle mass__________________________________________

Tone/Strength_____________________________________________________
Reflexes__________________________________________________________
4.

Sensory__________________________________________________________

5.

Any other________________________________________________________

LABORATARY INVESTIGATION:
Hb.

gm%

Blood sugar F

Cholestrol

gm% Any other

PP
FINAL DIAGNOSIS: ____________________________________________________
_______________________________________________________________________
FOLLOW UP
Sno
.

Date

Ailment
(Monthly)

Weight
(six monthly)

86

B.P.
(six monthly)

Sugar
(yearly)

DIET SURVEY

*DIET SURVEY AND NUTRITIONAL STATUS


Vegetarian / Non-Vegetarian

Food Material

1st Day

2nd Day

3rd Day

Daily average

Cereals :
1.
2.
3.
4.
Pulses :
1.
2.
3.
Roots and Tubers :
1.
2.
3.
Leafy Veg. :
1.
2.
3.
Non-Leafy Veg. :
1.
2.
3.
Nuts :
1.
2.
3.
Fruits :
1.
2.
3.
Milk and Dairy Products:
1.
2.
3.
Flesh food :
1.
2.
3.
Miscellaneous :
1.
2.
3.
4.
5.
*
Note : Refer to 87
Annexure IV to XI for details)

Daily intake per


consumption unit

DIETARY COMPOSITION / NUTRIENTS OF INTAKE


2.

COMPOSITION OF AVERAGE DAILY INTAKE PER CONSUMPTION UNIT:


Sno.

Food
material

Quantity
gms.

Calori
es

Protein
(Gms)

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Tot
al

88

Fat
(mg)

Calciu
m
(mg)

Iron
(mg)

Vitamin
A (g.)

Vitamin
B1 (mg)

Nicotin.
Acid
(mg)

Riboflavin
(mg)

Vitamin C
(mg)

Vitamin
D (I.U.)

3.

RECOMMENDED NUTRIENT INTAKE


DAILY REQUIREMENTS :
S.
N
o

Name

Age

Sex

Occ.

ECC

Calories
(K cal)

Protei
ns
(gm)

Fat
(mg)

Calci
um
(mg)

Iron
(mg)

Vit.
A
(g)

Vit.B
1

Nicot.
Acid (mg)

Riboflavi
n (Mg)

Vit.C
(mg)

(mg)

Total consumption
Total daily
requirements
Deficiency
Excess
Action taken:- 1.___________________________________________________________________________________________________
2. ___________________________________________________________________________________________________
3. ___________________________________________________________________________________________________
*
ECC =
Energy Consumption Coefficient
89

Vit.
D
(mg)

ANNEXURE I
PREFERRED CLASSIFICATION FOR OVERCROWDING : GUIDELINES
RECOMMENDED FLOOR SPACE

NO. PERSONS

> 110 sq feet

2 persons

90-100 sq feet

70-90 sq feet

50-70 sq feet

1/2

> 50

Nil

Note :
Child < 1 year is not counted
Children 1-10 years of age are counted as unit.

ANNEXURE - II
A)

MODIFIED PRASAD'S CLASSIFICATION FOR SOCIO ECONOMIC STATUS


Income per Capitum / Month (Rs.)
>1800

Social Class
I

900-1800

II

420- 900

III

180- 420

IV

<180

89

B)

KUPPUSWAMY SCALE SOCIO-ECONOMIC STATUS IN URBAN AREA


OCCUPATION OF HEAD :

SCORE

Professional
Semi Professional
Clerk, Shop Owner, Farm Owner etc.
Skilled Worker
Semi-Skilled Worker
Unskilled Worker
Unemployed

10
06
05
04
03
02
01

EDUCATION OF HEAD
Professional Degree
Graduate & PG
I.Sc./Post High School Diploma
High School Certificate
Middle School Completion
Primary School and literate
Illiterate

07
06
05
04
03
02
01

INCOME (Rs./m)
22734, and above
11367 22733
8504 11366
5683 8503
3410 5682
1138 3409
1137, and below

12
10
06
04
03
02
01

Modified family income groups of the Kuppuswamy's socioeconomic status scale was obtained by
multiplying conversion factor with the income groups for 1998. Conversion factor is determined by
dividing the CPI-IW by 88.428. The CPI-IW of Chandigarh is 149 for September 2009. The income
groups for 2009 were revised by applying a conversion factor of 1.684.
***
CPI-IW
=
(Consumer Price Index for industrial worker)
SOCIO ECONOMIC CLASSIFICATION

Ref.:

Upper (I)

26-29

Upper Middle (II)

16-25

Lower Middle (III)

11-15

Upper Lower (IV)

05-10

Lower (V)

<05

Kuppuswamy B. Manual of Socio Economic Status Scale (Urbans) Manasayam - 32, Netaji
Subash Marg, Delhi (Indian journal of Pediatrics, vol 70-March,2003 )
90

ANNEXURE - III
EXAMPLES OF FAULTY COOKING PRACTICE
i)

Cooking rice & throwing the rice water

ii)

Cutting vegetable & then washing them

iii)

Straining the flour & throwing the barn

iv)

Peeling all types of vegetable before cooking

EXAMPLES OF BENEFICIAL COOKING PRACTICES


i)

Cooking in iron pans

ii)

Use of jaggery over sugar

iii)

Soaking & germinating sprouts

iv)

use of paraboiled rice

iv)

Adding soyabean to wheat flour

v)

Using rice water to cook the pulse

91

ANNEXURE - IV
NUTRITIVE VALUE OF COMMON INDIAN FOOD
Sno.

Common foods
(per 100g) of edible
portion

CEREALS :
Maize
Rice (Raw milled)
Wheat flour
Wheat flour
refined(Maida)
PULSES :
Bengal Gram dhal
(Chana)
Black Gram (Urad)
dhal
Green Gram
(Moong) dhal
Peas (Green)
Rajmah
Red Gram dhal
Soyabean
LEAFY VEGETABLE :
Cabbage
Cauliflower (Green)
Coriander leaves
Mint
ROOTS & TUBERS :
Mustard leaves
Spinach

Calories
(K Cal)

Proteins
G

Fats
(g)

Calcium
(mg)

Iron
(mg)

Carotene
(g)

Vit B1
(mg)

Vit. B2
(mg)

Vit C
(mg)

Nicotine
Acid
(mg)
8

10

342
345
341
341

11.1
6.8
12.1
11

3.6
0.5
1.7
0.9

10.
10
48
23

2.3
0.7
4.9
2.7

90
0
29
25

0.42
0.06
0.49
0.12

1.8
1.9
4.3
2.4

0.10
0.06
0.17
0.07

0
0
0
0

372

20.8

5.6

56

5.3

129

0.48

2.4

0.18

347

24

1.4

154

3.8

38

0.42

0.2

323

24.5

1.2

124

4.4

49

0.47

2.4

0.21

93
346
335
432

7.2
22.9
22.3
43.2

0.1
1.3
1.7
19.5

20
260
73
240

1.5
5.1
2.7
10.4

83

0.25

0.8

0.01

132
426

0.45
0.73

2.9
3.2

0.33
0.39

25
-

27
66
44
48
1
34
26

1.8
5.9
3.3
4.8
2
4
2

0.1
1.3
0.6
0.6
3
0.6
0.7

39
626
184
200
4
155
73

0.8
40
1.42
15.6
5
16.3
1.14

120

0.06

0.4

0.09

124

6918
1620
6
2622
5580

0.05
0.05
7
0.03
0.03

0.8
1.0
8
0.5

0.06
0.26
9
0.26

12
27
10
33
28

92

Sno.

Common foods
(per 100g) of edible
portion

Carrot
Onion (small)
Potato
Radish (white)
Sweet potato
Turnip
OTHER VEGETABLES :
Brinjal
Cauliflower
Cucumber
Ladies Finger
Tinda
Tomato (Green)
NUTS :
Almond
Cashewnut
Coconut (Fresh)
CONDIMENTS & SPICES :
Chillies (Green)
Garlic (Dry)
Ginger (Fresh)
Turmeric Powder
FRUITS :
Amla
Apple
Banana
Dates (Fresh)
Grapes

Calories
(K Cal)

Proteins
G

Fats
(g)

Calcium
(mg)

Iron
(mg)

Carotene
(g)

Vit B1
(mg)

1
48
59
97
17
120
29

2
0.9
1.8
1.6
0.7
1.2
0.5

3
0.2
0.1
0.1
0.1
0.3
0.2

4
80
40
10
35
46
40

5
1.03
1.2
0.48
0.4
0.21
0.4

6
1890
15
24
3
6
0

24
30
13
35
21
23

1.4
2.6
0.4
1.9
1.4
1.9

0.3
0.4
0.1
0.2
0.2
0.1

18
33
10
66
25
20

0.38
1.23
0.6
0.35
0.9
1.8

655
596
444

20.8
21.2
4.5

58.9
46.9
41.6

230
50
10

29
145
67
349

2.9
6.3
2.3
6.3

0.6
0.1
0.9
5.1

58
59
116
144
45

0.5
0.2
1.2
1.2
1

0.1
0.5
0.3
0.4
0.1

93

Vit. B2
(mg)

Vit C
(mg)

7
0.04
0.08
0.10
0.06
0.08
0.04

Nicotine
Acid
(mg)
8
0.6
0.5
1.2
0.5
0.7
0.5

9
0.02
0.02
0.01
0.02
0.04
0.02

10
3
2
17
15
24
15

74
30
0
52
13
192

0.04
0.04
0.03
0.07
0.04
0.07

0.9
1
0.2
0.6
0.3
0.4

0.11
0.1
0
0.10
0.08
0.01

12
56
7
13
18
31

5.09
5.81
1.7

0
60
0

0.24
0.63
0.05

4.4
1.2
0.8

0.57
0.19
0.10

0
0
1

30
30
20
150

4.4
1.2
3.5
67.8

175
0
40
30

0.19
0.06
0.06
0.03

0.9
0.4
0.6
2.3

0.39
0.23
0.03
0

111
13
6
0

50
10
17
22
30

1.2
0.66
0.36
0.96
0.2

9
0
78

0.03
0.05

0.2
0
0.5

0.01
0.08

600
1
7

0.12

0.3

0.02

31

Sno.

Common foods
(per 100g) of edible
portion

Guava
Lemon
Lichi
Mango
Melon
Papaya
Tomato
MEAT & POULTRY :
Egg (Hen)
Goat Meat
Mutton (Muscle)
MILK PRODUCT :
Milk (Buffalo)
Milk (Cow)
Milk (Goat)
Milk (Human)
Cheese
Khoa (Whole
buffalo milk)
FATS :
Butter
Ghee (Cow)
Ghee (Buffalo)
Cooking Oil
SUGAR :
Sugar cane
Jaggery (Cane)

Calories
(K Cal)

Proteins
G

Fats
(g)

Calcium
(mg)

Iron
(mg)

Carotene
(g)

Vit B1
(mg)

1
51
57
61
74
17
32
20

2
0.9
1
1.1
0.6
0.3
0.6
0.9

3
0.3
0.9
0.2
0.4
0.2
0.1
0.2

4
10
70
10
14
32
17
48

5
0.27
0.26
0.7
1.3
1.4
0.5
0.64

6
0
0
0
2743
169
666
351

7
0.03
0.02
0.02
0.08
0.11
0.04
0.12

173
118
194

13.3
21.4
18.5

13.3
3.6
13.3

60
12
100

2.1
2.5

600
0

0.1
0.18

117
67
72
65
348
421

4.3
3.2
3.3
1.1
24.1
14.6

6.5
4.1
4.5
3.4
25.1
31.2

210
120
170
28
790
650

0.2
0.2
0.3
2.1
5.8

160
174
182
137
273

729
900
900
900

81
100
100
100

3200
2000
900
2500

398
383

0.1
0.4

0
0.1

12
80

0.155
2.64

94

Nicotine
Acid
(mg)
8
0.4
0.1
0.4
0.9
0.3
0.2
0.4

Vit. B2
(mg)

Vit C
(mg)

9
0.03
0.01
0.06
0.09
0.08
0.25
0.06

10
212
39
31
16
26
57
27

0.1
6.8

0.4
0.14

0
-

0.04
0.05
0.05
0.02
-

0.1
0.1
0.3
-

0.1
0.19
0.04
0.02
-

1
2
1
3
-

ANNEXURE - V
CALORIFIC VALUE PER HOUSE HOLD MEASURE
Sno.
Tea (Sugar
Milk
a.
b.
c.
d.
Curd

Food Items
1 cup)

Qty.
1 cup 200 ml

Calories
52

1 glass
1 glass
1 glass
1 glass

234
134
132
58

Buffalo
Cow
Toned milk
Skimmed milk

1 glass
1 glass
1 glass
1 glass

182
120
110
69

Boiled
Raw yolk
Raw Albumen
Fried
Omelette

One
One
One
One
One

80-85
60-65
15-20
155-160
155-160

One / 25 gm.
One / 30 gm.
One / 40 gm.

85
100-105
130-135

One
One
One
One
One
One cup (cooked)

180-185
185-190
100-105
230-240
190-195
68

1 cup
1 cup
1 cup / 20 gm / (raw)
1 cup cooked

170-185
250-260
77
75-80

One (20 gm)


One (30 gm)
One cup cooked
One
One
One
One
One bottle
a.
Amul 100gm
b.
Cadbury 100gm

49
74
125-135
215-220
155-160
140-150
140-145
100-115
588
530

Buffalo
Cow
Toned milk
Skimmed milk

Egg

Chapati
a.
Phulka (small)
b.
Chapati (med.)
c.
Roti (big)
Puri
Atta
Maida
Nan Plain
Prantha Plain (medium)
Bhatura (medium)
Wheat dalia (Raw-4Tsp/20gm)
Rice
a.
Boiled
b.
Pullao
Cornflakes
Porridge (oats)
Bread
Small
Big
Dals and Beans
Bread Pakora
Samosa
Vada
Bread butter sandwich
Cold drinks (sweet aerated)
Milk chocolate

95

ANNEXURE - VI
NUTRITIVE VALUE OF COOKED PREPARATIONS
Katori - 1
S
No.

Volume - (150 ml)

Cooked food stuff


cooked
Chapati (Thin)
Chapati (Medium)
Chapati (Big)
Rice
Wheat Porridge
Oat Meal Porridge
Dal Moong (with husk)
Dal Moong (washed)
Dal Moong (whole)
Dal Urad (washed)
Dal Urad &Channa (3+1)
Dal Urad (whole)
Dal Masoor
Dal Malka Masoor
Channa Dal
Arhar Dal
Rajmah
Bengal Gram (whole)
Coffee-milk 30 cc.
Sugar - 10 gm.
Tea-milk 20 cc.

Diameter - 78 cm

App.
Wt.
Qty.
One
One
One
1 katori
-do-do-do-do-do-do-do-do-do-do-do-do-do-do1 Cup

Raw

Protein Fats

(gm)
25
30
40
40
35
30
30
50
45
45
30+10
40
50
40
55
50
35
50
200

(gm)
3.0
3.6
4.8
2.7
4.2
4.0
7.2
12.2
10.8
11.0
9.2
9.6
12.6
10.0
11.4
11.1
8.0
8.5
1.0

1 Cup

200

0.7

Sugar - 10 gm.

96

Depth - 4 cm.
Energy

Sodium

(gm)
0.4
0.5
0.6
0.2
0.5
2.2
0.3
0.6
0.5
0.6
0.9
0.6
0.3
0.3
3.0
0.8
0.4
2.6
1.0

Carbohydrate
(gm)
17.3
20.8
27.7
31.2
25.0
18.8
17.0
30.0
25.5
27.0
23.6
24.0
29.5
28.6
32.7
28.8
41.2
30.4
11.3

(Kcal)
85
102
136
138
121
112
100
174
150
156
141
139
171
157
204
167
121
180
59

(mg)
5.0
6.0
8.0
6.0
8.4
13.6
14.0
20.0
25.8
16.0
10.0
24.8
14.2
18.6
4.8

0.7

108.0

53

3.2

ANNEXURE - VII
CALORIES EXPENDITURE IN VARIOUS ACTIVITIES
Activity
Minute
Lying down
Standing
Washing cloths
Driving motorcycle
Gardening and weeding
Walking downstairs
Dancing : Moderate
Vigrous
Sports
Skating
Badminton : Recreation
Competitive
Mountain climbing
Running

K. Calories
Consumption / Minute
1.0
2.6
3.1
3.4
4.9

Activity

Sitting
Driving a car
Walking (indoor)
Mopping floors
Farming and ploughing
(with bullocks)
Walking up-stairs

7.1
4.2
5.7
5.0
5.0
10.0
10.0
10.0

Table Tennis
Cycling
Swimming
Judo & Karate

97

K. Calories
Consumption
1.5
2.8
3.1
4.9
6.7
10.00 to 18.0

4.9 to 7.0
5.0 to 12.0
6.0
13.0

ANNEXURE - VIII
ASSESSMENT OF ENERGY REQUIREMENT FOR FAMILY
Practical nutrition work often involves the assessment of the calories of groups of persons. It is
usual to assess the caloric needs of woman & children in terms of those of the average man by applying
various coefficients to the different age & sex groups. The following scale is used for assessing caloric
requirement of an individual as recommended by National Institute of Nutrition, Hyderabad, pioneer in this
field. The calorie consumption of an average adult male doing sedentary work is taken as ONE ENERGY
CONSUMPTION COEFFICIENT (ECC) and the other coefficients are worked out on the basis of gender
and the occupational status for adults and by age for children and adolescents. (Ref. Nutritive Value Indian
Foods-National Institute of Nutrition. Indian Council of Medical Research. Hyd. India. (1989).
COEFFICIENT FOR COMPUTING CALORIE REQUIREMENT OF DIFFERENT GROUPS
GROUP
Adult male (sedentary worker)
Adult male (moderate worker)
Adult male (Heavy worker)
Adult female (sedentary worker)
Adult female (moderate worker)
Adult female (Heavy worker)
Adolescents - 12 to 21 years
Children - 9 to 12 years
Children - 7 to 9 years
Children - 5 to 7 years
Children - 3 to 5 years
Children - 1 to 3 years
*

1.0 Cu-Unit

* Cu-UNITS
1.0
1.2
1.6
0.8
0.9
1.2
1.0
0.8
0.7
0.6
0.5
0.4

2400 K Cal.

98

ANNEXURE - IX
CLASSIFICATION OF ACTIVITIES BASED ON OCCUPATIONS
Sedentary :
Male :

Teacher, Tailor, Barber, Executives, Shoemaker, Priest, Retired Personnel, LandLord, Peon, Postman, etc.

Female :

Teacher, Tailor, Executives, Housewife, Nurses, etc.

Moderate :
Male :

Fisherman, Basket-maker, Potter, Goldsmith, Agricultural, Labour, Carpenter,


Mason, Rickshaw-puller, Electrician, Fitter, Turner, Welder, Industrial Labour,
Cooli, Weaver, Driver, etc.

Female :

Servant-maid, Cooli, Basket-maker, Weaver, Agricultural Labour, Beedi-maker,


etc.

Heavy :
Male :

Stone-cutter, Blacksmith, Mine-worker, Wood-cutter, Gang-man, etc.

Female :

Stone-cutter.

99

ANNEXURE - X
BALANCED DIET
A balanced diet is one which contains different types of foods in such quantities and proportions so
that the needs for calories, proteins, minerals, vitamins and other nutrients is adequately met and a small
provision is made for little bit extra nutrients. The requirements of our body in terms of nutrients and
energy for the various groups is known and on this basis our daily diet can be planned. The requirement of
individual items depends upon growth status (age, sex, height and weight), physical activity and physical
stress or illness keeping in view the recommendation of the nutrition expert group of the ICMR for dietary
allowances, balanced diet for different age groups are presented below :

Food Groups

Cereals
Pulses
Leafy vegetables
Other vegetables
Roots and tubers
Milk
Oils and fats
Sugar and jaggery
7.00 A.M.

Break Fast

Adult Men

Adult Women

Sede Mode Heavy


ntary rate
work
work work

Sede Mode Heavy


ntary rate
work
work work

460
40
50
60
50
150
40
30

520
50
40
70
60
200
45
35

670
60
40
80
80
250
65
55

410
40
100
40
50
100
20
20

440
45
100
40
50
150
25
20

Children

675
50
50
100
60
200
40
40

1-3
yrs.

175
37
40
20
10
300
15
30

4-6
yrs.

270
35
50
30
20
250
25
10

10-12
yrs.

10-12
yrs.

Boys

Girls

420
45
50
50
30
250
40
45

380
45
50
50
20
250
35
45

SAMPLE MENU
1 Cup water + 1/2 lemon
or
1 Cup plain tea + 1/2 lemon (lemon tea)
1.
2.

Milk
Toast

1 Cup
2
or

Missi Roti
Butter

1 (20g. atta, 10gm. Gram Flour)


1 tsp.
or

Prantha

1
or

Dalia

1 Cup

100

3.

Egg

1
or

Paneer

25gm. (1 piece)
or

Curd

125gms (1/2 katori)

This provides 420 kcal & approx, 13 gm protein


Lunch

1.

Chapati

3-4 (90-120 gms.)


or

2.
3.
4.

Rice
Chicken curry

2-3 Katories (80g.)


1 katori (200gms.)

or
Paneer curry
Alu 1, Green Vege
Curd
Cooking fat

(50gms)
1 katori (250 gm)
1/2 katori (125 gm.)
4-5 tsp.

This provides 1000 kcal 35g. protein


Evening Tea

Tea
Sandwich

1 Cup
1
or

Biscuits

This provides 150 kcal 35g. protein


Dinner

1.
2.

Chapati/Rice
Dall

3.

or
Curd
Green & Leafy
vegetable
Cooking oil

As in lunch
1 katori (35gm)
1 katori (150gm.)
1 katori (250g.)
4-5 tsp.

This provides 900 kcal and 35g. protein


Fruits

One serving at midmorning

Salad

Alongwith regular meals.

101

ANNEXURE - XI
I.

INCREASE IN WEIGHT AND HEIGHT


Birth

Weight - 2.9kg

Height - 50cm

1 - 6 years

Wt. - Age (years) X 2+8 kg


Ht. - Age (years) X 6+77 cm

7 - 12 years

Age (years) x 7 5
-----------------------2

INCREASE IN WEIGHT, LENGTH & HEAD CIRCUMFERENCE DURING INFANCY


Age in months

Approximate daily
Weight gain (g)

Growth in length
(cm/month)

0-3
3-6
6-9
9-12

30
20
15
12

3.5
2.0
1.5
1.2

Change in head
(circumference
cm/month)
2.0
1.0
0.5
0.5

Weight (Kg)

Energy (K cal.)

Protein (gms)

03-07
07-09
09-13
15-17

600
600-1200
1200
1500

11
13
18
22

ENERGY & PROTEIN REQUIREMENT OF CHILDREN


Age Group
0-6 months
6-12 months
1-3 years
4-6 years

102

ANNEXURE - XII

W.H.O. DAY THEMES


YEAR

THEME

1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990

Know your health services


Health for your Child and the Worlds Children
Healthy surroundings make Healthy people
Health is Wealth
The Nurse: Pioneer of Health
Clean water means better health
Destroy disease carrying insects
Food and Health
Ten years of Health Progress
Mental Illness and Mental Health in the world today
Malaria Eradication: a World Challenge
Accidents need not happen
Preserve Sight: Prevent blindness
Hunger : Disease of millions
No trace of Tuberculosis
Smallpox : constant alert
Man and his cities
Partners in Health
Health in the World of Tomorrow
Health , Labour and Productivity
Early detection of Cancer saves lives
A full life despite Diabetes
Your Heart is your Health
Health begins at home
Better food for a Healthier World
Smallpox : Point of No Return
Foresight prevents Blindness
Immunize and protect your Child
Down with High Blood Pressure
A Healthy Child : A sure future
Smoking or Health : The choice is yours
Health for All by the year 2000 A.D.
Add years to life
Health for All by 2000 : The countdown has begun
Childrens Health : Tomorrows Wealth
Healthy Youth : Our Best Resource
Healthy Living : Everyone a winner
Immunization : A chance for every child
Health for All All for Health
Lets talk Health
Our Planet Our Health; think Globally, Act Locally

103

W.H.O. DAY THEMES (contd)

YEAR

THEME

1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009

Should Disaster strike Be prepared


Heart Beat The rhythm of life
Handle Life with Care Prevent violence and negligence
Oral Health for a Healthy Life
Target 2000 : A World without Polio
Healthy cities for Better Living
Emerging Infectious Diseases : Global Alert, Global Response
Pregnancy is Special Lets make it Safe
Active Aging makes the difference
Safe Blood starts with Me. Blood is Life
Mental Health stop exclusion, dare to care
Move for Health
Shape the future of life
Road Safety is no accident
Make every mother and child count
Working together for health
International Health Security
Protecting Health from climate change
Save lives. Make hospitals safe in emergencies.

104

ANNEXURE - XIII

NATIONAL HEALTH PROGRAMS

National Vector Borne Diseases Control Program

National Leprosy Eradication Program

Revised National Tuberculosis Control Program, (RNTCP)

National AIDS Control Program, (NACP)

National Program for Control of Blindness, (NPCB)

National Iodine Deficiency Disorders Control Program

Universal Immunization Program, (UIP)

National Rural Health Mission (NRHM)

National Urban Health Mission

National Program for Control and Treatment of Occupational Diseases

Reproductive and Child Health Program, (RCH)

Integrated Disease Surveillance Project 2004 2009

Integrated Child Development Service (IDSP) Scheme

Rabies Control Program

National Guinea Worm Eradication Program

Yaws Eradication Program

National Cancer Control Program

National Family Welfare Program

National Water Supply and Sanitation Program

Minimum Needs Program

Mid Day Meal Program

National Program for the Control of Diarroeal Diseases

National Program for Prevention and Control of Diabetes, Cardiovascular Diseases and
Stroke

National Vitamin A Prophylaxis Program

National Nutritional Anemia Prophylaxis Program

National Program for the Control of ARIs


105

ANNEXURE - XIV
IMPORTANT NATIONAL & INTERNATIONAL HEALTH RELATED DAYS
DAY

AREA

30th January
8th March
15th March
24th March
7th April
8th May
17th May
31st May
5th June

Anti Leprosy Day


International Women Day
Consumers Protection Day
World TB Day
World Health Day
Red Cross Day
World Hypertension Day
World No Tobacco Day
World Environment Day
National Filaria Day (India)
World Blood Donation Day
International Day against Drug Abuse & Illicit Trafficking
World Diabetes Day
Doctors Day (India)
World Population Day
World Rabies Day
Eye Donation Day
World Heart Day
International Day for Older Persons
ICDS Day
World Mental Health Day
Human Rights Day
International Day for Natural Disaster Reduction
National Cancer Awareness Day
World Immunization Day
World AIDS Day
International Day for Disabled / Handicapped person

14th June
26th June
27th June
1st July
11th July
8th September
28th September
1st October
2nd October
10th October
11th October
7th November
10th November
1st December
3rd December

IMPORTANT HEALTH RELATED WEEKS


1st 7th August
25th August 8th September
1st 7th September

World Breast Feeding Week


Eye Donation Fortnight
National Nutrition Week

106