Dr.

Neelam Sukhsohale, GGMC JJ MUMBAI

Epidemiological case history

1) Establish Diagnosis

2) Identify cause of illness / disease

3) Treatment

4) Tracing the source of infection in infectious cases & risk factors in non-communicable diseases

5) Identify medical, social, cultural, environmental, psychological & behavioral causes of illness in an
individual, his family & community

6) To carry out or implement preventive & control measures at individual, family & community level
so as to prevent spread of infection& recurrence in communicable & non-communicable diseases.

Contents of Epidemiological history taking

1) Identifying data : full name, age, sex, address with location (landmark)
2) Distance from the nearest health facility
3) Exposure history, family history, personal history ------------
4) Source of infection - tracing
5) Epidemiological factors – agent, host, environmental factors
6) Preventive & Control measures at individual, family & community level
7) Advice to be given to patient, family members & community

INDIVIDUAL CLINICAL CASE

• A --- year old male/female patient by name ---------(born out of consanguineous /non-
consanguineousin case of children) residing at -------, -----by religion, ----by caste, educated up
to----, ----by occupation, was admitted through OPD/Casualty in ward no. ----- bed no. on-----
at-----am/pm with chief complaints of ------(distance from health care facility)

• Chief complaints in chronological order (Patient’s words)

• 1.
• 2.
• 3.
• 4.

History of present illness (Patient’s words)

Patient was relatively alright ---- days/months back.

A chronological description of the development of the patient’s present illness from the first sign
and/or symptom, or from the previous encounter to the present usually stated in the patient’s words.”

1
include following elements: Onset, location, quality, severity, duration, timing, progression, context,
modifying factors and associated signs and symptoms, contact history (source of infection)

Negative history: (Patient’s words)

Past Medical / Surgical History

• H/o similar complaints in the past

• H/o Medical / Psychiatric Illnesses

• 1. Diabetes

• 2. Hypertension

• 3. Tuberculosis

• 4. COPD (Bronchial asthma, Chronic bronchitis, bronchiectesis, emphysema)

• 5. STD/HIV AIDS (High risk behaviour)

• 6. Jaundice, Depression

• H/o Allergies and Reactions to Drugs

• Current Medications (Including "Over-the-Counter")

Surgeries /Injuries /Hospitalizations / (Apendicectomy, Car Accident, etc.) Blood transfusions

Family History

• Type of family: Nuclear, Joint, Three generation

• No. of Family members:

• Family composition:

• Similar complaints / illnesses in the Family or other major illnesses/hereditary diseases e.g. TB,
DM, HT, IHD, cancers, genetic disorders

Personal History

 Addictions - Alcohol, smoking, tobacco, Other drugs etc,… (duration, quantity, frequency)

 Sleep and Rest

 Bowel and Bladder habits

 Diet : Vegeterian / Mixed diet

 H/o Contraceptive practice in female patients (OC pills, i pills, IUCD (Cu T)

2
 Physical activity

• Sedentary activity : e.g. Managers, executives, officers

• Moderate activity : e.g. Housewives looking after grown-up children, tailors

• Heavy activity : e.g. Housewives looking after small children, laborers, farmers, rickshaw-pullers

SOCIO-ECONOMIC HISTORY

URBAN AREAS: Modified Kuppuswamy scale

Based on 3 components 1) Education of head of family 2) Occupation of head of family 3)

Monthly family income in Rs/-

RURAL AREAS : Prasad scale Based on Per capita income

Modified Kuppuswamy scale scoring for urban areas is as follows - (Updated for 2017)

Education of head Score Occupation of Score Family income Score

of family head of family per month in
Rs/-

illiterate 1 Unemployed 1 ≤ 2242 1

Literate less than 2 Unskilled worker 2 2243 - 6662 2

middle school
certificate
Middle school 3 Semi-skilled worker 3 6663 - 11103 3
certificate
High school certificate 4 Skilled worker 4 11104 - 16656 4

Higher secondary 5 Arithmetic skill jobs 5 16657 - 22208 6

certificate
Graduate degree 6 Semi-professional 6 22209 - 44417 10

Postgraduate or 7 Professional 10 ≥ 44418 12

Professionnal degree

1. Upper class (I) = 26 - 29

2. Upper middle (II) = 16 – 25
3. Lower middle (III) = 11 – 15
4. Upper lower (IV) = 5 – 10
5. Lower (V) = <5

Prasad Scale (Updated for 2016)

• Social class Per Capita Income

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 • Class I Rs ≥ 6346

• Class II Rs 3173 - 6345

• Class III Rs 1904 - 3172

• Class IV Rs 952 - 1903

• Class V Rs < 951

• Psychological history (H/o mental stress: Financial, Exam stress, emotional, death of relatives)

Social history

DIETARY HISTORY By 24 hour recall method OR Hospital diet OR Routine diet

• Beverages (Tea/milk/coffee )

• Breakfast

• Lunch

• Dinner

• Snacks, fruits etc in between Others (specify )

Calculate: Calories (kcal) / day and Proteins (gms)/day

Calories ( kcal ) Proteins ( gms )

Requirement

Intake

Deficit
Deduction in calories > 40 years

• 40 – 49 years -- 5 %

• 50 – 59 ,, -- 10 %

• 60 – 69 ,, -- 20 %

• 70 – 79 ,, -- 30 %

• 80 – 89 ,, -- 40 %

• 90 – 99 ,, -- 50 %

Environmental History

• Type of house : kaccha/ pucca

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• Type of roof / floor / walls : Made up of mud /cement /stone / tin / thatched

• No. of rooms/ doors/ windows

• Overcrowding: no. of persons per room

• Lighting : well aerated, well lighted or not

• Ventilation : cross ventilation present/ absent,

• Kitchen : type of cooking fuel à LPG / Chulha / Kerosene stove/ Gobar gas/ mixed fuel

• Source of drinking water : Tap / well / hand-pump

• Water Supply : continuous (24 hrs/ intermittent ) storage of drinking water: steel utensil, matka

• Drawing water – mug with handle/ without handle

• Method of purification of water (Household level): boiling/straining/disinfection/UVR/filtration

• Storage of perishable & non-perishable foods

• Presence of separate latrine & bathroom: if yes, type of latrine ;

• if no, open air defecation – at what distance from the house

• Drainage : liquid drainage and solid drainage

• Garbage disposal /collection : daily, weekly …etc

• Pet animal : in c/o dogs à immunized/not

• Insect / Rodent Nuisance

• Courtyard of house : surroundings clean/not

• Peri-domestic collection of water

• Personal hygiene /community hygiene

Treatment history

• From records

General Examination

• Patient is ----obese/moderately/average built/ thin, well-nourished, conscious, cooperative, well

oriented with time, place and person , comfortably lying /sitting in bed

• Patient is febrile / afebrile

• Height : Weight : BMI (Quetlet index):

• Hip circumference : Waist circumference: Waist-hip ratio :

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 • Pulse :---/min rate, rhythm, volume, character, peripheral pulses

• Resp. Rate : ---/min , regular / Irregular, thoraco-abdominal / abdominal

• B.P -----mmHg------right/left arm in ----- position

Pallor / JVP / Clubbing / Icterus / Edema / Cyanosis / Lymphadenopathy etc,

Systemic Examination

• Cardiovascular

• Respiratory

• Gastrointestinal

• Genitourinary

• Neurologic / Psychiatric

• Musculoskeletal

• Skin / Breast

• Eyes / Ears / Nose / Mouth / Throat

• Allergic / Immunologic /Lymphatic / Endocrine

Provisional Diagnosis :

Final Diagnosis:

• Investigations performed / advised :

• Management / Treatment :

• Control and Preventive measures at Individual, Family & Community level

• Health seeking behaviour

• Medico-social problems in given case :

• Positive risk factors :

• Advice given :

• Follow up :

At the end of history taking, be prepared with the positive findings (in history taking – chief complaints,
past history, family history, personal history, environmental history, psychosocial history, dietary
history----etc ) general & systemic examination) or positive risk factors present in your patient.

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 ANC CASE
• A --- year old female patient by name ------residing at ------, -----by religion, ----by caste, educated
up to----, ----by occupation, was admitted through OPD/Casualty in ward no. ----- bed no. on-----
at-----am/pm with H /o amenorrhea since .……weeks of gestation preferably (not months)

• LMP : EDD :

• H /o present illness :

• Negative history to rule out high risk pregnancy

• H /o present pregnancy :

• She is a -----registered / booked case of pregnancy yes/no

• If yes, name of the hospital, gestational age at which registered

• Significant events occurred in

• 1st trimester (first 12 weeks)

• 2nd ,, (13 – 28 weeks),

• 3rd ,, (29 – 40 weeks)

• Whether high risk / normal

• H/o TT immunization

• H/o hospitalization & T/t if any

OBSTETRICAL HISTORY

G-P-A-L

S.N Year & Pregnancy Labour events, Method of Puerpereu Baby

. date events hosp/ home delivery m (weight ,
condition at
birth )

1.

2.

• Menstrual history

• Age at menarche, Age at marriage, Age of 1st confinement , previous menstrual cycles: duration,
amount of blood flow, regular/irregular, passage of clots

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 Past Medical / Surgical History

• Past H/o Medical / Psychiatric Illnesses

• 1. Diabetes

• 2. Hypertension

• 3. Tuberculosis

• 4. COPD (Bronchial asthma, Chronic bronchitis, bronchiectesis, emphysema)

• 5. STD/HIV AIDS

• 6. Jaundice, Depression

• H/o Allergies and Reactions to Drugs

• Current Medications (Including "Over-the-Counter")

Surgeries /Injuries /Hospitalizations / (Apendicectomy, Car Accident, etc.) Blood transfusions

Family History

• Type of family: Nuclear, Joint, Three generation

• No. of Family members:

• Family composition:

• Similar complaints / illnesses in the Family or other major illnesses/hereditary diseases e.g. TB,
DM, HT, IHD, cancers, genetic disorders

Personal History

 Addictions - Alcohol, smoking, tobacco, Other drugs etc,… (duration, quantity, frequency)

 Sleep and Rest

 Bowel and Bladder habits

 Diet : Veg/ Nonveg /Mixed

 H/o Contraceptive practice in (OC pills, i pill, IUCD) prior to pregnancy

Physical activity

• Mild activity : e.g. Managers, executives, officers

• Moderate activity : e.g. Housewives looking after grown-up children, tailors

• Heavy activity : e.g. Housewives looking after small children, laborers, farmers, rickshaw-pullers

SOCIO-ECONOMIC HISTORY : use Modified Kuppuswamy or Prasad scale

8
Social history / Psychosocial history :

Additional requirement for expectant mother

• Calories : + 350 kcal/ day and Proteins : + 15 g/day

• Women Men

• Sedentary work : 1900 2320

• Moderate work : 2230 2730

• Heavy work : 2850 3490

DIETARY HISTORY By 24 hour recall method OR Hospital diet OR Routine diet

• Beverages (Tea/milk/coffee )

• Breakfast

• Lunch

• Dinner

• Snacks, fruits Others (specify )

Calculate: Calories (kcal) / day and Proteins (gms)/day

Calories ( kcal ) Proteins ( gms )

Requirement

Intake

Deficit

Environmental History

• Type of house : kaccha/ pucca

• Type of roof / floor / walls : Made up of mud /cement /stone / tin / thatched

• No. of rooms/ doors/ windows

• Overcrowding: no. of persons per room

• Lighting : well aerated, well lighted or not

• Ventilation : cross ventilation present/ absent,

• Kitchen : type of cooking fuel à LPG / Chulha / Kerosene stove/ Gobar gas/ mixed fuel

• Source of drinking water : Tap / well / hand-pump

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 • Water Supply : continuous (24 hrs/ intermittent ) storage of drinking water: steel utensil, matka

• Drawing water – mug with handle/ without handle

• Method of purification of water: boiling/straining/disinfection/UVR/filtration

• Storage of perishable & non-perishable foods

• Presence of separate latrine & bathroom: if yes, type of latrine ;

• if no, open air defecation – at what distance from the house

• Drainage : liquid drainage and solid drainage

• Garbage collection :

• Pet animal : in c/o dogs à immunized/not

• Insect / Rodent Nuisance

• Courtyard of house : surroundings clean/not

• Peri-domestic collection of water

• Personal hygiene /community hygiene

Treatment history

• From records

General Examination

• Patient is ----obese/moderately/average built/ thin, well-nourished, conscious, cooperative, well

oriented with time, place and person , comfortably lying /sitting in bed

• Patient is febrile / afebrile

• Height : Weight :

• Pulse :---/min rate, rhythm, volume, character, peripheral pulses

• Resp. Rate : ---/min , regular / Irregular, thoraco-abdominal / abdominal

• B.P -----mmHg------right/left arm in ----- position

Pallor / JVP / Clubbing / Icterus / Edema / Cyanosis / Lymphadenopathy etc,

Obstetrical examination

• Inspection:

• Skin condition of abdomen : Linea nigra, striae gravidarum

• Presence of any scar marks (previous LSCS)

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 • Palpation

• Abdominal girth

• Symphysio-fundal height

• Height of fundus: whether corresponds to gestational age

• Palpation of foetal parts (lateral palpation)

• Grips : fundal & pelvic

• Auscultation

• FHS (FOETAL HEART SOUNDS)

Systemic Examination
• Cardiovascular
• Respiratory
• Gastrointestinal
• Genitourinary
• Neurologic / Psychiatric
• Musculoskeletal
• Skin / Breast
• Eyes / Ears / Nose / Mouth / Throat
• Allergic / Immunologic /Lymphatic / Endocrine

• Laboratory investigations adviced / done Ist thing : Pregnancy detection

1. Blood for HB gm% 6. Sickling test

2. Urine: albumin, sugar, microscopy 7. RDT for malaria

3. Blood grouping & Rh typing 8. Hepatitis B surface antigen test

4. VDRL

5. Elisa – HIV / AIDS

Any special investigations if any (USG/CBC/Stool exam/LFT/KFT-------)

Provisional diagnosis

E.g. ANC patient -------weeks of gestation with / without any risk with / without medical
health problems

• Services provided

Preventive services : Health education, TT immunization

• IFA, calcium tablets/ vitamin with dose & duration

• Advice to be given

11
 PNC / LACTATING MOTHER
• A --- year old female patient by name ----------residing at -------, -----by religion, ----by caste,
educated up to----, ----by occupation, was admitted through OPD/Casualty in ward no. ----- bed
no. on-----at-----am/pm. A ---------- duration of PNC delivered a M/F baby on date _________by
FTND or LSCS ---------

• Chief complaints (mother as well as baby)

• HOPI :

• Negative history :

• ANTENATAL HISTORY

• No. of ANC visits throughout pregnancy

• Any complications during pregnancy – high risk/normal

• H /o TT immunization, IFA tablets

• Any investigations (routine/special)

• Any drugs received : doses & duration

INTRANATAL HISTORY

• Any complication :

Excessive bleeding / delayed 2nd stage / foetal distress / maternal distress / cord prolapse

• Type of delivery : normal / abnormal; if abnormal à indication

• Whether delivery conducted at Home/ institution

• If at home, whether by trained / untrained person

• Maturity : full term / preterm / post-term

• H /o birth trauma, asphyxia, delayed labour

POST-NATAL HISTORY

Baby cried immediately after birth or not

If not ….specify the reason

• Any significant events in post-natal period

• Birth weight

12
 e.g any congenital defects / any infection / feeding problems, Breast problems / time of
establishment of breast feeding <2hrs, 2- 6hrs, 6 - 12hrs, >12hrs

Colostrum : directly fed / expressed & fed / expressed & discarded / not fed

Frequency of feeding : on demand / time OR schedule:

Immunization History: verify records BCG OPV hepatitis B

Complications in mother:

H/o High grade fever

• H/o Abnormal discharge P/V or Abnormal bleeding P/V

• Pain / tenderness in lower abdomen

• Changes in colour, amount, odour of lochia

• Dysuria, frequency of micturition

• Signs of mastitis

• Prolapse, sub involution / retroverted uterus

• Menstrual history

• Age at menarche, Age at marriage, Age of 1st confinement , previous menstrual cycles: duration,
amount of blood flow, regular/irregular, passage of clots

Past Medical / Surgical History

• Past H/o Medical / Psychiatric Illnesses

• 1. Diabetes

• 2. Hypertension

• 3. Tuberculosis

• 4. COPD (Bronchial asthma, Chronic bronchitis, bronchiectesis, emphysema)

• 5. STD/HIV AIDS

• 6. Jaundice, Depression

• H/o Allergies and Reactions to Drugs

• Current Medications (Including "Over-the-Counter")

Surgeries /Injuries /Hospitalizations / (Apendicectomy, Car Accident, etc.) Blood transfusions

Family History

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 • Type of family: Nuclear, Joint, Three generation

• No. of Family members:

• Family composition:

• Similar complaints / illnesses in the Family or other major illnesses/hereditary diseases e.g. TB,
DM, HT, IHD, cancers, genetic disorders

Personal History

 Addictions - Alcohol, smoking, tobacco, Other drugs etc,… (duration, quantity, frequency)

 Sleep and Rest

 Bowel and Bladder habits

 Diet : Vegeterian / Mixed

 H/o Contraceptive practice in (OC pills, i pill, IUCD) prior to pregnancy

Physical activity

• Mild activity : e.g. Managers, executives, officers

• Moderate activity : e.g. Housewives looking after grown-up children, tailors

• Heavy activity : e.g. Housewives looking after small children, laborers, farmers, rickshaw-pullers

SOCIO-ECONOMIC HISTORY : use Modified Kuppuswamy or Prasad scale

Social history / Psychosocial history :

Additional calories and proteins required during Lactation

Calories : 0 - 6 months à + 600 kcal /day 6 -12 months à +520 kcal/day

Proteins : 0 – 6 months à + 25 gms / day 6 – 12 months à + 18 gms/day

DIETARY HISTORY By 24 hour recall method OR Hospital diet OR Routine diet

• Beverages (Tea/milk/coffee )

• Breakfast

• Lunch

• Dinner

• Snacks, fruits Others (specify )

Calculate: Calories (kcal) / day and Proteins (gms)/day

14
 Calories ( kcal ) Proteins ( gms )
Requirement

Intake

Deficit

Environmental History

• Type of house : kaccha/ pucca

• Type of roof / floor / walls : Made up of mud /cement /stone / tin / thatched

• No. of rooms/ doors/ windows

• Overcrowding: no. of persons per room

• Lighting : well aerated, well lighted or not

• Ventilation : cross ventilation present/ absent,

• Kitchen : type of cooking fuel à LPG / Chulha / Kerosene stove/ Gobar gas/ mixed fuel

• Source of drinking water : Tap / well / hand-pump

• Water Supply : continuous (24 hrs/ intermittent ) storage of drinking water: steel utensil, matka

• Drawing water – mug with handle/ without handle

• Method of purification of water: boiling/straining/disinfection/UVR/filtration

• Storage of perishable & non-perishable foods

• Presence of separate latrine & bathroom: if yes, type of latrine ;

• if no, open air defecation – at what distance from the house

• Drainage : liquid drainage and solid drainage

• Garbage collection :

• Pet animal : in c/o dogs à immunized/not

• Insect / Rodent Nuisance

• Courtyard of house : surroundings clean/not

• Peri-domestic collection of water

• Personal hygiene /community hygiene

Treatment history: From records

15
 Examination of PNC Mother

General Examination

• Patient is ----obese/moderately/average built/ thin, well-nourished, conscious, cooperative, well

oriented with time, place and person , comfortably lying /sitting in bed

• Patient is febrile / afebrile

• Height : Weight :

• Pulse :---/min rate, rhythm, volume, character, peripheral pulses

• Resp. Rate : ---/min , regular / Irregular, thoraco-abdominal / abdominal

• B.P -----mmHg------right/left arm in ----- position

Pallor / JVP / Clubbing / Icterus / Edema / Cyanosis / Lymphadenopathy etc,

• Breast ,, :

• Systemic ,, : RS, CVS, CNS, --------------

• Scars of LSCS, Episiotomy wound à healed/not

• Vaginal discharge : no. of pads soaked / day

• Lochia à Type, colour, odour, amount, frequency

• Uterine involution

EXAMINATION OF NEWBORN

• Anthropometry

• Weight (kg), Length (cm), Head circumference

• Mid arm circumference - MAC (cm) Chest ,,

General appearance, hair, face, eyes, lips, tongue, teeth, gums, skin, nails

• Any signs of prematurity

• Any congenital malformations / disorders

• Reflexes : Moro’s reflex, sucking reflex, rooting reflex, Glabellar reflex, grasping reflex

• Developmental milestones :

• Motor, Language, Adaptive & Social milestones

• Recognizes mother, Social smile --------etc

• Systemic examination: RS, CVS, CNS,-----------

16
• Examination for BCG scar :

• Probable diagnosis ---------- days old PNC mother delivered normally / LSCS , Fullterm / Preterm /
LBW, Live / stillbirth with ---- complications if any
• Investigations done / Advised :

• Advice to be given:

• Preventive & control measures:

HEALTH RECORD FOR UNDER 5

• Name of Informant (Mother / Father/ Guardian), Literacy status of Father, Mother:

• A --- year old male/female child by name ----------residing at -------, -----by religion, ----by caste,
studying in playgroup/anganwadi/prenursery---- was admitted through OPD/Casualty in ward
no. ----- bed no. on-----at-----am/pm with

• Chief complaints of ------

• HOPI

• Negative history

• Past medical / surgical history :

• H/o similar complaints in the past

• Repeated h/o Diarrhea / ARI, h/o Pica , worm infestation, ( h/o passage of worms in stools )
H/o childhood illnesses  measles, chickenpox, pneumonia ( ARI ), hepatitis, TB, Poliomyelitis
------------ Prolonged drug intake / others

• H/o hospitalization, Surgeries, falls, accidents, blood transfusions etc

• H/o allergies and reactions to drugs

• Family history:

• Type of family: Nuclear, Joint, Three generation

• No. of Family members:

• Family composition:

• Similar complaints / illnesses in the Family or other major illnesses/hereditary diseases e.g. TB,
DM, HT, IHD, cancers, genetic disorders

• No. of siblings, presence of hereditary diseases, TB, DM, others

Family History

17
 • Type of family: Nuclear, Joint, Three generation

• No. of Family members:

• Family composition:

• Similar complaints / illnesses in the Family or other major illnesses/hereditary diseases e.g. TB,
DM, HT, IHD, cancers, genetic disorders

Personal History

 Addictions - Alcohol, smoking, tobacco, Other drugs etc,… (duration, quantity, frequency)

 Sleep and Rest

 Bowel and Bladder habits

 Diet : Vegeterian / Mixed

SOCIO-ECONOMIC HISTORY : use Modified Kuppuswamy or Prasad scale

Social history / Psychosocial history :

• Antenatal history :

• No. of ANC visits throughout pregnancy

• Any complication during pregnancy

• TT received : yes/no; if yes, dose

Drug received: doses & duration

INTRANATAL HISTORY

• Any complication :

Excessive bleeding / delayed second stage / foetal distress / maternal distress / cord prolapse /
any other

Delivery conducted at home/ institution

If at home, whether by trained/untrained person

Type of delivery: normal/ abnormal (LSCS/FORCEP)

• Maturity : full term / preterm

• h/o birth trauma / with asphyxia

• POST- NATAL HISTORY

• Post natal period : eventful / uneventful

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 • If eventful , then

• 1. congenital defect : if yes ; type

• Any infection Feeding problem

• If yes, cause . . . . .

• If no, time of establishment of breast feeding

<2 hrs, 2 - 6 hrs, 6 - 12 hrs, >12 hrs

• Colustrum: directly fed / expressed & fed / expressed & discarded / not fed

• Frequency of feeding : on demand / time schedule

• Growth Monitoring done: yes/ no if yes – whether confirmed from Growth chart

• Frequency _______;

Immunisation History : verify dates; write dates when received

BCG: Scar mark present or not OPV 0: Hepatitis B 1 2 3 4

DPT 1 DPT 2 DPT 3

OPV 1 OPV 2 DPT 3

Measles + Vit A ( 1 lac IU )

DPT b + OPV b + Vit A ( 2 lac IU ) DPT (5-6 years)

No of vitamin A administered :

Any other vaccine received (under 5 children): Rotavirus /MMR / HiB / PCV / Varicella /
Meningococcal + Pulse polio immmunisation (PPI)

Developmental history :Milestones

Age at which various motor, language, adaptive, social milestones have been achieved.

• Period of infancy : any significant events

• Pre-school age: ,,

• Diet history : consumed during last 24 hrs

• Beverages, Breakfast, Lunch, Dinner, Others (specify)

Calculate: calories & Proteins gms / day & deficit Calories , Proteins

Calories ( kcal ) Proteins ( gms )

Requirement

19
Intake

Deficit

 For 1st 10 kg - 100 kcal / kg/day

 For 2nd 10 kg - 50 kcal / kg/day

 Then for every next 10 kg 25 kcal ,,

Environmental History

• Type of house : kaccha/ pucca

• Type of roof / floor / walls : Made up of mud /cement /stone / tin / thatched

• No. of rooms/ doors/ windows

• Overcrowding: no. of persons per room

• Lighting : well aerated, well lighted or not

• Ventilation : cross ventilation present/ absent,

• Kitchen : type of cooking fuel à LPG / Chulha / Kerosene stove/ Gobar gas/ mixed fuel

• Source of drinking water : Tap / well / hand-pump

• Water Supply : continuous (24 hrs/ intermittent ) storage of drinking water: steel utensil, matka

• Drawing water – mug with handle/ without handle

• Method of purification of water: boiling/straining/disinfection/UVR/filtration

• Storage of perishable & non-perishable foods

• Presence of separate latrine & bathroom: if yes, type of latrine ;

• if no, open air defecation – at what distance from the house

• Drainage : liquid drainage and solid drainage

• Garbage collection :

• Pet animal : in c/o dogs à immunized/not

• Insect / Rodent Nuisance

• Courtyard of house : surroundings clean/not

• Peri-domestic collection of water

20
• Personal hygiene /community hygiene

Treatment history: From records

Examination of under 5

• General appearance : normal built / thin built / poorly built

• Hair : normal / lack of luster / depigmented thin & sparse / easily pluckable / flag sign

• Face : diffuse pigmented / nasolabial dyssebecia / moon face/ hypopigmented patch

• Eyes : conjunctiva – normal / dry on exposure for ½ min / dry & wrinkled / bitot’s spots / brown
pigmentation / angular conjunctivitis / pale conjunctiva. Cornea - normal / dry / hazy & opaque

• Lips : normal / angular stomatitis / cheilosis.

• Tongue : normal / pale & flabby / red & raw fissured / geographic

• Teeth : eruption of teeth /mottled enamel / carries / attrition

• Gums : normal / spongy / bleeding

• Skin : Normal / dry & scaly / follicular hyperkeratosis / petechiae / pellagrous dermatosis / flaky
paint dermatosis / scrotal & vulval dermatosis.

• Nails : nail hygeine koilonychia

• Oedema : in dependent parts

• Rachitic changes : knock knees / bow legs / epiphyseal enlargement / pigeon chest

• Reflexes :

• Anthropometry :

• Wt (kg), Length / Height (cm), HC (cm)

• MAC (cm) CC (cm)

• Internal system : RS , CVS , CNS , P/A

• Provisional diagnosis :

• Lab investigations : Hb , stool , . . .

• Advice & Preventive & Control measures:

• Positive findings:

Weight

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 • At Birth : 3 kg

• Weight gain in 0-3monthsà 800-900 gm/month ( 30gm/day)

• 4 months – 1year à 40 gm/month

• Doubles  6 months - 6 kg

• 3 times  1 year - 9 kg

• 4 times  2 years - 12 kg

• 5 times  3 years - 15 kg

• 6 times 5 years - 18 kg

• 10 times 10 years - 30 kg

• 3 months to 12 months – (Age in months + 9 )/2

• 2 (age in years ) + 8 à 1- 6 yrs
• 3 (age in years ) à 7-12 yrs
Length

• At Birth : 50 cm
• 3 months : 60 cm
• 6 months : 65 cm
• 9 months : 70 cm
• 1 year : 75 cm
• 2 years : 90 cm
• Thereafter ↑es by 5 cm every year till the age of 10 years
• length (cm) = 6 (age in years) + 77
 2 - 12 years

Mid upper arm circumference

• At Birth : 10 cm
• 1 year : 16 cm
• 5 years : 17 cm
• Remains constant between 1-4 yrs
Head circumference
• At Birth : 35 cm
• 3 months : 40 cm
• 6 months : 43 cm
• 1 year : 45 cm
• 2 years : 48 cm
• 3 years : 49 cm
• 5 years : 50 cm
• 7 years : 51 cm
• 12 years : 52 cm
Chest circumference
At Birth : CC < HC
1 year : CC = HC
After 1 year : CC > HC

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 Upper segment-lower segment ratio
• Normal US / LS ratios
• At Birth : 1.7 : 1
• At 3 years : 1.3 : 1
At 7 years : 1 : 1
Thereafter : 1 : 1.1

For PEM / ARI (Under five children)

Anthropometric measurements
Observed Expected
1. Weight W/A
2. Length/Height H/A & W/H
3. MAC
4. Chest circumference
5. Head circumference
6. US: LS ratio

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 ANIMAL BITE CASE
History of animal bite if Dog / Cat; ask whether it is ( Pet / Street / Stray)
Rodents (rat / rabbit / mice)
Wild animals: Pig, Monkey, Jackal, Mongoose, Wolves, Fox, Horse, Tiger, Loin etc ----------
Time of bite / duration since bite
In c/o Cats / Dogs: Type - (Pet / Street / Stray) Provoked / Unprovoked bite
Ask Whether there was any oozing / bleeding from the wound
Whether the patient had applied anything (Chilli powder, turmeric, salt, oil, lime, Raw chewed
rice, Wheat flour, tea/coffee powder, soil, cow dung, herbal products ----------------- any
inanimate substances)
H/o Immunisation against Tetanus / Rabies in the past
H/o Immunisation in animals (Dogs) – If possible, verify from immunisation
card/Record/certificate
- In Children, ask about Primary Immunisation
- In female patients, ask about Pregnancy / Lactation
- In all patients, ask about Steroid intake, radiation therapy, alcoholism, immunocompromised
state, severe malnutrition

General Examination:

Systemic Examination:

Local Examination :

- Anatomical site of bite, No. of bite marks

- Observe wound – type (abrasion, scratch, punctured, Lacerated CLWs ) & presence of redness,
oedema, ulceration etc

Diagnosis : Category ….I / II / III bite by WHO Classification

Treatment:

1. Local Cleaning of the wound: Soap & water, spirit, dettol, savlon…….other disinfectants

2. Inj TT 0.5 ml deep IM over deltoid in adults & over anterolateral aspect in children

3. ARV (CCV) Inj Rabipur (1 ml), Inj Verorab / Abhayrab/ Indirab ( 0.5 ml ), IM on days 0, 3, 7, 14, 28
 post exposure prophylaxis – WHO ESSEN SCHEDULE

Available in ARV OPD  ? Inj abhayrab 0.5 ml

CATEGORY III BITES

In all Category III bites, Immunoglobulin ie Inj Equirab – 40 IU / kg BW (5 ml = 1500 IU)

- If Dog is observable, observe the dog for 10 days & follow up SOS

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Antibiotics: Cap Ampicillin 500 mg qid / T. Septran ; Painkiller ; Antacids

Diabetic diet chart

 Morning – 7 am à 1 cup tea/cofee/milk/lemon water (without sugar/cream) + 1 marie biscuit

 Breakfast – 8.30 am – 3-4 slices wheat bread (Brown bread) / 3 chapati/vegetable/ 1 glass
oats/wheat flakes/broken wheat (dalia)/ 2 katori sprouts/2 katori upma/poha / boiled egg (white) /
soyabean milk plain or skimmed milk

 Madhyanha alpahar – 11am – 1 fruit (100gm) – preferably citrus fruits – oranges, guava, sweet
melon, grapes, awla lemon / 1 glass chash (butter milk) / 2 marie biscuits
 Lunch – 1.30 pm – 4 rotis (fulkas) + 1 katori rice/dalia, 1 katori green veg (less oil)
 1 katori dal /sprout green gram/chana/barbati/moth
 1 katori curd, salad (tomato/cucumber/raddish/cabbage)
 Afternoon breakfast – 4.30 pm: 1 cup tea/cofee/milk/lemon water (without sugar/cream) + 2
marie biscuit / dhokla/khandvi/ 25 gm murmura/chana/popkorn/lahi (rajgira/dhan) chana jor/1 piece
khakra/brown bread/veg sandwhich/ ½ plain rava dhosa/chila/1 pc rava idli sambar
 Evening snacks:1 fruit (100 gm)/ 1 glass chash

 Evening dinner: 8 pm : mix veg soup (without butter/maida/cornfloor) – salad

 4 roti , 1 katori rice/gruel/dalia
 1 katori green veg + 1 katori dal/kadi
 Before sleep – 10 pm – 1 glass milk / 1 fruit (100 gm)
 Water – 10-12 glass daily
 Daily brisk walking 40-50 min
 Cooking oil – 500-750 ml/month
 Methidana powder before 30 min of meal
 Small frequent meal – 3-4 hourly
 Avoid – sweets, vanaspati ghee, red meat, 5 white products (refined rice/flour, white bread, salt,
sugar, sago) No fruit juices (except citrus fruits without sugar) or cold drinks
 Less quantity – refined foods such as Rice, fish, oil, ghee, butter, cheese, potato, arbi, suran,
shalgam, carrot, sweet potato, crystal sugar or trans fatty acids (deep fried foods – 6 Ps puri, pakoda,
paratha, papad, paneer, pizza, etc pedha )
 Coconut water, rice/dal water, lemon water ----- can be consumed lavishly

Name Ingredients Calories Proteins

Hyderabad mix Roasted whole wheat 330/86gm 11.3/86gm

40 gm, Roasted Bengal
gram 16 gm, Roasted
Ground nut 10 gm and
Jaggery 20 gm

Besan mix Bengal gram flour, 500/100gm 9/100gm

wheat flour, jiggery,
ghee(1 part each)

Sooji mix Toned milk 750ml, 1432 28.4

25
 sugar 100 gm, sooji 25
gm, oil 5 gm, water
1000ml

Shakti ahar Roasted wheat 40 gm, 390/100gm 11.4/100gm

roasted gram 20 gm,
roasted peanut 10 gm,
Jaggery 30 gm

Nutritive values in terms of calories and proteins

Preparation Quantity for one Calorie (kcal) Protein (gm.)

serving

Rice 1 cup 170 4

Phulka 1 No 80 2

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Paratha 1 No 150 5

Puri 1 No 100 1

Bread 2 slices 170 4

Poha 1 cup 270 5.8

Upma 1 cup 270 6

Idli 2 No s 150 4

Dosa 1 No 125 2

Khichidi 1 cup 200 8

Plain dhal ½ cup 240 12

Sambhar 1 cup 110 4

Boiled egg 1 no 90 6

Omelette 1 no 160 11

Mutton 8 bits(1 Oz) 50 6

Fish fried 2 big pieces 220 12

Vada 2 no 180 2

Potato bonda 2 no 200 2

Samosa 1 no 200 5

Chikki 2-3pieces 290 8

Tea 1 cup 75 0 to 20.21 g

Coffee 1 cup 110 0

Cow’s milk 1 cup 180 6

Buffalo’s milk 1 cup 320 9

Biscuit 1 No 32 0.4

Vegetable cooked 1 katori 79 2.0

Leafy vegetable 1 katori 80 3.0

Cooked potato 1 katori 142 1.6

Vegetable salad 1 plate 25 2.0

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Mutton curry 1 plate 266 18.5

Chicken/ fish curry 1 plate 177 25.1

Paneer 11/2 cube 85 6.1

Reference: Parke’s Textbook of Preventive and Social Medicine, Elizabeth KE Nutrition and Child
Development, j Kishore, practical and viva for community medicine.

Antenatal period : 280 days

From the date of conception till the onset of true labour pains, approx. 280 days

Distribution of weight gain:

Foetus weight : 30%
Placenta : 6%
Liquor amni : 8%
Increase in blood volume : 13%
Increase in body fluids : 13%
Accumulation of fat : 30%

Historical significance of Malaria in India

For the first time, Dr Ronald Ross in 1897 discovered oocyte in d stomach wall of anopheles mosquito

5 most economic countries where leprosy is still prevalent are

India
Brazil
Madagascar
Mozambique
Nepal

Leprosy rehabilitation
Cycle /scooter repair…………………

Filarial : derived from d word Filum means thread

HTN & DM r sister concern diseases

1978: WHO emphasized d importance of HTN as Down with high blood pressure
Occupation prone to HTN
Doctors/Engineers/Advocates/Bank Employees/Active Politicians/Businessman/Drivers

Great people who were blind :

Surdas (Great singer & composer)
Ravindra Jain (Musician)
Helen Keller (Great Social worker & Reformer)
Dhutarsahtra
Louis Braillie (Discovered alphabets for the blind)

Sonawala loop
Dr Sonawala in d year 1972 got Graffenburg award for d discovery of this loo. It is a renovated device &
was not accepted for a long time with its side effects.
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C/I of cu T : anaemia Hb < 10 g
Current use of IUD in India is only 1.8 %

Maize/corn/bhutta ranks next to rice & wheat in world.

DEC / Hetrazen :

Cypermethrin: synthetic pyretroid

Quinal phos : insecticide kills mites & bugs that infect cotton plants & paddy

Paris green: king green/ Vienna green / schweinfenth green

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