Practical Guide Book Family Health Care

Family Health Care
A Practical Guide Book
Professor A. B. Biswas, MD(SPM)

Professor
Department of Community Medicine
&
Professor Dr. (Mrs) J. Mitra, DCH, MD(SPM)
Former Director of Medical Education
Govt. of West Bengal
Department of Community Medicine

R G Kar Medical College
Kolkata
2016
Family Health Care
Completion Certificate
This is to certify that Mr. /Ms. ___________________________
has completed his/ her family health care services
satisfactorily/unsatisfactorily.
Dated _______________________
Signature of Signature of
Teacher in Charge Head of the Department
Community Medicine
Name of the Student: Batch:
University Roll No:

Go in search o your people;
Love them;
Learn from them;
Plan with them;
Serve them;
Begin with what they have;
Build on what they know;
But of the best leaders
When their task is accomplished
Their work is done,
The people all remark
“We have done it ourselves’’
………………….a Chinese proverb

First edition, 1999
Second edition, 2001
Third edition, 2004
Fourth edition, 2007
Fifth edition, 2012
Sixth edition, 2013
Seventh edition, 2014
Revised eighth edition, 2016

Our heartfelt thanks to:
Prof. A. B. Mukherjee DPH, MD
Prof. (Dr.) G.K. Joardar DTMH, MD
Dr. (Mrs.) S. Nandy DCH, MD
Prof. (Dr.) R. N. Misra DTMH, MD
Dr. P. K. Mandal MD
Dr. R. N. Ray MD
Dr. (Mrs.) K. Mitra DCH, MD
Prof. (Dr.) D. K. Das MD
Dr. S. Mukhopadhyay DPH, MD
Dr. (Mrs.) B. Bandyopadhyay DCH, MD
Dr. S. Ray MBBS, DO
Dr. (Mrs.) R. Biswas MD
Dr. (Mrs.) D. Haldar MBBS
Prof. (Dr.) G. N. Sarkar MD
Dr. (Mrs.) P. Srivastava MD
Dr. (Mrs.) M. Saha MBBS, DO
Dr. I. Saha MD
Dr. A. Chakrovarty MBBS ,DMCW
Dr. (Mrs.) A Bhattacharyya MBBS
Dr. (Smt.) S. Nath MBBS
For their constructive criticism and support

Revision suggested by
All past and present faculty members of department of Community Medicine,
R G Kar Medical college.
Special thanks goes to all the past and present students of this department,
specially Mr. Krishanu Mukhoti, Mr. Abhishek Jaiswal and Miss Shefali Kumari for
their help in the preparation of the draft.
Preface to forth edition
The teaching of community medicine to undergraduate students has

acquired many dimensions during the years and is expanding in practical
manner. In the true sense a student is expected to gain some knowledge
and develop some skill during the process of learning the subject. The
teaching in community medicine has delineated by Medical council of India is
aimed at developing medical graduate with adequate knowledge of human
biology and laboratory sciences as well as competence in basic diagnosis and
management of illness. He must also have the knowledge attitude and skill
necessary to prevent illness and promote health. In order to fulfill these
goals training in Community medicine mainly takes the form of Community
Posting of undergraduate medical students in different phases of their MBBS
course. This community exposure of the students will provide them with
practical experience in working in the community with families; to
understand the demographic, socio economic and environmental aspects of
community health; to appreciate the need of the community and to respond
and guide the people in a correct direction. The responsibility as a team
leader will be instilled in him.
This practical book is a modest endeavor to help students during their

community posting. The warm response of students and constructive
criticisms from teachers prompted us to bring out a third edition with
changes we hope will benefit the students, not only during their training
period but also later on as basic doctor.
This book has seen the light of the day only because of the silent
encouragement and help of late professor B N Ghosh, Ex-Director All India
Institute of Hygiene And Public Health, Kolkata. Sincere acknowledgement
are also due to Dr Avijit Hazra, lecturer, Institute and Post graduate Medical
Education And Research, Kolkata and Mr Susanta Roy of Community
Development Medicinal Unit Documentation Center, Kolkata for their
endeavor in designing and DTP work.
J Mitra
A B Biswas
Contents
Lesson 1 Introduction
1-3
Lesson 2 Know your Community
4-15
Lesson 3 Study of socioeconomic characteristics of the family
16-26
Lesson 4 Study of Environment and Housing of the Family
27-32
Lesson 5 Family’s Knowledge and practice on health and
utilization of health services 33-35
Lesson 6 Nutritional profile of the family
36-48
Lesson 7 Health Status of the Under fives
49-58
Lesson 8 Antenatal/natal/postnatal care
59-63
Lesson 9 Health Checkup of Individual Family members
64-69
Lesson 10 Medico social Diagnosis, Actions taken and
Recommendations 70-75
Instruction during family visit
 It is necessary to be decently clad and wear your apron when visiting the community.
 In the first visit introduce yourself to the family allotted to you.
 Behave politely and modestly. Be friendly to the community.
 Never ridicule or show displeasure at any condition.
 Never make false promises to the family members to get your work done.
 In case of difficulty and non co-operation, consult your guide immediately.
 Always carry stethoscope, hammer, torch, measuring tape, weighing machine,
sphygmomanometer etc with you while you are on field.
 Conduct the clinical examination in a room/enclosure that allows privacy
 Record all findings accurately
 Do not do something that is completely alien to the local environment or culture.
 Give them as much information about your services as they ask for and allow them to
express their views about their services.
 It is you who is learning from the community, respect the knowledge and experience
that people have.
If you need any clarification, do not hesitate to consult the teachers.

Family Health Care: Practical Guide
Lesson 1.Introduction
1.1 Community
What is a community?
Community implies a group of people with common characteristics or interests living together within
a larger society. A community may have its own customs, traditions, leaders, or even language.
Examples of a community include a village, a tribe, an urban slum, a religious group etc like big or
small hospitals.
Community is defined as “a group of people who occupy a well defined geographical area, who have
common interests and needs, common pattern of socio-economic relationships, have a bond of
solidarity from the conditions of their abode, have a constellation and subject to some degree of grasp
control.” (Brig. S. Lal)
What is an urban community?
A community is called ‘urban’ if
 It’s population is above 5000

 At least 75 percent of male population is engaged in non-agriculture occupation
 It’s population density is at least 400 persons per square kilometer
Urban slum
A slum is defined as a heavily populated informal urban residential areas where dwellings are unfit
for human habitation due to dilapidation,overcrowding,faulty arragements and design of such
building, narrowness or faulty arrangement of streets, inadequate ventilation,lighting ,drinking water
or sanitation facilities or any combination of these factors which are detrimental for safey and health.
1.2 Community medicine
It is the study of health and disease in the population of a defined community or group. Its goal is to
identify health problems and needs of the defined population and to plan, implement and evaluate
the extent to which health measures effectively meet these needs.
It is defined as “ that specialty which deals with populations, comprises those doctors, who try to
measure the need of population, both seek and well, those who plan and administer services for the
control of health problems, and who are engaged in research and teaching in the field.”(K Park).
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In community medicine:
We treat:
 COMMUNITY AS WARD
 FAMILY AS BED
 INDIVIDUALS AS BENEFICIARIES
1.3 Why to teach in the community and not in ‘disease palaces’
The concepts and practice of community medicine deal with groups of population comprising both
sick as well as healthy individuals living in a defined community, and not merely those who are sick
and reporting to hospitals for their illnesses.
In community medicine, responsibility of prevention and cure of common endemic diseases is not
confined only to doctors; instead it should be discharged at every level i.e. at individual, family and
community levels.
The patient and community should be evaluated in real-life situation in search of multiple factors of
disease causation i.e. agent, host and environment factors.
What we see in hospitals is just an episode of the natural history of disease. Only through field visit
and community exposure we can explore ‘who’ gets sick, ‘with what’, ‘where’, ‘when’ and ‘why’. We
can also look at ‘what’ health services exist there, ‘for whom’, ‘where’, ‘when’ and ‘how much’.
Good health care also requires home visits. The education of doctors and health workers is not
complete without home visits, which are not possible in hospitals.
Hospitals provide fragmented, crisis-to-crisis care, whereas patients need continuous and
comprehensive care which can only be provided by a community physician or a family practitioner in
the community.
Family health care program in the community will provide exposure and experience of patient care in
family settings, needed by the present undergraduate medical students to make them technically
competent as well as socially motivated physicians.
1.4 Family practice
 Identification of earliest deviation or departure from normal health.

 Identification of the underlying causes, if any.
 Institution of remedial interventions for their correction.
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1.5 Family physician
He provides comprehensive and continuous primary health care to all members of the family.
Roles and main function of a family physician
A. Patient care role

 Comprehensive health care
 Primary health care
 Continuous care(‘womb to tomb’)
 Referral services
 First aid
 Medico-legal services
B. Coordinating role
Between patients and their families with hospital specialists to whom the patient is
referred for specific care, as well as with all community agencies, welfare agencies,
national health programs, developemental programs,etc
C. Community care
Identify problems and felt needs of community and take necessary actions,in order to
equip the community so that they can demand and utilize appropriate health and allied
interventions like water supply, sanitation, nutrition, reproductive and child health
services , etc.
1.6 Objectives of Community Diagnosis
During field posting in the community, the student will act as family physician to the allotted families
under supervision of the faculties of Community Medicine. Therefore, the present family health care
program in the community will be undertaken with the following broad objectives:
 To help students to make a community diagnosis.

 To learn the factors (like demographic, socioeconomic, environmental, cultural, etc.) which
contribute to or have influenced on health and nutrition status as well as health practices.
 To learn the management of patients in the family environment, within the available health
resources.
 To provide students with requisite experience of delivering comprehensive primary health
care to the family and to the community.
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Lesson 2: Know your community

2.1 Why should we know the community?
The basic idea is to familiarise oneself with the people to know their problems and to help them. In
order to help a community we must know what are its ‘actual needs’ (community’s needs as
perceived by service providers) and what are its ‘felt needs’ (community’s needs as perceived by
them). The things a community wants or thinks of as its needs (‘felt needs’) may not always be same
as the things that are really necessary to make a positive impact on all aspects of life (‘actual needs’).
If we do not know the hopes, desires and aspirations of the community, it may be difficult to help the
people. When both ‘felt needs’ and ‘actual needs’ synchronize and get satisfied, the program
becomes successful. The only way to identify the felt needs of the community is to interact with its
members, solicit their views and listen to them in order to collect valuable information.
If people are involved in planning and evaluating health services, they will know how the services will
help them. So they will be more interested in using them and will give support to improve and
maintain them. They should feel that it is their program rather than the government or health
workers’ program.
2.2 Learning objectives
After going through this lesson you should be able to:
 Understand the concept and process of community diagnosis and community

treatment.
 List and collect information necessary for making community diagnosis.
 List various sources from which information can be collected.
 Prepare a map of the locality.
 Identify the problems of the community.
2.3 Understanding community diagnosis
Community health encompasses the entire range of community organized effort for maintaining,
protecting, and improving the health of the people.
The diagnosis of disease in an individual patient is a fundamental idea in medicine. It is based on

recognizing symptoms and signs and making inferences from them. When applied to the community,
the signs and symptoms become a process of assessment and analysis of community’s problems and
disease patterns and their various influencing factors. This is known as community diagnosis.
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In community health, the entire community is considered as ‘patient’ requiring community diagnosis
and community treatment. Therefore community diagnosis is based on collection and interpretation
of relevant data.
2.4 Method of collection of information from the community and types of information to be
collected:
1. Talking with community decision makers, community members, health and health related
personnels working in the community. Decision makers are not only people who make formal
decisions (such as legislative or political leaders) but also those who have influence in the family and
are able to encourage the community to support health services. This can include people like village
leaders, religious leaders, teachers, traditional leaders or organized groups like women’s groups,
clubs etc.
2. Visit to community to observe the environmental situation.
3. Formal community and sample surveys and scrutiny of health service records
4. Transect walk: Exploratory walk undertaken by the team along with local community members to
observe, discuss and understand local matters with them. The drainage and sanitation, location of
drinking water taps will be observed. Exposure to social lifes like culture, customs, religion, health
behavior etc will be also be possible. In addition habits, behavior and interaction between various
castes and economic groups can be observed.
Transects are used as a prerequisite for preparing a map of the locality showing layout of the area,
drainage housing, backyards, infrastructures such as school, health posts, shops, Anganwadi centres,
wells, etc. Zones and areas which need to be further developed can be identified.
Types of information to be collected:
Basically two types of information, quantitative (e.g. weight, height, number of children immunized)
and qualitative (e.g. how do you feel about immunization programme), can be collected regarding
• Demographic characteristics
• Morbidity and mortality
• Socioeconomic factors
• Physical environment factors
• Available resources and utilization of health services
• Health problems felt by the community
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2.6 Schedule for obtaining basic background information about the community
2.6.1 Geographical characteristics:
 Name of the locality:_____________________ Urban/ Rural
 Geographical location: ______________________

[Prepare and attach a map of the area.]
 Total area: _____________square km.
2.6.2 Demographic characteristics:
 Total population: ________________

 Total number of families:__________
 Average family member:_____________
 Density of the population:________________
 Total number of families on the basis of:
a. Religion:____________________
b. Caste:___________________
c. Language:__________________
 Population distribution according to age and sex:
Age( in years) Male Female Total

<1
1-4
5-14
15-44
45-59
>60
TOTAL
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Age Pyramid of community:
 Sex Ratio:
 Education (Sex-wise, literate and illiterate)
 Occupation (major occupation, unemployment, etc)
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Map of the area
Page 8
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2.6.3 Morbidity and mortality data:
[Use health care providers’ records/survey records, etc. Also discuss with community leaders
and member to identify why beneficiaries are not using preventive services to the extent they
should.]
 Number of live births in last 1 year:

 Common place of delivery:
 Number of deaths in last 1 year:
Number Causes
Infant deaths
Maternal deaths
Other deaths
 Common morbid conditions and nutritional deficiency disorders:
 Utilization of preventive services:

a. Immunization coverage
b. Growth monitoring
c. Supplementary nutrition
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d. Antenatal coverage
e. Family planning practices
2.6.4 Environmental characteristics:
 Type of house : Pucca / Kuchha / mixed
 Sources of drinking water: Tap / Tube well / Open well / Pond
 Toilet facilities: Open / Community latrines / Private latrines
 Refuse disposal:
 Common method of disposal of the kitchen waste
 Collection and removal of liquid waste and drainage facilities
2.6.5 Available resources:
 Organizations (names of youth club, mahila mandal,etc )
 Educational and Health Facilities (like school, college, health centre, AWC,
Polyclinic)
 Recreational Facilities (like playground, children parks, library, community hall, etc)
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2.6.6 Substance abuse:
What are the common addictions in the community:
Smoking / Chewing tobacco ( khaini, jarda ,etc.) / Alcohol / Ganja / Drugs
Others (specify):
2.6.7 Health problems as felt by the community:
[Discuss with community decision makers and members and comment on the following]
 What population group (children, adult workers, etc.) are of greatest concern and why
 What specific health problems are of most concern and why
 What are the other health related concerns of the community
Service is not available in certain areas / Clinic hours are inconvenient to some people /
Community would like to have other additional services or manpower / others (specify)
 How community feels about health services that are currently available
(Include also perception about other government and private health services available in the
area)
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2.6.7 Identify the salient findings of the community, after reviewing all the information available
under different headings
[Group the problems under different headings e.g. communicable disease problem, nutritional
problem, environmental sanitation problem, medical care problem, population problem, etc. ]
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2.8 Methodology of family study
During field posting in the community, the student will act as family physician to the allotted
families under supervision of the faculties of Community Medicine. Therefore, the present family
health care program in the community will be undertaken with the following objectives.
2.8.1 Objectives
General Objective:
To make a medico-social diagnosis of family and provide requisite experience of delivering

comprehensive primary health care to the family and to the community.
Specific Objectives:
 To assess the various factors (demographic, socioeconomic, cultural, environmental) of the

family which contribute to or have influence on health and nutrition status as well as health
practices
 To assess the health status (physical, nutritional) and health related behaviors of the
individual family members
 To learn the management of patients in family environment, within the available health
resources
2.8.2 Study area:
2.8. 3 Duration of study:
2.8.4 Unit of Study: Allotted family in the Baghbazar Slum area.
2.8.5 Study design: This is an observational study. There are some data that are collected at a
particular point of time and some data that are collected longitudinally like weight of the baby.
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2.8.6 Study Technique, Variable and Source:
Study Variable Method of collection Source of data

General family background Interview Head of Family/wife of head
Socio-economic conditions, Social of the family
Problems,
Knowledge & Practice regarding
various diseases and health
Housing and environmental Observation, Interview Head of Family, The house
assessment and its neighborhood
Nutritional Status Interview, Observation, Diet survey, examination of

Measurement individual Family Members
Physical Examination Interview, observation, Examination of individual

palpation, percussion, Family Members
auscultation
Immunization, Antenatal and Record Review OPD Tickets, Folder
Postnatal care practices maintained in UTC,
Discharge certificates,MCPC
card
2.8.7 Tools used:
 A predesigned pretested schedule developed by the department of Community Medicine

 ‘Nutritive Value of Indian Foods’ published by National Institute of Nutrition, Hyderabad
 Iodine testing kit
 Clinical Instruments : Non elastic measuring tapes, infantometer, Salter’s weighing machine,
Adult weighing machine, Sphygmomanometer, Torchlight, Stethoscope, hammer.
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Lesson 3: Study of socioeconomic characteristics of

the family
3.1 Introduction
Members in the community are differentiated by certain characteristics they possess such as:
 Personal characteristics like sex, marital status, etc.

 Educational characteristics like literacy, etc.
 Economic characteristics like occupation, income type of activity, etc.
 Cultural characteristics like language, religion, caste , etc.
Each of these characteristics is important as they determine the functioning of the community in
normal and stressful situations. In this regard, family size and composition as well as their
socioeconomic status are equally important as the response of the family largely depends on these.
Thus they are related with social classification and differentiation which may directly influence- (a)
Health status (b) nutritional status (c) utilization of health services (d) sociocultural pattern of living
i.e. details of daily living.
What is Family?
Family is the basic unit of the society. So, in order to promote health and healthful behavior at this
basic level, it is important to consider family structure as well as characteristics related to
socioeconomic status of the family.
Family is the most important social unit in the community and is also the unit of which medical social
services are being provided. Household differs from the family in that all the members may not be
blood related e.g. servants.
It is defined as “Group of people living together who are biologically related or by marriage or by
adoption and sharing a common kitchen.”
 Biologically :it shares a pool of gene

 Culturally : it reflects the culture of the wider society of which it is part.
 Socially : it shares a common physical and social environment
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Role of the family in health and disease
No scientific practice towards an individual is complete without the knowledge of his /her family.
Composition and the structure of the family, its cultural and socioeconomic aspects, environmental
conditions, etc.,all play an important role in both health and disease, in the prevention and treatment
of individual illness, in the care of children and dependent adults, stabilization of the personality of
both adults and children and in rehabilitation of its members in case of problems and broken
relations in the community.
Similarly , no family practice can be meaningfully carried out without community background of the
health and disease problem.
In short, the approach to individual beneficiaries as is shown in the traditional method of practice of
medicine must be supplemented by the approach of the social medicine with the family as bed and
community as ward.
3.2 Learning Objectives:
At the end of this lesson you should be able to:
1. To understand the social and economic support system in the family and the important
variables related to socio-economic status.
2. To collect information regarding these variables.
3. To comprehend the classification of and identify the social class to which it belongs.
3.3 Guidelines for filling up the schedule for assessing socio-economic status of the family:
Identification Particulars:
a. Head of the family: A person who is the principal earning member and decision maker of the
family.
b. Type of family:
Nuclear: The simplest form of family consisting of husband and wife, with or without
unmarried children residing under the same roof
Joint: Family of siblings living together. The joint family may have a number of variations such
as married man with his family plus unmarried sisters and/or brothers; or husband, wife and
their married children, etc
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Particulars of Family members:
1. Age: For under 5 children, record age in completed months, and for others in completed
years.
2. Sex: Record as M=Male or F=Female, TG=Transgender
3. Marital Status: Record M=married, UM=Unmarried, W=Widow/widower, S=Separated
4. Education Status:
A persons above 7 years who can neither read nor write with understanding in any
one language, should be classified as IL (illiterate).Write LI-NF (literate non-formal) for
those above 7 years who can read and write with understanding in any one language
but do not have formal schooling. Write PS (pre-school) for children under 5 years of
age. For literate with formal schooling write the highest education status attained, that
is, the examination passed.
5. Occupation:
i) Professional: the highest social status for profession like medical,
engineering, or legal
ii) Semi- professional: next social status is for employment as college

teachers or administrative responsibilities like head master, officers in
Government and others enterprises, supervisory personnel, etc. Next
comes primary and high school teachers and clerical jobs and also include
persons who are in employment but do not carry high social status. This
will include class IV employees and village level workers.
iii) Clerical, Shop-owner , Farmer : Traders who maintain petty shops and
are engaged in small trade and business activities.
iv) Skilled workers: Occupation like tailor, carpenters, blacksmith, washer

man, potter, barber, beedi workers etc. can be included. Usually include
artesian who follow their family occupation.
v) Unskilled workers: Those are casual workers and are engaged by others
by wages. Usually they get their wages on daily basis and maintain their
family on such income.
b. Unemployed.
c. **In case a person is engaged in more than one occupation, select the one carrying the
highest social status. Type of occupation must be mentioned for all the family
members.
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6. Physical Activity: Mention as sedentary/ Moderate/ Heavy
7. Physiological Status:
For mothers: P=Pregnant; L=Lactating; NP&NL=non-pregnant and non lactating
For Infants: EBF=Exclusively Breast fed; CF=Complimentary feeding started
8. Social Problems:
 Literacy Status: Literacy status considered > 7 years of age and ability to read, write and
understand at least one language
 School Dropout: If child of school going age (6- 14 years) does not attend school for 3
consecutive months then he/she is considered a school drop out (except for holidays and
sickness)
 Unemployed adult: > 18 years adult neither involved in any job nor a student (excluding
home maker)
9.Socio Economic Status:
The topic should be approached only after good rapport with the family has been built up. Ask for
expenditure first because answers on income may not be forthcoming initially. You can cross check
the income and expenditure pattern to validate Family income per month is calculated by dividing
total income of the family in one month by the total numbers of the family members. It is calculated
out for the assessment of socioeconomic status and it should be updated based on current cost –
inflation index.
There are several scales to decide the socio economic status of the family. They are:
1. Modified Kuppuswamy scale 2012 (updated in 2014)
Commonly used for the urban areas of socio economic status. This scale has three factors which
assess the socio-economic status of the family, Occupation of the head of the family, Education level
of the head of the family, Family income per month. A weighted score is given for each of the three
characteristics and the total score is calculated and the individual family is assigned the appropriate
social class. For calculating family income, an inflation based conversion factor (CF) is applied
considering the price index of 2000 as 100 (New base, applied by Kumar et al). With the increasing
price the income grading can be updated and for this reason the scale in this category is called
“inflation rate adjusted Modified Kuppuswamy scale”.
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Weightage of different items in Kuppuswamy Scale for determining socioeconomic

status of urban families:
Items Weightage
Education of the head of the household
Professional degree, post-graduate and above 7
Bachelor’s degree 6
Intermediate or post –high school diploma 5
High school certificate 4
Middle school completion 3
Primary school completion or literate 2
Illiterate 1
Occupation of the head of the household (last occupation if retired)

Professional 10
Semi-professional 6
Clerk, shop-owner, farm-owner 5
Skilled worker 4
Unskilled worker 2
Unemployed 1
Family income per month (in Rs) in the year 2014,May

36,997 or above 12
18,498-36,996 10
13874-18,497 6
9249-13873 4
5547-9249 3
1866-5546 2
Less than equal to 1865 1
Class Categorization according to Modified Kuppuswamy scale :

The social class or socioeconomic status of the family, is then found out as follows:
Total score Socioeconomic class

26-29 Upper (I)
16-25 Upper middle (II)
11-15 Lower middle (III)
5-10 Upper lower (IV)
<5 Lower (V)
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2. Pareek and Kulsrestha’s scale is commonly used for the rural areas. This scale has nine factors
which assess the socio-economic status of a family:
1. Caste 2. Occupation
3. Education 4. Social participation
5. Land 6. House
7. Farm powers 8. Material possession, and
9. Family
3. B.G. Prasad’s scale (1961): Based on Per capita monthly income after correcting for cost inflation
factor. Used in rural areas.
Social class 1961 December 2004

I. Upper high 100 and above 10000 and above
II. High 50-99 5000-9999
III. Upper middle 30-49 3000-4999
IV. Lower middle 15-29 1500-2999
V. Poor Below 15 500-1499
VI. Very poor or (BPL) Below 500
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3.4 Schedule for assessment of socio economic status of Family:
3.4.1 Identification of family
Name of Head of Family __________________________________________ Type of Family Nuclear/Joint
Address _______________________________________________________________________
Religion __________ Caste _________ Mother tongue ______________ Place of origin _________ Length of stay____________
3.4.2 Particulars of family members
Serial Relation Marital Education Physical Physiological

Names Age Sex Occupation CU Remarks
no. with HOF Status Level Activity Status
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3.4.3 Family Tree:
3.4.4 Other relevant informations:
 How does the family get information/news:

Newspaper/Radio/Television/Telephone/Mobile/Computer/Others (specify)
 Possession of: Bicycle/Electricity/Fan/ Radio/ Television/Media Players/ Telephone/ Mobile phone/

Computer/ Refrigerator/ gas oven/ Others (specify)
 How do they pass their free time
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3.4.5 Social Problems:
 Any Unemployed member in the family
 Substance abuse
Type Amount Frequency
 Any mother who is unmarried, divorced or abandoned by husband’s family
 Any handicapped or chronically ill family member
 Any children above 5 years not going to school, if yes, reason
 Is the mother working anywhere? If so, who looks after the child in her absence
 Child Labour
 Others (please specify)
Page 24
3.4.6 Schedule for assessment of Family’s Income and expenditure pattern:
Monthly Income of Family
Total Income
Total Expenditure
Balance
Total no. of Earning members
Total number of Dependents

Per capita Income
Monthly expenditure of the family
Item Expenditure Percentage
Food
Fuel
Clothing
Education
Private Tution
Electricity
Substance abuse
Housing (rent, maintenance, tax)
Social functions (marriage, festivals, etc)
Health and illness
Travel/transport
Recreation
Any other expenditure
Total
Page 25
Pie Diagram of Expenditure of the family:
Page 26
Lesson 4: Study of Environment and Housing of the

Family
4.1 Introduction
It is established fact that environment has a direct impact on the physical, mental and social well-
being of those living in it. . The environmental factors range from housing, water supply waste
disposal, psychological stress and family structure , through social and economic support systems , to
the organization of health and social welfare services in the community.
Much of the ill- health in India is due to the , environmental conditions i.e. unsafe water , polluted
soil with unhygienic disposal of human excreta and refuse , poor housing ,insects and rodents, etc.
The high death rate, infant mortality rate , sickness rate and poor standards of health are, in fact ,
largely due to defective environmental sanitation. Improvement of environmental sanitation is thus
crucial to the prevention of disease and promotion of health of individuals and communities.
Therefore, as a first step, it is very essential to assess the existing status of those environmental
factors that are basic and fundamental to individual, family and community health.
For descriptive purpose, the environment of man has been divided into 3 components:
 Physical e.g. air, water, soil, housing, waste (such as refuse and human excreta ), etc.
 Biological e.g. microbial agents, insects, rodents, etc.
 Psychological e.g. cultural values, customs, habits, beliefs, attitude, religion, education,
lifestyles, community life, health services, social and political organization, etc.
o Understand the concept of environment, its different components and environmental

sanitation.
o Understand the role of different environmental factors in causation and spread of
different diseases.
o Collect information regarding different environmental factors.
o Analyze and comment on the existing environmental situation.
o Suggest measures to improve environmental sanitation
Page 27
4.3. Guidelines for filling up the schedule for assessing environmental conditions of the family:
4.3.1 Housing Types:
 Pucca house: Floor – paved, Walls – stone or brick built, Roof - concrete
 Kutcha house: Floor – packed earth, Walls – dried mud or thatched, Roof – thatched, slate or
other stones, tin asbestos
 Mixed house: Any combination of the two types
Set Back Area:
For proper lighting and ventilation, there should be an open space all round the house - this is
called "set back area".
4.3.2 Overcrowding:
Overcrowding will be said to be present, if any one of the following three criteria exists:
 PERSONS PER ROOM: The degree of overcrowding can best be expressed as the number of
persons per room, ie., number of persons in the household divided by the number of rooms in
the dwelling.
 FLOOR SPACE: If the per capita floor space is less than 50 square feet then overcrowding is
said to be present.
 (A baby under 12 months is not counted; children between 1 to 10 counted as half a unit).
 SEX SEPARATION: Overcrowding is considered to exist if 2 persons over 9 years of age, not
husband and wife, of opposite sexes are obliged to sleep in the same room.
4.3.3 Ventilation:
Unless mechanical ventilation and artificial lighting are provided, every living room should be
provided with at least 2 windows, and at least one of them should open directly on to an open space.
The windows should be placed at a height of not more than 3 feet (1 m) above the ground in living
rooms. Window area should be 1/5th of the floor area. Doors and windows combined should have
2/5th of the floor area.
4.3.4 Lighting:
After opening all the doors and windows of the room if we able to read the smallest letter of news
paper at the centre of the room without any artificial light, then we say natural light is adequate.
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4.4 Schedule for assessment of environmental condition: housing, water supply, disposal of refuse
and excreta
Housing:
 Site / location/ Approach Road:
 Type: pucca / kutccha / mixed
 Ownership : own / rented / free
 Number of living rooms:

 Total area of the living rooms (floor space):
Per unit floor space:
Person per room :
Sex Separation:
 Comment on overcrowding:
 Ventilation: adequate / inadequate

o Combined Windows & door space area
o Cross-ventilation: present / absent
 Lighting: adequate / inadequate
 Kitchen: in separate room / in living room / on verandah
 Type of fuel used: Coal / Wood / LPG / Kerosene oil / Electric heater / other (specify)
 Smoke nuisance: present / absent
 Storage of food: proper / improper
 Kitchen garden: present / absent
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 Comment on drainage system around the house:
 Comment on drainage of household waste water:
 Observe and comment on breeding places of mosquitoes:
 Fly nuisance: present / absent
 Rodent Nuisance: Present/Absent
Water supply:
 Source of water:
 Drinking purpose: tube well / tap (domestic / public) / pond / river / other (specify)
 Cooking purpose: tube well / tap (domestic / public) / pond / river / other (specify)
 Washing-bathing purpose: tube well / tap (domestic / public) / pond / river / other
(specify)
 Distance of drinking water source (If outside house)
 Duration of supply: continuous / intermittent
 Adequacy of supply: adequate / inadequate
 Comment on well, if any: (shallow / deep, protected / unprotected, distance from latrine /
rubbish, etc)
 Observe and comment on how people draw, carry & store water in house and how they draw
water from pitchers / containers:
 Is drinking given any special treatment at household (like boiling, domestic filtration,
chlorination etc): yes / no (if yes specify)
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Excreta disposal:
 Latrine:
 Present / absent
 Within house / outside house
 Sanitary / not sanitary
 Where do family members go to defecate?

Sanitary latrine / open field / other (specify)
 Where do you dispose child’s stool?
 Any arrangement of regular cleaning: yes(specify) / no
Refuse Disposal:
 How do people dispose of refuse: throw indiscriminately / common pit / collected in a

container / burning / composting / municipal service
 How is the kitchen waste disposed:

o Solid waste –
o Sullage (liquid waste) –
Page 31
Plan of House
Page 32
Lesson 5: Family’s Knowledge and practice on health

and utilization of health services
5.1 Introduction
All the people, whether rural or urban, have their own beliefs and practices concerning health and
diseases. Not all the ideas and beliefs are bad . Some are based on centuries of trial and error and
have positive roles while others may be useless or even harmful. Some have stood in the way of
acceptance or utilization of health services. It is therefore essential to know people's knowledge
regarding diseases causation and health promotion, and this to understand the factors that influence
people's decisions and adopting a healthful behaviour and proper utilization of health services. This
will help to identify the areas were communication is needed. If people know that what are the
services available to them and how these will help them to get rid of disease and maintain health,
they will be motivated to utilize the services and, in the long run , will provide their support to
improve and maintain them.
5.2. Learning objectives
•Understand what are the preventive and promotion services available to the people,
particularly to the mothers and children.
•Collect information on knowledge, beliefs, attitudes and practices of the family towards
health and disease conditions.
•Collect information on extent of utilization of existing health services by the family
•Identify the factors which influence their utilization behavior and recommend necessary
actions.
5.3. Services available
Before assessment of utilization of services one must know what is the package of services offered
under different national programs like ICDS, NRHM, RNTCP, NVBDC,P NACP etc.
Page 33
5.4 Knowledge about common diseases
5.4.1 Knowledge regarding causation, modes of transmission, prevention and availability of

services with respect to the following diseases:
[Discuss with adult family members and comment on the following]
Ever
Care Seeking Behavior
Heard Causation/ Mode of
Disease a. Past
of Transmission prevention
b. Future
Disease
Diarrhoea
Pneumonia/
cough and
cold
Malaria
Dengue
Tuberculosis
AIDS/STD
Others
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5.4.2 Knowledge and practice about Non Communicable Diseases:
Whether Care Seeking

Disease Mode of prevention
Heard Behavior
Hypertension
Diabetes
Cancer
Heart Disease
and stroke
5.5 Visits to Health Facilities:
If health Facilities not visited regularly, reasons
Page 35
Lesson 6. Nutritional profile of the family
6.1 Introduction
Assessment of nutritional profile of a family is an important step in planning and programming health
and nutrition intervention activities directed towards the family. In practical terms, problem definition
related to nutritional status of a family evolves round the following questions: What are the specific
nutritional deficiencies encountered in a family? Who are affected? What are the ecological factors
(dietary and non-dietary) responsible for these deficiencies?
 Understand the importance and practice of different methods applied to nutritional assessment.
 Carry out dietary survey, anthropometric measurements as well as clinical assessment of
nutritional deficiency disorders.
 Analyze types and amounts of food consumed by the family.
 Calculate the nutrient intake of the family (calorie, proteins, vitamins, iron, etc.)
 Identify the types of nutritional deficiencies prevalent in the family and the underlying factors
responsible for these.
 Suggest measures to improve the quality of food and existing dietary patterns of the family.
6.3. Guideline for Nutritional assessment of the family
The nutritional assessment of the community can be carried out using the following methods:
a. Clinical examination for nutritional deficiency signs.

b. Anthropometry or body measurements.
c. Diet surveys.
d. Biochemical tests.
e. Vital statistics such as mortality and morbidity rates.
Out of these, first 3 methods are usually suitable for application in field conditions.
6.3.1 Clinical examination
This is one of the simplest techniques to assess malnutrition and is relatively inexpensive . But the method can
detect only small number of clinically manifest cases while large numbers of clinically inapparent cases of
malnutrition remain unidentified in the community .
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6.3.2 Anthropometry or body measurements
It is most widely used means to assess nutritional status (particularly in children). The most commonly used
and simple body measurements are weight, height and mid-arm circumference. Using these measurements,
following parameters are usually calculated:
a. Weight for age

b. Weight for height
c. Height for age etc.
However, use of anthropometric measurements depends on two factors:
 Accurate assessment of age

 Appropriate reference values for comparison/ growth charts
6.3.3 Diet survey
Importance:
 Diet has a far reaching influence on health status.

 It is essential to have an idea of dietary patterns in the community along with their nutritional
assessment.
Purpose:
 To know what people eat-both quantitatively and qualitatively.

 To know inadequacies in existing dietary pattern.
 To find out relationship, if any, between health status and diet consumed by the family.
 To suggest improvement of existing pattern of the diet of the family.
Methods
The following methods are usually employed for diet survey:
 Weighment method: a. Raw food b. Cooked food
Merits & demerits:
 Method is accurate and gives a definite idea of dietary consumption pattern of the family.
 Time consuming and dependent on cooperation of the people surveyed. Unless people are properly
motivated they will not give requisite cooperation.
 In Indian culture most of the families would not like cooked food to be weighed before consumption.
So weighing of cooked food is culturally unacceptable.
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 Questionnaire method:
Family: Family members are asked to recall intake of individual food items in last 24 hours
Individual: For assessment of individual intake , a set of standardized measured utensils(e.g. a set of
cups, vessels, spoons etc.) are used to assess use of different food items.
Merits & demerits:
 One day recall method of dietary survey is usually practiced in field condition as it is
easier, less time consuming and provides reasonably good results, provided enquiries
are made in details.
 Depends on ability of family members to correctly recall foodstuffs consumed by
them.
 Inventory method (Food listing method):
Merits & demerits:
 It is only an estimate of previous week’s store of foodstuffs – not a direct measurement.

 Illiteracy is a constraint – not suitable in developing countries.
 Suitable methods for hostels where food items are purchased and stored for weeks and
months in advance.
Some important points related dietary survey:
a) The object of the survey must be made clear to the family, especially the housewife.
b) The day of survey should be planned in such a way that festive holidays are not included.
c) In case of any unknown or uncommon food prepared and consumed by the family, it is better to
record the total amount of the constituents only required for the preparation of the food.
d) Collect information on meals/ snacks taken outside the home as well as quantity of supplements from
any feeding programs, for the calculations of food items consumed by the family.
e) The dietary intake may be expressed in terms of consumption unit per day or per person per day.
f) Age and sex of all members in the family should be recorded, as requirement and intake of nutrients
may vary accordingly.
g) Number of absentees/ servants/ guests in the family should be taken into account for calculation of
total consumption unit in the family. Number of pregnant/ lactating women in the family as well as
exclusively breast-fed infants should also be noted for the purpose of calculation of nutrient
requirements.
h) Remember 1 teaspoon=5 ml, 1 bowl=250 ml, 1 tablespoon=15 ml, 1 cup=200 ml
Page 38
Method of analysis of foodstuffs consumed by the family and their requirements:
a) List the various food items consumed by the family in last 24 hours and mention quantity of each item
in Table provided below.
b) Find out the intake for each food group, enter into Table 6.1 and compare the intake with for that
particular food group by help of table 6.3. The portion sizes are to be calculated with the help of tables
in section 6.3.3.1 and 6.3.3.2
c) Find out the nutritive value of various food items consumed by the family (from the book titled
‘Nutritive Value of Indian Foods’ published by National Institute of Nutrition, Hyderabad) and calculate
the total amount of major nutrients of particular food items consumed by the family and enter into
table 6.2
d) Calculate total nutritional requirements of the family and the balance as per their RDA in Table 6.4
e) Make appropriate suggestions based on these calculations to render the family diet as balanced as
possible.
6.3.3.1: The recommended Portion sizes of different food groups for adults (Source ICMR)
Page 39
6.3.3.2: The recommended Portion sizes of different food groups for children (Source ICMR)
Page 40
6.3.4 Methods of Anthropometric Measurements:
 Measurement of weight (spring balance):

Hang the scale freely from a hook. Keep the dial at eye level. Adjust the pointer to ‘0” before placing
the child in the sling. Undress the child with the help of the mother. Place the child in the sling-the
mother should not hold the child after it is placed in the sling. Read the weight to the nearest marking-
read by standing just opposite to the dial. Scale should read ‘0” when the sling is empty. Check reading
of scale with a known weight at least once daily.
 Measuring height:
The child’s socks and shoes are removed. The child is asked to stand with the back of the head,
shoulder blades, buttocks, calves and heels touching a vertical surface. By holding the child’s knees and
ankles the legs are kept straight and feet flat. The child is asked to look forward. The
headboard/marking surface is placed firmly on top of head and hair is compressed. The height is
measured upto the last completed 0.1cm.
 Measuring Length of baby:

It is measured with the help of an infantometer keeping the child in supine position.
 Measuring Mid-upper arm circumference:
The tip of shoulder is located. Also the shoulder and elbow tips are located. The tape is placed at tip of
shoulder and is pulled past the tip of the elbow. The midpoint is marked, and then the measurement is
taken with correct tape tension.
6.3.5 Measuring the iodine content of salt:
The small cap of the iodine testing kit is to be filled with salt and the salt surface made flat. Two drops of test
solution are added on the surface of the salt by piercing the white ampoule with a pin and gently squeezing
the ampoule. Then the color on the salt is compared with a color salt and the iodine content is determined. If
no violet/blue color appears on the salt, upto 20 drops of recheck solution in red ampoule is added on the
same spot salt, until a violet/blue color appears.
Page 41
6.3.6 Schedule for Oral Questionnaire (24 Hours Recall)
Table 6.1 Dietary Intake of the family (food group wise)
Individual Itemwise Total Quantity (food

Food groups Food items
quantity [gm/ml] group wise)
CEREALS
PULSES
GREEN LEAFY
VEGETABLES
(specify)
ROOTS AND TUBERS

(specify)
OTHER VEGETABLES
(specify)
FRUITS
(specify)
MILK & MILK

PRODUCTS
(specify)
Page 42
Table 6.1 Dietary Intake of the family (food group wise)(contd.)
Individual Total Quantity

Food groups Food items Itemwise quantity (food group
[gm/ml] wise)
FLESH FOODS INCLUDING

MILK
FATS & OILS (specify)
SUGAR & JAGGERY
NUTS & OILSEEDS
SPICES & CONDIMENTS
MISCELLANEOUS (specify)
Page 43
Table 6.2 Dietary Intake of the family (nutrient wise)
Quantity Calories Protein Iron Vit A Thiamin Riboflavin Vit C

Foodstuff
(gm/ml) (Kcal) (gm) (mg) (µg) (mg) (mg) (mg)
Total
consumption
Page 44
Table 6.3: Dietary requirement of the family and the balance (Food group wise)
Food Group Amount requirement according to balanced diet

Type
Physiological
Sl. Age Sex of Pulses
Status Cereals Roots Fats Sugar
Work and Green Leafy Other Milk and milk
and and Fruits and and
flesh Vegetables Vegetables products
Millets tubers oils jaggery
foods
Total requirement
Total Consumed
Balance %
Page 45
Table 6.4: Dietary requirement of the family and the balance (Nutrient wise)
Type Nutrient requirement according to RDA

Physiological
Sl. Age Sex of
Status Calories Protein Iron Vita A Thiamine Riboflavin Vit C
Work
(Kcal) (gm) (mg) (µg) (mg) (mg) (mg)
Total requirement
Total Consumed
Balance %
Page 46
Diagram for Balance of intake and requirement of food groups and nutrients in the family
Page 47
6.3.7 Schedule for anthropometric and clinical measurement of Under 5 children
Anthropometric
1 2 3
Height/length (in cm)
Weight (in g)
Mid-arm circumference
(in cm)
Clinical
Parameters
General Appearance
Hair
Face
Eyes
Lips
Tongue
Teeth
Gums
Glands
Skin
Nails
Edema
Rachitic Change
Hepatomegaly
Calf Tenderness
Ankle and knee jerks
Physiological changes
Page 48
Lesson 7: Health Status of the Under-5

7.1 Guideline for filling up schedule for child health checkup:
7.1.1 Measuring the growth and development of the child:
Measuring the child’s growth in growth chart:
A growth chart is designed primarily for longitudinal follow-up of a child so that changes in
weight over time can be interpreted. In 2006 and 2007, The WHO released new international
growth charts depicting the optimal growth of children from birth to age five years and charts for
monitoring the growth of the children and adolescents. It was primarily developed based on a
breastfed population, and it is recommended to use these to monitor both breastfed and non-
breastfed infants and children from birth to 5 years of age as they describe the growth of infants
and children with no economic, health and environmental limits to growth.
Serial measurements plotted on a growth chart that include length, weight, weight to length,
BMI, Head circumference, will identify a pattern of growth (curve) for that child. Although a
single point on a curve can be used as a nutrition screen, serial measurements plotted on a
growth chart are far more sensitive indicators to use to assess child’s growth and health.
Measuring the child’s Development:

By appropriate measurement tools
7.2.2. Definitions of breastfeeding categories
The following definitions of breastfeeding are used in research:
Exclusive breastfeeding
The infant has received only breastmilk from his/her mother or a wet nurse, or expressed breastmilk,
and no other liquids or solids, with the exception of drops or syrups consisting of
vitamins, mineral supplements or medicines.
Predominant breastfeeding
The infant’s predominant source of nourishment has been breastmilk. However, the infant may
also have received water and water-based drinks (sweetened and flavoured water, teas, infusions
etc.); fruit juice; oral rehydration salts solution; and ritual fluids (in limited quantities). With the
exception of fruit juice and sugar-water, no food-based fluid is allowed under this definition.
Full breastfeeding
This definition includes both exclusive breastfeeding and predominant breastfeeding.
Page 49
Partial breastfeeding
Partial breastfeeding refers to a situation where the baby is receiving some breastfeeds but is also
being given other food or food-based fluids, such as formula milk or weaning foods.
Breastfeeding
The child is receiving breastmilk, either directly from the breast or expressed. This definition may
include exclusive, predominant and partial breastfeeding.
Bottle-feeding
The child has received liquid or semi-solid food from a bottle with a nipple/teat. This term applies
irrespective of the nature of the liquid or semi-liquid.
Artificial feeding
The baby who is artificially fed receives no breastmilk at all.
Supplementary feeding
Supplementary feeds are feeds given to a baby under 6 months old to supplement his intake of
breastmilk, where this is insufficient.
Complementary feeding
Complementary feeding means the introduction of other foods and drinks after six months of age.
These foods are in addition to an adequate intake of breastmilk.
Page 50
7.3 Schedule for Under-5 Health Checkup

Serial No of child
Age (in completed months) Sex
Chief Complaints:
History of Present Illness:
Birth History:
Date of birth: Birth weight: Term/Post Term/ pre term
Place of delivery: Birth attendant: Type of delivery:
History of Significant past illness (including congenital diseases):
Feeding History (24 hour recall):
Type:
Amount and method:
Frequency:
Investigations (if any):
Provisional diagnosis (if any):
Page 51
Knowledge and Practice towards Infant feeding (for the youngest child)
Topic Current Knowledge Practice Reason for deviation
Type of first food

offered
Colostrum feeding
Brest Feeding
Initiation
EBF for (months)
Breast feeding
Frequency for last
24 hours *
Breast feeding
(months)
Complementary
feeding initiation
(months)
Liquid
Supplementation
(mention tool of
feeding)
Feeding during
illnesses
*(mention night feed and whether demand fed)
Page 52
Knowledge of mother about Immunization
Topic Knowledge
Name of vaccines
Reason for administration
Date of next dose
Pulse polio
Vitamin A Prophylaxis
Page 53
Immunization Status of Child
Age at From where

Name of Vaccine Remarks
Vaccination obtained
BCG
DPT-I
DPT-II
DPT-III
OPV-O
OPV-I
OPV-II
OPV-III
Pentavalent I
Pentavalent-II
Pentavalent-III
Hep-B(Birth)
Hep-B I
Hep-B II
Hep-B III
Measles (1st Dose)
Measles (2nd Dose)
DPT-B
OPV-B
DPT-B
Others (specify)
JE
PPI
Reasons for non-immunization/partial immunization:
Page 54
Treatment and management:
Page 55
Serial No of child
Age (in completed months) Sex
Chief Complaints:
History of Present Illness:
Birth History:
Date of birth: Birth weight: Term/Post Term/ pre term
Place of delivery: Birth attendant: Type of delivery:
History of Significant past illness (including congenital diseases):
Feeding History (24 hour recall):
Type:
Amount and method:
Frequency:
Investigations (if any):
Provisional diagnosis (if any):
Page 56
Immunization Status of Child
Age at From where

Name of Vaccine Remarks
Vaccination obtained
BCG
DPT-I
DPT-II
DPT-III
OPV-O
OPV-I
OPV-II
OPV-III
Pentavalent I
Pentavalent-II
Pentavalent-III
Hep-B(Birth)
Hep-B I
Hep-B II
Hep-B III
Measles (1st Dose)
Measles (2nd Dose)
DPT-B
OPV-B
DPT-B
Others (specify)
JE
PPI
Reasons for non-immunization/partial immunization:
Page 57
Treatment and management:
Page 58
Lesson 8: Obstetric History

8.1 Particulars of the woman
Serial no:
Identification:
Name:
Age (in years): Age of marriage (in years): Parity:
8.2 Menstrual History:
Age at Menarche: Menstruation: Volume:
Duration: Periodicity:
EDD(for pregnant women)- LMP (for pregnant women):
Comments:
8.3 History of Previous Pregnancy:
Order of Age at Type of Place of Conducted Complications,

Outcome
Pregnancy Pregnancy delivery delivery by If any
8.4 Other Significant Histories:
 Relevant medical illness:
 Any Abdominal operation:
 Relevant family history:
Page 59
8.5 Knowledge and practice of mother about Family Planning:
Topic Knowledge Practice (reason if deviation)
Ideal Age of Marriage
Ideal Age of Pregnancy
Interval between Pregnancies
Reproductive Intention
Gender Preference*
Contraceptive Methods
* In knowledge write opinion of girl child’s future
Page 60
8.6 Knowledge and Practice of Mother in Antenatal and postnatal period:
Practice for latest pregnancy

Topic Current Knowledge
(reason if deviation)
Antenatal
Identification of
Pregnancy and
Early
Registration
Number of visits
Iron
supplementation
consumption
Diet with ICDS
visit
Rest
Personal hygiene
and care of
breast
Others
Postnatal
No of visits
Examinations
done
Advice received
(Family
planning, IYCF)
Immunization
Birth
Registration
JSSK
Page 61
8.7 Clinical Records of Antenatal Care of Present Pregnancy (To be taken if within one year of child birth)
Visit 1 Visit 2 Visit 3 Visit 4

Item
Date: Date: Date: Date:
Gestation period (weeks)
History
Other Significant Complaint
Height (cm)
General Survey
Weight (kg)
BP (mm Hg)
Pallor
Edema
Fundal Height (weeks)

Obstetric examination
Lie
Presentation
Fetal Heart Sound
Breast Examination
Other Significant Findings
Hb%
Investigations
Urine Examination
(sugar, protein)
Other test findings
(VDRL, Blood group, USG, etc)
IFA Supplied/prescribed
consumed
TT Given
Advice
Other Advices
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8.8 Postnatal Medical Records (To be taken if within one year of child birth)
Mother Baby
Relevant systemic
Day Significant findings Examination
findings
(Date) Any in general survey Any Findings (eg.
(eg. lochia, Fundal Advice Advice
Complaints (like pulse, Complaints Cord, eyes,
height, breast. stitch,
temperature) stool, bath)
bowels)
Page 63
Lesson 9: Health Checkup of Individual Family

members
9.1 Patient Particulars
Serial Number:
Date of examination:
Name: Age: Sex:
Occupation:
9.2 Medical History
Presenting Complaints, with duration:
History of present illness:
History of relevant past illness with Medical History:
Family and personal history:
9.3 Clinical examinations:
General Survey:
Height: Weight: BMI:
Waist Circumference: Hip Circumference: Waist-Hip Ratio:
Pallor: Cyanosis: Icterus: Clubbing: Edema:
Pulse: BP: Respiration:
Others:
Page 64
Systemic Examination:
Examination of Chest:
Inspection:
Palpation:
Percussion:
Auscultation: Heart Sound: Lung Sounds:
Examination of Abdomen:
Inspection: Palpation:
Percussion: Auscultation:
Nervous system:
Skeletal system:
Any other findings:
9.4 Significant Investigation findings:
9.5 Provisional Diagnosis:
9.6 Management of case:
Page 65
Serial Number:
Name: Age: Sex:
Occupation:
9.2 Medical History
General Survey:
Others:
Page 66
Inspection:
Palpation:
Percussion:
Nervous system:
Skeletal system:
Any other findings:
Page 67
Serial Number:
Name: Age: Sex:
Occupation:
9.2 Medical History
General Survey:
Others:
Page 68
Inspection:
Palpation:
Percussion:
Nervous system:
Skeletal system:
Any other findings:
Page 69
Lesson 10: Medico social Diagnosis, Actions taken and

Recommendations
A group of students will be allotted the families with the concerned case. The families will be interviewed to
elicit the required relevant information as discussed in previous lessons. A broad outline is given below but
certain points have to be stressed more in case of certain diseases. Basically, the information gathered should
be concerned with natural history of the disease, health-seeking behavior, impact of disease on the family and
vice versa. Each group should then prepare to present their case. Following this, discussion will be held by the
faculty of concerned departments to discuss different aspects of the case.
10.1 Medico social diagnosis:
Mention the followings
1. Demographic and Socio-economic Diagnosis:
2. Environmental Diagnosis:
3. Knowledge, practice of health and health related behaviors and healthcare utilization of family:
4. Nutritional Diagnosis:
5. Important Health problems of family:
10.2 How to formulate Community Treatment or community health actions (Actions taken and
recommendations):
It is the sum of activities decided upon to meet the health needs and health problems, keeping in mind the
resources available, felt need of the community, nature of the problems and their impact on the health of
people at large.
A program of community health action must have the following characteristics.
It must effectively utilise available resources. It must co-ordinate the effects of all other agencies, Services
should be acceptable, accessible and affordable to all. It must encourage the full participation of community in
the program. There are several ways in which a community can be involved in the health services. The
community can help to decide what health services should be provided to them to make sure that these
services will meet their needs.
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Medico Social Diagnosis
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Actions taken by the students
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Recommendations
Page 75

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Practical Guide Book Family Health Care

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Family Health Care

A Practical Guide Book

Professor A. B. Biswas, MD(SPM)

Department of Community Medicine

This is to certify that Mr. /Ms. ___________________________

has completed his/ her family health care services

Teacher in Charge Head of the Department

Name of the Student: Batch:

University Roll No:

Learn from them;

Plan with them;

Begin with what they have;

Build on what they know;

But of the best leaders

When their task is accomplished

Their work is done,

The people all remark

“We have done it ourselves’’

………………….a Chinese proverb

Second edition, 2001

Third edition, 2004

Fourth edition, 2007

Fifth edition, 2012

Sixth edition, 2013

Seventh edition, 2014

Revised eighth edition, 2016

Prof. (Dr.) G.K. Joardar DTMH, MD

Dr. (Mrs.) S. Nandy DCH, MD

Prof. (Dr.) R. N. Misra DTMH, MD

Dr. (Mrs.) K. Mitra DCH, MD

Prof. (Dr.) D. K. Das MD

Dr. S. Mukhopadhyay DPH, MD

Dr. (Mrs.) B. Bandyopadhyay DCH, MD

Dr. S. Ray MBBS, DO

Dr. (Mrs.) R. Biswas MD

Dr. (Mrs.) D. Haldar MBBS

Prof. (Dr.) G. N. Sarkar MD

Dr. (Mrs.) P. Srivastava MD

Dr. (Mrs.) M. Saha MBBS, DO

Dr. A. Chakrovarty MBBS ,DMCW

Dr. (Mrs.) A Bhattacharyya MBBS

Dr. (Smt.) S. Nath MBBS

For their constructive criticism and support

R G Kar Medical college.

The teaching of community medicine to undergraduate students has

This practical book is a modest endeavor to help students during their

If you need any clarification, do not hesitate to consult the teachers.

What is an urban community?

A community is called ‘urban’ if

 It’s population is above 5000

1.2 Community medicine

1.3 Why to teach in the community and not in ‘disease palaces’

1.4 Family practice

 Identification of earliest deviation or departure from normal health.

1.5 Family physician

Roles and main function of a family physician

A. Patient care role

1.6 Objectives of Community Diagnosis

 To help students to make a community diagnosis.

Lesson 2: Know your community

2.2 Learning objectives

After going through this lesson you should be able to:

 Understand the concept and process of community diagnosis and community

2.3 Understanding community diagnosis