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    Mostaque Ahmed
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    3 views94 pages

    29a48a9af94a7c0417131f6e61a2d59e

    Uploaded by

    Mostaque Ahmed

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 94
    —=— FAMILY STUDY cs - IN A RURAL SETTING IN west BENGAL a Mriduchhanda Mrinmay r Nazrul mi Ghosh Naba Kumar Naushad f ba — INTRODUCTION © Family :-It is. a primary unit of society consisting of individuals related biologically or by marriage or adoption, living under the same room and consuming food from a common kitchen. © The term family differs from a household due to the fact that all members of a household may not be related. TYPES OF FAMILY ° Nuclear Family * Joint / Extended Family © Three Generation Family INTRODUCTIO ROLE OF FAMILY © To provide a decent home to its members © Itserves as a platform of division of labour of household works * Provides a legal platform to share property for inheritance and helps in social care and socialization * Italso serves as a medium for economic functions INTRODUCTIO IMPLICATIONS OF FAMILY STUDY Family serves as a primary unit of society © Reflects the important aspects of a community like role in diseases and health ° Helps to identify, prevent and treat individual illnesses ° Plays an important role as an biological unit and also focuses on the care of children and dependent adults. - ~~ OBJECTIVES WeTIEs wv e GENERAL OBJECTIVES To make a Medico social Diagnosis of the Family ~ Objectives Contin ° Specific Objectives a) Tostudy the demographic, socioeconomic and environmental conditions of the family. To assess the health status of individual family members c) Toassess maternal health, antenatal and post natal care b = oe OBJECTIVES CONTINUED d) To determine the immunization status, feeding practices, health and nutritional status of under 5 children e)To estimate Dietary Practices of the family f) To take appropriate remedial measures for the problem identified. SSS — = E ee MATERIALS AND METHODS © eType of study: Descriptive type of epidemiological study anti aell « eStudy Area: Faridpur village near Mallickpur, South 24 Paraganas * eDuration of study: One month (10" Feb - 8"" March) SS gs as i —— MATERIALS AND METHODS CONT.. © eTools used - | ° 1.Predesigned, Pretested schedule © 2.Measuring tapes © 3.Weighing machine ° 4.Sphygmomanometer © 5,Stethoscope * 6.Torchlight © 7.Medical records | tf EA 2 bs ri ATERIA : CONT.. PROCEDURE A.BRIEFING- Briefing about the family study was done by the faculty members of the department 2. w - wa iy a . Ventilation my j Lightin, pe = ; a“ “Hf . Adult Consumption Unit SOCIETIES i . School Dropout i . Unemployed Youth ATERIALS AND METHODS CONT.. B.CRITERIA FIXATION; Criteria fixation is done for the following- Type of family Literacy aaivil ATERIALS AND METH (C.FAMILY ALLOTMENT : One family was allotted to our group D.INTERVIEW-With the help of Predesigned, Pretested schedule, Hasna Banu Bibi was interviewed E.OBSERVATION- The housing and environmental conditions of the family were observed FANTHROPOMETRIC MEASUREMENT-Using measuring tape and weighing machine, the following parameters were measured : For mother- Height, Weight For child-Height, Weight, Mid upper arm circumference G.CLINICAL EXAMINATION-Examination was done for pallor, cyanosis, icterus, oedema, neck glands and vesicles. H.DIETARY SURVEY- The Dietary survey was done by 24 hour recall method I,RECORD ANALYSIS- The findings were recorded and subsequently analysed. . Anthropometric Clinical Dietary Interview Observation Measurements Examination Survey Family Identification Head of Family: Jamal Laskar Address: Village-Faridpur, P.O-Mallickpur, P.S-Baruipur, Dist-South 24 Paraganas Type of Family: Nuclear Family Religion: Islam Caste:Sunni Place Of Origin:Faridpur Length of Stay: From Birth Mother tongue: Bengali Other Languages:Hindi, Arabic Main Source Of Income: Salary of head of the family and wife. Names Banu Bibi Hasib Ali Laskar Relation With HOF Wife re blog Marital Riclatry Married Female Married ei etary aro | Eight Pre-School ern e Unskilled worker Belt factory Worker Unskilled worker Bidi Binder SERUM int LSNF Jamal Laskar *HOUSING “WATER SUPPLY AND STORAGE *EXCRETA AND REFUSE DISPOSAL pe *Site - Elevated Type - Kuccha *Ownership - Owned *No of living room ~1 ‘Total area of living rooms — 15 x 9 sq.ft +Per unit floor space — 54 sq.ft *Sex separation — NA *Person per room — 2.5 *Comment on overcrowding - Not overcrowded *Area other than living rooms utilized for living purposes — 19x 6 sq.ft *Combined windows and door space = Is less than 2/5" of the floor space of the living room Ventilation - Inadequate *Cross-ventilation — absent +Lighting - Inadequate Kitchen - on Veranda *Type of fuel used - Wood *Smoke nuisance - Present Storage of food - improper HOUSING: Separate cattle shed — Absent +Drainage system around the house — Absent *Kitchen garden - absent Drainage of household wastewater - In || the pond “Breeding place of mosquitoes - present +Fly nuisance — present HEMATIC DIAGRAM O HOUSE WATER SUPPLY WATER SUP Source of water — 1.Drinking purposes : Tube well 2.Cooking purpose : Tube well 3.Washing-bathing purpose : Tube well Distance of drinking water source - 10m Nature of supply - continuous Adequacy of supply - Adequate Comment on how people draw, carry, sto! water in house and how they draw water from containers — water is drawn in buckets Special treatment of drinking water at house hold - No Sanitary Latrine present outside house +Family members including children go to defecate in Sanitary latrine Regular cleaning - Yes *How do people dispose of refuse - collected ina container *How is Kitchen waste disposed — Solid waste in common container, which is then disposed off in the pond * Sullage in pond SOCIOECONOMIC STATUS SOCIOECONOMIC STATUS ° Both the adult male and female members are earning. © The child is the dependant member. © There is no other source of economic help from outside. » Family income per month:6000. ° Per capita income of the family:2000. IOECONOMIC S ° Monthly expenditure of the family: TATUS contd. e ITEM EXPENDITURE © Food 3000(51.28%) ° Fuel 150(2.56%) © Clothing 250(4.27%) Electricity 150(2.56%) » Substance abuse 150(2.56%) * Mobile Phone 200(3.42%) © Social functions 500(8.54%) © Health and illness 250(4.27%) © Travel and transport 100(1.7%) © Recreation 100(1.7%) © Loan 1000(17.09%) © Total expenditure of the family-5850 (100%) Balance of income over expenditure-150 SOCIOECONOMIC STATUS contd. © Modified Prasad scale: Based on per capita monthly income: © Social class Income(Rs.) e Upper high 10000 and above ° High 5000-9999 © Upper middle 3000-4999 e Lower middle 1500-2999 © Poor 500-1499 © Very poor or BPL Below 500 © Thus according to Prasad scale the family belongs to lower middle class. MONTHLY EXPENDITURE PIE CHART NOt | Food = Clothing = Substance abuse © Health and illness © Recreation 3% 2% =| 2% 4% 396374% % im Fuel m Electricity ‘= Social functions © Travel, transport = Loan SOCIOCULTURAL PROBLEMS SOCIOCULTURAL PROBLEM © The head of the family is a smoker. © There is no orphan, school dropout and no problem of child labour, © No presence of any handicapped or chronically ill member in the family. e No history of broken family. © No other sociocultural problem identified. © Problem of early marriage and teenage pregnancies in the family. ENITIES AND R FACILITIES © The head of the family possesses a bicycle . REJ ° The family enjoys amenities of electrical appliances like lights, fans and television © The family uses mobile phone as a mode of communication. TABLE NO 2- COMMUNICABLE DISEASES Disease Mode of Prevention —_| Availability of transmission services Diarrhoea Contaminated food | No idea ‘To take proper | PHC food & water Malaria Mosquito Bite | Mosquito net | Private & coil Practitioner Tuberculosis No idea No idea se ARI No idea ‘Warm clothes & avoid exposure to cold aT No idea HIV/AIDS ‘No idea No idea No idea Leprosy No idea No idea = No idea diseases TABLE NO 3- NON COMMUNICABLE DISEASES DIABETES HYPERTENSION CORONARY HEART DISEASE CANCER MENTAL DISEASE INCREASE INTAKE OF SUGAR NO IDEA NO IDEA NO IDEA NO IDEA PREVENTION SUGAR RESTRICTION SALT RESTRICTION NO IDEA NO IDEA NO IDEA ~~ Health knowledge of non communicable NONE NONE NONE NONE f UNDER 5 HEALTH 7 CHILD HEALTH CHECKUP « Name- Hasib Ali Laskar ° Age- 45 months Sex- Male © Chief Complaints - Cough and Cold © H/O present illness- Cough and Cold for 3 days with running nose and no fever H/O of Past Illness - Diarrhoea- At 2 years of age TABLE NO. 5 DATE OF BIRTH BIRTH WEIGHT GESTATIONAL AGE PLACE OF DELIVERY TYPE OF DELIVERY BIRTH ATTENDANT ANY CONGENITAL MALFORMATION CONDITION OF BABY AT BIRTH NEED OF RESUSCITATION Birth History 2.5 KG TERM INSTITUTIONAL NORMAL DOCTOR NO NORMAL NO FEEDING HISTORY © Time of initiation of Breast Milk -Half an hour after Delivery * Colostrum - Given © Prelacteal feed given- Yes , Honey as a Social Custom once only. » Exclusive Breast Feeding- Yes up to 6 months Age of initiation of complementary feeding- After 6 months * Type of Food Offered- Semi Solid » Name of Food offered - Khichdi , Cooked Rice , Eggs » Amount of Food Given During Illness- Same as above CURRENT FEEDING PRACTICE(24HRS RECALL) ° Morning- Tea, Biscuits, Parched Rice ° Noon- Rice, fish e Evening- Fruits, Biscuits ° Night- Rice, Pulses, vegetables Amount of Food Taken by child presently No of Katori(150 ml) -1 No of times -4 CONT... e Visit to ICDS : Yes © Deworming: Not Done TABLE 6- IMMUNIZATE BCG OPVo HEPATITIS B DPT1 DPT 2 DPT3 DPT BOOSTER (i5") DPT BOOSTER(2"?) OPV1 OPV 2 OPV; OPV BOOSTER HEPATITIS Bi HEPATITIS B2 HEPATITIS B3 MEASLES VITAMIN A PPI 315.10 315.10 NOT GIVEN 28.7:10 08.9.10 6.10.10 NOT GIVEN NOT GIVEN 28.710 08.9.0 6.10.10 NOT GIVEN 28.7.10 NOT GIVEN NOT GIVEN NOT GIVEN NOT GIVEN ALL DOSES TAKEN NURSING HOME PARTIALLY IMMUNISED AT PAR WITH AGE HARIHARPUR PRIMARY HEALTH CENTRE HARIHARPUR PRIMARY HEALTH CENTRE HARIHARPUR PRIMARY HEALTH. CENTRE FINAL IMMUNISATION STATUS e All OPV doses were taken except the booster dose. © Pulse Polio doses are complete. BCG Scar present thus signifying that the vaccine was taken at birth. ° Measles, Hepatitis B full course and Vitamin A are not given. ¢ Child is Partially Immunized. —— CLINICAL FINDINGS Vitals : Temperature- 98.3 F Resp. Rate-24/min Heart Rate- 75/min Pulse- 84/min Pallor Cyanosis/Clubbing/ Pedal edema/Generalized lymphadenopathy ABSENT Jaundice Respiratory Distress Ear Discharge CLINICAL FINDINGS CONTND. © Eye-Normal ° Pustules- Absent e Umbilical Discharge- Absent e Skin pigmentation- Normal » Abdominal Distension- Absent * CVS - Normal GROWTH CHART ONT.. Anthropometric measurement: Height- 36 cms Weight-u Kg Mid Upper Arm Circumference- 13 cms Malnutrition According to WHO growth chart the child was found to be Moderately Underweight Lab Investigations- Not performed From the above parameters it is found that the child is moderately underweight and is PRESENTLY SUFFERING FROM COUGH AND COLD. INDIVIDUAL HEALTH RECORD OF INDIVIDUAL © Name : Hasna banu bibi OAge : 22 yrs OSex: female OPresenting complains: indigestion & acidity for last 2 months OHistory of present illness: «The problem is aggravated in empty stomach and relieved after dig food. «No history of malaena and heart-burn. * Abdominal fullness & discomfort after taking the food was present. QHistory of past illness :no significant past illness MATERNITY RECORD © Married for: 6 years e Age at menarche : 12 years © Age of marriage : 15 years e Para: 1 Pre term and 1 term. FIRST | SECOND | eyRS LIVE BIRTH | NORMAL. “LIVE BIRTH | NORMAL | HOME OBSTETRIC HISTORY © She has not taken any antenatal care for the 1 baby. © The baby was delivered at home by trained birth attendant after 7'* month of gestation, i.e.; Preterm baby ° Baby was alive for one day only, and she died at home. ANTENATAL CARE e During second pregnancy she made three visits, during which the following investigations were done. 1) Blood for Hb% 2) Blood group ABO & Rh 3) Blood for sugar 4) Blood for VDRL 5) Urine examination SERVICES RECEIVED eTT immunization: “1st dose: at 1 month of gestation “©2"d dose : One month after the first dose e IRON FOLIC ACID tablets: O received oo tablets for last 3 month Qi tab/day PHYSICAL EXAMINATION HEIGHT : cm WEIGHT: Kgs OB >» AS BMI IS LESS THAN 18.5, SHE IS UNDERWEIGHT Pallor: Clubbing: | Jaundice: absent Oedema: | Cyanosis: Pulse:74/min BP:110/70 mm of Hg Respiratory Rate- 19/min Temperature: normal Neck veins : not engorged Neck glands: not palpable SYSTEMIC » CVS: No abnormality found » Respiratory system: no abnormality found » GI system: no abdominal fullness & no tender point is found on examination » CNS : No abnormality found » GENITOURINARY: No abnormality found PROVISIONAL DIAGNOSIS :- Wife of the head of the family is underweight and presented with Indigestion and Acidity. RS TABLE NO 7 FOOD GROUPS FOOD ITEMS [QUANTITY(gm/di) Cereals 1. Rice 250 2. Puffed rice 100 Pulses i. Lentil 100 ‘Green leafy vegetables 1.Cabbage 200 [Other vegetables Roots and tubers, 1. Potato 100 2. onion 100 Fruits a. guava 100 Milk and milk products Animal foods 1. egg 250 Fats and oils Mustard oil 100 Sugars 50 UTRIENT C SS ONSUMPTION SHEET TABLE NO 8 Foodstuff | Amountig | Calories(Kca | Proted | Fatigm | Fe(me |Caimg | Vit-Almicragra | vit8im | Vit.82(m | Wit.clme my 9 nem) |) ) ) ma) ® ) Eiice 750 aes [16 2s] ms —| oses| ois = Zutied 100 sf o7s[ oa] 66] 33 0 0.21 oor zs vice Bent 100 aaa] asa] os| 76] 69 270) 0.45 0.20 = ‘Acabhage 200 sa] a6] oa, a6] 7a 240. 0.42 ois] 2a ‘Sotto 100 ov] 16] oaf cas) 10 ery 0.10 01 7 6.0nien 100 a2| cal ool a7 o 0.08 O01 nu 7Guava 100 sil oo] 3, oz! 10 0 0.03 eos; 212 ‘age 100 wal 333] aaa] 210] 60 420 0.10 0.40 = SiMustard 100 900 _| 100 = z a 3 a = ail ‘LO.Sugar 50 199 4 = 3 : = E a = Total 71200 3057 | 69.20] 235.7] 21.as| 319.5 esa ters] o96s| ane Consumpti eu IP AR A N OF | ON t IM TI AND DAILY REQUIREMENT OF N UTRIENTS TABLE NO 9 Nutrients |Calories(Ke]Proteinig |Fatiam) | Fetme) | Catma) — | Vit. A(MICR | vitBa(mg) | vitw2tma) | Vit.C(ma) al) m) OGRAM) RDAIReco [2960 m7 a7 30 1200 8000 1s a 80 mmended Dietary Allowance) ‘Cansumpti [3057 69.25 100 2183/3255 954 161s [0.965 ‘488 on Excess [97 33 011s 408, Deficit 2.45, 9.83 874.5 7046 0.735 vau ZOVINEOIWIAN MULTIPLE BAR DIAGRAM SHOWING COMPARISON BETWEEN DAILY REQUIREMENTS AND CONSUMPTION 700 600 500 400 300 209 o103.27 190.966 100M 00 67.24 1003713 100.1193 190 107.67 Wo $6.77 100 o oS ES Sat & # FS TES SSS, Oe os Ss ‘es CONSUMPTION OF DIFFERENT NUTRIENTS 400 ie & = @RDA m= AMOUNT TAKEN SUMMARY © Three membered Bengali speaking nuclear Muslim family residing in Faridpur Village, Mallickpur for the last 30 years. ° Main source of income is salary of head of family i.e. Jamal Laskar and his wife Hasna Banu Bibi » Live ina kuccha house with no overcrowding but inadequate ventilation, lighting and absence of a drainage system ee SUMMARY CONT.. © Improper method of drawing drinking water by buckets © Mosquitoes and fly nuisance also present. © No drainage system with sullage and garbage being dumped into the pond. © Per capita income of Rs 2000/month © Belongs to lower middle group according to Modified Prasad’s Scale. SUMMARY CONT. © There are no school dropouts or orphans. * Jamal Laskar , head of the family is a smoker e Early marriage of the lady, Hasna Banu Bibi at 15 years. © Two TEENAGE pregnancies, the first being pre term and surviving only for a day after delivery CONT.. ° Wife of HOF suffers from bouts of indigestion and acidity and is also moderately underweight. © The child, Hasib Ali Laskar is moderately underweight according to WHO growth curve for boys and suffers from repeated cough and cold infections. e Measles Vaccine, Hepatitis B full course vaccine and Vitamin A injections are not given to the child and he is hence partially immunized. CONT.. © The family has minimal knowledge about diseases like Malaria, Diarrhoea, Hypertension, Diabetes. © Diet had excess of Fat and Vitamin C Diet lacked in Iron, Ca, Vit A , Protein and Vit Bz. PROBLEM IDENTIFICATION a PROBLEMS IDENTIFIED PHYSICAL ENVIRONMENT HOUSING © The house has inadequate ventilation, lighting and has fly nuisance. REFUSE DISPOSAL © The house lacks a proper drainage system WATER SUPPLY © The method of drawing drinking water is improper SOCIO CULTURAL PROBLEM e The head of the family is a smoker. © Wife of HOF had two teenage pregnancies. HEALTH KNOWLEDGE © The family has no knowledge regarding diseases like TB, HIV ete. CONT... MATERNAL HEALTH ° The mother is underweight and frequently suffers from indigestion UNDER 5 HEALTH © The child is underweight and suffers from repeated episodes of cough and cold © Child is partially immunized. CONT.. DIETARY ASSESSMENT © Their diet lacks in Calcium, Vitamin A,Bz, Protein, Tron. FAMILY DIAGNOSIS FAMILY DIAGNOSIS ° This is a three membered Bengali speaking Muslim family, residing in Faridpur for last 30 years, ina kuccha house with no overcrowding but inadequate ventilation and lighting. The family belongs to Lower Income Group by Modified Prasad’s Scale. The adult woman is underweight and has frequent episodes of acidity and indigestion. The child is also moderately underweight and had cough and cold during the time of visit. The family diet contains excess Fat, Vitamin C and is deficient in Protein, vitamin A,B2. RECOMMENDATIONS RECOMMENDATIONS To family :- 1) To use filtered water provided by municipality and use long handled mugs for taking out water 2) To complete the immunization of the child from the nearest sub centre Diet 3) As the diet was deficient in protein, iron, calcium, vitamin A & Bz, hence they were advised to consume green leafy vegetables, cereals, milk products, pulses, fruits, eggs, and soya bean. RECOMMENDATIONS To Individuals : 1) Hasna Banu Bibi — a) Advised to take frequent small meals daily and consume plenty of water b) Avoid Spicy Food c) To take meals according to time d) To use barrier method of contraception e) Being a bidi binder she should use a mask during work. 2) Hasib Ali Laskar a) Avoid Exposure to Cold ACTIONS TAKEN © The family were asked to immediately discard water that was stored in containers for more than 7 days. © They were advised to avoid dipping fingers while drawing water from containers. © The family was described causation and modes of transmission of various communicable diseases and their modes of prevention like TB, Malaria etc © She was made aware of the different occupational hazards related to Bidi binding. CO *Hand washing with soap and water was advised before taking food. ee The wife was advised to motivate her husband to quit smoking. «The mother is motivated to complete the immunization of the child (i.e. two doses of Measles, OPV and DPT Boosters.) +The wife was asked to consume higher amounts of locally available high calorie indigenous food and also feed her child properly as they both are moderately underweight. LIMITATIONS © Head of the family was absent at the time of visit. Study was conducted ina very short duration of just a single visit. Diet survey ideally be taken for one dietary cycle which is 7 days whereas the assessment was made for only 24 hours. Fallacies: © Recall Bias. © The amount of food items taken were approximated in many cases. Individual dietary patterns could not be assessed. <

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