Family Adoption &

Family Survey

Dr. Anuj Singh

Asst. Professor
Community Medicine Dept.
UIMS, Prayagraj
 OBJECTIVES
• WHAT?

• WHY?

• HOW TO DO IT?

• WHAT ARE THE IMPORTANCES OF PROGRAM?

 INTRODUCTION
• In India, around 65.5 % of population resides in rural area
whereas availability of health care facilities present in urban
area.
• Health is a human right
• We need to achieve ‘health for all’.
• Barriers: illiteracy,
• Ignorance about diseases, distance,
• take time off from their daily wages work.
• Hence there is a need to take measures to make healthcare
more accessible to the rural and needy population.
 AIM:

• To provide an experiential learning opportunity to Indian Medical

graduates towards community based health care and thereby enhance
equity in health.
 Objectives:

• During the Medical UG training program, the learner should

be able to :

• 1. Orient the learner towards primary health care

• 2. Create health related awareness within the community

• 3. Function as a first point of contact for any health issues

within the community

• 4. Act as a conduit between the population and relevant

health care facility

• 5. Generate and analyze related data for improving health

outcomes and Evidence based clinical practices.
 Specifics of the Program:

• Family adoption program is recommended as a part of curriculum of

Community Medicine and should begin from 1st professional year with

competencies being spread in ascending manner for entire MBBS training

program.

• The family adoption shall preferably include villages not covered under

PHCs adopted by medical college. If transit time from college to site is more

than 2 hours.

• Medical students may be divided into teams and each team may be

allocated visits, with 5 families per student.

 Other considerations:

• Every college may arrange one diagnostic medical camp in the

village wherein identification of: anemia, malnutrition in

children, hypertension, diabetes mellitus, ischemic heart

diseases, kidney diseases, any other local problems may be

addressed.

• If required, patients shall be admitted in the hospital for acute

illness under care of student, charges may be waived off or

provide concession or govt. schemes.

• For chronic illness, students shall be involved.

• Subsidized treatment charges may be provided under

govt. schemes or welfare schemes.

• Camps may be arranged by Dean and Community

Medicine/ P.S.M. department with active involvement of

Associate/ Asst.Professors, social worker and supporting

staff.

• Local population may be involved with village leaders.

 PROTO-TYPE LOG BOOK FOR FAMILY ADOPTION

• Address details
• Name of the student:
• Roll no.
• Village name:
• Tehsil/ district:
• State/ union territory:
• Name of the mentor:
• MENTOR STATUS: asst. Prof/ S.R.
And details: (if changed, details of
• FAMILY NAME AND ADDRESS:
• Housing standards

• Malaria/ flu/other diseases pertinent to the region

• If there is any illness or medical emergency required by the

house-hold, the student should take initiative in being the

primary contact for the family.

• The student in turn should consult his/her mentor for further

management of the patient.

• The hospital to which the college is attached must provide

• Government schemes may be utilized for optimal
management.
• Follow-up records must be maintained by the student. These
must be periodically evaluated by mentors with the help of
senior residents.
• The entire data sheet may be prepared by every student and
submitted latest by the end of the last visit for evaluation.
• Progress notes must include every demographic point and
history recorded.
• At the end of the program, students may be envisioned to
become leaders for the community.
THANK YOU
1. Family Adoption is a part of Community
Medicine curriculum that starts from 1st. Prof to
final year

2. FAP shall include villages preferably not covered

under PHC adopted Med. Coll. If the transit time
is >2hrs, than jhuggis/bastis/town on outskirt of
cities may be considered

3. Medical students divided into teams with 5

families/students

4. The entire team work under a mentor teacher

1) Rural Area

2) Urban Area

3) Periurban Area

4) Slum Area
1) RURAL: People living in low density and small
settlements and predominantly agriculturist.

2) URBAN: Population of minimum 5000, with

density being 400/square K.m. of which 75%
are non-agriculturist by occupation
3) PERIURBAN: A specific and non-neutral
space refer to a transition or interaction
zone, where urban and rural activities are
juxtaposed, and landscape features are
subject to rapid modification induced by
human activities.

4) SLUM: An inadequate lighting, lack of safe

drinking water supply, absence of toilet
facilities and non-availability of the basic
social and health sciences.
 How many
Types of House?
1) KUCHA: Wall, floor and roof made up of
mud.

2) PUCCA : Floor, roof and walls are made up of

bricks.

3) SEMI-PUCCA : Any of the above is made

up of brick or plaster
What is PROBLEM VILLAGE?
PROBLEM VILLAGE
1) No source of safe water is available within a
distance of 1.6 km.
2) Where water is available at a depth of more
than 15 metres
3) Excess salinity, iron, fluorides and other toxic
elements
4) Water is exposed to the risk of cholera.
 What are
WATER BORN DISEASES?
 What is
Safe and wholesome water?
What is
• Household?

• Family?

• Types of family?
• HOUSEHOLD: Group of people living together;
taking food from the same kitchen and whose
members may not be blood related e.g.
hostels, servants etc.

• FAMILY: Group of individuals related by blood

or marriage or adoption, living together under
one roof and sharing food from single kitchen.
TYPES OF FAMILY

1) Nuclear family
2) Joint family
3) Three generation family
4) Broken Family
1. Nuclear family-
• it consists of married couple and their
dependent children.
2. Joint family-
• It consists of a number of married couples and their
children who live together in the same household. All
the men are related by blood and the women of the
household are their wives, unmarried girls and widows
of the family kinsmen.
• All the property is held in common. There is a common
family purse to which all the family income goes and
from which all the expenditures are met.
• All the authority is vested in the senior male member
of the family. He is the most dominant member and
controls the internal and external affairs of the family.
• The familial relations enjoy primacy over marital
relations.
3. Three generation family -
• Not common in India but popular in foreign
countries. Young couples are unable to find
separate housing accommodation and
continue to live with their parents and have
their own children. Thus, representatives of
three generations related to each other by
direct descent live together.
 Who is
HEAD OF THE FAMILY?
HEAD OF THE FAMILY

• The person among the members of the

household who is the chief earner or bears
the chief responsibility for the economic
maintenance of the household.
 What are
FUNCTIONS OF FAMILY?
1) Family fulfill the biological requirements of man like
food, shelter and procreation

2) Act as bridge between two generations

3) Socialization of growing children in family setup

4) Family environment affects physical, social and mental

development of a child

5) Health is generated or lost in a family setting

6) Family is an instrument of social security against

various emergencies of life i.e. accidents, disability and
death etc.
 What is
Overcrowding?
Overcrowding

• Overcrowding exists if two persons over nine

years of age not husband wife of opposite sex
are obliged to sleep in one room.

• If overcrowding exist gives rises increase

prevalence of respiratory, skin, contagious
diseases etc.
 What are
Good Housing Standard?
1) Access to road, free from Mosquitoes breeding
places, nuisances, dust, smoke, noise, traffic
and soil should be dry and safe having well
drainage system.
2) Set-back light and air space around house in
urban area 2/3 of space, in rural area 1/3 of
area space.
3) Plinth – that should be 2 to 3 feet from ground
level.
4) Rooms not less than two
5) Floor area Ideal is 80 sqr feet to 100 sqr feet
per person but it should not be less than 50
sqr feet
6) Cubic air space:- 1000 cubic feet air space is
Ideal for one person it should not be less than
500 cubic feet per person.
7) Windows:- Window+door area should be 2/5
of floor area. For proper ventilation.
8) Two windows opposite to each other one
opened to free air. For proper ventilation.
9) Proper lighting: - means a person can read
news paper or book in darkest corner of house
without artificial light in sun light.

10) Cattle shade:- open from all sides 8 feet x 4

feet for one cattle cow, buffalo and 25 feet
away from house.
 METHODS OF DIETARY INTAKE
ASSESSMENT :
S. no Methods

1 Diet Balance Sheet Method

2 Inventory Method

3 Weighment Method

4 24 hour Recall Method

5 Food Frequency Questionnaire

 1. Diet Balance Sheet Method:
• This method is used when information regarding
availability and consumption of food is required
at a macro level like at the global, national, region
or state levels. The total food supplies available
and used up at a given level are taken into
account in this method. Effectively the difference
between receipt (of food various sources) and
expenditure over a given period of time gives the
food consumed by population. The consumption
per capita/day is worked out as :
• = Food consumed by population x 365
Mid yr pop
• These figures are used for various types of planning
and budgeting, namely plan for agriculture, fertilizers,
productions, imports and Public Distribution System
(PDS). The method has got certain demerits.
– It is a gross method.
– The consumption of rich and poor is equated and averaged
out when this method is used. It gives the consumption
pattern but doesn’t include purchasing power of the
individual.
2. Inventory Method:
• As mentioned earlier the inventory method is
carried out at an institutional level, on a
homogenous group as present in a hostel, jail,
mess, army barrack, orphanage etc. It is
essentially done from books. Amounts of
various food stuffs available as per records are
taken into consideration. The balance of
various food items is again checked after a
reference point of say 7 days (one week).
Inventory Method: Cont..
Individual consumption / day =
Stocks at beginning of week - Stocks at end of week
No. of individuals x No. of days
• Merits:
I. It is fast, much easier, less cumbersome and faster than
the weighment methods.
II. It is fairly accurate.
III. It may not indicate accurate individual food
consumption but is fairly satisfactory for the purposes
of planning.
Inventory Method: Cont..
• Demerits:
I. It doesn’t account for wastage%.
II. It gives only the mean individual consumption
but actual individual consumption is not
reflected.
III. The estimates are as good as the food records
made available.
IV. The results will be affected if the subjects are
eating some food stuff obtained from any
source other than the common kitchen
3. Weighment Method :
• In this method the foods are actually weighed
using a grocer’s balance. Both raw and cooked
food is weighed. In community surveys (at a
family level), the raw food is weighed rather
than the cooked food, since weighing cooked
food is not acceptable to the families. In an
institution however, the cooked food can also
be weighed, since cooking is carried out at a
central kitchen.
Weighment Method: cont..
1. Convince the housewife of the need of the survey
for the benefit of the family
2. Avoid holidays/fares/festivals/feasts as the dietary
practice of these days does not reflect the actual
dietary practices.
3. It should be carried out for 3 to 7 days consecutively.
4. At least two visits a day for lunch and dinner have to
be made.
5. Two investigators should be available - one talks and
weighs and the other records observations.
6. Any pets, breast fed children, guests etc. should be
considered.
Weighment Method : Cont..
• Merits:
I. It accounts for the non edible parts of food as well.
II. The wastage is also taken into account.
III. This method is more accurate than the inventory
method.

• Demerit:
I. It is a very cumbersome, time consuming and tedious
process as it involves weighing of all foods.
 4. 24 hour Recall (or Questionnaire) Method
• The 24 recall (questionnaire) method is a relatively
easy method based on the recall capabilities of the
individual over a period of the past 24 hours. Since it is
a short term retrospective method it is more prone to
errors. A set of cups and ladles standardized for volume
are used.
• The housewife is asked about the types of food items
prepared at the time of breakfast, lunch and dinner.
The raw ingredients used for cooking each meal are
noted. The cups are exhibited to the housewife. The
cooked food items are noted in terms of these cups.
The intake of each food item by the specific individual
in the family is also assessed by using these cups.
24 hour Recall: Cont..
• Advantage:
I. The method is fairly accurate.
II. It takes lesser time than the weighment method.

• Disadvantage:
I. The method is based on recall capability of the
respondent so there is a likelihood of inaccurate
recall and error in derivation of nutrients.
II. A fair degree of cooperation is to be sought from the
respondent.
III. The process is a cumbersome.
 5. Food Frequency Questionnaire
(FFQ) Method:
• Food frequency questionnaire (FFQ) method is
based on the principle as to how frequently an
item is consumed over a period of time. It is an
epidemiological technique used to study the meal
patterns and dietary habits of people. It can be
used to assess the specific dietary intakes during
pregnancy, lactation, etc. It can even be
conducted through post. For example a FFQ may
read “In one week how often do you consume
the following items….”
(FFQ) Method: Cont..
• Item Frequency (Consumption per Week)
• Meat 1 2 3 4…..
• GLV 1 2 3 4…..
• Sprouts 1 2 3 4……
•
• This filled up questionnaire is then analysed,
using pre-decided values of for nutrients for
different food items.
• *Most acceptable and feasible method in the
community to be practiced by the students
•Energy requirement

?
Methods of
 Method of socio-economic
classification
1) MODIFIED KUPPUSWAMY SCALE

2) UDAY PAREEKH SCALE

3) MODIFIDE BG PRASAD CLASSIFICATION

1. KUPPUSWAMY SCALE
MODIFIED KUPPUSWAMY SCALE
Scoring for Kuppuswamy Scale
 Uday Pareekh Scale
Components Weighted score

A. Caste

Schedule caste 1
Lower caste 2
Artisan caste 3
Agriculture caste 4
Prestige caste 5
Dominant caste 6
 2. Uday Pareekh Scale
S.no Headings

1 Caste

2 Occupation

3 Education

4 Land

5 Social participation

6 House

7 Farm power

8 Material possessions

9 Family type
 Uday Pareekh Scale
Components Weighted score

A. Caste

Schedule caste 1
Lower caste 2
Artisan caste 3
Agriculture caste 4
Prestige caste 5
Dominant caste 6
 Uday Pareekh Scale
Components Weighted score

B. Occupation

None 0

Labore 1

Caste occupation 2

Business 3

Independent Profession 4

Cultivation 5

Service 6
 Uday Pareekh Scale
Components Weighted score

C. Education
Illiterate 0

Can read only 1

Can read and write 2

Primary 3

Middle 4

High school 5

Graduate 6

And above 7
 Uday Pareekh Scale
Components Weighted score

D. Land

No land 0

Less than 1 acre 1

1 – 5 acre 2

5 – 10 acre 3

10 – 15 acre 4

15 – 20 acre 5

20 and above 6
 Uday Pareekh Scale
Components Weighted score

E. Social participation

None 0

Member of one organization 1

Member of >1 organization 2

Office holder in such a 3

organization
Wide public leader 4
 Uday Pareekh Scale
Components Weighted score

G. House

No house 0

Hut 1

Kutcha house 2

Mixed house 3

Pucca house 4

Mansion 5
 Uday Pareekh Scale
Components Weighted score

H. Farm power
No draught animals 1

1-2 draught animals 2

3-4 draught animals 4

5-6 draught animals 6

 Uday Pareekh Scale
Components Weighted score

I. Material possessions
Bullock cart 0

Cycle 1

Radio 2

Chairs 3

Mobile phone 4

Television 5

Refrigerators 6
 Uday Pareekh Scale
Components Weighted score

J. Family type
Single 1

Joint 2

Extended 3

Size up to 5 2

Any other distinctive features 2

Scoring for Pareek’s Scale
3. Modifide BG Prasad
classification