STUDY OF SOCIO-CLINICAL CASE IN OUR

ALLOTED FAMILY IN KADARHAT ,

SONARPUR , SOUTH 24 PARGANAS.

Shreyangi Halder – Roll no. 101

Soham Pathak –Roll no. 96
Srajan Gupta – Roll no.100
Saloni Agrahari – Roll no. 78
CONTENTS :

• INTRODUCTION
• METHODOLOGIES
• OBJECTIVES
• OBSERVATIONS
• SUMMARY
• RECOMMENDATIONS
• ACKNOWLEDGEMENTS
• BIBLOGRAPHY
INTRODUCTION :

HYPERTENSION

Hypertension is a chronic condition of concern due to it’s role in the

causation of coronary heart disease , stroke and other cardiovascular
complications.
It is the commonest cardiovascular disorder , posing a major public
health challenge to the population in socio-economic and
epidemiological transition.
 HYPERTENSION
Risk factors:

Risk factors can be of two types- non modifiable & modifiable

Non modifiable risk factors-

• Age : risk increases with increase in age

• Sex : among middle aged individuals males are at a higher risk than females but after
menopause males and females are at equal risk. Sometimes females may be at higher risk
than males after menopause

• Genetic factors: individuals with a family history of hypertension are likely to develop
MODIFIABLE RISK FACTORS:

• Obesity

• High salt intake: more than 5g/day

• High saturated fat intake

• Alcohol intake

• Calorie consumption more than the individual’s requirement

MODIFIABLE RISK FACTORS CONTINUED :
• Lack of physical activity

• Stress

• Socioeconomic factors

• Other factors like taking OCPs

Classification of blood pressure management(Based on
American Heart Association)
Category Systolic pressure (mm of Hg) Diastolic pressure (mm of Hg)
Optimal <120 and <80

Normal 120-129 and/or 80-84

High Normal 130-139 and/or 85-89

Grade 1 Hypertension 140-159 and/or 90-99

Grade 2 Hypertension 160-179 and/or 100-109

Grade 3 Hypertension >=180 and/or >110

Isolated systolic Hypertension >=140 and <90

COMPLICATIONS OF HYPERTENSION:

• Myocardial infarction
• Hypertensive nephropathy
• Cerebrovascular accidents
• Hypertensive retinopathy
• Heart Failure
• Chronic renal failure
 HYPERTENSION IS AN ICEBERG
PHENOMENON
According to this concept, diseases in a
community may be compared to an
iceberg. The floating tip of the iceberg
represents what the physician sees in the
community i.e., clinical cases.
The vast submerged portion of the iceberg
represents the hidden mass of disease i.e.,
latent, in apparent pre symptomatic and
undiagnosed cases and carriers in the
community.
The waterline represents the demarcation
between apparent and inapparent disease.
 RULE OF HALVES
Hypertension is an iceberg disease . It became evident in the early 1970s that
only about half of the hypertensive subjects in the general population of most
developed countries were aware of the condition , only half of those aware of
the problem were being treated and only half of those were considered
adequately treated.
 MANAGEMENT
Management can be either lifestyle modifications or pharmacological therapy
1. LIFESTYLE MODIFICATION

• Weight reduction
• Adopt DASH Diet (Dietary approaches to stop
hypertension)
• Dietary sodium reduction and potassium
supplement
• Restriction of saturated fats
• Reduce alcohol intake
• Regular Exercise
• Smoking cessation
• Stress management
2. PHARMACOLOGICAL THERAPY

• Diuretics : Chlorothiazide, Furosemide

• Beta blockers: Atenolol , Propranolol
• Angiotensin receptor blockers: Telmisartan , Losartan
• Vasodilators : Nitroglycerin, sodium nitroprusside
• ACE inhibitor :Captopril , Enalapril
• Calcium channel blocker : Amlodipine ,verapamil
• Aldosterone antagonist like spironolactone
• Renin inhibitor like Aliskiren
 CLINICAL FEATURES
High blood pressure often does not causes any symptoms, so that it is known as silent killer
disease.
In some patients symptoms might develop like:-

• Severe head ache • Confusion

• Blurred vision • vertigo
• Dizziness • Chest pain
• Nausea • Shortness of breath
• Vomiting • Irregular heart beat
• Fatigue • Epistaxis
METHODOLOGIES:

1. Type of Study: the study is observational, descriptive, cross sectional

2. Place of Study: Kadarhat, Biswaspara,Sonarpur Municipality , South 24 Paraganas

3. Study Period: the study was conducted between 18th to 30th July 2022 ( date of
field visit 30th July)

4. Study Duration: the study was conducted for 14 days.

5. Study Population: 5 members of the allotted family.

METHODOLOGIES CONTINUED:

6. Study Tools:
• Manual for family health care
• Sphygmomanometer
• Stethoscope
• Measuring tape

7. Methods of data collection: various methods used were-

• Observations
• Interviewing the family members
• Performing measurements and clinical examination
 OBJECTIVES:
• To study the sociodemographic structure of the allotted family

• To assess the health and nutritional status and to find out if there is any deviation
from normal .

• To find out the socio-clinical illness of our allotted family

• To detect the socio-clinical factors responsible for the disease.

• To provide recommendations for the improvement of their health status.

 INTRODUCTION OF THE FAMILY:

1. Name of person interviewed: Parul Biswas

2. Age: 74 years
3. Sex: Female
4. Name of head of the family: Sailen Biswas
5. Type of family: Joint family
6. Address: Kadarhat, Sonarpur, South 24 Paraganas
7. Religion: Hindu
8. Mother tongue: Bengali
9. Length of stay at present place: Since birth
FAMILY CHART :
Name Relation Age Sex Marital Educatio Occupati Monthly Physical Physiolog Addiction
with Status n Level on income activity ical
Head of status
Family
Sailen Head of 47 Male Married Middle Fisherma 8000 Moderat _
Biswas the n e Tobacco
Family
Parul Mother 74 Female Widow Primary Home - Sedentar _ -
Biswas maker y

Putuli Wife 45 Female Married Secondar Housewif _ Sedentar NPNL _

Biswas y e y
Priya Daughter 22 Female Higher Student _ Sedentar _ _
Biswas Secondar y
Unmarrie y
d
Bishal Son 20 Male Higher Student _ Sedentar _ _
Biswas _ Secondar y
y

NPNL = NON PREGNANT NON LACTATING

 INTRODUCTION OF THE FAMILY CONTINUED:
Socioeconomic status: according to Inflation rate adjusted Modified Kuppuswamy
Socioeconomic status scale (2021)

Education of head of family:

Middle 3

Occupation of head of family :

Fisherman 5

Total monthly income of the family: 2

8000

TOTAL SCORE 3+5+2=10 10 = Upper Lower class

HENCE OUR ALLOTED FAMILY BELONGS TO UPPER LOWER CLASS

PRIORITY MEMBERS :

1. Parul Biswas (Mother) as she is 74 years old (Geriatric age group) and is
suffering from hypertention.
2. Putuli Biswas (wife) as she is 45 years old and hence in the reproductive age
group.
3. Priya Biswas(daughter) as she is 22 years old and hence in the reproductive age
group.
HISTORY OF ILLNESS AMONG ANY MEMBER OF
THE FAMILY :

1. History of present illness: Suffering from hypertension for last 15 years.

2. History of past illness: No significant history.

3. Family history of illness: Not significant

PERSONAL HYGIENE

PERSONAL HYGIENE KNOWLEDGE PRACTICE

Regular bath present Regular bath practiced
Nails present Nail cutting practiced
Hair present Hair hygiene practiced
Clothing present Clothing Hygiene practiced
Teeth and gums present Teeth and gum hygiene
practiced
Hand washing present Hand washing practiced
 CASE OF
HYPERTENSION IN
OUR ALLOTED FAMILY
PATIENT PARTICULARS:

• Date of examination: 30th July, 2022

• Name: Parul Biswas
• Age :74 years
• Sex: Female
• Occupation: Home maker
RISK FACTORS

NON MODIFIABLE RISK FACTORS IN OUR FAMILY MEMBER

AGE 74 years
SEX Female
GENETIC FACTORS No family history
 RISK FACTORS CONTINUED

MODIFIABLE RISK FACTORS IN OUR FAMILY MEMBER

OBESITY Present
HIGH SALT INTAKE >5 gm/day
HIGH SATURATED FAT INTAKE Present
ALCOHOL INTAKE Absent
CALORIE CONSUMPTION MORE THAN THE Calorie deficiency present
INDIVIDUALS REQUIREMENT
LACK OF PHYSICAL ACTIVITY Present
STRESS Present
SOCIOECONOMIC FACTORS Present
CLINICAL EXAMINATION OF FASIL HAQUE (HOF)

GENERAL SURVEY:

• Height: 150cm
• Weight:60 kg
• BMI: 26.6 ( PRE- OBESE) ACCORDING TO WHO CLASSIFICATION
• Pallor: absent
GENERAL SURVEY CONTINUED

Icterus: absent
Edema: present
Pulse: 85 BEATS PER MINUTE
BP: 130/100mm of Hg ( hypertensive on medication)
Thyroid gland: not enlarged (NORMAL)
MEDICAL HISTORY

• Presenting complaints: presence of dizziness for the past few weeks

• History of present illness: dizziness
• History of significant past illness: viral infection with rashes
• Family history: no significant illness present
• Any drug history: AMLODIPINE (5 mg OD)
• Diet history of individual: Sufficient nutrition with high salt intake.
EARLY DETECTION: ASK IF ANY OF THESE
SYMPTOMS ARE PRESENT
SYMPTOMS YES/NO
Shortness of breath Absent
Blood in sputum Absent
History of fits Absent
Difficulty in opening mouth Absent

Ulcers/patch/growth in the mouth that Absent

has not healed in two weeks
Any change in tone of your voice Absent
 HOUSING
• Physical environment

• Site: interior
• Type: Pucca
• Ownership: Own
• Attachment: Side to side
• Setback area: Adequate
• No. of living rooms-1
• No.of rooms-3
• Total floor space-192 sq ft
• Per capita floor space-38. 4 sq ft
• Persons per room- 1-2
• Sex seperation-Yes
 HOUSING(2)
• Comment on overcrowding: Yes
• Ventilation and cross ventilation: Adequate
• Lighting : Adequate
• Kitchen : Separate
• Type of fuel used : LPG cylinder
• Smoke ventilation: Absent
• Storage of food : Improper
• Kitchen Garden : Absent
• Bathroom for bathing: Seperate
 HOUSING (3)
•Biological Environment
• Rat problems present
• Mosquitoes/flies present
• Cockroaches present

• Water Supply
• Source of water: Government tube well
• Drinking purpose: Government tube well
• Washing purpose: Government tube well
• Cooking purpose: Tap water
• Distance of drinking water source- within 200m
• Distance between source of water and latrine- near
• Duration of supply – Continuous
• Adequacy of supply- Adequate
 HOUSING(4)
• Drinking water
• Collect: 1000 ft tube well
• Carry: Pots and containers
• Store: Pots and containers
• Is drinking water given any special treatment at household? : No

• Excreta Disposal
• Latrine : Present
• Location: Inside the house
• Type of latrine: Sanitary
• No.of members sharing the latrine: 5
• Is latrine being cleaned regularly? : Yes
• Frequency : Everyday
 HOUSING(5)

• Methods of refuse disposal practised by the family

• Kitchen waste/garbage : collected in containers covered with lid

• Solid waste: Collected in plastic bag
• Liquid waste : Drained regularly
DIET SURVEY

• It is the process of assessing the dietary intake of the family and is one of the methods
of nutritional assessment of the family.

• A diet survey provides information about dietary intake patterns, specific foods
consumed and estimated nutrient intakes by a family It indicates relative dietary
inadequacies as judged by present standards.

• Diet has a very essential influence on health status as it is the most fundamental
parameter governing the health of an individual.

• It is essential to have an idea about the dietary patterns of the community as it is a

direct index of community’s nutritional status.
Methods of diet survey
• Weighment method.
-Raw food
-Cooked food

• Oral questionnaire method

-24 hours recall method
-7 day diet history

• Stock inventory method

• Food Balance Sheet
 ORAL QUESTIONNAIRE
We have done the survey by 24 hours oral questionnaire
method. The family members were asked to recall intake of
individual food items in last 24 hours. For assessment of
individual intake, a set of standardized measured utensils are
used to assess use of different food items
 MERITS AND DEMERITS OF ORAL
QUESTIONNAIRE
MERITS
• It is usually practiced in the field as it’s easier,
less time consuming.
• It provides reasonably good results, provided
enquiries are made in details.
DEMERITS
• Family might have observed fast or feast on
previous day.
• Any member can be suffering from chronic
diseases.
• Family member might be uncooperative or
give false information.
• It doesn’t tell anything about an individual’s
nutritional status.
• It is difficult to interpret, if any family
member takes meal from outside.
• There might be possibility of recall bias.
 MENU

BREAKFAST LUNCH SNACKS DINNER

• Tea • Rice • Tea • Roti

• Roti • Spinach • Ladies finger
• Potato curry • Lentils (Arhar dal)
• Fish Curry
 Dietary intake of the family (food group wise)
[Schedule for Oral questionnaire ( 24 hours recall)]
FOOD GROUPS FOOD ITEMS INDIVIDUAL ITEM WISE TOTAL QUANTITY(food group
QUANTITY (g/ml) wise)
Cereal Rice 1000 1700
Wheat 700

Pulses Lentils(Arhar Dal) 65 65

Green leafy vegetables Spinach 250 250
Non leafy vegetables Ladies finger 250 250

Roots and Tubers Potato 250 330

Onion 80
Animal foods Fish 150 150
Milk 1000ml 1000ml
Fats and oils Cooking oil 70 ml 70 ml
Sugar 30 30
Miscellaneous Tea leaves 10 40
Salt 30
DIETARY INTAKE OF NUTRIENTS BY THE FAMILY FROM VARIOUS
FOOD SOURCES
(Source: Nutritive value of Indian foods, ICMR,2014)
Food sources Quantity(g/ml) Calories(kcal) Protein(g) Fat(g) Calcium(mg)

Rice 1000 3460 64 4 90

Wheat 700 2387 84.7 11.9 334

Lentils(Arhar dal) 65 222.95 16.25 3.9 44.85

Spinach 250 6.5 5 1.75 182.5

Potato 250 242.5 4 0.25 25

Onion 80 42.5 0.77 0.085 39.95

Lady finger 250 87.5 4.75 0.5 165

 Dietary intake of nutrients by the family from different types of food sources
(Source: Nutritive value of Indian foods, ICMR,2014)

Food sources Quantity(g/ml) Calories(kcal) Protein(g) Fat(g) Calcium(mg)

Fish 165 151.8 27.39 2.31 1072.5

Cooking oil 70ml 630 _ 70 _

Milk 1000ml 670 32 41 1200

Sugar 30 119.4 0.03 _ 3.6

Tea leaves 10 _ _ _ _

Salt 30 _ _ _ _

Total 8361.15 238.9 136.5 3207.4

 NUTRIENT REQUIREMENTS OF THE FAMILY
Age Nature of CU Energy Protein Visible Calcium
Family member (years) Sex activity (Consumption
(kcal/day) (g/day) fat(g/day) (mg/day)
unit)
Parul Biswas 74 Female Sedentary 0.8 1688 46 20 1000

Sailen Biswas 47 Male Moderate 1.2 2532 54 30 1000

Putuli Biswas 45 Female Sedentary 0.8 1688 46 20 1000

Priya Biswas 22 Female Sedentary 0.8 1688 46 20 1000

Bishal Biswas 20 Male Sedentary 1.0 2110 54 25 1000

Total 4.6 9706 246 115 5000

 Nutrient surplus/deficiency

• Total calorie requirement of the family – 9706 kcal/day

• Total calorie intake – 8361 kcal/day

• Calorie deficiency – 1345 kcal/day(13.8%)

• Total protein requirement of the family – 246 g/day

• Total protein intake – 238.9 g/day

• Protein deficiency– 7.1 g/day(2.9%)

 Nutrient surplus/deficiency(contd.)

• Total visible fat requirement of the family – 115 g/day

• Total visible fat intake – 136.5 g/day

• Visible fat excess –21.5 g/day(18.6%)

• Total calcium requirement of the family – 5000 mg/day

• Total calcium intake – 3207.4 mg/day

• Calcium deficiency– 1792.6 mg/day(35.8%)

 SUMMARY
•We visited a Hindu family of Sailen Biswas aged 47 years in Kadarhat, Sonarpur
Municipality, South 24 Parganas. He is the Head of the Family. His mother, Parul Biswas, aged
74 years, who is preobese is suffering from hypertension.

•Sailen Biswas has an addiction of tobbacco.

•Other members include Putuli Biswas (wife), Priya Biswas (daughter), & Bishal Biswas(son).

•According to the Inflation Rate Adjusted Modified Kuppuswamy Socio- economic Status scale
(2021) they belong to UPPER LOWER CLASS.

•This is joint family.

•Their diet is slightly calorie deficient .

RECOMMENDATIONS
RECOMMENDATIONS at INDIVIDUAL LEVEL

• Parul Biswas was advised to take a proper diet ,DASH diet ( Dietary Approaches to Stop
Hypertension ) eating plan rich in fruits and vegetables , food with high dietary fiber like
whole grain cereals,beans ,peas legumes : low fat dairy products eg skimmed milk with a
reduced content of saturated fat and total fat
• She was advised to reduce her dietary salt intake to less then 5 gm/day.
• She should continue to take her anti hypertensive medication after consultation with a doctor.
• She should monitor her blood pressure at regular intervals either at home or at a nearby clinic.
RECOMMENDATIONS at FAMILY LEVEL

• Their diet is slightly calorie deficient along with calcium deficiency and visible fat excess.
So they should try and include more proteins(milk,egg,meat) Calcium(milk and dairy
products) and more dietary fibres(fruits and green leafy vegetables). They should also try to
reduce their intake of saturated fats like ghee, butter, oils, etc
• They should maintain proper hygiene and sanitation protocols to ensure prevention of
communicable and vector diseases like malaria and dengue.
• They should also try and reduce their salt intake as one of the members of the family is
hypertensive and currently under medication for such.
• They should try and use unsaturated oil which may include vegetable derived oils (except
coconut and palm oil).
• They are recommended to engage in more physical activities which might include brisk
walking for at least 30mins /5 days a week for adults and outdoor games for the children.
RECOMMENDATIONS at COMMUNITY LEVEL

• They were made aware of the risk factor for cardiovascular diseases by the
community health officer.
• They were made aware of NPCDCS (National Program for Prevention and
Control of Cancer, Diabetes, Cardiovascular diseases and Stroke) programmes
by the local leaders of the community.
• They were advised to participate in regular health camps conducted for
screening of non communicable disease (diabetes ,hypertension) by the
government.
• They were made aware of the hazards and late complications of hypertension
and how to cope up with it at the community health centre.
BIBLIOGRAPHY

• Park, K.(2021)Textbook of Preventive and Social Medicine 26th edition. M/s Banarsidas

Bhanot Publishers, Jabalpur

• (2021)Manual for Family Health Care. 4th edition. Department of Community Medicine,

KPCMCH.
 ACKNOWLEDGEMENT

We would like to thank the members of the allotted family for their co-
operation and the staff members and community leaders for their help.

My acknowledgement would be incomplete without thanking all our

professors of Community medicine department.

Lastly, our special thanks again to the Department of Community Medicine,

KPCMCH for their guidance and support.
THANK YOU