ADIS Projects Final Manual II

DEPARTMENT OF COMMUNITY MEDICINE
GOVERNMENT MEDICAL COLLEGE

CHANDIGARH
FAMILY STUDY MANUAL
VOLUME - II
ROLL NO.
BATCH
NAME
FROM "HIPPOCRATIC OATH"
"Into whatever house I enter, I will go with the object of helping the sick, holding aloof from all voluntary and
all other hurtful wrong doing, and from licentious practices whether with women or men free or bound, and
regarding the things, I see or hear, in the exercise of my art, or outsides its exercise, in my intercourse with
men, which ought not to be divulged, I will keep silent regarding them as inviolable secrets".
I certify that I have read the " Hippocratic Oath", and understand that the family records to be entered
in the note book are of a confidential nature.
---------------------------------------------(Student's Signature)
CERTIFICATE
This is to certify that Mr. / Ms. ___________________________has completed his/her assignment of family
study satisfactorily / unsatisfactorily.
Professor & Head,

Deptt. of Community Medicine,
Govt. Medical College,
Chandigarh-160047
Dated :____________
2
FIELD WORK & ASSESSMENT

S.
NO.
DATE OF VISIT
FAMILY ASPECT STUDIED
GRADE
PAGE
FACULTY
REMARKS
PART-A
1.
GUIDELINES FOR FAMILY STUDY
2.
VITAL STATISTICS OF THE AREA
3.
COMMUNITY SURVEY
4.
ENVIRONMENTAL SURVEY
5.
FAMILY RECORD
6.
ECONOMIC SURVEY
7.
IMMUNIZATION RECORD
8.
PERSONAL HYGIENE
9.
FAMILY WELFARE SURVEY
10.
HEALTH KNOWLEDGE
11.
SURVEY FOR SOCIAL PROBLEMS
12.
DIET
SURVEY
&
NUTRITION
STATUS
13.
ANTENATAL CARE
14.
POSTNATAL CARE
15.
INFANT HEALTH CARE
16.
UNDERFIVE HEALTH CARE
17.
ADOLESCENT HEALTH CARE
18.
INDIVIDUAL HEALTH CARE
19.
GERIATRIC HEALTH CARE
20.
SUMMARY & CONCLUSION
21.
ANNEXURES I-XI
PART-B
22.
STUDENT OWN FAMILY STUDY

OVERALL GRADING:
GRADE
A- >70%
C- 50-60%
B- 60-70%
D- <50%
I/C Academics
3
GUIDELINES FOR FAMILY STUDY

Each student will be assigned two families-one at RHTC Palsora and another his /her own family at
home.
FAMILY:
A family is a social unit of biologically related people sharing from the same kitchen and living under
one roof.
SPECIFIC INSTRUCTIONAL OBJECTIVES:

To enable each student:
1. To understand that the family is the basic and social unit of the community.
2. To obtain first hand experience of application of principles of Preventive Medicine for the welfare of
the family, i.e health promotion and specific protection, earliest diagnosis and prompt treatment and
limitation of disability and rehabilitation (if required).
3. To orient them so that they can help the families as family physician.
4. To help them in learning about general medical practice at family / household level. In addition to
these, the other objectives are:
i. To observe and study the environmental factors responsible for good health, for
causation and transmission of diseases in the family.
ii. To learn the importance of observing the person in his natural environment i.e, in
prepathogenic phase affected by multiplicity of factors and their importance in
causation of
disease.
iii. To study the socio-economic factors responsible for the good health and disease as well,
in the family.
iv. To assess the nutritional status of the family and dietary pattern of community as a
whole and
advise them accordingly.
v. To study the health status of each individual in family and advise accordingly.
vi. To study and observe the psychosocial or emotional factors having their relation and
impact on
the health and disease of the family.
vii. To suggest feasible, practical and affordable (cost effective) improvements in the
environment
4
viii. to take part / in the health education program organised from time to time / for the
promotion / actively of health and prevention of diseases in future.
ix. To ascertain the need of family welfare measures of the family and motivate them to
select the
family planning devices as per their felt needs (cafeteria approach) and
the availability under National Family Welfare Program (NFWP).

x. To get first hand experience of various social and cultural practices prevalent in the
community with the help of Medico-social worker and apply this knowledge for
providing the comprehensive health care to the family.
FAMILY STUDY
CASE STUDY
Family study aims at the complete health study of the

family.
It aims at the health of an individual only.
All the aspect of health i.e. promotive, preventive,

curative are given importance.
Mainly curative aspect is dealt with

Only deals with the treatment of diseased part.
Aims at all the five levels of prevention.

To study the epidemiology of disease in respect of
agent, host and environment.
To study the disease in question and its

treatment only i.e. mainly the host part is kept
in view. Environment and social factors are
ignored and not given any importance.
Case or patient in chronic/acute illness has to take

domicillary treatment. So study of socioeconomic
status, physical, biological & Psycho-social
environment, habits and customs related with health
practices of family are also done.
Hospital is the place of stay and its

environment is only a temporary phase which
may not help ultimately for complete cure.
RESPONSIBILITIES OF STUDENTS:
It is envisaged that the students, are friends, guides and health advisors to the assigned families and
shall act as family Physician during the whole period of their training at the centres. Medical services needed
by the members of the families are being provided through the Rural Health Training Centre (RHTC), Palsora,
Urban Health Training Centre (UHTC), Sector 44, and referral is done to OPDs of various Departments of the
Govt. Medical College & Hospital (GMCH), Chandigarh.
5
The students must imbibe the missionary spirit and adopt a humane approach. You should always
remember your duty and responsibilities (Hippocratic oath). In obtaining the information from the family
always attempt to convey the idea that we are truly interested in their overall welfare and all the information
gathered will remain confidential especially about their income, marital life and interfamilial relations.
You shall visit your families as and when allotted as part of your practical work and maintain their
records. You are free to visit your families at any other time if you or your family so desires. In addition you
have to carry out the environmental and socio-economic survey of the house and the family and conduct the
physical examination of all members of your families with appropriate recommendations for improvement of
the socio-economic status, environmental conditions and treatment of illness if any. The faculty / staff of the
department of community medicine is always available for regular guidance.
You must wear your apron and always carry your stethoscope, tape and torch with you, whenever you
visit your families. All other equipments required are made available from the concerned Health Centre.
You shall present your family to the whole class bringing out all the important features on socioeconomic status, the dietary factors, environment on one hand, the growth and development of the children in
the family, antenatal mother, geriatric person, common disease in the family, their problems on the other hand
and how you tried to help them. The outlines for guidance are also provided.
VITAL STATISTICS OF THE STUDY AREA

Date:__________
STUDY AREA
INDIA
Total Births :
Live Births :
Still Births/Abortions
Crude Birth Rate
Total Death
Crude Death Rate
Total Infant Deaths
Infant Mortality Rate
Total Maternal Deaths
Maternal Mortality Rate
Total Population
Male:
Female:
Antenatal Mothers
Infants
<5yrs
>60yrs
Total Number of Eligible Couples
Total Number of Eligible Protected
Condom users
Cu-T Insertions
OCP - Users
Tubectomies Done
Vasectomies Done
i)
Couple Protection Rate
(Contraceptive Prevalence)
7
COMMUNITY SURVEY
Date:__________
1.
Name of Place:
Union Territory Chandigarh.
2.
Name of Study Area: Urban Area/Peri-Urban Area/Urban Slums/Rural Area:_______________.
3.
Main Religion represented in the population:Sikhs
4.
Important Community / Social organizations
Hindus
Others
Govt.:1.____________.2._______________
NGOs: 1.____________.2._______________
__________________________________________
Principal industries/means of livelihood: ___________________________________.

Method of Village/Urban Government:
Recording births & deaths:
Gram Panchayat/NAC/MCC
Gram Pradhan/Panchayat Secretary/Chowkidar/ANM/TBA/Any other
Educational facilities available:
No. of Schools : Govt.____________.Public__________

No. of Colleges : Govt.____________.Public__________
Health facilities available:

Medical Care: _________________________________
Medical practitioners (No.) Modern Medicine/Ayurveds/Homeopaths/other indigenous:______.
TBAs: _______________AWS/AWW/AWH______________VHG_____________
6.
Water Supply:
Tap/Well/Other Specify: continuous/intermittent supply
7.
Excreta disposal:
Sanitary Latrine
Personal
Community
Any other, specify: __________________________.

8.
Waste water disposal: Open drain/closed

drain/water logging
8
9.
Refuse disposal:
Dumping/Composting/ Bins (Municipal Corporation)
10.
Disposal of dead:
Ritual burning/Crematorium/other, specify___________.
11.
Channels of Communication in the community:

Interpersonal:
Mass Media:
Folk Media:
TV/Radio/Newspaper
_______________________________.
Important customs prevalent in community:
Birth
________________________________
Marriage
________________________________
Others
________________________________
Main health problems in community
1.
________________________________
(Interview opinion leaders/ Panchayat members)
2.
________________________________
3.
_________________________________
4.
_______________________________
1.
_______________________________
2.
_______________________________
3.
______________________________
Unmet needs of community
COMMUNITY DIAGNOSIS:
1. _________________________.
2. _________________________.
3. _________________________.
QUESTIONS:
What is the significance of conducting community survey?
What are the different ways of conducting community survey?
What is Community Diagnosis?
How can community diagnosis help in health planning and management?

9
ENVIRONMENTAL SURVEY
Date:__________
LEARNING OBJECTIVES: To enable medical students

To assess the Environmental Status.
To understand the influence of environmental factors on health of the family.
To suggest suitable modifications in the environment to alleviate/prevent health problems in the family within th
given constraints.
Name of Ward / Mohalla /Street:
Sector
House No.
HOUSING CONDITION:
House:
Owned / Rented
Roof:
Thatched / Tin or Cement Sheets / Bricks / Cemented & Plastered.
Walls:
Mud / Bricks
Floor:
Mud with cowdung / Cemented / Tiled.
Number of Doors
Area
sq. ft.
Number of Windows
Area
sq. ft.
*Open space around the house:
Numbers of Rooms
*Separate kitchen:
*Separate bath room:
Latrine:
Total floor space area of living rooms
**Overcrowding
*Cross Ventilation
Lighting:
*Dampness
Water Supply: Tap water / Hand pump / Well
Type: Kuchha / Pucca / Mixed
Own / Community / Indiscriminate defecation.

sq.ft. Floor space/Area/person
(see annexure I)
10Adequate
/ Inadequate
sq.ft.
If tap water:
*
Own tap / Community tap
Continuous / Intermittent
Water storage:
Drums/Buckets/Utensils/Any other, specify_____________________.
Stored water :
Covered / Uncovered
Method of drawing water from pot : Mug/Ladle/Steel Glass / Tumbler / Other specify___________
Sullage disposal : Kuchha drains / Pucca drains/ None / Any other, specify____________________
Cooking : Gas / Stove / Chula / Electric Plate
Refuse disposal : Own bin / Community bin / Indiscriminate throwing / Dumping / Any other, specify
If Bins used, Whether Covered / Uncovered
**Animals/Birds in the house
Animals kept in the house / separate shed
Insects / Rodents / Mosquitoes / Houseflies of medical importance seen
Smoke vent : Present / Absent
If yes, distance of shed from the house
ft.
If yes,
specify________.
*
Preventive measures used
Measures Used: Mosquito Nets / Repellants / Sprays / Rat traps / Flytraps / Any other, specify._____
**Good cleanliness inside the house
GENERAL REMARKS:
Environment:
Please write
Good cleanliness outside the house
Disease Breeding
Why: ______________________________________
Health Promoting
Why: ______________________________________
* Yes - 01,
** Present - 01,
* No - 02
11
** Absent 02
QUESTIONS:
Enumerate criteria for overcrowding.
Enumerate diseases associated with overcrowding.
What are the diseases transmitted by Mosquitoes?
Classify various water borne diseases.
Enumerate the household methods for disinfection of water.
How can you find out whether water being supplied through municipal corporation is potable and fit for
drinking or not?
What are diseases associated with cattles and pets?
What is manure pit and soakage pit?
What is sanitary landfill and composting? Differentiate between sewage, sewerage and sullage.
Comment upon physical and biological environment of the family allotted to you.
Comment on adequacy of ventilation and lighting in family allotted to you?
What do you mean by kitchen hygiene?
What do you mean by VIP latrine?
SKETCH OF THE HOUSE OF ALLOTED FAMILY:
12
FAMILY RECORD
LEARNING OBJECTIVES:
Date:__________
The student should be able

To conduct the Interview as per steps in interview technique.
To learn the importance of each variable in relation to the identification and family record collected below.
-
To learn types, functions, advantages & disadvantages of particular type of family and
To learn the role of family in health and disease.
Total family members
Type of family:
Joint/Nuclear/Extended/ Three generation
Religion: Hindu/sikh/muslim
FAMILY COMPOSITION
S.
No.
Name
Age
Sex
Relation to
head of family
Education
Occupation
Income/
month
Immunization
Status
Any
Health
Problems
Head of family comes first. Rest in chronological (order of age), including deaths / still births.
**
Any birth / death during clinical posting to be recorded and to be updated in flying posting before examination.
13
Rema
rk If
any
QUESTIONS:
What are the steps of interview technique?

Difference between family and household.
Enumerate functions of family.
Enumerate merits and demerits of nuclear and joint family.
How much should be the spacing between two children? Why?
Name the diseases associated with the occupations of the family members
Explain the following terms:
Broken family
Extended family
Problem family
New familiy
14
SOCIO-ECONOMIC SURVEY
Date: __________
LEARNING OBJECTIVES: To enable medical students:
To learn the methods of assessment of socio-economic status and significance of different classifications t
various set-ups
To learn the concept of poverty line
To learn association of socio-economic status with health.
To be able to advice the family members for modification of expenditure pattern to improve health status in th
available economic resources
INCOME SOURCE AND EXPENDITURE PATTERN:
6.2.1
Land
Monthly income (in rupees)

House
Shop
Wages/Salary
Of all members
Cottage
Industry
6.2.2 Per capita income per month: ______________

2.
A.
EXPENDITURE (Monthly):
Food
Housing
Clothing
Transport
Education
Medical aid
Electricity / Water
Communication (Telephone/Mobile)
Fuel
Ceremonies
Any other, specify
15
Others
Total
Total expenditure (monthly) ___________________

C.
Assessment:
(a) Above/below poverty line
(b) Socio-economic status based on Modified Kuppuswamy scale ( See Annexure IIA & B):
- Score : Income ____ + Occupation ____ + Education ______ : Total ______
- Socio-economic status based on the score obtained: _________
QUESTIONS:
Name the different scales used to measure the socio- economic status.
What are the limitations of Kuppuswamy classification?
How much is the per capita per month income in India at present?
What is the economic criteria for poverty line and name the other criteria?
Enumerate the diseases associated with upper socio-economic status.
Enumerate the diseases associated with lower socio-economic status.
16
IMMUNIZATION RECORD (For Under Five Children & Antenatal Mothers only)
Date:__________
To learn methods of eliciting information about immunization status of the individuals.

To learn eligibility, contraindications, precautions, dosages, route of administration, vaccination schedule, side effects of the vaccines,
cold chain maintenance etc. regarding vaccines used under National Immunization Program.
To be able to perform immunisation.
S.
No.
Name
Age
B
C
G
DPT
I
II
III
OPV
B
II
C
1
2
3
4
M
I
II
17
III
Measles
B
TT
I
Hepatitis
A/B
II
Chickenpox /
MMR/ Typhoid
etc.
Immunization
Complete /
Partial / Nil
Reasons for failure

of Immunization
QUESTIONS:
What is the National Immunization Schedule?
What are the common complications of vaccines?
Discuss specific complications of vaccines used in national immunization schedule.
What are dosages, routes and sites of administration of vaccines used in UIP?
What advice you will give to mother after DPT & BCG vaccination of the child?
Why Measles vaccine is recommended at the age of nine months?
What is toxic shock syndrome?
If a child has been vaccinated just one day before PPI under NIS, whether that child be vaccinated agai
during PPI? Discuss reasons.
Suggest Immunization schedule for a two years, four years and six years old unimmunized child.
What are the newer vaccines?
Differentiate between EPI and UIP.
What is cold chain? Name the different equipments used in maintaining cold chain
What is Reverse Cold Chain? Give examples.
19
PERSONAL HYGIENE
LEARNING OBJECTIVES: To enable the medical students:
Date:__________
To do assessment of personal hygiene of individual and family.

To learn the influence of poor personal hygiene on health status.
To learn how to impart health education regarding personal hygiene to individual and family
** S.No. OF FAMILY MEMBERS
CLEANLINESS:
Bath: Daily/Occasional
Use of soap : Daily/Occasional
Washing of hands : before taking food
After going to toilet
CLOTHING :
*Clean
How often exchanged?
How often washed?
SKIN :
*Clean
*Any skin disease
If yes, specify:
If, present : Under Tt/Cured/Not Tt /Others
NAILS
*Trimmed
HAIR :
*Combed
Washed :Regularly/irregularly
*Soap / Shampoo used
*Presence of lice
If yes, specify-Tt taken or not.
EYES
*Presence of discharge
*Presence of congestion
If yes, specify status
EARS
*Presence of wax
*Presence of discharge
If yes, specify status
LIPS:
Normal /Chapped/Angular/ Stomatitis

TEETH:
Brushed :Regularly/irregularly
*Presence of tartar/caries
*Use of brush/datoon
TONGUE:
Clean/coated
*Presence of ulcers
If yes, advice given-specify
MOUTH:
*Washed after meals

*Presence of bad odour
*Presence of gingivitis / stomatitis
*Please fill: Yes - 01, No - 02
20
**S.No.
is according to Family Record
QUESTIONS:
What are the different types of hygiene you know?
What is the difference between hygiene and sanitation.
What are the diseases transmitted/associated with application of Kajal?
What are the diseases associated with poor genital hygiene?
Which disease is likely to be transmitted by walking bare foot?
What do you mean by effective handwashing?
What is occular hygiene? How is it different from visual hygiene?
Enumerate diseases cause by poor personal hygiene?
What is the correct method of brushing? What is the life of toothbrush?
How will you assess the quality of soap and which soap you will recommend for washing and bathing purpose?
21
FAMILY WELFARE SURVEY

Date:__________

1.To learn the problem of population explosion and its reasons.
2. To learn about the various family planning devices under cafeteria approach.
3.To learn the attitude of people towards National family welfare program (NFWP).
KNOWLEDGE:
*India is facing the problem of population explosion :
Reasons for population explosion :
___________________
_________________
___________________
_________________
In your opinion, how many children a couple should have: ___________
Family planning methods known :
Barrier methods/ OCP / Cu-T / Saheli / Tubectomy / Vasectomy / Any other, specify :
v)
What in your view should be the spacing between 2 children : ___________________.
ATTITUDE:
Attitude towards use of family planning methods : Using / Willing to use;
If cant use, why; specify________________________________________________.
Attitude towards spacing of children: Doing / willing to do; If not, why; specify______________.
Ideal number of children in their view: _________________________.
*Is a male child must:
*Preference of son to daughter:
If yes, give reason: _______________________________________________.
vi)
Which permanent sterilization methods (Tubectomy/vasectomy) you will prefer and why?
______________________________________________
PRACTICE:
i)
FP methods: Used / Not used
S.no.
Contraceptive
Duration
1.
Condoms
2.
Cu-T
3.
OCP / Saheli
4.
Tubectomy Done
5.
Vasectomy Done
* Please fill : Yes - 01, No - 02
Using/Withdrawn
Side effect/any other problem
**Unmet need of Contraception

22
QUESTIONS:
1. What are different kinds of family planning devices available in the National family welfare
program?
2. What do you mean by cafeteria approach under NFWP?
3. Who is an ideal candidate for Cu T?
4. Is it essential to know about attitude of elderly in the house regarding family planning methods?
5. What is PNDT act?
6. What are conventional contraceptive? What is an ideal contraceptive?
7. Define Sex Ratio. Enumerate reasons for the decline in sex ratio.
8. What is meant by Unmet Need for family planning?
9. Define the following terms: a) Target Couple
b) Eligible Couple c) Couple Protection Rate
10. What are the Natural family planning methods?

11. Explain scope of family planning services.
23
SOCIO-CULTURAL ENVIRONMENT
Date:__________
LEARNING OBJECTIVES: To enable the medical students:To learn the importance of socio-cultural factors in health and disease
To learn the level of knowledge, attitude, customs, beliefs and practices of the family in health and
disease
To learn the benefits and harmful effects of the customs and practices scientifically and advise the
family accordingly.
Information regarding customs and health practices

Name of the respondent: _____________________
Marriage
What is the legal age for marriage in India for boys: ___ , for girls __
At what age you were married ? _____
In your opinion, what should be the age at marriage for boys __ , & girls ___
Child bearing
1. Age at first pregnancy of the respondent (if applicable) _____
2. Number of children born: __________
3. Age at last pregnancy: ____________
4. Details regarding the last pregnancy and its outcome:
- Registered in antenatal clinic : Yes/No _________ Or Period of gestation at the
time of registration in Antenatal Clinic ______ weeks/not registered.
- Received antenatal care: Yes/No _______ Number of antenatal visits _____
- Food intake : Whether food intake increased : Yes/No since second trimester?
- Any food restriction:
Yes/No,
If yes,
- For which food item? ___________________________ , Why _____

_______________________________________________________
- Any special/additional food item given ? Yes/No, Names:______________
Reasons _____________________________________________________
- Number of hours of rest in daytime : Nil/ __________
- Any complications during pregnancy: Yes/No _______________________
- Anemia : Present/ Absent (as per record/history)
- Outcome of pregnancy: Abortion/still birth/ preterm/full term
- Delivery: Institutional/ Home
24
Delivered by : Doctor/Nurse/Trained
Dai/Untrained Dai/Relatives or neighbours/self
- Cord applicants : ash/cowdung/ghee/ antiseptic/other _________none applied

- No. of days of isolation during puerperium: _____
Child rearing
1. Should colostrum be given to the newborn child ? Yes/No and why ? _____
______________________________and have you given it to your baby ? Y/N
After how many hours/days of birth, breast feeding should be given ? ____
And why ? ______________________________________ and when have you started breast
feeding ? ______
Any prelacteal feeds given to the child? ___________________________
Do you give any other food than breast milk before six months of age? Yes/No ______________
Do you give water to a child who is getting only breast feed? Yes/No _____
At what age supplementary feeding should be started ? ____
When did you start supplementary foods for your child ? _____
Which foods should be introduced at 6 m ____________________________ _______________,
8 m __________________________________________.
Have you registered your child with well baby clinic/under five clinic ? Y/N
Against what diseases, vaccines should be given for an infant ?
_________, __________, _________, _________, ________, __________
Is your child vaccinated for the vaccines due for date ? Y/N, If no, reasons
______________________________________________________
Apart from vaccine preventable diseases, which diseases commonly occur during first year ?
_____________________________________________
Did your child ever suffer from diarrhoea ? Y/N. If Yes, what actions did you take: a) ORS given :
Y/N, b) Home Available Fluids given : Y/N, if Yes, specify ________________________ c)
Any other action, specify: _____________.
Did your child ever suffer from pneumonia? Y/N, If yes, could you recognize it? Y/N, What were
the signs and symptoms? _________________________,
What actions did you take: ________________________________________.
Other child rearing practices

1. Application of kajal.
Y/N, If yes, with common applicator Y/N
2. Massage with oil
Y/N
25
3. Exposure to sunlight
Y/N
4. Use of ghutti
Y/N
5. Food prohibited during fever:
Y/N
6. Restrictions of fluids during diarrhea : Y/N
Concept of disease causation:

i)
"Evil eye"
ii)
Karma"
iii)
Punishment by God
iv)
Bad weather
v)
Dirty water / food
vi)
Any other, specify
Are diseases preventable?
Knowledge, attitude and practices in some common diseases

(Students should impart health education)
1. Tuberculosis
Is tuberculosis curable ? Y/N
What measures should be taken to prevent transmission of the disease ?
___________________________________________________________
___________________________________________________________
Should the patient of T.B. be isolated ? Y/N
What is the duration of treatment ? ________ If complete treatment is not taken, what will
happen to the patient ? _______________________
2. Measles
Can it be prevented ? Y/N, If yes, how ? __________________________
What do you do in case a child gets measles? _____________________
___________________________________________________________
What is the cause of measles ? __________________________________
3. Poliomyelitis
(a) Can it be prevented? Y/N, If yes, how ___________________________
4. KAP regarding any other disease existing in the family? (e.g. Hypertension. Diabetes etc.
Attach separate sheets.)
26
Nutrition
Which are the faulty cooking practices in the family? Enlist them (See Annexure III)
2)
i)
______________________________________________________________
ii)
______________________________________________________________
iii)
______________________________________________________________
Which are the beneficial cooking practices in the family? Enlist them (See Annex. III)
i)
______________________________________________________________
ii)
______________________________________________________________
iii)
______________________________________________________________
Health services utilization:

Which are the health centers /agencies serving in your village/ locality?
________________________________________________________________________
Are you availing benefits regularly? Yes / No,
If No, please specify:
________________________________________________________________________
Are you satisfied with the health services provided? Yes / No,
If No, please specify:
________________________________________________________________________
Are you visited by the medical social/health workers/ANM regularly? Yes/No
Where do you go in case of emergency?
________________
_________________
Analysis and interpretation

Customs and practices conducive to health _________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Customs and practices harmful for health
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
27
Customs and practices having no bearing on health

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
QUESTIONS:
What are the various socio-cultural factors affecting health and diseases of the community?
What is social pathology?
What are the customs you have observed in the community which do not have a bearing on
health of the community?
Enlist the diseases to which social stigma is attached?
Define custom, culture, mores and folkways.
28
SURVEY FOR SOCIAL PROBLEMS

Date:__________

To learn regarding various social problems in the family and the community
To suggest suitable measures to tackle those problems
Unemployed adult:
Yes
No
Poverty:
Yes
No
Overcrowding:
Yes
No
Gambling:
Yes
No
Marital conflicts / Abuse / Divorce or Separation:
Yes
No
Any unmarried mother:
Yes
No
In case of working mother, who takes care of the children: _____________________

Orphans in the family:
Yes
No
Children >6 years, not going to school:
Yes
No
If yes, state the reason _________________________.

Children <14 years, working: (Child Labour)
Yes
No
If yes, place of work __________________________.

11.
Any Delinquent Child in the Family:
Illness in the family:
Yes
No
If yes, effect of illness on:

i)
Individual Patient:
At Psychosocial / Emotional Level:_________________________
At Economic Level: ___________________________________
ii)
Family:
Psychosocial_______________________________________
Economic ________________________________________
iii)
Attitude of family members:
Positive & Caring

Co-operative & Sympathetic /Empathetic
Indifferent & Non Co-operative
Attitude of Neighbours :________________________________.
Indifferent & Non Co-operative
Emphathetic / Sympathetic & Co-operative

29
QUESTIONS:
What are the various social problems in the family and at the community level?
Suggest suitable measures to manage social problem in your family?
Explain various factors responsible for social problems?
Name the different social institutions existing in your field practice area. In what ways do these
impact the health status of the people ?
30
DIETARY ASSESSMENT
(To Be Completed In Three Visits)
Date:__________

To analyze the concept & importance of balanced diet.
Merits and demerits of various methods of dietary survey.
To collect the accurate information regarding food consumption of both the household and individual
member.
To understand the concept of energy consumption unit (ECU) and calculation of dietary intake per
consumption unit, detect deficiencies/excesses and correlate them to the nutritional status of the
family members.
To advise the family regarding required change in diet in case of deficiency/excess.
To calculate food intake according to various food items and nutrients relevant to that particular area and
the group.
Collection, analysis, interpretation and advice regarding diet to the individual suffering from nutritional
disorder/needing special nutrition to the vulnerable groups.
Visit I:
Recommended daily allowance of family members
Date:_______________
The following information is aimed to find out the dietary requirement of family members as per
recommendation. This will help students to understand what is required for the family members of the
family allotted to them and then compare that with what they are actually taking (See annexure X).
Name
Age
Sex
Occupation
Cereals
Pulses
31
GLV
Other
vegetables
Roots
&
tubers
Sugar
Milk
Fat
&
oil
DAILY DIET CONSUMPTION BY THE FAMILY IN GRAMS

(MODIFIED QUESTIONNAIRE METHOD)
Method for assessment of average daily consumption:
Find out fortnightly/monthly consumption for items procured fortnightly/monthly e.g. rice, wheat,
pulses, oil etc. and calculate average daily consumption
Find out weekly consumption for items such as fish, meat, eggs, fruits etc. and calculate average
daily consumption
Find out daily consumption of regularly used items such as milk, vegetables etc.
Find out consumption of any occasionally used items during last 24 hours e.g. chocolates, biscuits,
sweets, ice-cream etc.
Take into account if any member has not taken meal during the 24 hrs. period of taking history
Deduct the consumption of food by guests, if any
Dont take the diet consumed on the occasion of fast, feast and festival.
Now, calculate the average daily consumption (last 24 hrs.) by the family and enter below(See annexure
IV, V, VI, VII & IX):
S. No.
item
gms.
S. No.
item
1.
Wheat
2.
Rice
3.
Pulses
4.
Sugar / jaggery
5.
Oil/Ghee (total)
6.
Saturated fat
7.
Un-saturated fat
8.
Fish
9.
Meat
10.
Poultry
11.
Eggs
12.
Fruits
13.
Vegetables green leafy
14.
Vegetables, non-leafy
15.
Tuber
16.
Milk
17.
Milk product (specify)
18.
Any other, specify
Calculation of Consumption units:

. Total number of family members:___________________________.
. Total number of consumption units *: _________________________.
* Key for calculating consumption units(ANNEXURE VIII)
32
gms.
Visit II:
Date____________
Intake of foodstuffs per consumption unit (C.U.): (Prepare bar diagram)

Foodstuff
Average intake
Recommended
(for 1 C.U.)
Cereal
gms
460 gms.
Pulses
gms
40 gms.
Milk
gms
150 gms.
Fruits
gms
80 gms.
Green Vegetables
gms
40 gms.
Other vegetables
gms
60 gms.
Tubers
gms
50 gms.
Fats & Oils
gms
40 gms.
Sugar & Jaggery
gms
30 gms.
Eggs
gms
50 gms.
Meat/Fish
gms
30 gms.
9.3
% Deficit/Excess
Average Daily Consumption Of Individual Suffering From Nutritional Disorder/Needing Special
Nutrition (Dietary intake should be studied for all individuals qualifying this condition. Format given
below to be copied for each of them)
Name of the individual : _______________ Age ______
Sex ___
Physiological/pathological condition needing special nutrition : _______________________

Foodstuff
Average intake*
Recommended
(for the individual)
Cereal
gms
gms.
Pulses
gms
gms.
Milk
gms
gms.
Fruits
gms
gms.
Green Vegetables
gms
gms.
Other vegetables
gms
gms.
Tubers
gms
gms.
Fats & Oils
gms
gms.
Sugar & Jaggery
gms
gms.
Eggs
gms.
gms.
Meat/Fish
gms
gms.
% Deficit/excess
Average means usual intake as informed by respondent.

33
CONSUMPTION OF FOOD ITEMS & NUTRIENTS (PER CONSUMPTION UNIT)

(Construct bar diagram):
Sr.
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Food items
Qty.
gms
Calories Proteins Fat Vit. A* Thiamine Riboflavin

(gms.) gms (g)
(mg)
(mg)
Niacin Ascorbic Iron

(mg) Acid (mg) (mg)
Calcium
(mg)
Cereals
Pulses
Milk
Fruits
Green leafyVegetables
Other Vegetables
Roots & Tubers
Fats & Oils
Sugar & Jaggery
Eggs
Meat & Fish
Any other (nuts etc.)
Specify
Total per consumption
Unit
Recommended value
daily intake per C. U.
Percentage
* in terms of carotene
2425
60
34
20
2400
1.2
1.4
16
40
28
400
Deficiencies in the Diet & advice given:

Family diet according to per consumption unit
Deficiencies:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Advice given:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
35
Visit III:
Date____________
Nutritional Status Of Family

Sr.
No.
Name
Age
Nutritional assessment based

on anthropometrics/clinical
examination *
Dietary
deficiencies
Action taken
* Mention values for anthropometry and clinical findings and your diagnosis based on these.
36
QUESTIONS:
What are the various methods of assessing nutritional status of an individual?
What are the different methods of conducting diet survey? What are the advantages and
disadvantages of various methods of conducting diet survey?
What is the objective of conducting diet survey?
What dietary advice and treatment you will give to a three-year child suffering from Vit. A
deficiency?
What dietary advice you will give to a patient of Diabetes Mellitus?
What dietary advice you will give to a pregnant and lactating mother?
What is the protein requirement of a one-year old normal child?
What are the parameters for assessing protein quality in foodstuffs?
What are clinical features and management of rickets?
What is D.A.S.H. diet?
Classify malnutrition and discuss management of various types of malnutrition.
What is therapeutic diet?
37
PREVENTIVE CHECK-UP
Date:__________
LEARNING OBJECTIVES:
To enable medical students:
To learn about common health conditions in the various age groups.

To learn the concept of high risks and screening.
Importance of screening/preventive check-up in relation to health status. Identification of target groups for
preventive check up and individuals to be screened for the diseases relevant to their age and various
tests to be used for screening.
Early diagnosis of risk factors and health problems, timely referral, management at domestic and institutional
level and health education.
ANTENATAL CARE (ANC)

Date:__________
Name
Religion
Age
Occupation
Address
LMP
EDD
Registered/unregistered: ______________If registered, name the centre:____________.

Date of first visit (check-up)
*Planned pregnancy
Number of visits paid

If unplanned: Wanted/Unwanted.
Present complaints:
1.________________________________
3._____________________________________
2.________________________________
4._____________________________________
Onset duration & progress(ODP) of presenting illness:

________________________________________________________________________________________
________________________________________________________________________________________
38
Menstrual history_________________________________
Age at menarche
Obstetric history: _________________________________
Age of marriage
Sno.
No. of
pregnancies
Any
complications
Please fill
Age
Sex
Place of
delivery
Yes - 01,
Conducted
by
Live/Still
birth/IUD
No - 02
H/o Past illness:___________________________________________________________________

_______________________________________________________________________________
Family history :___________________________________________________________________
Personal history :__________________________________________________________________
*
Appetite
Bowel & bladder
Sleep
Habits
Diet history :_____________________________________________________________________

Contraceptive history:______________________________________________________________
Care provided for present pregnancy:
*T.T given :
If yes, no. of doses : reqd. _________ given: ________.
*Folic Acid & iron tablets given :
If yes, no. of tablets __________ since _____________.
If no, specify reason : ___________________________.
Economic / Environmental history :
GENERAL EXAMINATION
Height :
cm
Weight:
kg
Blood Pressure:_____ mmHg
Resp Rate
min
Pulse Rate
min
Pallor
Oedema
Clubbing:
Cyanosis
Icterus
Breast examination:___________________________________________________________
39
SYSTEMIC EXAMINATION
*P/A Inspection:
Abd distension
Visible pulsations
Visible movements
Linea Nigra
Striae gravidarum
Fundal Ht
*Foetal movements
Presentation:_____________ Lie:__________
Palpation:
Auscultation:
Foetal Heart Sound
Respiratory Distress
INVESTIGATIONS:
5. 1) Blood group: Self: _______ Husband: ________ Compatible: Yes/No
2)
VDRL : +
gm%
3)
Hb
4)
5)
USG:______________
Urinary Albumin
gm%
Urinary Sugar
RISK ASSESSMENT:
*High Risk:
If yes, reasons 1.__________2.___________3.___________
ADVICE / ACTION TAKEN BY STUDENT

1. Personal hygiene
______________________
_______________________
Physical activity
______________________
_______________________
Rest
______________________
_______________________
Diet
______________________
_______________________
Drugs
______________________
_______________________
Regular check-up ______________________
_______________________
T.T./Folic acid+ F.S. tablet ________________ _______________________

Any Other :_____________________________
S.No.
DATE OF
VISIT
ANTE NATAL FOLLOW UP

COMPLAINTS DIAGNOSIS & TREATMENT
40
REMARKS
Questions:
Enumerate high-risk pregnancy criteria. What is meant by the term high risk newborn?
How many minimum visits should be made at ANC clinic and what actions should be taken at each visit?
What additional nutrients should be provided during pregnancy?
What are the drugs contraindicated during pregnancy?
What are the facilities for ANC care in the area?
What do you mean by TORCH infection?
How will you prepare a lady for safe delivery? What do you mean by five cleans?
Define a) Maternal death b) Maternal mortality rate (MMR) c) Late maternal death d) pregnancy related
death.
Enumerate the causes contributing towards maternal mortality and what steps can be taken to counter them.
41
POSTNATAL CARE (PNC)

Date:__________
Name
Age
Religion
Occupation
Address
H/O Delivery:
Complaints at present:
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: ________________________________________________
______________________________________________________________________
Menstrual history: ______________________Obstetric history: __________________
Past history.: ___________________________________________________________
______________________________________________________________________
Family history: __________________________________________________________
Personal history: ________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________
________________________________________________________________________
Contraceptive History: ____________________________________________________
Economic/Environmental History in brief: ______________________________________
________________________________________________________________________
GENERAL EXAMINATION
Height :
cm
Weight:
kg
Resp Rate
min
Pulse Rate
min
Pallor
Clubbing:
Cyanosis
Oedema
Icterus
Breast examination:___________________________________________________________
42
SYSTEMIC EXAMINATION
*P/A Inspection:
Abd distension
Visible pulsations
Linea Nigra
Striae gravidarum
Visible movements
Palpation:
Fundal Ht
QUESTIONS:
What are the contraceptive methods for such a case?
What is the minimum number of postnatal visits required?
What are the common complications during postnatal period?
What are the facilities for PNC in the area studied by you?
Define : Perinatal mortality rate. Enlist the various causes contributing towards perinatal mortality.
43
EXAMINATION OF NEWBORN
Date:__________
H/o Delivery : _________________________________________________________________
Any complaints
1. ___________________________________________________________________________
2. ___________________________________________________________________________
ODP of presenting illness: _______________________________________________________
_____________________________________________________________________________
Family tree: ___________________________________________________________________
_____________________________________________________________________________
Feeding history (right from birth): _________________________________________________
______________________________________________________________________________
Immunization: _________________________________________________________________
Height :
Resp Rate
cm
min
Weight:
Pulse Rate
kg
min
Cyanosis
Pallor
Icterus
Anthropometry : Length :
Head :
Chest:
Weight:
Mid-arm:
Foot to toe examination (for congenital malformations)

If any abnormality detected please specify, otherwise write NAD / WNL
Anterior fontanelle:
__________.
Chest:
__________.
Umbilical cord:
__________.
Hip:
__________.
Ears:
__________.
Genitalia:
__________.
Eyes:
__________.
Legs:
__________.
Mouth:
__________.
Feet:
__________.
Nose:
__________.
Nails:
__________.
Neck:
__________.
Rectum:
__________.
Examination of Reflexes: Normal / Abnormal, If any Abnormal reflex detected, please specify:
______________________________________________________________________________
Diagnosis: _____________________________________________________________________
Investigation:
1)
Blood group
2) Hb
gm%
3) Any other : ________________________.
Treatment, If any :_______________________________________________________________

44
Advice:
Feeding: ________________________________________________________________
Immunization: ___________________________________________________________
Follow-up: growth monitoring by growth chart
Cord care : _____________________________________________________________
No Application of kajal
Advice / Action taken by Student:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
POST NATAL FOLLOW UP
S.No.
DATE OF
VISIT
COMPLAINTS
DIAGNOSIS & TREATMENT
45
REMARKS
INFANT HEALTH CARE

Date:__________
Informant: _______________________. Name: __________________________________.
Any complaints:
1._______________________________________________________________________
2._______________________________________________________________________
3._______________________________________________________________________
ODP of present illness: _____________________________________________________
________________________________________________________________________
H/o delivery in brief: _______________________________________________________
Family tree: ______________________________________________________________
*Working mother:
Nutrition history:
Breast feeding/Top feeding/Weaning __________________________________________
Food Items
Calories
Proteins
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
Total: ____________________________________________________________________
Required: ________________________________________________________________
Deficit/Excess: ____________________________________________________________
Immunization history: complete / incomplete, If incomplete specify reason_____________
_________________________________________________________________________
Milestones: (Record actual months)
1.
Social smile (2 months)_________ 2.
3.
Turning over (4-5months)________ 4.
5.
Teething (6months)______________ 6.
7.
Crawling (9-10mths)_____________8.
Walking with support (10-11months)
Head holding (3months)_________________

Sitting with support (5-6mths)____________
Sitting without support (6-8mths)__________
First words (10-11mths)__________________
Customs & beliefs related to infant care in this infant:____________________________________

_______________________________________________________________________________
Economic/Environmental History in brief: _____________________________________________
________________________________________________________________________________
GENERAL EXAMINATION
Height:
Resp Rate
cm
min
Clubbing:
Cyanosis
Weight:
Pulse Rate
46
Icterus
kg
min

Pallor
Oedema
Signs of nutritional deficiencies: ___________________________________________________

Anthropometry: _________________________________________________________________
Head :
Chest:
Weight:
Mid-arm:
Systemic Examination:
Respiratory system
Central nervous system
Cardiovascular system
Musculo skeletal system
Diagnosis:________________________________________________________________
Investigation, If any :_______________________________________________________
Treatment, If any:__________________________________________________________
Advice / Action taken by Student:
1.
Personal hygiene:____________________________________________________
2.
Diet: ______________________________________________________________
3.
Immunization as per National Immunization Schedule:

Follow-up(Growth monitoring) according to growth chart
Family planning:
Yes / No, please specify ______________________________
Removing misconceptions in child care if any ; specify:

A)
B)
C)
D)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
*
S.No.
DATE OF VISIT
Please fill
Yes - 01,
No - 02
INFANT HEALTH FOLLOW UP

COMPLAINTS
47
REMARKS
UNDERFIVE CHILD CARE

Date:__________
Informant: _______________________. Name: __________________________________.
Any complaints:
1._______________________________________________________________________
2._______________________________________________________________________
3._______________________________________________________________________
ODP of present illness: ______________________________________________________
_________________________________________________________________________
H/o delivery in brief: ________________________________________________________
Family tree: _______________________________________________________________
*Working mother :
Nutrition history:
Breast feeding/Top feeding/Weaning ___________________________________________
Food Items
Calories
Proteins
1. _______________________________________________________________________
2. _______________________________________________________________________
3. _______________________________________________________________________
Total: ____________________________________________________________________
Required: _________________________________________________________________
Deficit/Excess: ____________________________________________________________
Immunization history: complete / incomplete, If incomplete specify reason_____________
_________________________________________________________________________
Milestones: (Record actual months)
1.
Social smile (2 months)_________ 2.
3.
Turning over (4-5months)________ 4.
5.
Teething (6months)______________ 6.
7.
Crawling (9-10mths)_____________8.
Walking with support (10-11months)
Head holding (3months)________________

Sitting with support (5-6mths)____________
Sitting without support (6-8mths)__________
First words (10-11mths)_________________
Customs & beliefs related to underfive care in this child:__________________________________

_______________________________________________________________________________
________________________________________________________________________________
GENERAL EXAMINATION
Height :
cm
Resp Rate
min
Clubbing:
Weight:
Pulse Rate
Cyanosis
kg
min
48

Pallor
Oedema
Icterus
Signs of nutritional deficiencies: ___________________________________________________

Anthropometry: _________________________________________________________________
Head :
Chest:
Weight:
Mid-arm:
Systemic Examination:
If any abnormally detected please specify, otherwise write NAD / WNL

Respiratory system
_____________ Central nervous system____________________
GIT __________________Eye___________________Ear_______________________
_____________ Musculo skeletal system_____________
Diagnosis:______________________________________________________________________
Investigation, If any :______________________________________________________________
Treatment, If any:___________________________________________________________ _____
Advice / Action by Student:
1.
Personal hygiene:___________________________________________________________
2.
Diet: _____________________________________________________________________
3.
Immunization as per National Immunization Schedule:

Follow-up(Growth monitoring) according to growth chart
Family planning:
Yes / No, please specify ___________________________________
Removing misconceptions in child care if any ; specify:

A)
B)
C)
D)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
*
S.No.
DATE OF
VISIT
Please fill
Yes - 01,
No - 02
UNDERFIVE HEALTH FOLLOW UP

49
REMARKS
QUESTIONS:
What are the common health problems of the under five children?
Name the medical conditions for which the child is normally asymptomatic?
What are the components of newborn care?
What are the different health care targets related to under five children in the national health policy?
What information can you get from the road to health card? Who prepared this card?
What are the effects of eating junk food?
What are the various national health programs associated with health of under five children?
How will you keep a healthy child healthy?
50
ADOLESCENT HEALTH CARE

Date:__________
Name
Age
Religion
Marital Status :
Occupation
Married / Unmarried
Address
Complaints (If any):
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: _______________________________________________
______________________________________________________________________
Past history: ____________________________________________________________________
_______________________________________________________________________________
Family history: __________________________________________________________________
Personal history: ________________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________________
Habits: ____________________________ Sleep : ______________________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: ______________
Menstrual hygiene practiced :
Yes / No
H/O of passage of white discharge per vaginum:
Yes / No
________________________________________________________________________________
GENERAL EXAMINATION
Built & Nourishment: Well / Poor
Height :
Resp Rate
cm
min
Weight:
Pulse Rate
kg
min

Pallor
Oedema
Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify:_________________________________________
Any signs of nutritional deficiencies: Yes / No, If yes,
please specify:___________________________
51
SYSTEMIC EXAMINATION :
Respiratory system
GIT __________________Eye___________________Ear_______________________
SIGNS OF PUBERTY:
1. __________________________________6.____________________________________
2. ___________________________________7.____________________________________
3. ___________________________________8.____________________________________
4. ___________________________________9.____________________________________
5. ___________________________________10.___________________________________
Is there any role model in your life: Yes / No, If yes, please specify____________________
___________________________________________________________________________
If givan a choice what would you like to become in your life?__________________________
___________________________________________________________________________
If givan a choice what would your parents want you to become?________________________
___________________________________________________________________________
Do you have good and trustworthy friends? Yes / No
Have you ever tried to use any of the following:
1.
Alcohol:
2.
Cigarette :
3.
Drugs :
4.
Any other:
Are you addicted to any of the above?

If yes, type
Duration
Yes / No
Years
Have you heard about HIV / AIDS? Yes / No

Who are the persons who may get HIV / AIDS?
1.___________________2._____________________3._______________4._____________
What are you doing to protect & promote your health?
_____________________________________________________________________________
________________________________________________________________________________
52
Diagnosis of health status: Healthy / Not Healthy if not, please specify_____________________

________________________________________________________________________________
Health advice given:_______________________________________________________________
ADOLESCENT HEALTH FOLLOW UP
S.No.
DATE OF
VISIT
COMPLAINTS
QUESTIONS:
Who is an adolescent?
Is it a vulnerable period of life? Why?
What are the common health problems seen in adolescent age groups?
What are the national health programs associated with health of adolescents?
53
REMARKS
GERIATRIC HEALTH CARE

Date:__________
Name
Age
Religion
Occupation
Address
Working / Not working, If not working, specify the source of income________________________
Chief Complains including Psychosocial Problems (If any):
1.
____________________________________________________________________
2.
____________________________________________________________________
3.
____________________________________________________________________
4.
____________________________________________________________________
ODP of presenting illness: __________________________________________________________

________________________________________________________________________________
Past history.: _____________________________________________________________________
________________________________________________________________________________
Family history: ___________________________________________________________________
Personal history: ________________________________________________________________
Bowel/Bladder: _____________________ Appetite : ___________________________________
Habits: ____________________________ Sleep : ______________________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN FEMALES : H/o menopause:____________________________________________________
Psychosocial and Environmental History in brief: _______________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Height :
Resp Rate
Clubbing:
cm
min
Weight:
Pulse Rate
kg
min
Cyanosis

Pallor
Oedema
Icterus
Lymphadenopathy: Yes / No, If yes, please specify:_________________________________________

Any signs of nutritional deficiencies: Yes / No, If yes, please specify:___________________________
54
SYSTEMIC EXAMINATION:
Locomotor system (joints) :_____________________________________________
Respiratory system
_____________ Central nervous system__________________
GIT __________________Eye___________________Ear____________________
______________________________________________
Diagnosis:___________________________________________________________________
Investigation, If any :__________________________________________________________
Treatment, If any:_____________________________________________________________
ADVICE/ACTION TAKEN BY STUDENT
Attitude towards illness
Effect of illness on patient & family members
Problems in the family due to illness.________________________________________
S.No.
DATE OF
VISIT
______________________________________________
____________________________
GERIATRIC HEALTH FOLLOW UP

REMARKS
QUESTIONS:
Enumerate the common health problems of geriatric age group.
For which problems the middle-aged people must be screened?
Name the lifestyle related diseases and how will you apply behaviour change communication
(BCC) for their prevention?
What is geriatrics? How can you classify old age people? Differentiate between geriatrics and
gerontology?
What are the services being provided to this age group?
What are the normal dietary modifications required after the age of 40 yrs, 50 yrs and 60 years?
55
Why?
Name some non- government organizations (NGOs) working actively for the welfare of the
elderly.
56
INDIVIDUAL HEALTH
Date:__________
Name
Age
Religion
Occupation
Address
Chief Complaints (If any):
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
ODP of presenting illness: _______________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: _________________________________________________________
Personal history:________________________________________________________
Bowel/Bladder: _____________________ Appetite : __________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ___________________________________________________________
_______________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: __________________
Contraceptive History: _______________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
Immunization History:____________________________________________________________
Economic/Environmental History in brief: ____________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Height :
Resp Rate
cm
min
Weight:
Pulse Rate
kg
min

Pallor
Oedema
Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify: _________________________________________
57
Respiratory system
GIT __________________Eye___________________Ear______________________
Diagnosis: _____________________________________________________________________
Investigation, If any :_____________________________________________________________
Treatment, If any:________________________________________________________________
ADVICE/ACTION TAKEN BY THE STUDENT
Problems in the family due to illness.__________________________________________
S.No.
DATE OF
VISIT
________________________________________________
______________________________
INDIVIDUAL HEALTH FOLLOW UP

58
REMARKS
INDIVIDUAL HEALTH
Date:__________
Name
Age
Religion
Occupation
Address
1. ____________________________________________________________________
2. ____________________________________________________________________
3. __________________________________________________________________________________
4. ____________________________________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: ________________________________________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________
________________________________________________________________________
IN FEMALES : Menstrual history: ______________________Obstetric history: ______________
Contraceptive History: ___________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
Immunization History_____________________________________________________________
Economic/Environmental History in brief: ____________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Height :
Resp Rate
cm
min
Weight:
Pulse Rate
kg
min

Pallor
Oedema
Clubbing:
Cyanosis
Icterus
Lymphadenopathy: Yes / No, If yes, please specify:___________________________________
Any signs of nutritional deficiencies: Yes / No, If yes,
59 please specify:___________________________
Respiratory system
_____________ Central nervous system_____________
GIT __________________Eye___________________Ear____________________
Diagnosis:________________________________________________________________
Treatment, If any:___________________________________________________________
Problems in the family due to illness._________________________________________
S.No.
DATE OF
VISIT
_____________________________________________
______________________________

60
REMARKS
INDIVIDUAL HEALTH
Date:__________
Name
Age
Religion
Occupation
Address
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: __________________________________________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
Immunization History:_____________________________________________________________
Economic/Environmental History in brief: __________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Height :
Resp Rate
cm
min
Weight:
Pulse Rate
kg
min

Pallor
Oedema
Clubbing:
Cyanosis
Icterus
61
Respiratory system
GIT __________________Eye___________________Ear____________________
Diagnosis:________________________________________________________________
Treatment, If any:___________________________________________________________
S.No.
DATE OF
VISIT
_____________________________________________
______________________________

62
REMARKS
INDIVIDUAL HEALTH
Date:__________
Name
Age
Religion
Occupation
Address
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: __________________________________________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Height :
Resp Rate
cm
min
Weight:
Pulse Rate
kg
min

Pallor
Oedema
Clubbing:
Cyanosis
Icterus
63
Respiratory system
GIT __________________Eye___________________Ear____________________
Diagnosis:________________________________________________________________
Treatment, If any:___________________________________________________________
_____________________________________________
______________________________

S.No.
DATE OF
VISIT
COMPLAINTS
64
REMARKS
INDIVIDUAL HEALTH
Date:__________
Name
Age
Religion
Occupation
Address
1.____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
_____________________________________________________________________
Past history: ___________________________________________________________
______________________________________________________________________
Family history: __________________________________________________________
Habits: ____________________________ Sleep : _____________________________
Diet History: ____________________________________________________________________
________________________________________________________________________________
IN CHILDREN :
Family tree:_____________________________________________________________________
_______________________________________________________________________________
GENERAL EXAMINATION
Height :
Resp Rate
cm
min
Weight:
Pulse Rate
kg
min

Pallor
Oedema
Clubbing:
Cyanosis
Icterus
65
Respiratory system
GIT __________________Eye___________________Ear____________________
Diagnosis:________________________________________________________________
Treatment, If any:___________________________________________________________
_____________________________________________
______________________________

S.No.
DATE OF
VISIT
COMPLAINTS
66
REMARKS
SUMMARY & CONCLUSION OF THE FAMILY STUDY

Date:__________
1. Specify the health problems in the family:
Medical ______________________________________________________________
Nutritional ___________________________________________________________
Environmental ________________________________________________________
Social ________________________________________________________________
2. Enlist the medico-social problems as felt by the family:
_________________________________________________________________________
_________________________________________________________________________
Name
Age
Conditions for which

individual needs to
be screened
Methods of
screening
Findings/
Results of the test
Action taken
List the medical problems detected:

________________________________________________________________________________________
-_______________________________________________________________________________________
Which of the above problems could have been prevented?
________________________________________________________________________________________
67
__
DEPARTMENT OF COMMUNITY MEDICINE

GOVERNMENT MEDICAL COLLEGE, CHANDIGARH
STUDENT'S OWN FAMILY STUDY
Date:__________
Name of student
Batch
Address
Population of the area/sector
Religion
Facilities in your area/sector :

Education :
Medical:
Social :
Primary
Middle/High School
Secondary
College
Doctors : Private
Govt.
Govt. Dispensary
Hospital
Organisation
Clubs
Nursing Home
FAMILY RECORD
S
No.
Name
Age/
DOB
Sex
Marital
Status
Relation
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
68
Education
Occup
-ation
Height
(mtrs)
Weight
(Kg)
Illness
(if any)
IMMUNIZATION STATUS
S.No.
BCG Scar
Present/Absent
TT
(Mention
Year)
Hepatitis
Any other
(eg MMR)
Immunization
Status
1
2
3
4
ENVIRONMENTAL STATUS
Total area
Drinking Water
Sq. ft.
Tap water
Overcrowding :
Any other
(Specify) _______
Mode of refuse disposal (House to Public bin): _________________________________
Animals/Birds (Pets):
Aqua Guard
Present/Absent
Filter/Zero B
_______________________________________________
Y/N, If yes, please (specify) _________________________________________

Immunization status: Nil/Given, specify_________________________________
Insect/ Mosquito repellents :
Not used/Mat/Ointment/Spray/Any other_________
ECONOMIC STATUS:
Total Family Income :
(monthly)
Rs.
Per Capita Income (PCI) : Rs.
SOCIAL STATUS
Habits: (Father/Head)
Yes/No
Frequency
Smoking
Alcohol
Beetal chewing
Any other
69
Duration
A.
KAP OF MOTHER REGARDING COMMUNICABLE DISEASES

(Please encircle the correct options)
Multiple option possible
Yes - 1, No - 2
HIV/AIDS
a)
b)
It is:
1.
2.
A sexually Transmitted disease and occur by sexual contact.

Caused by HIV
3.
A curable disease.
4.
Once infected, the person will be infected for life.
5.
Leads to development of many other diseases.
6.
A disease of only Foreigner.
7.
A diseases of high risk groups
8.
Any other specify:______________________________________________
High Risk Groups are:Commercial sex worker

Health professional
Truckers
Migrant labourers
Street children
c)
It is transmitted by:1.
Transfusion of infected blood.
2.
Contaminated needles & syringes
3.
Touching the patient.
4.
Most commonly by sexual intercourse.
5.
Sharing food same utensils and towels.
Coughing and sneezing

Mother to child
Bite of mosquito and utensils
9.
Any other specify:______________________________________________
70
d)
e)
2.
Treatment 1.
No treatment available
2.
No vaccine available
3.
Use of strong antibiotic / injection
4.
No treatment but prevention possible
5.
Any other specify:_______________________________________________
Prevention & control is possible by : 1.
Use of condoms during intercourse.
2.
To keep away from patients suffering from AIDS.
3.
Using Disposable syringes / needles.
4.
Screening of Blood for HIV before its transfusion.
5.
Any other specify:_________________________________________________
TUBERCULOSIS
a)
Tuberculosis is an infectious diseases:It affects lungs only.

It affects lungs and any other part of body
b)
3.
Patient becomes weak.
4.
Cough persists for more than three weeks
5.
Occurs because of evil forces / past sins
6.
How does it spread?

1.
By sputum
2.
By drinking contaminated water
3.
By sharing towels
4.
By drinking contaminated milk
5.
71
c)
Treatment It is curable
DOTS treatment is available
It is available free at Govt. Hospital
3.
Treatment is costly.
Treatment is to be taken for (i) <6 months,

(ii) 6-9 months
(iii) 1 year
Drugs have severe side effects.
d)
DOTS provider is :Voluntary worker

School teacher
MPW / ANM
e)
Prevention & Control is possible 1.
Patients should cover mouth while coughing.
2.
Family contacts should be given ATT drugs.
Patients should be isolated.

BCG vaccine should be given to children <2 years
Infection can still spread even if patient is taking treatment
3.
DIARROHEA
a)
Diarrhoea means :1.
More number of stools than usual.
2.
Stools may have blood.
3.
Stools are watery.
4.
No deficiency of water can occur.
5.

72
b)
Mode of spread 1.
Caused by some curse or evil eyes.
2.
Caused by wrong feeding habits
3.
Spreads by eating uncovered foods in market.
4.
Dirty hands and flies also spread it
By consuming unsafe water

c)
Treatment 1.
2
Breast feeding should be continued

Feeding should be stopped.
3.
Person should avoid milk and other fluids.
4.
Plenty of fluids (ORS) should be given.
5.
Consult a doctor.
6.
Cannot be controlled without medicines
7.
Prevention & control is possible -
B.
1.
By keeping your environment clean.
By protecting foods from flies.
3.
By washing hands regularly.
4.
By storing water in covered buckets
5.
By using tumbler with long handle for taking out water
6.
KAP OF MOTHER REGARDING MCH / RCH SERVICES:

a)
Pregnancy: Pregnant mother should not
1.
Take non-vegetarian food.
2.
Take drugs without medical advice.
3.
Eat extra food than her daily average intake.
Smoke or take alcohol

Take papaya, black gram, bengal gram etc.
73
Pregnant mother should take:

1.
More energy dense food.
2.
More iron & calcium during her pregnancy.
3.
Take more spicy food.
4.
More sleep & rest
5.
Go for check-up regularly
6.
Take vaccine for tetanus
7.
Gain weight around 11 kg
8.
Place of delivery should be i) home based

ii)institutional delivery
High risk pregnancy are:
Abnormal presentation
Bleeding PV
Mothers age >30
Teenage pregnancy
High blood pressure during pregnancy
Diabetes during pregnancy
b)
Child:
1.
Should bathe child immediately
2
Janam ghuti and honey should be given
Baby should be kept in separate cot

Breast milk is the only thing that should be given to child for
first 6 months
Colostrum (first thick milk after delivery) should not be given
to the child.
Top feeds/milk should be started after 6 months.
Milk should be diluted before giving it to the child.
Kajal should be applied in eyes
Should anything be applied on umblical stump
74
C.
KAP OF MOTHER REGARDING NON-COMMUNICABLE DISEASES
HYPERTENSION (HIGH BLOOD PRESSURE)

a)
What happens in high blood pressure?

1.
Palpitation in chest
2.
Weakness in body.
3.
Increased pressure in blood vessels.
Headache
b)
Risk Factors 1.
Can be transmitted from parents to children.
2.
Increases by consuming more salt.
3.
Increases by taking more oily food, alcohol & smoking
Can occur in young people.

Only a diseases of elderly
c)
6.
Treatment, Prevention & Control is possible 1.
Diet control - low fat, high fiber diet
2.
Can be controlled by medication only.
3.
Weight reduction.
4.
Exercise/walking.
5.
Cessation of smoking & alcohol intake.
6.
Yoga & relaxation also help.
7.
HEART ATTACK
Heart attack means
1.
More pressure on heart.
2.
Cessation of heart activity.
75
b)
3.
Chest pain on left side.
4.
Can occurs when an individual is in stress.
5.
Even consuming alcohol occasionally can lead to heart attack.
6.
Smoking is also a risk factor.
7.
Risk Factors Increase intake of saturated fat / oil

Increase smoking
Increase alcohol intake
Decrease physical activity
Stress & tension
6
Can be transmitted from parents to children.
High blood pressure can cause Heart attacks.

8.
c)
Any other specify:________________________________________________
Treatment, Prevention & Control 1.
Diet control
2.
Weight reduction
3.
Exercise
4.
Can be controlled by drugs only

Bypass surgery may be required.
Yoga & relaxation also help
7.
DIABETES
a)
Diabetes is:1.
An infectious disease.
2.
Charactrised by frequency of micturtion.
3.
Feeling of weakness.
76
4.
Increased appetite for food.
5.
Affect other organs of the body e.g. eyes, kidneys etc.
Related with obesity

Only a diseases of elderly
Anybody can suffer from it
b)
Risk Factors: 1.
It passes on from parents to children.
It is a disease of old age only.

It is a disease of young age & old age both
It occurs in those who eat lot of sweets & sugar
Exercise has protective effect on diabetes
c)
Treatment, Prevention and Control 1.
There is no treatment for diabetes.
2.
It can be controlled by drugs only.
3.
It can be controlled by dietary measures.
Weight control can help.

It can be controlled by vegetables like methi, karela, jammun etc.
Treatment & follow-up services available in Govt. Hospital
Health education regarding diabetes is helpful to patients
Foot care is very important in diabetes
77
INDIVIDUAL HEALTH
*Present Illness (last 15 days)
(Write symptoms)
Duration
1
2
3
4
*Chronic disease
(Hypertension/Coronary artery disease/Diabietes mellitus /
COPD / Cataract / paralysis/other)
TREATMENT HISTORY: (CURRENT)

Medical/Surgical
problem
Medication
Dose- (adequate
inadequate)
Frequency
(Reg/Irreg.)
Duration
1.
2.
3.
4.
Any other major ailment in life till date, if yes, please specify:_______________
i)
Disease
_________________________________________
ii)
Any hospitalization _____________________________________
iii)
Operations ____________________________________________
78
USE OF ANY AIDS & APPLIANCES

Aids
Yes/No
Duration (Months & Years)
Hearing
Dentures
Spectacles
Any other
PHYSICAL EXAMINATION
a)
General Examination -
Pulse rate :
/ min.
Blood pressure SBP
mm Hg.
DBP
*Pallor :
Respiratory rate:
Height
/ min.
cms.) Weight
*Icterus
JVP - Raised*
*Clubbing
* Oedema feet
Oral cavity_______________________ *Lymphadenopathy
(Kg.)
Thyroid_____________________
Deficiency signs (Nutritional)__________________________________________________________

b)
Systemic Examination -
Per Abdomen
1.
Inspection
*Movement with Respiration
*Visible veins/Peristalsis
*Visible mass______________________ Hernial sites_______________________________

2.
Palpation
*Guarding
* Tenderness
Any mass___________________________________________________________________
Hernial sites_________________________________________________________________
Liver_______________________________Spleen___________________________________
*Please fill Yes - 01, No - 02
79
3.
Percussion
Resonance/Dullness___________________________________________________________
*Fluid thrill
4.
Shifting dullness
Auscultation
Bowel sounds
CIRCULATRY VASCULAR SYSTEM

1.
Inspection
*Apex beat visible
2.
Palpation
Apex beat (Localization/Character)________________________________________________
*Thrill
*Parasternal Heave
3.
Percussion (Area of cardiac dullness)
4.
Auscultation
Heart sounds_________________________________________________________________
*Added sounds (Murmur/click/pericardial rub)
if yes, please specify _________________
RESPIRATORY SYSTEM
1.
Inspection - Shape of chest_________________Trachea_____________________________
2.
Palpation - Chest expansion
3.
Percussion - Note_______________________Liver dullness__________________________
(cms.) Trachea__________________________________
Cardiac dullness_______________________________________________________________
4.
Auscultation -
Breath sounds______________________________________________
*Crepts/Rhonchi
*Pleural rub
GENITO URINARY SYSTEM

1.
Inspection
*Prolapse
if yes, please specify______________________
Hernial sites_________________________________________________________________
2.
Palpation
* Any Mass
*BPH:
Hernial sites_______________________________________________
if yes, please specify________________________________________
80
CENTRAL NERVOUS SYSTEM

1.
Higher mental functions____________________________________________
2.
Autonomic functions ______________________________________________
3.
Motor -
Muscle mass__________________________________________
Tone/Strength_____________________________________________________
Reflexes__________________________________________________________
4.
Sensory__________________________________________________________
5.
Any other________________________________________________________
LABORATARY INVESTIGATION:
Hb.
gm%
Blood sugar F
Cholestrol
gm% Any other
PP
FINAL DIAGNOSIS: ____________________________________________________
_______________________________________________________________________
FOLLOW UP
Sno
.
Date
Ailment
(Monthly)
Weight
(six monthly)
81
B.P.
(six monthly)
Sugar
(yearly)
Social and Health problems in Family:
(Please enumerate)
1.
2.
3.
4.
82
INDIVIDUAL HEALTH
*Present Illness (last 15 days)
(Write symptoms)
Duration
1
2
3
4
TREATMENT HISTORY: (CURRENT)

Medical/Surgical
problem
Medication
Dose- adequate
inadequate
Frequency
Reg/Irreg.
Duration
1.
2.
3.
4.
*Chronic disease
(Hypertension/Coronary artery disease/Diabietes mellitus /
COPD / Cataract / paralysis/other)

*
Any other major ailment in life till date, if yes, please specify:_______________
i)
Disease
_________________________________________
ii)
Any hospitalization _____________________________________
iii)
Operations ____________________________________________
83
USE OF ANY AIDS & APPLIANCES

Aids
Yes/No
Duration (Months & Years)
Hearing
Dentures
Spectacles
Any other
PHYSICAL EXAMINATION
a)
General Examination -
Pulse rate :
/ min.
Blood pressure SBP
mm Hg.
Pallor :DBP
*Icterus
Respiratory rate:
Height
/ min.
cms.) Weight
(Kg.)
JVP - Raised*
Oral cavity_______________________ *Lymphadenopathy
Thyroid_____________________
Deficiency signs (Nutritional)__________________________________________________________

*Clubbing
b)
* Oedema feet
Systemic Examination -
Per Abdomen
1.
Inspection
*Movement with Respiration
*Visible veins/Peristalsis
*Visible mass______________________ Hernial sites_______________________________

2.
Palpation
*Guarding
Any mass____________________________* Tenderness

Hernial sites_________________________________________________________________
Liver_______________________________Spleen___________________________________
Please fill Yes - 01,
84
No - 02
3.
Percussion
Resonance/Dullness___________________________________________________________
*Fluid thrill
5.
Shifting dullness
Auscultation
Bowel sounds_________________________________________________________________
CIRCULATRY VASCULAR SYSTEM

1.
Inspection
*Apex beat visible
2.
Palpation
Apex beat (Localization/Character)________________________________________________
*Thrill
*Parasternal Heave
3.
Percussion (Area of cardiac dullness)
4.
Auscultation
Heart sounds_________________________________________________________________
Added sounds (Murmur/click/pericardial rub)
if yes, please specify _________________
RESPIRATORY SYSTEM
1.
Inspection - Shape of chest_________________Trachea_____________________________
2.
Palpation - Chest expansion
3.
Percussion - Note_______________________Liver dullness__________________________
(cms.) Trachea__________________________________
Cardiac dulness_______________________________________________________________
4.
Auscultation -
Breath sounds______________________________________________
*Crepts/Rhonchi
*Pleural rub
GENITO URINARY SYSTEM

1.
Inspection
*Prolapse
if yes, please specify______________________
Hernial sites_________________________________________________________________
2.
Palpation
* Any Mass
*BPH:
Hernial sites_______________________________________________
if yes, please specify________________________________________
85
CENTRAL NERVOUS SYSTEM

1.
Higher mental functions____________________________________________
2.
Autonomic functions ______________________________________________
3.
Motor -
Muscle mass__________________________________________
Tone/Strength_____________________________________________________
Reflexes__________________________________________________________
4.
Sensory__________________________________________________________
5.
Any other________________________________________________________
LABORATARY INVESTIGATION:
Hb.
gm%
Blood sugar F
Cholestrol
gm% Any other
PP
FINAL DIAGNOSIS: ____________________________________________________
_______________________________________________________________________
FOLLOW UP
Sno
.
Date
Ailment
(Monthly)
Weight
(six monthly)
86
B.P.
(six monthly)
Sugar
(yearly)
DIET SURVEY
*DIET SURVEY AND NUTRITIONAL STATUS

Vegetarian / Non-Vegetarian
Food Material
1st Day
2nd Day
3rd Day
Daily average
Cereals :
1.
2.
3.
4.
Pulses :
1.
2.
3.
Roots and Tubers :
1.
2.
3.
Leafy Veg. :
1.
2.
3.
Non-Leafy Veg. :
1.
2.
3.
Nuts :
1.
2.
3.
Fruits :
1.
2.
3.
Milk and Dairy Products:
1.
2.
3.
Flesh food :
1.
2.
3.
Miscellaneous :
1.
2.
3.
4.
5.
*
Note : Refer to 87
Annexure IV to XI for details)
Daily intake per

consumption unit
DIETARY COMPOSITION / NUTRIENTS OF INTAKE

2.
COMPOSITION OF AVERAGE DAILY INTAKE PER CONSUMPTION UNIT:

Sno.
Food
material
Quantity
gms.
Calori
es
Protein
(Gms)
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Tot
al
88
Fat
(mg)
Calciu
m
(mg)
Iron
(mg)
Vitamin
A (g.)
Vitamin
B1 (mg)
Nicotin.
Acid
(mg)
Riboflavin
(mg)
Vitamin C
(mg)
Vitamin
D (I.U.)
3.
RECOMMENDED NUTRIENT INTAKE

DAILY REQUIREMENTS :
S.
N
o
Name
Age
Sex
Occ.
ECC
Calories
(K cal)
Protei
ns
(gm)
Fat
(mg)
Calci
um
(mg)
Iron
(mg)
Vit.
A
(g)
Vit.B
1
Nicot.
Acid (mg)
Riboflavi
n (Mg)
Vit.C
(mg)
(mg)
Total consumption
Total daily
requirements
Deficiency
Excess
Action taken:- 1.___________________________________________________________________________________________________
2. ___________________________________________________________________________________________________
3. ___________________________________________________________________________________________________
*
ECC =
Energy Consumption Coefficient
89
Vit.
D
(mg)
ANNEXURE I
PREFERRED CLASSIFICATION FOR OVERCROWDING : GUIDELINES
RECOMMENDED FLOOR SPACE
NO. PERSONS
> 110 sq feet
2 persons
90-100 sq feet
70-90 sq feet
50-70 sq feet
1/2
> 50
Nil
Note :
Child < 1 year is not counted
Children 1-10 years of age are counted as unit.
ANNEXURE - II
A)
MODIFIED PRASAD'S CLASSIFICATION FOR SOCIO ECONOMIC STATUS

Income per Capitum / Month (Rs.)
>1800
Social Class
I
900-1800
II
420- 900
III
180- 420
IV
<180
89
B)
KUPPUSWAMY SCALE SOCIO-ECONOMIC STATUS IN URBAN AREA

OCCUPATION OF HEAD :
SCORE
Professional
Semi Professional
Clerk, Shop Owner, Farm Owner etc.
Skilled Worker
Semi-Skilled Worker
Unskilled Worker
Unemployed
10
06
05
04
03
02
01
EDUCATION OF HEAD
Professional Degree
Graduate & PG
I.Sc./Post High School Diploma
High School Certificate
Middle School Completion
Primary School and literate
Illiterate
07
06
05
04
03
02
01
INCOME (Rs./m)
22734, and above
11367 22733
8504 11366
5683 8503
3410 5682
1138 3409
1137, and below
12
10
06
04
03
02
01
Modified family income groups of the Kuppuswamy's socioeconomic status scale was obtained by
multiplying conversion factor with the income groups for 1998. Conversion factor is determined by
dividing the CPI-IW by 88.428. The CPI-IW of Chandigarh is 149 for September 2009. The income
groups for 2009 were revised by applying a conversion factor of 1.684.
***
CPI-IW
=
(Consumer Price Index for industrial worker)
SOCIO ECONOMIC CLASSIFICATION
Ref.:
Upper (I)
26-29
Upper Middle (II)
16-25
Lower Middle (III)
11-15
Upper Lower (IV)
05-10
Lower (V)
<05
Kuppuswamy B. Manual of Socio Economic Status Scale (Urbans) Manasayam - 32, Netaji
Subash Marg, Delhi (Indian journal of Pediatrics, vol 70-March,2003 )
90
ANNEXURE - III
EXAMPLES OF FAULTY COOKING PRACTICE
i)
Cooking rice & throwing the rice water
ii)
Cutting vegetable & then washing them
iii)
Straining the flour & throwing the barn
iv)
Peeling all types of vegetable before cooking
EXAMPLES OF BENEFICIAL COOKING PRACTICES

i)
Cooking in iron pans
ii)
Use of jaggery over sugar
iii)
Soaking & germinating sprouts
iv)
use of paraboiled rice
iv)
Adding soyabean to wheat flour
v)
Using rice water to cook the pulse
91
ANNEXURE - IV
NUTRITIVE VALUE OF COMMON INDIAN FOOD
Sno.
Common foods
(per 100g) of edible
portion
CEREALS :
Maize
Rice (Raw milled)
Wheat flour
Wheat flour
refined(Maida)
PULSES :
Bengal Gram dhal
(Chana)
Black Gram (Urad)
dhal
Green Gram
(Moong) dhal
Peas (Green)
Rajmah
Red Gram dhal
Soyabean
LEAFY VEGETABLE :
Cabbage
Cauliflower (Green)
Coriander leaves
Mint
ROOTS & TUBERS :
Mustard leaves
Spinach
Calories
(K Cal)
Proteins
G
Fats
(g)
Calcium
(mg)
Iron
(mg)
Carotene
(g)
Vit B1
(mg)
Vit. B2
(mg)
Vit C
(mg)
Nicotine
Acid
(mg)
8
10
342
345
341
341
11.1
6.8
12.1
11
3.6
0.5
1.7
0.9
10.
10
48
23
2.3
0.7
4.9
2.7
90
0
29
25
0.42
0.06
0.49
0.12
1.8
1.9
4.3
2.4
0.10
0.06
0.17
0.07
0
0
0
0
372
20.8
5.6
56
5.3
129
0.48
2.4
0.18
347
24
1.4
154
3.8
38
0.42
0.2
323
24.5
1.2
124
4.4
49
0.47
2.4
0.21
93
346
335
432
7.2
22.9
22.3
43.2
0.1
1.3
1.7
19.5
20
260
73
240
1.5
5.1
2.7
10.4
83
0.25
0.8
0.01
132
426
0.45
0.73
2.9
3.2
0.33
0.39
25
-
27
66
44
48
1
34
26
1.8
5.9
3.3
4.8
2
4
2
0.1
1.3
0.6
0.6
3
0.6
0.7
39
626
184
200
4
155
73
0.8
40
1.42
15.6
5
16.3
1.14
120
0.06
0.4
0.09
124
6918
1620
6
2622
5580
0.05
0.05
7
0.03
0.03
0.8
1.0
8
0.5
0.06
0.26
9
0.26
12
27
10
33
28
92
Sno.
Common foods
portion
Carrot
Onion (small)
Potato
Radish (white)
Sweet potato
Turnip
OTHER VEGETABLES :
Brinjal
Cauliflower
Cucumber
Ladies Finger
Tinda
Tomato (Green)
NUTS :
Almond
Cashewnut
Coconut (Fresh)
CONDIMENTS & SPICES :
Chillies (Green)
Garlic (Dry)
Ginger (Fresh)
Turmeric Powder
FRUITS :
Amla
Apple
Banana
Dates (Fresh)
Grapes
Calories
(K Cal)
Proteins
G
Fats
(g)
Calcium
(mg)
Iron
(mg)
Carotene
(g)
Vit B1
(mg)
1
48
59
97
17
120
29
2
0.9
1.8
1.6
0.7
1.2
0.5
3
0.2
0.1
0.1
0.1
0.3
0.2
4
80
40
10
35
46
40
5
1.03
1.2
0.48
0.4
0.21
0.4
6
1890
15
24
3
6
0
24
30
13
35
21
23
1.4
2.6
0.4
1.9
1.4
1.9
0.3
0.4
0.1
0.2
0.2
0.1
18
33
10
66
25
20
0.38
1.23
0.6
0.35
0.9
1.8
655
596
444
20.8
21.2
4.5
58.9
46.9
41.6
230
50
10
29
145
67
349
2.9
6.3
2.3
6.3
0.6
0.1
0.9
5.1
58
59
116
144
45
0.5
0.2
1.2
1.2
1
0.1
0.5
0.3
0.4
0.1
93
Vit. B2
(mg)
Vit C
(mg)
7
0.04
0.08
0.10
0.06
0.08
0.04
Nicotine
Acid
(mg)
8
0.6
0.5
1.2
0.5
0.7
0.5
9
0.02
0.02
0.01
0.02
0.04
0.02
10
3
2
17
15
24
15
74
30
0
52
13
192
0.04
0.04
0.03
0.07
0.04
0.07
0.9
1
0.2
0.6
0.3
0.4
0.11
0.1
0
0.10
0.08
0.01
12
56
7
13
18
31
5.09
5.81
1.7
0
60
0
0.24
0.63
0.05
4.4
1.2
0.8
0.57
0.19
0.10
0
0
1
30
30
20
150
4.4
1.2
3.5
67.8
175
0
40
30
0.19
0.06
0.06
0.03
0.9
0.4
0.6
2.3
0.39
0.23
0.03
0
111
13
6
0
50
10
17
22
30
1.2
0.66
0.36
0.96
0.2
9
0
78
0.03
0.05
0.2
0
0.5
0.01
0.08
600
1
7
0.12
0.3
0.02
31
Sno.
Common foods
portion
Guava
Lemon
Lichi
Mango
Melon
Papaya
Tomato
MEAT & POULTRY :
Egg (Hen)
Goat Meat
Mutton (Muscle)
MILK PRODUCT :
Milk (Buffalo)
Milk (Cow)
Milk (Goat)
Milk (Human)
Cheese
Khoa (Whole
buffalo milk)
FATS :
Butter
Ghee (Cow)
Ghee (Buffalo)
Cooking Oil
SUGAR :
Sugar cane
Jaggery (Cane)
Calories
(K Cal)
Proteins
G
Fats
(g)
Calcium
(mg)
Iron
(mg)
Carotene
(g)
Vit B1
(mg)
1
51
57
61
74
17
32
20
2
0.9
1
1.1
0.6
0.3
0.6
0.9
3
0.3
0.9
0.2
0.4
0.2
0.1
0.2
4
10
70
10
14
32
17
48
5
0.27
0.26
0.7
1.3
1.4
0.5
0.64
6
0
0
0
2743
169
666
351
7
0.03
0.02
0.02
0.08
0.11
0.04
0.12
173
118
194
13.3
21.4
18.5
13.3
3.6
13.3
60
12
100
2.1
2.5
600
0
0.1
0.18
117
67
72
65
348
421
4.3
3.2
3.3
1.1
24.1
14.6
6.5
4.1
4.5
3.4
25.1
31.2
210
120
170
28
790
650
0.2
0.2
0.3
2.1
5.8
160
174
182
137
273
729
900
900
900
81
100
100
100
3200
2000
900
2500
398
383
0.1
0.4
0
0.1
12
80
0.155
2.64
94
Nicotine
Acid
(mg)
8
0.4
0.1
0.4
0.9
0.3
0.2
0.4
Vit. B2
(mg)
Vit C
(mg)
9
0.03
0.01
0.06
0.09
0.08
0.25
0.06
10
212
39
31
16
26
57
27
0.1
6.8
0.4
0.14
0
-
0.04
0.05
0.05
0.02
-
0.1
0.1
0.3
-
0.1
0.19
0.04
0.02
-
1
2
1
3
-
ANNEXURE - V
CALORIFIC VALUE PER HOUSE HOLD MEASURE
Sno.
Tea (Sugar
Milk
a.
b.
c.
d.
Curd
Food Items
1 cup)
Qty.
1 cup 200 ml
Calories
52
1 glass
1 glass
1 glass
1 glass
234
134
132
58
Buffalo
Cow
Toned milk
Skimmed milk
1 glass
1 glass
1 glass
1 glass
182
120
110
69
Boiled
Raw yolk
Raw Albumen
Fried
Omelette
One
One
One
One
One
80-85
60-65
15-20
155-160
155-160
One / 25 gm.
One / 30 gm.
One / 40 gm.
85
100-105
130-135
One
One
One
One
One
One cup (cooked)
180-185
185-190
100-105
230-240
190-195
68
1 cup
1 cup
1 cup / 20 gm / (raw)
1 cup cooked
170-185
250-260
77
75-80
One (20 gm)

One (30 gm)
One cup cooked
One
One
One
One
One bottle
a.
Amul 100gm
b.
Cadbury 100gm
49
74
125-135
215-220
155-160
140-150
140-145
100-115
588
530
Buffalo
Cow
Toned milk
Skimmed milk
Egg
Chapati
a.
Phulka (small)
b.
Chapati (med.)
c.
Roti (big)
Puri
Atta
Maida
Nan Plain
Prantha Plain (medium)
Bhatura (medium)
Wheat dalia (Raw-4Tsp/20gm)
Rice
a.
Boiled
b.
Pullao
Cornflakes
Porridge (oats)
Bread
Small
Big
Dals and Beans
Bread Pakora
Samosa
Vada
Bread butter sandwich
Cold drinks (sweet aerated)
Milk chocolate
95
ANNEXURE - VI
NUTRITIVE VALUE OF COOKED PREPARATIONS
Katori - 1
S
No.
Volume - (150 ml)
Cooked food stuff

cooked
Chapati (Thin)
Chapati (Medium)
Chapati (Big)
Rice
Wheat Porridge
Oat Meal Porridge
Dal Moong (with husk)
Dal Moong (washed)
Dal Moong (whole)
Dal Urad (washed)
Dal Urad &Channa (3+1)
Dal Urad (whole)
Dal Masoor
Dal Malka Masoor
Channa Dal
Arhar Dal
Rajmah
Bengal Gram (whole)
Coffee-milk 30 cc.
Sugar - 10 gm.
Tea-milk 20 cc.
Diameter - 78 cm
App.
Wt.
Qty.
One
One
One
1 katori
-do-do-do-do-do-do-do-do-do-do-do-do-do-do1 Cup
Raw
Protein Fats
(gm)
25
30
40
40
35
30
30
50
45
45
30+10
40
50
40
55
50
35
50
200
(gm)
3.0
3.6
4.8
2.7
4.2
4.0
7.2
12.2
10.8
11.0
9.2
9.6
12.6
10.0
11.4
11.1
8.0
8.5
1.0
1 Cup
200
0.7
Sugar - 10 gm.
96
Depth - 4 cm.
Energy
Sodium
(gm)
0.4
0.5
0.6
0.2
0.5
2.2
0.3
0.6
0.5
0.6
0.9
0.6
0.3
0.3
3.0
0.8
0.4
2.6
1.0
Carbohydrate
(gm)
17.3
20.8
27.7
31.2
25.0
18.8
17.0
30.0
25.5
27.0
23.6
24.0
29.5
28.6
32.7
28.8
41.2
30.4
11.3
(Kcal)
85
102
136
138
121
112
100
174
150
156
141
139
171
157
204
167
121
180
59
(mg)
5.0
6.0
8.0
6.0
8.4
13.6
14.0
20.0
25.8
16.0
10.0
24.8
14.2
18.6
4.8
0.7
108.0
53
3.2
ANNEXURE - VII
CALORIES EXPENDITURE IN VARIOUS ACTIVITIES
Activity
Minute
Lying down
Standing
Washing cloths
Driving motorcycle
Gardening and weeding
Walking downstairs
Dancing : Moderate
Vigrous
Sports
Skating
Badminton : Recreation
Competitive
Mountain climbing
Running
K. Calories
Consumption / Minute
1.0
2.6
3.1
3.4
4.9
Activity
Sitting
Driving a car
Walking (indoor)
Mopping floors
Farming and ploughing
(with bullocks)
Walking up-stairs
7.1
4.2
5.7
5.0
5.0
10.0
10.0
10.0
Table Tennis
Cycling
Swimming
Judo & Karate
97
K. Calories
Consumption
1.5
2.8
3.1
4.9
6.7
10.00 to 18.0
4.9 to 7.0
5.0 to 12.0
6.0
13.0
ANNEXURE - VIII
ASSESSMENT OF ENERGY REQUIREMENT FOR FAMILY
Practical nutrition work often involves the assessment of the calories of groups of persons. It is
usual to assess the caloric needs of woman & children in terms of those of the average man by applying
various coefficients to the different age & sex groups. The following scale is used for assessing caloric
requirement of an individual as recommended by National Institute of Nutrition, Hyderabad, pioneer in this
field. The calorie consumption of an average adult male doing sedentary work is taken as ONE ENERGY
CONSUMPTION COEFFICIENT (ECC) and the other coefficients are worked out on the basis of gender
and the occupational status for adults and by age for children and adolescents. (Ref. Nutritive Value Indian
Foods-National Institute of Nutrition. Indian Council of Medical Research. Hyd. India. (1989).
COEFFICIENT FOR COMPUTING CALORIE REQUIREMENT OF DIFFERENT GROUPS
GROUP
Adult male (sedentary worker)
Adult male (moderate worker)
Adult male (Heavy worker)
Adult female (sedentary worker)
Adult female (moderate worker)
Adult female (Heavy worker)
Adolescents - 12 to 21 years
Children - 9 to 12 years
*
1.0 Cu-Unit
* Cu-UNITS
1.0
1.2
1.6
0.8
0.9
1.2
1.0
0.8
0.7
0.6
0.5
0.4
2400 K Cal.
98
ANNEXURE - IX
CLASSIFICATION OF ACTIVITIES BASED ON OCCUPATIONS
Sedentary :
Male :
Teacher, Tailor, Barber, Executives, Shoemaker, Priest, Retired Personnel, LandLord, Peon, Postman, etc.
Female :
Teacher, Tailor, Executives, Housewife, Nurses, etc.
Moderate :
Male :
Fisherman, Basket-maker, Potter, Goldsmith, Agricultural, Labour, Carpenter,

Mason, Rickshaw-puller, Electrician, Fitter, Turner, Welder, Industrial Labour,
Cooli, Weaver, Driver, etc.
Female :
Servant-maid, Cooli, Basket-maker, Weaver, Agricultural Labour, Beedi-maker,

etc.
Heavy :
Male :
Stone-cutter, Blacksmith, Mine-worker, Wood-cutter, Gang-man, etc.
Female :
Stone-cutter.
99
ANNEXURE - X
BALANCED DIET
A balanced diet is one which contains different types of foods in such quantities and proportions so
that the needs for calories, proteins, minerals, vitamins and other nutrients is adequately met and a small
provision is made for little bit extra nutrients. The requirements of our body in terms of nutrients and
energy for the various groups is known and on this basis our daily diet can be planned. The requirement of
individual items depends upon growth status (age, sex, height and weight), physical activity and physical
stress or illness keeping in view the recommendation of the nutrition expert group of the ICMR for dietary
allowances, balanced diet for different age groups are presented below :
Food Groups
Cereals
Pulses
Leafy vegetables
Other vegetables
Roots and tubers
Milk
Oils and fats
Sugar and jaggery
7.00 A.M.
Break Fast
Adult Men
Adult Women
Sede Mode Heavy

ntary rate
work
work work
Sede Mode Heavy

ntary rate
work
work work
460
40
50
60
50
150
40
30
520
50
40
70
60
200
45
35
670
60
40
80
80
250
65
55
410
40
100
40
50
100
20
20
440
45
100
40
50
150
25
20
Children
675
50
50
100
60
200
40
40
1-3
yrs.
175
37
40
20
10
300
15
30
4-6
yrs.
270
35
50
30
20
250
25
10
10-12
yrs.
10-12
yrs.
Boys
Girls
420
45
50
50
30
250
40
45
380
45
50
50
20
250
35
45
SAMPLE MENU
1 Cup water + 1/2 lemon
or
1 Cup plain tea + 1/2 lemon (lemon tea)
1.
2.
Milk
Toast
1 Cup
2
or
Missi Roti
Butter
1 (20g. atta, 10gm. Gram Flour)

1 tsp.
or
Prantha
1
or
Dalia
1 Cup
100
3.
Egg
1
or
Paneer
25gm. (1 piece)
or
Curd
125gms (1/2 katori)
This provides 420 kcal & approx, 13 gm protein

Lunch
1.
Chapati
3-4 (90-120 gms.)

or
2.
3.
4.
Rice
Chicken curry
2-3 Katories (80g.)

1 katori (200gms.)
or
Paneer curry
Alu 1, Green Vege
Curd
Cooking fat
(50gms)
1 katori (250 gm)
1/2 katori (125 gm.)
4-5 tsp.
This provides 1000 kcal 35g. protein

Evening Tea
Tea
Sandwich
1 Cup
1
or
Biscuits
This provides 150 kcal 35g. protein

Dinner
1.
2.
Chapati/Rice
Dall
3.
or
Curd
Green & Leafy
vegetable
Cooking oil
As in lunch
1 katori (35gm)
1 katori (150gm.)
1 katori (250g.)
4-5 tsp.
This provides 900 kcal and 35g. protein

Fruits
One serving at midmorning
Salad
Alongwith regular meals.
101
ANNEXURE - XI
I.
INCREASE IN WEIGHT AND HEIGHT

Birth
Weight - 2.9kg
Height - 50cm
1 - 6 years
Wt. - Age (years) X 2+8 kg

Ht. - Age (years) X 6+77 cm
7 - 12 years
Age (years) x 7 5
-----------------------2
INCREASE IN WEIGHT, LENGTH & HEAD CIRCUMFERENCE DURING INFANCY

Age in months
Approximate daily
Weight gain (g)
Growth in length
(cm/month)
0-3
3-6
6-9
9-12
30
20
15
12
3.5
2.0
1.5
1.2
Change in head
(circumference
cm/month)
2.0
1.0
0.5
0.5
Weight (Kg)
Energy (K cal.)
Protein (gms)
03-07
07-09
09-13
15-17
600
600-1200
1200
1500
11
13
18
22
ENERGY & PROTEIN REQUIREMENT OF CHILDREN

Age Group
0-6 months
6-12 months
1-3 years
4-6 years
102
ANNEXURE - XII
W.H.O. DAY THEMES

YEAR
THEME
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
Know your health services

Health for your Child and the Worlds Children
Healthy surroundings make Healthy people
Health is Wealth
The Nurse: Pioneer of Health
Clean water means better health
Destroy disease carrying insects
Food and Health
Ten years of Health Progress
Mental Illness and Mental Health in the world today
Malaria Eradication: a World Challenge
Accidents need not happen
Preserve Sight: Prevent blindness
Hunger : Disease of millions
No trace of Tuberculosis
Smallpox : constant alert
Man and his cities
Partners in Health
Health in the World of Tomorrow
Health , Labour and Productivity
Early detection of Cancer saves lives
A full life despite Diabetes
Your Heart is your Health
Health begins at home
Better food for a Healthier World
Smallpox : Point of No Return
Foresight prevents Blindness
Immunize and protect your Child
Down with High Blood Pressure
A Healthy Child : A sure future
Smoking or Health : The choice is yours
Health for All by the year 2000 A.D.
Add years to life
Health for All by 2000 : The countdown has begun
Childrens Health : Tomorrows Wealth
Healthy Youth : Our Best Resource
Healthy Living : Everyone a winner
Immunization : A chance for every child
Health for All All for Health
Lets talk Health
Our Planet Our Health; think Globally, Act Locally
103
W.H.O. DAY THEMES (contd)
YEAR
THEME
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Should Disaster strike Be prepared

Heart Beat The rhythm of life
Handle Life with Care Prevent violence and negligence
Oral Health for a Healthy Life
Target 2000 : A World without Polio
Healthy cities for Better Living
Emerging Infectious Diseases : Global Alert, Global Response
Pregnancy is Special Lets make it Safe
Active Aging makes the difference
Safe Blood starts with Me. Blood is Life
Mental Health stop exclusion, dare to care
Move for Health
Shape the future of life
Road Safety is no accident
Make every mother and child count
Working together for health
International Health Security
Protecting Health from climate change
Save lives. Make hospitals safe in emergencies.
104
ANNEXURE - XIII
NATIONAL HEALTH PROGRAMS
National Vector Borne Diseases Control Program
National Leprosy Eradication Program
Revised National Tuberculosis Control Program, (RNTCP)
National AIDS Control Program, (NACP)
National Program for Control of Blindness, (NPCB)
National Iodine Deficiency Disorders Control Program
Universal Immunization Program, (UIP)
National Rural Health Mission (NRHM)
National Urban Health Mission
National Program for Control and Treatment of Occupational Diseases
Reproductive and Child Health Program, (RCH)
Integrated Disease Surveillance Project 2004 2009
Integrated Child Development Service (IDSP) Scheme
Rabies Control Program
National Guinea Worm Eradication Program
Yaws Eradication Program
National Cancer Control Program
National Family Welfare Program
National Water Supply and Sanitation Program
Minimum Needs Program
Mid Day Meal Program
National Program for the Control of Diarroeal Diseases
National Program for Prevention and Control of Diabetes, Cardiovascular Diseases and
Stroke
National Vitamin A Prophylaxis Program
National Nutritional Anemia Prophylaxis Program
National Program for the Control of ARIs

105
ANNEXURE - XIV
IMPORTANT NATIONAL & INTERNATIONAL HEALTH RELATED DAYS
DAY
AREA
30th January
8th March
15th March
24th March
7th April
8th May
17th May
31st May
5th June
Anti Leprosy Day

International Women Day
Consumers Protection Day
World TB Day
World Health Day
Red Cross Day
World Hypertension Day
World No Tobacco Day
World Environment Day
National Filaria Day (India)
World Blood Donation Day
International Day against Drug Abuse & Illicit Trafficking
World Diabetes Day
Doctors Day (India)
World Population Day
World Rabies Day
Eye Donation Day
World Heart Day
International Day for Older Persons
ICDS Day
World Mental Health Day
Human Rights Day
International Day for Natural Disaster Reduction
National Cancer Awareness Day
World Immunization Day
World AIDS Day
International Day for Disabled / Handicapped person
14th June
26th June
27th June
1st July
11th July
8th September
28th September
1st October
2nd October
10th October
11th October
7th November
10th November
1st December
3rd December
IMPORTANT HEALTH RELATED WEEKS

1st 7th August
25th August 8th September
1st 7th September
World Breast Feeding Week

Eye Donation Fortnight
National Nutrition Week
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ADIS Projects Final Manual II

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DEPARTMENT OF COMMUNITY MEDICINE

GOVERNMENT MEDICAL COLLEGE

FAMILY STUDY MANUAL

FROM "HIPPOCRATIC OATH"

Professor & Head,

FIELD WORK & ASSESSMENT

FAMILY ASPECT STUDIED

GUIDELINES FOR FAMILY STUDY

VITAL STATISTICS OF THE AREA

FAMILY WELFARE SURVEY

SURVEY FOR SOCIAL PROBLEMS

INFANT HEALTH CARE

UNDERFIVE HEALTH CARE

ADOLESCENT HEALTH CARE

INDIVIDUAL HEALTH CARE

GERIATRIC HEALTH CARE

SUMMARY & CONCLUSION

STUDENT OWN FAMILY STUDY

GUIDELINES FOR FAMILY STUDY

SPECIFIC INSTRUCTIONAL OBJECTIVES:

advise them accordingly.

the health and disease of the family.

the availability under National Family Welfare Program (NFWP).

Family study aims at the complete health study of the

It aims at the health of an individual only.

All the aspect of health i.e. promotive, preventive,

Mainly curative aspect is dealt with

Aims at all the five levels of prevention.

To study the disease in question and its

Case or patient in chronic/acute illness has to take

Hospital is the place of stay and its

VITAL STATISTICS OF THE STUDY AREA

Couple Protection Rate

Union Territory Chandigarh.

Name of Study Area: Urban Area/Peri-Urban Area/Urban Slums/Rural Area:_______________.

Main Religion represented in the population:Sikhs

Important Community / Social organizations

Principal industries/means of livelihood: ___________________________________.

Gram Pradhan/Panchayat Secretary/Chowkidar/ANM/TBA/Any other

Educational facilities available:

No. of Schools : Govt.____________.Public__________

Health facilities available:

Tap/Well/Other Specify: continuous/intermittent supply

Any other, specify: __________________________.

Waste water disposal: Open drain/closed

Dumping/Composting/ Bins (Municipal Corporation)

Ritual burning/Crematorium/other, specify___________.

Channels of Communication in the community:

Important customs prevalent in community:

Main health problems in community

(Interview opinion leaders/ Panchayat members)

Unmet needs of community

What is the significance of conducting community survey?

What are the different ways of conducting community survey?

What is Community Diagnosis?

How can community diagnosis help in health planning and management?

LEARNING OBJECTIVES: To enable medical students

Thatched / Tin or Cement Sheets / Bricks / Cemented & Plastered.

Mud with cowdung / Cemented / Tiled.

*Open space around the house:

*Separate bath room:

Total floor space area of living rooms

Water Supply: Tap water / Hand pump / Well

No. of Schools : Govt.__.Public

- For which food item? _______________________ , Why _