Family Study In A Rural Setting In West Bengal, India

• 1. CONDUCTED BY Team Members Mithilesh Mriduchhanda Mosharaf Mrinmay Mousumi Das Nazrul Mousumi Ghosh Naba Kumar Moumita Naushad Our Guide Dr Kakali Boral Maam

2. INTRODUCTION Family :-It is a primary unit of society consisting of individuals related biologically or by marriage or adoption, living under the same room and consuming food from a common kitchen. The term family differs from a household due to the fact that all members of a household may not be related. TYPES OF FAMILY Nuclear Family Joint / Extended Family Three Generation Family 3. ROLE OF FAMILY To provide a decent home to its members It serves as a platform of division of labour of household works Provides a legal platform to share property for inheritance and helps in social care and socialization It also serves as a medium for economic functions INTRODUCTION CONT. 4. IMPLICATIONS OF FAMILY STUDY Family serves as a primary unit of society Reflects the important aspects of a community like role in diseases and health Helps to identify, prevent and treat individual illnesses Plays an important role as an biological unit and also focuses on the care of children and dependent adults. INTRODUCTION CONT. 5. OBJECTIVES GENERAL OBJECTIVES To make a Medico social Diagnosis of the Family 6. Objectives Continued Specific Objectives a) To study the demographic, socioeconomic and environmental conditions of the family. b) To assess the health status of individual family members c) To assess maternal health, antenatal and post natal care 7. OBJECTIVES CONTINUED d) To determine the immunization status, feeding practices, health and nutritional status of under 5 children e)To estimate Dietary Practices of the family f) To take appropriate remedial measures for the problem identified. 8. MATERIALS AND METHODS Type of study: Descriptive type of epidemiological study Study Area: Faridpur village near Mallickpur, South 24 Paraganas Duration of study: One month (10th Feb 8th March) FARIDPUR 9. MATERIALS AND METHODS CONT.. Tools used 1.Predesigned, Pretested schedule 2.Measuring tapes 3.Weighing machine 4.Sphygmomanometer 5.Stethoscope 6.Torchlight 7.Medical records 10. A.BRIEFING- Briefing about the family study was done by the faculty members of the department MATERIALS AND METHODS CONT.. PROCEDURE 11. MATERIALS AND METHODS CONT.. B.CRITERIA FIXATION: Criteria fixation is done for the following- 1. Type of family 2. Literacy 3. Ventilation 4. Lighting 5. Adult Consumption Unit 6. School Dropout 7. Unemployed Youth 12. MATERIALS AND METHODS CONT.. C.FAMILY ALLOTMENT : One family was allotted to our group D.INTERVIEW-With the help of Predesigned, Pretested schedule, Hasna Banu Bibi was interviewed 13. INTERVIEW-With the help of Predesigned, Pretested schedule, Banu bibi was interviewed E.OBSERVATION- The housing and environmental conditions of the family were observed F.ANTHROPOMETRIC MEASUREMENT-Using measuring tape and weighing machine, the following parameters were measured : For mother- Height, Weight For child-Height, Weight, Mid upper arm circumference MATERIALS AND METHODS CONT.. 14. H.DIETARY SURVEY- The Dietary survey was done by 24 hour recall method I.RECORD ANALYSIS- The findings were recorded and subsequently analysed. G.CLINICAL EXAMINATION-Examination was done for pallor, cyanosis, icterus, oedema, neck glands and vesicles. MATERIALS AND METHODS CONT.. 15. SCHEMATIC DIAGRAM OF PROCEDURE OF FAMILY STUDY Presentation Data Compilation and Analysis Data Collection Interview Observation Anthropometric Measurements Clinical Examination Dietary Survey Allotment Of Family Criteria Fixation Briefing 16. Family Identification Head of Family: Jamal Laskar Address: Village-Faridpur, P.O-Mallickpur, P.S-Baruipur, Dist-South 24 Paraganas Type of Family: Nuclear Family Religion: Islam Caste:Sunni Place Of Origin:Faridpur Length of Stay: From Birth Mother tongue: Bengali Other Languages:Hindi, Arabic Main Source Of Income: Salary of head of the family and wife. 17. TABLE NO 1- DETAILS OF FAMILY MEMBERS Names Relation With HOF Age Sex Marital Status Education Level Occupatio n Jamal Laskar Self 26yr Male Married Six Unskilled worker Belt factory Worker Hasna Banu Bibi Wife 22yr Female Married Eight Unskilled worker Bidi Binder Hasib Ali Laskar Son 45 month Male NA Pre-School Family Identification 18. FAMILY TREE Jamal Laskar Hasna Banu Bibi Hasib Ali Laskar 19. HOUSING WATER SUPPLY AND STORAGE EXCRETA AND REFUSE DISPOSAL 20. HOUSING Site Elevated Type Kuccha Ownership Owned No of living room 1 Total area of living rooms 15 x 9 sq.ft Per unit floor space 54 sq.ft 21. Sex separation NA Person per room 2.5 Comment on overcrowding Not overcrowded Area other than living rooms utilized for living purposes 19x 6 sq.ft Combined windows and door space Is less than 2/5th of the floor space of the living room Ventilation Inadequate HOUSING CONT.. 22. Cross-ventilation absent Lighting Inadequate Kitchen on Veranda Type of fuel used Wood Smoke nuisance Present Storage of food improper HOUSING CONT.. 23. Separate cattle shed Absent Drainage system around the house Absent Kitchen garden absent Drainage of household wastewater In the pond Breeding place of mosquitoes present Fly nuisance present HOUSING CONT.. 24. SCHEMATIC DIAGRAM OF ALLOTED HOUSE LIVING ROOM LATRINE STORE VERANDA KITCHEN 25. WATER SUPPLY Source of water 1.Drinking purposes : Tube well 2.Cooking purpose : Tube well 3.Washing-bathing purpose : Tube well Distance of drinking water source 10m Nature of supply continuous Adequacy of supply Adequate Comment on how people draw, carry, store water in house and how they draw water from containers water is drawn in buckets Special treatment of drinking water at house hold - No 26. EXCRETA DISPOSAL Sanitary Latrine present outside house Family members including children go to defecate in Sanitary latrine Regular cleaning - Yes 27. REFUSE DISPOSAL How do people dispose of refuse collected in a container How is Kitchen waste disposed Solid waste in common container, which is then disposed off in the pond Sullage in pond 28. SOCIOECONOMIC STATUS Both the adult male and female members are earning. The child is the dependant member. There is no other source of economic help from outside. Family income per month:6000. Per capita income of the family:2000. 29. SOCIOECONOMIC STATUS contd. Monthly expenditure of the family: ITEM EXPENDITURE Food 3000(51.28%) Fuel 150(2.56%) Clothing 250(4.27%) Electricity 150(2.56%) Substance abuse 150(2.56%) Mobile Phone 200(3.42%) Social functions 500(8.54%) Health and illness 250(4.27%) Travel and transport 100(1.7%) Recreation 100(1.7%) Loan 1000(17.09%) Total expenditure of the family-5850 (100%) Balance of income over expenditure-150 30. SOCIOECONOMIC STATUS contd. Modified Prasad scale: Based on per capita monthly income: Social class Income(Rs.) Upper high 10000 and above High 5000-9999 Upper middle 3000-4999 Lower middle 1500-2999 Poor 500-1499 Very poor or BPL Below 500 Thus according to Prasad scale the family belongs to lower middle class. 31. PIE CHART SHOWING TOTAL MONTHLY EXPENDITURE 51% 3%4%3%3% 8% 4% 2% 2% 17% 3% . Food Fuel Clothing Electricity Substance abuse Social functions Health and illness Travel,transport Recreation Loan PIE CHART NO 1 32. SOCIOCULTURAL PROBLEM The head of the family is a smoker. There is no orphan, school dropout and no problem of child labour. No presence of any handicapped or chronically ill member in the family. No history of broken family. No other sociocultural problem identified. Problem of early marriage and teenage pregnancies in the family. 33. AMENITIES AND RECREATIONAL FACILITIES The head of the family possesses a bicycle . The family enjoys amenities of electrical appliances like lights, fans and television The family uses mobile phone as a mode of communication. 34. HEALTH KNOWLEDGE ON COMMUNICABLE DISEASES Disease CAUSATION Mode of transmission Prevention Availability of services Diarrhoea Contaminated food &water No idea To take proper food & water PHC Malaria Mosquito Bite Mosquito Bite Mosquito net & coil Private Practitioner Tuberculosis No idea No idea No idea _ ARI Exposure to cold No idea Warm clothes & avoid exposure to cold _ RTI No idea No idea No idea _ HIV/AIDS No idea No idea No idea _ Leprosy No idea No idea No idea _ TABLE NO 2- COMMUNICABLE DISEASES 35. Health knowledge of non communicable diseases DISEASE CAUSATION PREVENTION AVAILABILITY OF SERVICES DIABETES INCREASE INTAKE OF SUGAR SUGAR RESTRICTION NONE HYPERTENSION NO IDEA SALT RESTRICTION NONE CORONARY HEART DISEASE NO IDEA NO IDEA NONE CANCER NO IDEA NO IDEA NONE MENTAL DISEASE NO IDEA NO IDEA NONE TABLE NO 3- NON COMMUNICABLE DISEASES 36. CHILD HEALTH CHECKUP Name- Hasib Ali Laskar Age- 45 months Sex- Male Chief Complaints Cough and Cold H/O present illness- Cough and Cold for 3 days with running nose and no fever H/O of Past Illness Diarrhoea- At 2 years of age 37. Birth History DATE OF BIRTH 31.05.2010 BIRTH WEIGHT 2.5 KG GESTATIONAL AGE TERM PLACE OF DELIVERY INSTITUTIONAL TYPE OF DELIVERY NORMAL BIRTH ATTENDANT DOCTOR ANY CONGENITAL MALFORMATION NO CONDITION OF BABY AT BIRTH NORMAL NEED OF RESUSCITATION NO TABLE NO. 5 38. FEEDING HISTORY Time of initiation of Breast Milk Half an hour after Delivery Colostrum - Given Prelacteal feed given- Yes , Honey as a Social Custom once only. Exclusive Breast Feeding- Yes up to 6 months Age of initiation of complementary feeding- After 6 months Type of Food Offered- Semi Solid Name of Food offered Khichdi , Cooked Rice , Eggs Amount of Food Given During Illness- Same as above 39. CURRENT FEEDING PRACTICE(24HRS RECALL) Morning- Tea, Biscuits, Parched Rice Noon- Rice, fish Evening- Fruits, Biscuits Night- Rice, Pulses, vegetables Amount of Food Taken by child presently No of Katori(150 ml) 1 No of times - 4 40. CONT Visit to ICDS : Yes Deworming: Not Done 41. IMMUNIZATION STATUS VACCINE DATE OF VACCINATION PLACE OF VACCINATION REMARKS BCG OPV 0 HEPATITIS B 31.5.10 31.5.10 NOT GIVEN NURSING HOME PARTIALLY IMMUNISED AT PAR WITH AGE DPT 1 DPT 2 DPT 3 DPT BOOSTER (1ST) DPT BOOSTER(2ND) 28.7.10 08.9.10 6.10.10 NOT GIVEN NOT GIVEN HARIHARPUR PRIMARY HEALTH CENTRE OPV 1 OPV 2 OPV 3 OPV BOOSTER 28.7.10 08.9.10 6.10.10 NOT GIVEN HARIHARPUR PRIMARY HEALTH CENTRE HEPATITIS B1 HEPATITIS B2 HEPATITIS B3 28.7.10 NOT GIVEN NOT GIVEN HARIHARPUR PRIMARY HEALTH CENTRE MEASLES NOT GIVEN VITAMIN A PPI NOT GIVEN ALL DOSES TAKEN TABLE 6- IMMUNIZATION HISTORY 42. FINAL IMMUNISATION STATUS All OPV doses were taken except the booster dose. Pulse Polio doses are complete. BCG Scar present thus signifying that the vaccine was taken at birth. Measles, Hepatitis B full course and Vitamin A are not given. Child is Partially Immunized. 43. CLINICAL FINDINGS Vitals : Temperature- 98.3 F Resp. Rate-24/min Heart Rate- 75/min Pulse- 84/min Pallor Cyanosis/Clubbing/ Pedal edema/Generalized lymphadenopathy Jaundice Respiratory Distress Ear Discharge ABSENT 44. CLINICAL FINDINGS CONTND. Eye-Normal Pustules- Absent Umbilical Discharge- Absent Skin pigmentation- Normal Abdominal Distension- Absent CVS - Normal 45. GROWTH CHART 46. Anthropometric measurement: Height- 36 cms Weight-11 Kg Mid Upper Arm Circumference- 13 cms Malnutrition According to WHO growth chart the child was found to be Moderately Underweight Lab Investigations- Not performed From the above parameters it is found that the child is moderately underweight and is PRESENTLY SUFFERING FROM COUGH AND COLD. CONT.. 47. RECORD OF INDIVIDUAL Name : Hasna banu bibi Age : 22 yrs Sex: female Presenting complains: indigestion & acidity for last 2 months History of present illness: The problem is aggravated in empty stomach and relieved after taking food. No history of malaena and heart-burn. Abdominal fullness & discomfort after taking the food was present. History of past illness :no significant past illness 48. MATERNITY RECORD Married for: 6 years Age at menarche : 12 years Age of marriage : 15 years Para: 1 Pre term and 1 term. 49. HISTORY OF PREGNANCIES ORDER OF PREGANAN CY AGE O PREGNANC Y OUTCOME ABORTION /STILLBIRT H/LIVEBIR TH TYPE OF DELIVERY PLACE OF DELIVERY CONDUCT ED BY D/N/TBA/O THER COMPLICA TIONS IF ANYa FIRST 16 YRS LIVE BIRTH NORMAL HOME TBA PRETERM BABY DELIVERED AFTER 7 MONTHS, DIED 1 DAY AFTER BIRTH SECOND 18 YRS LIVE BIRTH NORMAL NURSING HOME SUBHASGR AM DOCTOR N.A. TABLE NO 4- HISTORY OF PREGNANCIES 50. OBSTETRIC HISTORY She has not taken any antenatal care for the 1st baby. The baby was delivered at home by trained birth attendant after 7th month of gestation, i.e.; Preterm baby Baby was alive for one day only, and she died at home. 51. ANTENATAL CARE During second pregnancy she made three visits, during which the following investigations were done. 1) Blood for Hb% 2) Blood group ABO & Rh 3) Blood for sugar 4) Blood for VDRL 5) Urine examination 52. SERVICES RECEIVED TT immunization: 1st dose: at 1st month of gestation 2nd dose : One month after the first dose IRON FOLIC ACID tablets: received 90 tablets for last 3 month 1 tab/day 53. PHYSICAL EXAMINATION HEIGHT : 150 cm WEIGHT : 36Kgs BMI: 16 AS BMI IS LESS THAN 18.5, SHE IS UNDERWEIGHT 54. GENERAL SURVEY Pallor: Clubbing: Jaundice: absent Oedema: Cyanosis: Pulse:74/min BP:110/70 mm of Hg Respiratory Rate- 19/min Temperature: normal Neck veins : not engorged Neck glands: not palpable 55. SYSTEMIC EXAMINATION CVS: No abnormality found Respiratory system: no abnormality found GI system: no abdominal fullness & no tender point is found on examination CNS : No abnormality found GENITOURINARY: No abnormality found PROVISIONAL DIAGNOSIS :- Wife of the head of the family is underweight and presented with Indigestion and Acidity. 56. FOOD CONSUMED BY THE FAMILY MEMBERS IN LAST 24 HOURS FOOD GROUPS FOOD ITEMS QUANTITY(gm/dl) Cereals 1. Rice 2. Puffed rice 250 100 Pulses 1. Lentil 100 Green leafy vegetables 1.Cabbage 200 Other vegetables Roots and tubers 1. Potato 2. onion 100 100 Fruits 1. guava 100 Milk and milk products Animal foods 1. egg 250 Fats and oils Mustard oil 100 Sugars 50 TABLE NO 7 57. NUTRIENT CONSUMPTION SHEET Foodstuff Amount(g m) Calories(Kca l) Protei n (gm) Fat(gm ) Fe(mg ) Ca(mg ) Vit.A(microgra m) Vit.B1(m g) Vit.B2(m g) Vit.C(mg ) 1.Rice 250 865 16 1 2.5 22.5 _ 0.525 0.125 _ 2.Puffed rice 100 325 7.5 0.1 6.6 23 0 0.21 0.01 _ 3.Lentil 100 343 25.1 0.6 7.6 69 270 0.45 0.20 _ 4.Cabbage 200 54 3.6 0.2 1.6 78 240 0.12 0.18 248 5.Potato 100 97 1.6 0.1 0.48 10 24 0.10 0.01 17 6.Onion 100 50 1.2 0.1 0.60 47 0 0.08 0.01 11 7.Guava 100 51 0.9 0.3 0.27 10 0 0.03 0.03 212 8.Egg 100 173 13.3 13.3 2.10 60 420 0.10 0.40 _ 9.Mustard oil 100 900 _ 100 _ _ __ _ _ _ 10.Sugar 50 199 - _ - - _ _ _ _ Total Consumpti on 1200 3057 69.20 115.7 21.83 319.5 954 1.615 0.965 488 TABLE NO 8 58. COMPARISON OF CONSUMPTION AND DAILY REQUIREMENT OF NUTRIENTS Nutrients Calories(Kc al) Protein(g m) Fat(gm) Fe(mg) Ca(mg) Vit.A(MICR OGRAM) VitB1(mg) VitB2(mg) Vit.C(mg) RDA(Reco mmended Dietary Allowance) 2960 71.7 47 30 1200 8000 1.5 1.7 80 Consumpti on 3057 69.25 100 21.83 325.5 954 1.615 0.965 488 Excess 97 53 0.115 408 Deficit 2.45 9.83 874.5 7046 0.735 TABLE NO 9 59. 0 100 200 300 400 500 600 700 RDA AMOUNT TAKEN 100 103.27 100 96.6 100 111 100 67.24 100 27.13 100 11.93 100 107.67 100 56.77 100 610 MULTIPLE BAR DIAGRAM SHOWING COMPARISON BETWEEN DAILY REQUIREMENTS AND CONSUMPTION BAR DIAGRAM 1 WITH RDA TAKEN AS 100 CONSUMPTION OF DIFFERENT NUTRIENTS 60. SUMMARY Three membered Bengali speaking nuclear Muslim family residing in Faridpur Village, Mallickpur for the last 30 years. Main source of income is salary of head of family i.e. Jamal Laskar and his wife Hasna Banu Bibi Live in a kuccha house with no overcrowding but inadequate ventilation, lighting and absence of a drainage system 61. SUMMARY CONT.. Improper method of drawing drinking water by buckets Mosquitoes and fly nuisance also present. No drainage system with sullage and garbage being dumped into the pond. Per capita income of Rs 2000/month Belongs to lower middle group according to Modified Prasads Scale. 62. SUMMARY CONT. There are no school dropouts or orphans. Jamal Laskar , head of the family is a smoker Early marriage of the lady, Hasna Banu Bibi at 15 years. Two TEENAGE pregnancies, the first being pre term and surviving only for a day after delivery 63. CONT.. Wife of HOF suffers from bouts of indigestion and acidity and is also moderately underweight. The child, Hasib Ali Laskar is moderately underweight according to WHO growth curve for boys and suffers from repeated cough and cold infections. Measles Vaccine, Hepatitis B full course vaccine and Vitamin A injections are not given to the child and he is hence partially immunized. 64. CONT.. The family has minimal knowledge about diseases like Malaria, Diarrhoea, Hypertension, Diabetes. Diet had excess of Fat and Vitamin C Diet lacked in Iron, Ca, Vit A , Protein and Vit B2. 65. PROBLEMS IDENTIFIED The house has inadequate ventilation, lighting and has fly nuisance. The house lacks a proper drainage system The method of drawing drinking water is improper PHYSICAL ENVIRONMENT HOUSING REFUSE DISPOSAL WATER SUPPLY 66. SOCIO CULTURAL PROBLEM The head of the family is a smoker. Wife of HOF had two teenage pregnancies. The family has no knowledge regarding diseases like TB, HIV etc. HEALTH KNOWLEDGE CONT 67. CONT The mother is underweight and frequently suffers from indigestion The child is underweight and suffers from repeated episodes of cough and cold Child is partially immunized. MATERNAL HEALTH UNDER 5 HEALTH 68. CONT.. Their diet lacks in Calcium, Vitamin A,B2, Protein, Iron. DIETARY ASSESSMENT 69. FAMILY DIAGNOSIS This is a three membered Bengali speaking Muslim family, residing in Faridpur for last 30 years, in a kuccha house with no overcrowding but inadequate ventilation and lighting. The family belongs to Lower Income Group by Modified Prasads Scale. The adult woman is underweight and has frequent episodes of acidity and indigestion. The child is also moderately underweight and had cough and cold during the time of visit. The family diet contains excess Fat, Vitamin C and is deficient in Protein, vitamin A,B2. 70. RECOMMENDATIONS To family :- 1) To use filtered water provided by municipality and use long handled mugs for taking out water 2) To complete the immunization of the child from the nearest sub centre Diet 3) As the diet was deficient in protein, iron, calcium, vitamin A & B2, hence they were advised to consume green leafy vegetables, cereals, milk products, pulses, fruits, eggs, and soya bean. 71. RECOMMENDATIONS To Individuals : 1) Hasna Banu Bibi a) Advised to take frequent small meals daily and consume plenty of water b) Avoid Spicy Food c) To take meals according to time d) To use barrier method of contraception e) Being a bidi binder she should use a mask during work. 2) Hasib Ali Laskar a) Avoid Exposure to Cold 72. ACTIONS TAKEN The family were asked to immediately discard water that was stored in containers for more than 7 days. They were advised to avoid dipping fingers while drawing water from containers. The family was described causation and modes of transmission of various communicable diseases and their modes of prevention like TB, Malaria etc She was made aware of the different occupational hazards related to Bidi binding. 73. Hand washing with soap and water was advised before taking food. The wife was advised to motivate her husband to quit smoking. The mother is motivated to complete the immunization of the child ( i.e. two doses of Measles, OPV and DPT Boosters.) The wife was asked to consume higher amounts of locally available high calorie indigenous food and also feed her child properly as they both are moderately underweight. CONT.. 74. LIMITATIONS Head of the family was absent at the time of visit. Study was conducted in a very short duration of just a single visit. Diet survey ideally be taken for one dietary cycle which is 7 days whereas the assessment was made for only 24 hours Fallacies: Recall Bias. The amount of food items taken were approximated in many cases. Individual dietary patterns could not be assessed. 75. ACKNOWLEDGEMENTS We would like to convey our deep sense of gratitude to Dr Anima Haldar ( HOD, Dept of Community Medicine) We would like to thank our guide Dr Kakali Boral, for helping us throughout the project. We are also grateful to the other teachers of the Department and also the families at Faridpur to help us complete this project.