DEPARTMENT OF COMMUNITY MEDICINE

CALCUTTA NATIONAL MEDICAL COLLEGE

KOLKATA - 700014

Published By

DEPARTMENT OF COMMUNITY MEDICINE

CALCUTTA NATIONAL MEDICAL COLLEGE

KOLKATA

2017
i
Contributors:
Prof. Malay Mundle

Prof. Nabanita Bhattacharyya

Dr. Dipendra Narayan Goswami

Dr. Pritibikash Halder

Dr. Shankar Prasad Bhattacharya

Dr. Sarmila Mallik

Dr. Agnihotri Bhattacharyya

Dr. Shuvankar Mukherjee

Dr. Kanti Bhushan Choudhury

Dr. Baishakhi Paria

Dr. Soma Chakrabarti

Dr. Sukanta Majumdar

Dr. Sunetra Kaviraj Roy

Dr. Avijit Paul

Dr. Sumitra Sen

Dr. Diptaman Nandy

Dr. Sumita Saha

ii
 MANUAL FOR FAMILY STUDY

DEPARTMENT OF COMMUNITY MEDICINE

CALCUTTA NATIONAL MEDICAL COLLEGE

Name of the student:

Roll No:

Session:

Names of Guides:

Signature of Guide(s) Head of the Department

Community Medicine

iii
 CONTENTS
Sl. No. Topic Page No
I Introduction 1
II Objectives 2
III Identification of the family 3
IV Family Composition 4
V Environmental Sanitation 6
VI Socio-economic Status 8
VII Socio-cultural Problems 9
VIII Knowledge, Attitude & Practice as regards the 10
Common Diseases, Infant Feeding, Family Planning
and Personal Hygiene
IX Maternal Health Care & New Born Care 13
X Under 5 Child Health Records 16
XI Individual Health Care 19
XII Nutritional Profile 24
XIII Summary 27
XIV Medico-social Diagnosis 28
XV Action Taken 29
XVI Recommendation 30
XVII Annexure 31

iv
 I. INTRODUCTION
(Rationality of performing a family study)

1
 II. OBJECTIVES
General Objective

To make a medico-social diagnosis of the allotted family

Specific Objectives

1. To find out the socio demographic characteristics of the family

2. To study the environmental status of the family

3. To assess the socio economic status of the family

4. To understand the knowledge, attitude and practices of the family

members regarding communicable and non-communicable diseases,

personal hygiene, infant feeding and family planning practices of the

family

5. To assess the health status of individual members of the family

6. To make a diet survey to assess the deficiency or surplus of nutrients

consumed.

7. To make recommendations for action to be taken by individual

members as well as the family and the community as a whole.

2
 III. IDENTIFICATION OF THE FAMILY
Dates of Interview:
Name of the Head of the Family (as stated by family members):
Address:
Type of Family:
Religion:
Mother tongue:
Length of stay (in the present address):
Location of family (schematic):

3
 IV. FAMILY COMPOSITION

Serial Name Age Sex Relation Marital Educational Occupation Income Physical
No. To Status Status per month Activity
H.O.F. Status

4
 Total family members : Male: Female:

 Adults : Male: Female:

 School-age children(5-14yrs) : Male: Female:

 Pre-school children (1-4yrs) : Male: Female:

 Infants(0-1yr) : Male: Female:

 No. of births in last one year : a) Gender: Date of birth:

b) Gender: Date of birth:

 No. of deaths in last one year :

Age at which died Cause of death

 No of pregnant mothers:

 No of lactating mothers:

5
 V. ENVIRONMENTAL SANITATION

a) HOUSING
 Type of construction : Pucca /Mixed /Kutcha
 Ownership : Owned /Rented
 No of living rooms :
 No of persons per room :
 Total floor area of living rooms(sq ft):
 Per capita floor space :
 Sex separation : Present /Absent
 Overcrowding :
 Total door and window area (sq ft):
 Cross ventilation : Present /Absent
 Ventilation : Adequate /Inadequate
 Lighting : Adequate /Inadequate
 Kitchen : Separate /Verandah / Living room
 Smoke outlet : Present /Absent

b) WATER SUPPLY
 Source of drinking water :
 Distance from house :
 Washing and bathing :
 Frequency of supply : Continuous /Intermittent
 Distance of drinking water source from latrine :

6
  Drinking water storage :
 Type of container :
 Covered : Yes /No
 Method of drawing water from container:
 Is drinking water treated before use: Yes/No
 If Yes, (Specify)..................................................
 Is water stored for more than one week: Yes /No

c) LATRINE
 Type of latrine: RCA type/Conservancy type/Makeshift type
 No of users:
 Frequency of cleaning:
 Disposal of stool of children:

d) GARBAGE DISPOSAL
 Storage at generation point :
 Collection from house :
 Collection from community bin :

e) BREEDING PLACES
 Mosquito :
 Housefly :

f) ANIMALS AS PETS

7
 VI. SOCIO ECONOMIC STATUS
 Number of earning members:

 Number of dependent members:

 Total Monthly Family Income:

 Any regular help from outside:

 Per Capita Family Income:

 Presence of modern amenities:

 Breakup of Monthly Family Expenditure Pattern:

 Food:

 Electricity:

 Fuel:

 Health and illness:

 Addiction:

 Education:

 Recreation and Entertainment:

 Miscellaneous:

 Income and Expenditure:

 Socioeconomic Status of the family:
 Name of the scale:
 Score:
 Status:

8
 VII. SOCIO-CULTURAL PROBLEMS:

1. Addiction:

Sl. Name Addicted to Mode of Amount Frequency Duration

No. addiction taken

2. Whether mother is unmarried/divorced/separated/left out husband

3. Presence of any widow/widower/separated from spouse/divorced person
in the family

4. Whether under five children are kept alone or in the care of minors

5. Presence of unemployed adults

6. Presence of any child above 5 years who never went to school:

7. Presence of any school dropout: Yes/No

If yes, reason(s) ………………………………………….

8. Child labour (<14 years) and nature of work:

Orphan:

9
 VIII. KNOWLEDGE ATTITUDE AND PRACTICE REGARDING
PERSONAL HYGIENE
Name of the respondent:
Personal Hygiene Knowledge Attitude Practice
Hand washing
Regular bath
Care of nails
Care of hair
Care of clothing
Care of teeth

KNOWLEDGE ATTITUDE AND PRACTICE REGARDING FOOD

HYGIENE
Whether cooked food is eaten in the next day without refrigeration:

UTILISATION OF HEALTH CARE SERVICES:

Service Immunisation Ante natal Illness Others
Source
Frequency in last 5 years
Reasons
Satisfaction
Recommendations

Comment on services provided by government health facility:

Reasons if government health facilities are not utilized on regular basis:
Time consuming/ inconvenient timing/ uncooperative behavior from stalls/
unavailability of staffs/ unavailability of medicines/ time taken for examination
is inadequate

10
SCHEDULE TO ASSESS KNOWLEDGE ATTITUDE AND PRACTICE AS
REGARDS COMMON DISEASES:
Name of the respondent:
Name of the disease Knowledge Attitude Practice

Diarrhoea Causation
Transmission
Prevention
Treatment
ARI Causation
Transmission
Prevention
Treatment
Measles Causation
Transmission
Prevention
Treatment
Malaria Causation
Transmission
Prevention
Treatment
Dengue Causation
Transmission
Prevention
Treatment
Tuberculosis Causation
Transmission
Prevention
Treatment
Leprosy Causation
Transmission
Prevention
Treatment
HIV/AIDS Causation
Transmission
Prevention
Treatment

11
KNOWLEDGE ATTITUDE AND PRACTICE REGARDING INFANT
FEEDING:
Name of the respondent:
Infant feeding Knowledge Attitude Practice
Prelacteal feeding
Colostrum
Exclusive breast feeding with
duration
Complementary feeding
Feeding during illness

KNOWLEDGE ATTITUDE AND PRACTICE REGARDING FAMILY

PLANNING:
Name of the respondent:
Topic Knowledge Attitude Practice
Legal age of marriage
Age at first pregnancy
Total number of children in
the family
Gender preference
Interval between children
Contraception
Medical termination of
pregnancy

KNOWLEDGE ATTITUDE AND PRACTICE REGARDING ADOLESCENT

HEALTH CARE:
Name of the respondent:
Topic Knowledge Attitude Practice
Diet
Immunization
Menstrual hygiene in
girls
Teenage pregnancy
Addiction

12
 IX. MATERNAL & NEW BORN CARE

ANTENATAL MOTHER
Date of registration:
Early registration: Yes/No
H/O previous pregnancy:

Year Duration Complication Type of Place of Conducted Outcome

delivery delivery by

H/O present pregnancy

Age: Married for: Height:
Gravida: Parity: LMP: EDD:
Records of ante natal visit Visit 1 Visit 2 Visit 3 Visit 4
Date
Gestational period
Weight
Pallor
Jaundice
Oedema
B.P
Fundal height
Presentation
FHS
H/O TT immunization
H/O IFA tablets consumption
Hb%
Urine examination
Blood group and RH
PP blood sugar
VDRL
Risk factors
Advice

13
POST-NATAL CARE

A. MOTHER: Date:

Post natal examination:

Jaundice:

Pallor:

Pulse:

B.P:

Temperature:

Oedema:

Fundal Height:

Condition of Breast:

Advice for family planning: Yes/No

Methods accepted: Yes/No

If not accepted give reasons:

If dead, cause of death:

Time of death: during delivery/ within six weeks after delivery

Death notified: Yes/No

14
B. SURVIVAL OF NEW BORN:

Upto 28 days: alive/dead

If dead, cause of death:

Death notified: Yes/No

NEW BORN CARE:

Date of birth: Sex: Birth weight (Kg):

Skin Color:

Temperature:

Eye:

Activity:

Cry:

Feeding:

Sleep:

Any swelling or Discharge:

Bladder and bowel:

Congenital anomaly:

15
 X. UNDER FIVE CHILD HEALTH RECORD:
Name:
Age:
Sex: M/F
Date of birth:
Place of delivery:
Type of delivery:
Birth weight:
Present weight:
Any disability:
Developmental milestones:
Developmental milestones Age
Neck holding
Sitting
Crawling
Standing
Walking
Running

Development: Normal/delayed
H/O present illness:
H/o past illness:

16
Immunization status of the child:
Name of the vaccine Date of the Place of the
vaccination vaccination
BCG
OPV 0/Hep Birth dose
Pentavalent 1 DPT 1
Hep 1
Pentavalent 2 DPT 2
Hep 2
Pentavalent 3 DPT 3
Hep 3
OPV 1
Fractionated IPV 1
OPV 2
Fractionated IPV 2
OPV 3
Measles 1 and JE 1
Measles 2
DPT Booster and JE 2
OPV Booster

Vitamin A oil:
No of doses:
Age:
REMARKS ON IMMUNISATION:

Anthropometric measurement
Weight (kg):
Height/Length (cm):
MUAC (cm):
Head circumference:
Chest circumference:

17
General survey/examination
Pallor/cyanosis/jaundice/oedema/clubbing
Lymph glands:
Vitamin deficiency signs: Angular stomatitis / glossitis / cheilosis / Bitot’s spot /
others
Skin: Nails: Hairs:
Systemic examination
Cardiovascular system
Respiratory system
GI system
Central nervous system
Laboratory investigation (if required)
Diagnosis
Feeding practices
Type of food first offered:
Colostrum given: yes/no
Prelacteal feeding : yes/no
Breast feeding started after ............ hrs of birth
Exclusive breastfeeding yes/no
If no, type of food given
H/O bottle feeding any time since birth: yes/no
Liquid supplementation (if given, age)
Complementary feeding started at (months)
Type of food given at the beginning of complementary feeding
Child feeding pattern during illness: normal/restricted/altered/stopped
Treatment /action taken/advice:

18
 XI. INDIVIDUAL HEALTH STATUS (i)
Name:
Age:
Sex:
H/O Present illness:
H/O Past illness:
Personal history:
Menstrual history:
General survey/examination
Pallor/cyanosis/jaundice/oedema/clubbing:
Neck glands:
Neck veins:
Pulse:
Respiration:
Blood pressure:
Temperature:
Weight (Kg):
Height (cm):
Waist circumference:
BMI:
Systemic examination
Cardiovascular system:
Respiratory system:
GI system:
Central nervous system:
Laboratory investigation (if required):
Diagnosis:
Treatment/action taken/advices:

19
 XI. INDIVIDUAL HEALTH STATUS (ii)
Name:
Age:
Sex:
H/O Present illness:
H/O Past illness:
Personal history:
Menstrual history:
General survey/examination
Pallor/cyanosis/jaundice/oedema/clubbing:
Neck glands:
Neck veins:
Pulse:
Respiration:
Blood pressure:
Temperature:
Weight (Kg):
Height (cm):
Waist circumference:
BMI:
Systemic examination
Cardiovascular system:
Respiratory system:
GI system:
Central nervous system:
Laboratory investigation (if required):
Diagnosis:
Treatment/action taken/advices:

20
 XI. INDIVIDUAL HEALTH STATUS (iii)
Name:
Age:
Sex:
H/O Present illness:
H/O Past illness:
Personal history:
Menstrual history:
General survey/examination
Pallor/cyanosis/jaundice/oedema/clubbing:
Neck glands:
Neck veins:
Pulse:
Respiration:
Blood pressure:
Temperature:
Weight (Kg):
Height (cm):
Waist circumference:
BMI:
Systemic examination
Cardiovascular system:
Respiratory system:
GI system:
Central nervous system:
Laboratory investigation (if required):
Diagnosis:
Treatment/action taken/advices:

21
 XI. INDIVIDUAL HEALTH STATUS (iv)
Name:
Age:
Sex:
H/O Present illness:
H/O Past illness:
Personal history:
Menstrual history:
General survey/examination
Pallor/cyanosis/jaundice/oedema/clubbing:
Neck glands:
Neck veins:
Pulse:
Respiration:
Blood pressure:
Temperature:
Weight (Kg):
Height (cm):
Waist circumference:
BMI:
Systemic examination
Cardiovascular system:
Respiratory system:
GI system:
Central nervous system:
Laboratory investigation (if required):
Diagnosis:
Treatment/action taken/advices:

22
 XI. INDIVIDUAL HEALTH STATUS (v)
Name:
Age:
Sex:
H/O Present illness:
H/O Past illness:
Personal history:
Menstrual history:
General survey/examination
Pallor/cyanosis/jaundice/oedema/clubbing:
Neck glands:
Neck veins:
Pulse:
Respiration:
Blood pressure:
Temperature:
Weight (Kg):
Height (cm):
Waist circumference:
BMI:
Systemic examination
Cardiovascular system:
Respiratory system:
GI system:
Central nervous system:
Laboratory investigation (if required):
Diagnosis:
Treatment/action taken/advices:

23
 XII. NUTRITIONAL PROFILE OF THE FAMILY
FOODS CONSUMED IN LAST 24 HRS
FOOD GROUPS FOOD ITEMS AMOUNT IN LAST 24
HOURS(GM/ML)
CEREALS

PULSES

GREEN LEAFY
VEGETABLES
ROOTS AND TUBERS

OTHER VEGETABLES

FRUITS

MILK & MILK

PRODUCTS
EGG
FLESH
FOODS FISH

MEAT

FATS& OILS

SUGAR& JAGGERY

NUTS AND OIL SEEDS

MISCELLANEOUS

Salt iodised: yes/no

24
 NUTRIENT INTAKE SHEET
Food Quantity Energy Protein Fat Retinol Thiami Riboflavi Vit- C Folic Iron
stuff (gm) (Kcal) (gm) (gm) equivalent ne n (mg) acid (mg)
(µg) (mg) (mg) (mg)

Total
consu
mptio
n

25
 DAILY NUTRITIONAL REQUIREMENTS OF THE FAMILY
Study subject Energy Protein Fat Retinol Thiamine Riboflav Vitamin Niacin Iron
(Kcal) (gm) (gm) Equivale (mg) in C (mg) (mg) (mg)
nt (mg)
(µg)
ADULTS:

Male
Female
Pregnant
Lactating

ADOLESCE
NTS
10-12 YRS
BOY
GIRL

13-15 YRS
BOY
GIRL

16-18 YRS
BOY
GIRL

INFANTS
AND
CHILDREN
<1YR
1-3YRS
4-6YRS
7-9YRS
TOTAL
DAILY
REQUIREME
NT
TOTAL
DAILY
CONSUMPTI
ON

DEFICIT/SU
RLUS
PERCENTA
GE

26
XIII. SUMMARY

27
XIV. MEDICO SOCIAL DIAGNOSIS

28
XV. ACTION TAKEN BY THE STUDENTS DURING THEIR
FAMILY VISIT

29
 XVI. RECOMMENDATION

To the individual

To the family

To the community

30
 XVII. ANNEXURE

FAMILY: It is a group of individuals related either by birth or marriage or

adoption living together under the same roof and sharing a common kitchen.
Biologically: It reflects the culture of the wider society of which it is a part.
Socially: It shares a common physical and social environment.
Family is a primary unit in all societies and is also the focal point of providing
health care and the right place for integrated preventive promotive and curative
services. House hold differs from the family in that all the members may be
blood related e.g. servants.
Types of families:
A. Nuclear family: It consists of the married couple and their children while
they are still regarded as dependents.
B. Other than nuclear family: Any family consisting of more than one
married couple or any relative of the couple other than their children.

Family practice:
1. Identification of earliest deviation of departure from normal health.
2. Identification of the underlying causes, if any.
3. Institution of remedial intervention for their prevention.
Family Physician:
Family Physician provides comprehensive and continuous primary health care
to all members of the family.
Roles and main functions of the family physician:
1. Comprehensive health care
2. Primary health care
3. Continuous care
4. Referral service
5. First aid
6. Medico-legal service
7. Issue of medical certificates

31
8. Coordinating role: between patients and their families with hospital
specialist.
9. Community care role: Identify problems and felt needs of the community
and take necessary action.
Educational status:
Illiterate: a person aged above 7 years who cannot read and write with
understanding.
Literate non formal: who can read and write with understanding any language
but has no formal schooling.
Occupation:
Service: The highest social status is for professions like legal, medical or
engineering. Next social status is for employment as college teachers or
administrative responsibilities like head master, officer in government or other
enterprises. Next comes primary and high school teachers and clerks.
Small business: Traders who maintain petty shops and are engaged in small
trade and business activities.
Skilled worker: Occupations like tailor, carpenter, blacksmith, washer man,
potter, barber and bidi worker
Unskilled worker: those who are casual workers and engaged by others.
Housing types:
Type Floor Walls Roof
Pucca Paved Stone/ brick built Concrete
Kuccha house Packed earth Dried mud/thatched Thatched or tin
Mixed Any combination of the above

Socio-cultural problem:
Child labour: Age less than 14years engage in work (in or outside family)
School drop-out: Age 5-14 years absent from school for consecutive 3 months
except vacation.
Physical activity:
Mention type of activity as Sedentary/Moderate/Heavy
32
Sedentary: Teachers, doctors, lawyers, executives, students, clerks,
shopkeepers, tailors, barber, shoemakers, priest, landlord, post man, nurse
Moderate: Fisherman, basket makers, potters, gold smith, carpenters, mason,
agricultural labours, rickshaw pullers, electricians, fitters, welders, industrial
labours, coolies, drivers, maid servants, bidi makers
Heavy: Wood cutters, stone cutters, blacksmith, miners, gang men
Consumption unit:
The energy consumption of an average male doing sedentary work is taken as 1
C.U and co-efficients for other individuals are worked out on the basis of
calorie requirements relative to that of sedentary man. 1 unit corresponds to an
energy requirement of 2320 Kcal per day.
Group Consumption unit
Adult male sedentary worker 1.0
Adult male moderate worker 1.2
Adult male heavy worker 1.6
Adult female sedentary worker 0.8
Adult female moderate worker 0.9
Adult female heavy worker 1.2
Adolescents 1.0
Children 9-12 0.8
Children 7-9 0.7
Children 5-7 0.6
Children 3-5 0.5
Children 1-3 0.4

33
 BMI-for-age GIRLS
5 to 19 years (z-scores)

32 32

30
Obesity 2
30

28 28

26
Overweight 26

1
24 24
BMI (kg/m²)

22 22

Normal 0
20 20

18 18

-2
Thinness
16 16

-3
14 14

12 Severe thinness 12

Months
10 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 10
Years 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age (completed months and years)
2007 WHO Reference
 BMI-for-age BOYS
5 to 19 years (z-scores)

32 32

30
Obesity 2
30

28 28

26 Overweight 26
1
24 24
BMI (kg/m²)

22 0 22

Normal
20 20

18 18
-2

16
Thinness -3 16

14 14

12 Severe thinness 12

Months
10 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 3 6 9 10
Years 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Age (completed months and years)

2007 WHO Reference