DEPARTMENT OF PREVENTIVE AND

SOCIAL MEDICINE
GOVERNMENT MEDICAL COLLEGE ANANTNAG

Clinico-psychosocio-economical case : PNC

Presented by :-
1. Neefa Bashir(18)
2. Asma Rehman(27)
3. Humaira Bashir (29)
4. Mubashir(31)
5. Syed Shahzeb(32)
FAMILY SURVEY
Family Profile:-

● Residence : Panzgampora (SAGAM)

● Block : Sagam
● Head of the family : Jasbir Ahmad Wani
● Type of family : Nuclear
● Number of family members : 3
 Family overview :-

Name Age Sex Relatio Educat Marital Occup

n to ional Status ation
HOF status
Jasir 22 years M HOF 9th Pass Married Daily
Ahmed Wager
Wani

Iqra Jan 21 years F Wife 8th Pass Married Home

Maker

Muntaha 8 months F Daughter

Jasir
Environmental Conditions :-
Constructional features :-

● Layout:Detached
● Setback:open(adequate)
● Material:semipucca
● Walls:burnt bricks in mud
● Floor:cemented
● Roof:Tinned
Surroundings :-

● Approach : kuccha
● Drainage : unsatisfactory
● Openness : adequate
● Fly breeding Area : present
● Mosquito breeding Area : present
 Living room

St a i rs
Bathroom
House map :-
door
Main

Kitchen
 House Hygiene :-

● Number of inhabitants : 2
● Number of living Rooms : 2
● Total floor Area of the living rooms : 264
sq.ft
● Number of windows in living room : 6
(32.25 sq.ft)
● Ratio of ventilation area to living rooms :
>1:5
● Overcrowding : Absent

● Ventilation : Adequate

● Lighting : Adequate

● Rat harbourage : Present

● Houseflies : Absent

● Other Pests : Absent

● Cleanliness :
Satisfactory
 Kitchen :-
● Location : not separate
● Smoke vent : not provided
● Food storage : unsatisfactory
● Floor : Cemented
● Walls : Burnt bricks in mud
● Roof : Open (wooden planks laid)
● Drainage : Absent
● Cleanliness : Satisfactory
● Note : No closed wire system , risk of
Electric hazards.
 Bathroom :-

● Provision : inside the house

● Floor : cemented
● Walls : cemented
● Drainage : satisfactory(open
drainage)
● Ablution facilities : water
● Cleanliness : satisfactory
 Latrine :-

● Provision : outside the house

● Type : water seal type
● Nature : sanitary
Waste Disposal :-

● Excreta : septic tank

● Refuse : Burning
● Waste water : open
drainage
● Note : dumped animal
waste found.
 Water supply :-

● Source : Tap water

● Purification at source : Absent(Not
done)
● Treatment of water at household :
Roll Boiling
● Storage : water buckets with
proper lid
Advice :-
● We advised the family to dump the animal wastes
away from the house so as to prevent mosquito
breeding.
● We advised the family to make a separate kitchen
with proper drainage and smoke vent.
● We warned them about the electric hazards related
to naked live wires.
● We suggested them to store food in refrigerator
instead of keeping it in closed containers.
● The mosquito net of their windows was torn,we
advised them to replace it with new one.
 SOCIO-ECONOMIC CONDITION OF
THE FAMILY
Family:
Name Age Sex Relation to EDUCATIO OCCUPATIO INCOME
HOF N N

Jasir 22 years M HOF 8th Pass Daily Wager Rs 8000/month

Ahmed
Wani
Iqra Jan 21 years F Wife 9th Pass Home Maker ____

Muntah 8 months F Daughter

a
Jasir
Economic Status:

Expenditure per month in rupees:

• Food = 1500 ( rice , cooking oil , cerelac , bananas )
• Education = 0
• Medical expenses =800
• Fuel = Gas (LPG) [<1000 rupees ( 3 months/cylinder)]
• Electricity =180
• Rent = 0
TOTAL EXPENDITURE = 2810 rupees.
Income per month
Income available only from Wages ,average is 8000/month
(No other sources of income ,as No land ,No Business or No Handicrafts Present)

Savings per year roughly calculated ( TOTAL INCOME – EXPENDITURE )

= 8000-2810/month =62000 rupees

Modern Amenities Like,

Electricity, LPG stove , Refrigerator ,Washing Machine ,Mobile phone and Internet
connection were present.
Calculating Socio-Economic status of the family from the data available
Using Kuppuswamy scale (2019) which takes into account the

I. Education (scores from 1-7 )

II. Occupation (scores from 1-10)
III.Income (scores from 1-12)

Total range from 3 to 29

• Education of the head is 8th standard(Middle school)
Score =3
• Occupation of the head (Trade worker ) Score = 4
• Total monthly income of the family (8000 rupees )
Score =2
Total Score = 9
Socio-economic class= ( Upper Lower class)
 Other Scales for measuring the socio-economic status of a family
In Urban areas:
• Kuppuswamy scale
• Shrivastava scale

In Rural areas:
• Uday Pareekh scale
• Radhokar sacale
• BG Prasad scale , are used

Among these Kuppuswamy is widely used (both for rural as well as urban
areas).
NUTRITIONAL STATUS
 Anthropometric Measurements
Name Weight Height/Length BMI
[in Kg] [in meters] [kg/m²]

Jasir Ahmad Wani 57.2 1.75 18.67 –

[HOF], 22 yrs Normal

Iqra Jan 40.2 1.54 16.95 -

[Wife], 21 yrs Underweight

Weight Weight for Length MUAC

Age

Muntaha Jan 6.2 Kg 0 to -2 SD 72 cm 14 cm

[Daughter], 8
months.
 Dietary Assessment
• 24 hour recall method.
• Nutritive values of food items
1. Park’s Textbook of Preventive and Social Medicine
2. Food Item Label
3. Nutritive Values of Indian Foods
• Measurements as;
• 1 tsp=5 gm, 1 tbsp=15gm
• 1 Cup= 150 g rice, 1 cup= 100-125 g flour, 1 cup=245 g of milk
• 1 ladle=50 ml oil
 Breakfast :- Nunchai and Home-made roti.
Food Item Quantity Calories Proteins Fats Carbohyrat Fe [mg] Ca[mg] Salt[g]
[Kcal] [g] [g] es [g]
Chai[Cow’s 2 cups= 490/100× 490/100× 490/100× 490/100× 490/100× 490/100× 1 tsp=5 g
Milk] 490 g 67= 328 3.2 =15.68 4.1 = 20.1 4.4 = 21.56 0.2= 0.98 120=588 approx
approx 164 each 7.84 each 10.05 each 10.78 each 0.49 each 294 each 2.5 each
245 each
Roti 2×2=4 rotis 100/100× 100/100× 100/100× 100/100×
[Wheat] Using 1 295=295 11.4=11.4 0.6 =0.6 71 = 71
cup
flour=100g 1 tsp 5.7 each + 1 tsp 35.5 each
2 rotis each mustard oil mustard
50 g each =4.5g×9= Oil= 4.5g
40 kcal fat
167 each Total=5.10
2.55 each
 11 am :- Lipton/Sweet Tea and Home-made roti.
Food Item Quantity Calories Proteins Fats Carbohyrat Fe [mg] Ca[mg]
[Kcal] [g] [g] es [g]
Chai[Cow’s 2 cups= 490 490/100× 490/100× 490/100× 490/100× 490/100× 490/100×
Milk] g approx 67= 328 3.2 =15.68 4.1 = 20.1 4.4 = 21.56 0.2= 0.98 120=588
245 each 164 each 7.84 each 10.05 each 10.78 each 0.49 each 294 each

Roti 2×1= 2 rotis 50/100× 50/100× 50/100× 50/100×

[Wheat] Using ½cup 295= 147.5 11.4=5.7 0.6 =0.3 71 = 35.5
flour=50g
1 roti each ½ tsp 2.85 each ½ tsp 17.7 g each
25 g each mustard mustard
oil=2.25g×9 Oil= 2.25 g
=20 kcal fat
84 each
Total=2.55
1.27 each

Sugar 1½ tbsp 22.25×4= 22.5

=22.5 g 90 kcal 11.25 g
11.25 each 45 each each
 Lunch : Rice with Potatoes & Nutri.
Quantity Calories Proteins Fats Carbohydr Ca [mg] Fe [mg] Fiber [g]
[g] [Kcal] [g] [g] ates [g]
Rice 1½ cups × 225/100× 225/100× 225/100× 225/100×
150= 225 345=776 6.8=15.3 0.5 =1.125 78.2= 176
112 each 388 each 7.6 each 0.56 each 88 each

Potatoes ¼ kg 250/100× 250/100 - 250/100 250/100

125g each 80=200 ×1=2.5 ×22=55 ×1.3=3.25
100 each 1.25 27.5 each 1.62 each

Nutri ¼ packet 50/100× 50/100× 50/100× 50/100× 50/100× 50/100× 50/100×

200/4=50 336=168 52= 26 0.9=0.45 34=17 533=266 21.2=10.6 3.4= 1.7
25 g each 84 each 13g each 0.225 each 8.5 each 133 each 5.3 each 0.85 each

Oil - 1 ladle= 45×9 45 g

Mustard 50ml=45 g =400 22.5 g
22.5g each 200 each each

Salt 2 tsp=10g
 Evening :- Nunchai and Home-made roti.
Food Item Quantity Calories Proteins Fats Carbohyrat Fe [mg] Ca[mg] Salt[g]
[Kcal] [g] [g] es [g]

Chai[Cow’s 2 cups= 490/100× 490/100× 490/100× 490/100× 490/100× 490/100× 1 tsp=5 g

Milk] 490 g 67= 328 3.2 =15.68 4.1 = 20.1 4.4 = 21.56 0.2= 0.98 120=588 approx
approx 164 each 7.84 each 10.05 each 10.78 each 0.49 each 294 each 2.5 each
245 each

Roti 2×1= 2 50/100× 50/100× 50/100× 50/100×

[Wheat] rotis 295= 147.5 11.4=5.7 0.6 =0.3 71 = 35.5
Using
½cup ½ tsp 2.85 each + ½ tsp 17.7 g each
flour=50g mustard oil mustard
1 roti each =2.25g×9= Oil= 2.25 g
25 g each 20 kcal fat
84 each Total=2.55
1.27 each
 Dinner : Rice with Potatoes & Nutri.
Quantity Calories Proteins Fats Carbohydr Ca [mg] Fe [mg] Fiber [g]
[g] [Kcal] [g] [g] ates [g]

Rice 1½ cups × 225/100× 225/100× 225/100× 225/100×

150= 225 345=776 6.8=15.3 0.5 =1.125 78.2= 176
112 each 388 each 7.6 each 0.56 each 88 each

Potatoes ¼ kg 250/100× 250/100 - 250/100 250/100

125g each 80=200 ×1=2.5 ×22=55 ×1.3=3.25
100 each 1.25 27.5 each 1.62 each

Nutri ¼ packet 50/100× 50/100× 50/100× 50/100× 50/100× 50/100× 50/100×

200/4=50 336=168 52= 26 0.9=0.45 34=17 533=266 21.2=10.6 3.4= 1.7
25 g each 84 each 13g each 0.225 each 8.5 each 133 each 5.3 each 0.85 each

Oil - 1 ladle= 45×9 45 g

Mustard 50ml=45 g =400 22.5 g
22.5g each 200 each each

Salt 2 tsp=10g
5g each
 24 hour calculation
Jasir Ahmad Wani Iqra Jan
Intake RDA- Inference Intake RDA- Inference
Moderate Sedentary
worker Lactating
[7-12]
Calories[Kcal] 2416 2710 300 kcal def. 2416 1660+520 235 Kcal
=2180 Excess
Proteins [g] 78 54 24 g excess 78 46+13=59 19 g excess
Carbohydrates 360 130 230 g excess 360 210 150 g excess
[g]
Fats [g] 80 30g 50 g excess 80 g 30 50g excess
Fe[mg] 12 19 7 mg deficit 12 23 11 mg deficit
Ca[mg] 1150 mg 1000 mg Within normal 1150 mg 1200 Almost normal
range
Salt[g] 15g <5g EXCESS 15g <5g EXCESS
Fiber[g] 4.94 41 VERY LOW
INTAKE
Nutrient Balanced diet Diet of the family Comments

Protein 10-15 % 10% Decrease Protein

Proportion
Fats 15-30% 30% High Fat
Proportion
Carbohydrates 50-80% 60%
1. Foods they eat frequently :
• Rice, Potatoes, Tomatoes, Pulses, Milk, Wheat[Atta/Roti]
2. Foods they eat rarely
• Meat, Fish, Fruits, Chicken .
 On Appearance
• Jasir Ahmad Wani :Concious, thin, dull, anxious looking with
discolored eyes.

• Iqra Jan : Conscious, pale, thin, dull, anxious looking .

 Problems & Advices [ Based on anthropometry, dietary
habits and appearance]
Problem Advice
Wasting and low animal protein Increased comsumption of eggs,
intake soyabean, milk [meat,chicken, fish
too if possible,]
Excess Salt intake Reduce Salt
Excess Oil consumption Reduce oil per serving, do exercises
Less Fe intake Spinach, Beetroot, Nuts, Pumpkin
Seeds
Less Fiber intake Beans, Chickpeas, Carrots, Pulses
Less Fruit consumption Apples, Bananas, Grapes, Kiwi.
Socio clinical case:

Postnatal case
• Name of mother: Iqra jan
• Age: 21 yr
• Education: 9th std
• Husband’s name: Jasir Ah. Wani
• Address: Haergam Sagam
• Date of admission: 7-12-2022
• Date of delivery: 9-12-2022
• Mode of admission: Self
• Contact details: 6005581921
• Religion: Islam
• Occupation: Housewife
• Locality: Rural
• Place of delivery: Maternity and Child Care hospital Shairbagh Anantnag
 Family Profile
• Type of family: Nuclear
• Total members: 3
• Total family income: Rs. 10000 per month
• Socio economic status: lower middle class
(modified kuppuswamy scale)
• History of presenting illness:
The patient , Iqra Jan , 21yrs was admitted in the hospital on
7-12-2022 when she experienced decreased fetal movements.
The patient delivered baby on 9-12-2022.
The baby delivered was normal with no visible deformity.
 Obstetric history
• Obstetric Score: Para 1 Live 1 (P1L1)
Antenatal history
• Last menstrual period (Lmp): 05-03-2022
• Expected delivery date (EDD): 12-12-2022
• Pregnancy was confirmed on USG
• She was anaemic.
• She was prescribed iron folic acid tablets.
• Tetanus toxoid vaccination: done (2 doses)
• Antenatal problems: Dizziness, giddiness, nausea.
• Total no. of antenatal visits: 9 (2+3+4)
 Intranatal history
• Date of delivery: 9-12-2022
• Time: 1:09 am
• Duration: 15 min
• Nature of delivery: normal
• Episiotomy was done.
• Sex of baby: Female
• Mode of delivery: induced
• Place of delivery: Maternity and childcare hospital Shairbagh
 Neonatal history
• Birth weight: 3kg
• Baby cried immediately after birth.
• There were no birth injuries or congenital deformities.
• No cyanosis or difficulty in breathing.
Perinatal care:
• Cleaning of skin: Done
• Cleaning of eyes: Done
• Cleaning of airway: Done
• Breast feeding: within 30 min.
• Prelacteal feed was not given.
• APGAR score: 10 (normal)
• Birth registration: done
• Family and social support: satisfactory
• Rooming in: satisfactory
Immunization history:
 Personal history
• Diet: mixed
• Food habit: regular
• Appetite: normal
• Sleep: normal
• Bowel and bladder: normal
• Physical activity: moderate
• Weight: decreased
Drug history: none
No past medical history/ surgical history
 General physical examination
• Built: Skinny
• Weight: 40.2 kg
• Height: 154cm
• BMI: 16.8 kg/m2
• Nutritional status: under weight
• Pulse: 80 beats/min
• Blood pressure: 110/70mmhg
• Respiratory rate: 16 breaths/min
• Mild pallor
• No signs of jaundice, cyanosis, clubbing, lympadenopathy
• No thyroid swelling seen
• Satisfactory oral hygiene
.
Mild pallor
 Systemic examination

• Respirtory system: normal

• Cardiovascular system: normal
• CNS: normal
• GIT: normal
• Breasts: soft, non tender,
• Nipples: normal
Examination of baby (at the time of birth):
• Birth weight:3kg
• No signs of cyanosis, jaundice
• Normal CVS, RS, CNS, GIT
• Genitalia: normal
• Feeding: normal
• APGAR score: 10
• No congenital deformities or birth injury.
• There were no post partum complications.
24 hour calculation [Mentioned earlier]

Iqra Jan
Intake RDA- Inference
Sedentary
Lactating
[7-12]
Calories[Kcal] 2416 1660+520 235 Kcal
=2180 Excess
Proteins [g] 78 46+13=59 19 g excess
Carbohydrates 360 210 150 g excess
[g]
Fats [g] 80 g 30 50g excess
Fe[mg] 12 23 11 mg deficit
Ca[mg] 1150 mg 1200 Almost normal
Salt[g] 15g <5g EXCESS
Fiber[g]
 Advice given to mother
• Mother was advised to introduce additional foods in her diet
(like eggs, fruits, chicken, nutri, milk, butter)
• She was advised to take iron supplements.
• She was advised to visit anganwadi centre to gain benefits.
• She was counselled about birth spacing and use of contraceptives.
• Information regarding golden card was given [had it already ]
• Information regarding various programs like janani suraksha youjna
vandemataram scheme, RCH, ICDS.
Schedule for infant
General information
• Infant‘s name :Muntaha jasir
• Infant‘s age :8months
• Infant’s gender :Female
• Birth order : First child
• Father‘s name :Jasir Ahmed
• Mother‘s name :Iqra jan
Delivery
• Place of delivery : Institutional (MATERNITY AND CHILD CARE

HOSPITAL SHERBAGH ANG)

• Delivered by : Doctor
• Nature of delivery : Vaginal
• Birth weight ( as per records) : 3kg
Feeding
• Breast feeding :Yes
• Type of breastfeeding :Exclusive breast feeding
• Timely introduction of complementary feeds after 6 months
• Complementary foods given : Biscuit with tea (twice a day)
• : Bananas (once a day)
• : cerelac (once a day)
Immunization
 Development

Gross motor milestone Age

• Head control • 3_4 months
• Roll over • 4_5 months
• Sit with support • 6 months
• Sit without support • 7_8 months
Fine motor milestones Age
• Bidextrous grasp :4 months
• Unidextrous grasp : 5-6 months
• Radial Palmer grasp : 8 months
 Language milestones Age
• Cooing sound • 3 months
• Laughs when happy • 4 months
• (Mama, mamu) sounds • 6_7 months
Social milestones Age
• Social smile • 2_3 months
• Interacts with mother • 3_4 months
Examination :Anthropometry

• Length (in cms) • 73cm

• Weight (in kg) • 6.2kg
• Head circumference • 45cm
• Chest circumference • 47cm
• Upper mid arm circumference • 14cm
Examination

Vital signs
• Temperature • 37.5°C
• Respiratory rate • 32 breaths /min
• Pulse • 92 b/min
General physical examination :
Head to toe examination
• Colour of skin
• Size/shape/ symmetry of head
• Closure of posterior fontenella
• Eyes
• Ear, nose and throat
• • Position of trachea normal
• Skin and appendages
• Normal
• Normal
• By 6 month
• No signs of : pallor, icterus,
• Pupillary reflex present
• No signs of : nasal Obstruction, any
deviated septum,
• No thyroid enlargement
• Normal nails, hands and feet
Systemic examination

• Respiratory system • Normal respiratory sounds

• No chest deformity visible
• CVS • Normal heart sounds
• Genital system • Normal maturity stage
Advice to mother regarding infant care
• The mother was advised to introduce other complementary foods
like rice, egg yolk and vegetables in the diet.
• Consult paediatrician regarding infant health
• Visit anganwadi centre to gain benefits.
• Proper hygiene of the infant to prevent infections
• Electronic appliances (heater) should be kept out of reach of child
Mother was educated regarding various schemes like Beti Bachao Beti
padhao, RCH program.