CSCD Proforma for UGs and PGs in Community Medicine

1. Dr. Shubha DB
Assistant Professor
Community Medicine
JJMMC
Clinical Social Cultural
Demographic Proforma

2. Why CSCD Proforma?
1. Along with the clinical illness how the social factors
influence in the disease.
2. To make a clinico - social diagnosis.
3. Correlating the clinico - social diagnosis in occurrence of
disease
4. To suggest remedial measures

3. Difference between a social and clinical
Proforma
Sl.
No.
Social Proforma Clinical Proforma
1.
Impact of external environment on the health of
family forms important part of study.
Insignificant
2.
Socio economic history or study is important for
family study and family advice
Not much importance is given
3.
Study of diet and nutrition and advice to the family
forms important part of study.
Not given much importance except
in nutritional deficiency.
4.
Preventive and promotive advice is the strongest tool
in family care programmes
Curative component is given more
importance

4. CSCD Proforma
• Address
• Religion & Caste
• Type of family
• Dietary history
• Socio economic status
• Environmental history
• Social & cultural practices
• KAP regarding health & disease
• Summary/Clinico-Social Diagnosis

5. GENERAL INFORMATION
1.Address:
Importance:
a. To know the existing and prevailing health problems.
b. To know the nearest health facilities available.
c. Geographic distribution of diseases.

6. Religion and caste: Hindu/ Muslim/ Christian/Others (Specify)
1.Certain religious practices may have a role to play with certain health
aspects, diseases, health beliefs, health seeking behaviour, food habits
2.Child rearing and feeding practices usually vary according to each
religion.
Ex: Pardha system in Muslims → Vit D def.
- Government has specific schemes for the socially oppressed – SC, ST
and OBCs
- Food faddism also varies in different religion.

7. FAMILY STRUCTURE
Family: Is the smallest unit of community where group of individuals who are related by
blood, marriage or adoption living together and sharing food from the common kitchen.
 Biological unit – The individuals share a pool of genes
 Social unit– They share a common physical and social environment
 Cultural unit– The family reflects the culture of the wider society of which it is a part
and determines the behaviours of its members.
 It is also an epidemiological unit

8. Types of family:
• Nuclear family
• Joint family
• 3 generation family

9. What is a nuclear family/elementary family?
Married couple living with their children while the children are still regarded as
dependent on the couple.
i. They share a common dwelling place
ii. Husband plays a dominant role usually
iii.Greater burden in terms of responsibilities for child rearing.
‘New’ families are the nuclear families that are less than 10 years old

10. What is a joint family/extended family?
Number of married couples and their children live together in the same house. The men are
all related by blood and the women are their wives, unmarried girls and widows of their
family kinsmen.
1. The property is held in common. There is a common purse to which all the money goes
and the family expenditure is met with by that common purse.
2. The most senior male member is the head of family and takes all the decisions. His wife
is the head of the women folk in the family.
3. Familial relations enjoy primacy over marital relations.
This is a lateral extension of the nuclear family

11. What is a three generation family?
Representatives of three generation are living together. Young married couples continue to stay with
their parents and have their own children as well.
i. This is fairly common in countries like India where married couples find it difficult to find separate
accommodation.
ii. It has some of the advantages of the joint family with regards to the responsibility in upbringing of the
children
iii. In urban areas with working women it has more relevance; the grand parents can take care of children in
the absence of their parents.
iv. Also, senior citizens of the family stay with the young couple; they are also taken care of, thereby
supporting them.
This is a linear extension of the nuclear family.

12. Diet History

13. Dietary Survey Methods
• Aim of any dietary survey is to discover the habitual nutrient intakes of
individuals.
• There are several methods available:
Recording methods:
1. Precise weighing method
2. Weighed intake record (weighed inventory)
3. Food diary
Recall methods:
1. Diet history ('usual' intake)
2. Diet recall (actual food intake), e.g. 24hr recall
3. Food intake questionnaire, e.g. food frequency questionnaire

14. Dietary History
Type of diet – Vegetarian/Mixed
Diet recall: 24hr recall method
Kcal Protein
Before breakfast
Breakfast
Lunch
Evening snack
Dinner
Before sleeping
Total consumed
Recommended
Deficit

15. Work Examples
Sedentary Teacher, Tailor, Barber, Priest, Executive, Peon, Retired personnel,
Shoe maker, Housewife, Nurse, Doctor, Clerk, Shopkeeper,
Manager, Goldsmith, Lawyer.
Moderate Potter, Basket maker, Carpenter, Mason, Electrician, Welder,
Fisherman, Coolie worker, Postman., Maid, Weaver, Driver,
Agricultural/Industrial labourers, Beedi maker
Heavy Stonecutter, Blacksmith, Mine worker, Wood cutter, Farm laborer,
Army soldier.

16. Nutrition Requirements
Adults Male Kcal/Kg/day Female Kcal/Kg/day
Sedentary 2320 39 1900 35
Moderate 2730 46 2230 41
Heavy 3490 58 2850 52
Pregnancy + 350
Lactation + 600, + 520
Kcal/day Kcal/kg/day
Infants (<6m) 5.4kg 500 92
Infants (6-12m) 8.4 670 80
Children (1-3yrs) 12.9 1060 82
Children (4-6yrs) 18.1 1350 75

17. Socio Economic Status

18. Total annual income of the family- income from all sources.
• Pension schemes: widow/ old age pension etc.,
Socioeconomic status:
Different scales are used to assess SES –
• Urban area: Kuppuswamy scale.
• Rural areas: B G Prasad classification, Parikh classification
• Both: SLI, BPL/APL, Wealth index.

19. Modified B G Prasad SES Classification
• The scale was made in 1961 for classification of people based on income.
• The scale was modified in 1982 and 2001 by introducing linking factors to convert CPI (1982 and
2001) from the new base of 100 to the old base CPI (1960).
• The linking factors for 1982 and 2001 were 4.93 and 4.63, respectively.
Consumer Price Index Numbers for Industrial Workers for July 2021 = 122.8
Multiplication factor = Current index value (122.8)/Base index value in 2001 (100) = 1.228
New income value = multiplication factor × old income value × 4.63 × 4.93

20. Modified BG Prasad SES Classification updated for
July 2021
Social Class Original Classification (Rs./month) Latest Revision (Rs./month) = multiplication
factor (1.228) × old income value × 4.63 × 4.93
I 100 And above
II 50 99
III 30 49
IV 15 29
V Below 15

21. Modified BG Prasad SES Classification updated for
July 2021
Social Class Original Classification (Rs./month) Latest Revision (Rs./month) = multiplication
factor (1.228) × old income value × 4.63 × 4.93
I 100 And above 2,803 and above
II 50 99 1402 – 2802
III 30 49 841 – 1401
IV 15 29 420 – 840
V Below 15 419 and below

24. Housing Conditions

25. Variable Pucca Kachha
1 Durability Long lasting Short lasting
2 Definition A house is called Pukka if it is
constructed using the following
materials
A house is called kutcha if it
is constructed using the
following materials
Wall Roof  Unburnt bricks
 Bamboos
 Mud
 Grass
 Reeds
 Thatch
 Loosely packed stone
 Burnt bricks
 Stones
 Concrete
 Cement
 Timber
 Tiles
 Metal
 Asbestos
 Concrete
 Bricks
 Stone
 Timber

26. Living conditions/standards (By scoring method)
Sl. No. Parameter 0 1
1 Structure Attached/Semi-attached Detached
2 Construction type Kuccha Pukka
3 Dampness of walls Yes No
4 Cleanliness No Yes
5 Lighting Inadequate Adequate
6 Ventilation Inadequate Adequate
7 Cross-ventilation No Yes
8 Overcrowding Yes No
9 Safe water source No Yes
10 Drinking water Not purified Purified

27. Living conditions/standards (By scoring method)
Sl. No. Parameter 0 1
11 Distance to get water (within 400meters) No Yes
12 Kitchen separate No Yes
13 Smoke vent No Yes
14 Drainage system for kitchen No Yes
15 Fuel used in kitchen Wood/kerosene/dung LPG
16 Storage of food articles in kitchen Uncovered Covered
17 Presence of cockroaches/rats in house Yes No
18 Space for washing clothes/utensils in & around the
house
No Yes
19 Use of sanitary latrine No Yes
20 Garbage disposal No Yes

28. Living conditions/standards (By scoring method)
Sl. No. Parameter 0 1
21 Livestock (within 25 feet of house) Yes No
22 Maintenance of cattle shed Unhygienic Hygienic
23 Surrounding of house: breeding places of flies &
mosquito
Yes No
24 Drainage system Open Closed
Total
Grade: Poor (0-8) Moderate (9-16) Good (17-24)

29. Overcrowding

30. Overcrowding
• Overcrowding refers to the situation in which more people are living within a
single dwelling than there is space for, so that movement is restricted, privacy
secluded, hygiene impossible, rest and sleep difficult.
• Criteria –
1. Persons per room: Number of persons in the household divided by the
number of rooms in the dwelling. The accepted standards are :
• 1 room – 2 persons
• 2 rooms – 3 persons
• 3 rooms – 5 persons
• 4 rooms – 7 persons
• 5 or more rooms – 10 persons (additional 2 for each further room)

31. Overcrowding
2. Floor space: The accepted standards are :
• 110 sq. ft. (11 sq. m) or more – 2 persons
• 90- 100 sq. ft. (9-10 sq. m) – 1 ½ persons
• 70- 90 sq. ft. (7-9 s q . m) – 1 person
• 50-70 sq. ft. (5-7 sq. m) – ½ person
• Under 50 sq. ft (5 sq. m) – nil
{A baby under 12 months is not counted; children between 1 to 10 years
counted as half a unit}
3. Sex separation: Overcrowding is considered to exist if 2 persons over 9 years
of age, of opposite sexes are obliged to sleep in the same room.

32. Cultural Practices of the Family
Note down the specific cultural practices prevalent in the family such as:
1. Withholding food items during antenatal/postnatal period (HOT or COLD food)
2. Pre lacteal feeds
3. Withholding colostrum
4. Application on the umbilical cord
5. Branding

33. KAP regarding Health and Disease
1. How are diseases caused? Spread? Cured? Prevented?
2. Advantage of having a sanitary latrine in your house? Handwashing
practices?
3. Optimum number of children for a couple? Spacing?
4. KAP regarding family planning practices?
5. What are the diseases transmitted by mosquito?
6. What are the diseases transmitted by housefly?

34. Summary/Clinico-Social diagnosis – This is the family of Mr/Mrs X educated upto ……….
working as …… residing in..................... (An urban slum) belonging to ...... socioeconomic
status with satisfactory/un-satisfactory housing conditions and good/bad KAP regarding
health & disease.
Advice –
1.To the patient
2.To the family
3.To the community

35. Things to carry
• Stethoscope
• Pen Torch
• Measuring tape
• BP apparatus
• Reflex Hammer
• ICDS Growth charts

36. Clinical Cases
• ANC, PNC, MCH (U5)
• AGE, PEM, PUO, ARI
• HIV
• Tuberculosis
• T2DM, HTN
• Dog bite case
• Leprosy

37. ANC/PNC/MCH/Under 5
• Government schemes – knowledge, access/utilization
• Thayi/MCP card
• Growth Chart (ICDS)
• Anthropometry – HC, CC, MUAC

42. National Immunization Schedule for infants,
children and pregnant women (UIP)

43. National Immunization Schedule for infants,
children and pregnant women (UIP)

44. National Immunization Schedule for infants,
children and pregnant women (UIP)

45. National Immunization Schedule for infants,
children and pregnant women (UIP)

46. National Immunization Schedule for infants,
children and pregnant women (UIP)
Td - Tetanus
diphtheria to
replace TT

47. NCDs
• Height
• Weight
• BMI
• Waist Circumference
• Hip Circumference
• W:H (WHR)
• BMI = weight (in kilograms) / height (in meters)
^2
• Males: IBW = 50 kg + 2.3 kg for each inch over 5
feet.
• Females: IBW = 45.5 kg + 2.3 kg for each inch over
5 feet.
• According to the World Health
Organization (WHO), a healthy WHR is:
• 0.9 or less in men
• 0.85 or less for women
• In both men and women, a WHR of 1.0 or higher
increases the risk for heart disease and other
conditions that are linked to being overweight.

48. NCDs

50. THANK YOU