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Presentation of Family Visit Survey
1.
2. •Name of village :- Achrol
•Address :- Bhilon ki basti, opp. petrol pump
•Head of the family :- Mr. Banwari Lal Meena
•Age :- 48yrs
•Sex :- Male
•Religion :- Hindu
•Caste :- Meena
3. •Type of family :- Nuclear Family
•Socio-Economic Class :- Middle Class(B. G Prasad)
•Socio-Economic Data :-
i. Total family income per month in Rs. 7000
ii. Income per capita per month in Rs. 2600
4. S.
No.
Name of the
Member
Age Sex Relation with
the
Head of family
Education Occupation Income Expenditure
1. Mr. Banwari Lal
Meena
48 M Head Primary
School
Labourer RS. 5200
2. Mrs. Malti Devi
Meena
45 F Wife Illiterate Househelp RS. 1800
3. Mr. Somesh
Meena
15 M Son Secondary
School
- -
4. Miss Anju
Meena
8 F Daughter Primary
School
- -
5. S. No. Particulars Amount Spent % of total income
1. Food RS. 1500 21.4%
2. Clothing RS. 400 0.05%
3. Housing RS. 300 0.04%
4. Education RS. 100 0.01%
5. Medical care RS. 50 0.05%
6. Recreation RS. 500 0.07%
7. Travel RS. 300 0.04%
8. Miscellaneous - -
8. • Ventilation :- adequate
• Lighting :- adequate
• Kitchen
i. Separation :- no, combined with living room
ii. Fuel used :- upla/wood/coal
iii. Windows :- above chulha
iv. Smoke outlet :- none
10. • Bathroom :- separate bathroom present
• Drainage :- not proper, into the fields
• Place of defecation :- own latrine
• Toddler’s defecation :- own latrine
12. • Water supply
i. Sources of water :- Handpump and well
ii. Distance of water source :- 800m
from the house (In km.)
iii. Drinking water storage is done in :- Buckets(closed)
iv. Drinking water drawn by :- ladle
v. Do the family members :- No
know about Chlorination of water
14. • Surroundings of the house
i. Livestock and Poultry
• Separate :- Yes
• Collection and disposal of dung :- Proper
ii. Domestic Animal :- 2 Cows
iii. Cattle shed :- No
16. • Suggestions
•Avoid dumping of the garbage on streets
•Avoid storage of stagnant water
•If possible, avoid cooking on chulha
•Construction of cemented roof to avoid damping
•Applying putty/paint on walls to avoid damping
•Separation of toilet and cooking area(chulha)
to avoid transmission of diseases caused by
faeco-oral route.
17. i. Belief of the family as to how the diseases is caused :- Gods will
ii. What type of treatment do they seek at the time of illness :- Allopathic and Ayurvedic
iii. Usual source of medical care :- PHC
iv. What do your prefer for your sick child :- Home Treatment and Local Doctor
v. Do you know about Family Planning methods :- Yes
female individual has done the tubectomy procedure; barrier methods of contraception also used
i. Do you know the source of getting Family Planning services :- Yes
18. THREE DAYS DIET SURVEY (Oral questionnaire)
Food Items Day 1 Day 2 Day 3 Average
Cereals(wheat, rice) 1000gm 1500gm 1000gm 1160gm
Pulses(Dal) 80gm 30gm 50gm 53gm
Green Leafy
Vegetables
40gm 50gm 40gm 43gm
Root Vegetables
(potato)
10gm 10gm 10gm 10gm
Milk 1000ml 1000ml 1000ml 1000ml
Oil/Ghee 30ml 40ml 30ml 33ml
Salt 15gm 15gm 15gm 15gm
Sugar 20gm 20gm 20gm 20gm
19. RECOMMENDED DIETARY ALLOWANCE
S. No. Member of the
family
Age Sex Net Energy
(Kcal/day)
Protein
(g/day)
Visible Fat
(g/day)
Calcium
(mg/day)
Iron
(mg/day)
1. Mr. Banwari Lal
Meena
48 M 2730 60 30 600 17
2. Mrs. Malti Devi
Meena
45 F 2230 55 25 600 21
3. Mr. Somesh
Meena
15 M 2750 54.3 45 800 32
4. Miss Anju
Meena
8 F 1690 29.5 30 600 16