Family Adoption Program

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Introduction

• TheAlma-Ata Declaration on 12th September, 1978 in the international

conference on primary health care - World Health Organization (WHO) -
‘Health for all’
• Milestoneto be met with by all developing and developed countries of the
world by year 2000
• Governmentof India (GOI) had launched a Community Health worker
(CHW) scheme and Village Health Guide (VHG) programme in 1977.
• This program failed to achieve the expected impact
• State
governments extended their support in this project through different
schemes
• Availability
of about 1 million Accredited Social Health Activists (ASHA)
across the country
Intro…
• NationalMedical Council (NMC) was making continuous modifications in
setting up and maintaining high standards of medical education in India
• Equitablehealth distribution through well-trained allopathic doctors could
be provided to the citizens of India

• However,the rural population remained deprived of general medical

treatment.

The family adoption programme: Taking Indian

medical undergraduate education to villages
Current scenario of availability of health care
facilities in villages

• There are 662538 villages distributed amongst 736 districts in

India
• Rural
population constitutes about 66.7% of the country’s total
population
• Health
problems in rural area are typically related to infectious/
communicable/ water-borne diseases, injuries and snake/ insect
bites
• Urbanpopulation suffers from life style diseases of diabetes,
hypertension, malignancies and mental illnesses
• Metabolic disorders, accidents and injuries as well as mental
illnesses are now affecting all populations
• Ignorance is an additional challenges in health improvement of
rural population
Contd…
• EachPHC caters to population of approximately 30,000 in plains or
20,000 in hilly areas.
• Public
health centers with essentially single-physician clinics
handle the primary health needs (primary health centers (PHCs) of
general population in India
• There are 155404 and 2517 Sub Centres, 24918 and 5895 Primary
Health Centres (PHCs) and 5183 and 466 Community Health
Centres (CHCs) respectively which are functioning in rural and
urban areas of the country.
Family adoption program (FAP)
• Part of curriculum of Community Medicine
• Begins from 1st professional year and remain throughout the
curriculum.
• Taking Indian medical undergraduate education to villages
Need of the Program
• In India, around 65.5% of population resides in rural settings.
• Health care facilities and services are skewed towards urban set
ups.
• Though adequate healthcare supplies exist in the community , it is
the access to healthcare to a rural citizen that is a major concern
• Issueslike health illiteracy, ignorance about communicable and
non communicable diseases, means to reach health care facility,
services, take time off from their daily wages work and workforce
shortages are some of the barriers that limits timely and quality
health related awareness
• Need to take measures to make healthcare more accessible to the
rural and needy population .
AIM
• Toprovide an experimental learning opportunity to Indian Medical
graduates towards community based health care and thereby
enhance equity in health.
Objectives
• 1. Orient the learner towards primary health care
• 2. Create health related awareness within the community
• 3.
Function as a first point of contact for any health issues within
the community
• 4.
Act as a conducit between the population and relevant health
care facility
• 5.
Generate and analyse related data for improving health
outcomes and evidence based clinical practices
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FAMILY STUDY
DEPARTMENT OF COMMUNITY MEDICINE
INTRODUCTION - DEFINITION
• FAMILY is a primary unit in a society.
• According to the American bureau of census - Family is a group of
two or more persons related by blood, marriage or adoption and
residing together. All such persons are considered as members of
one family.
INTRODUCTION - DEFINITION
• According to Burgess and Locke - Family is a group of persons
united by the ties of marriage, blood or adoption, consisting of a
single house hold interacting and intercommunicating with each
other in their respective social roles of husband and wife, mother
and father, son and daughter, brother and sister creating common
culture.
INTRODUCTION - DEFINITION
• HOME:
An environment which offers security and
happiness.
• HOUSE:A dwelling that serves as living quarters for
the one or more family.
• HOUSE HOLD: A domestic unit consisting of
members of a family who live together with non-
relatives such as servants.
• HOUSEWIFE: A wife who manages a house hold
while her husband earns the family income.
INTRODUCTION - DEFINITION
• FAMILY OF ORIGIN: The family into which one is born.
• FAMILYOF PROCREATION: The family which one setup after the
marriage.
• SOCIETY: A group of people or individuals united by certain
relations and who work together for the achievement of common
goals.
Eg: Indian/western society
INTRODUCTION - DEFINITION
• COMMUNITY: A human population living with in a limited
geographic area and carrying out interdependent life.
Eg: Village/urban community
• CULTURE: Learned behaviour which has been socially acquired.
Eg: Worship of god
FAMILY LIFE CYCLE
• Families are not constant, they are ever changing. A normal family
life cycle is generally conceived as 6 phases.
 FAMILY LIFE CYCLE
Sl Phases Beginning of Ending of phase
no phase
01 Formation Marriage Birth of the1st
child
02 Extension Birth of the 1st Birth of the last
child child
03 Complete Birth of the last 1st child leaves
extension child the home
04 Contraction 1st child leaves Last child leaves
home the home
05 Complete Last child has left 1st spouse dies
contraction the home
06 Dissolution 1st spouse dies Death of the
survivor
FAMILY LIFE CYCLE
• Strictly
speaking this type of family life cycle is applicable in case
of developed countries like America and Europe not in India, but
trend is changing in family system from joint family to nuclear
family due to urbanization, industrialization, globalization & women
empowerment.
FAMILY LIFE CYCLE
• InIndia, according to prevalent customs the married couple resides
in the house of parents, based on the type of residence -
1. Patrilocal residence: The wife goes to the house of husband.
2. Matrilocal residence: The husband goes to the house of wife.
TYPES OF FAMILY
1. Based on authority:
a) PATRIARCHAL FAMLY : The father is the head of the family and he
is the owner, administrator & guardian of the family property. He
will be having say or hold in family matters and the property will
be transferred through the father to sons.
Eg: Aryans, Roman & Greeks
TYPES OF FAMILY
b) MATRIARCHAL FAMILY: The mother is the head of the family and
she is the owner, administrator & guardian of the family property.
She will be having say or hold in family matters and the property
will be transferred through the mother to daughter.
Eg: Bhants in costal region, Khasis and Garos in Assam
TYPES OF FAMILY
2. Based on structure:
• a)Nuclear family- is the simplest form
consisting of husband, wife and unmarried,
dependent children residing under same
roof. In this type of family the husband and
wife plays a dominant role.
• Advantage – 1) The quality of the life will
be better 2) Good privacy 3) Intimate
relationship.
• Disadvantage – The absence of parents,
grand parents, uncle, aunt and near
relatives places a greater burden in terms
TYPES OF FAMILY
b) Joint family- This type families are
common in rural areas of India and is
consists of number of married couples and
their children with or with out unmarried
sisters, brothers & widow/er under the
same roof. The eldest male member will be
the head of the family.
Advantage – 1) The responsibilities will be
shared between family members 2) The
emotional bondages and security for
children and elderly will be good.
Disadvantage – 1) compromised privacy
TYPES OF FAMILY
c) Three generation family – In this type of family there are
representative of 3 generation. It occurs when young married
couples are unable to find separate housing accommodation and
continues to live with their children and parents.
Advantage and disadvantages are same as nuclear and joint
family.
FUNCTIONS OF FAMILY
A. Essential functions:
1. Provision of home: The family is to
provide a clean and decent home, where
the members of the family get love and
affection and their relationship is
intimate.
2. Reproduction and bringing up of children:
This is a very important function of the
family. It is the responsibility of both
husband and wife. The father provide
education and moral support, mother
takes care of the children up to certain
FUNCTIONS OF FAMILY
3.Division of labour – The role and functions performed
by the people in the family group were well defined.
The male members had a sole duty to earn for living
and support the family. The female members will be
having total responsibility for the day to day care of the
children and running the house hold. In urban
communities there is less marked distinction between
the function of male and female members.
FUNCTIONS OF FAMILY
B. Non-essential functions:
1. Economic unit: Every family will be having
properties like house, shop, farm etc and it gives
financial security and these properties will be
inherited to their children.
2. Religious unit: Family acts as a centre for religious
training, who learn various religious practices like
worship, discourses from parent and grand parent.
FUNCTIONS OF FAMILY
3. Educational unit: In the family mother will be first teacher, family
environment plays a major role in the formation of habits and
behaviour like eating habits, personal hygiene.
FAMILY STUDY
• Family is the smallest unit for study in the community.
• Familystudy is defined as “The study of members of the family in
their natural surrounding”.
FAMILY STUDY
Aim of family study:
a) To know the influence of social, economical, behavioural, cultural,
environmental and dietary factors on the health status of the
family members.
b) To apply promotive, preventive, curative and rehabilitative
services in to the family.
FAMILY STUDY
Importance of family study in
undergraduate and postgraduate
education:
a) To train the UG and PG students as
basic doctors for the need of the family in
terms of health promotion, disease
prevention, early detection of disease, care
of the sick and their rehabilitation.
b) To familiarize with clinico-social
problems of the community.
c) To study the knowledge, attitude and
practice in relation health and disease.
FAMILY STUDY
d) To improve the health status of the family members by
educating them on living condition, nutrition, mode of transmission
and prevention of common diseases, family planning and child
care.
e) To provide comprehensive medical care to the family and its
members
FAMILY SYUDY & CASE STUDY
Unit of study is Family Unit of study is Case/patient

Problem of the family is studied Problem of the case/patient is

studied

Study of SES is important for Not significant

health /nutrition education

Influence of external Not significant

environment on the health status
of the family members is
important

Study of diet and nutrition is Not significant except in

important nutritional disorders like PEM,
obesity and ect

Providing promotive, preventive, Providing curative services is

curative and rehabilitative important
services to the family is
important
- THANK YOU -
FAMILY CASE STUDY

Department of Community
Medicine
 Family study brings out all the important
features of environment, the growth and development
of children in the family, common diseases and other
health conditions in the family members, and allow us
to think about solving their problems.
Family study is a method of exploring and
analyzing the life of a family unit
Objectives
• To study the family composition
• To
study and observe environmental factors having their influence
on the health and disease of the family members
• To
study and observe social and economic factors associated with
health and disease
Contd.
• To study the health status of the family members
• Toidentify and enlist the factors responsible for the current health
status, in their natural surroundings
• To
identify and enlist the health demands, health problems and
health needs of the family
Contd.
• To study the mortality in the family
• To
study the knowledge, attitude and practices of family members
towards health and disease (emphasis on cultural factors, Belief,
social & Religious customs)
• ToRecommend simple and practical solutions for the identified
problems
• Incase of communicable diseases family
study helps us to find out source of
infection ,mode of
transmission ,susceptible persons &
preventive measures adopted by family
members.

• Incase of non communicable disease,

family study helps to identify risk factors
among the family members, to assess the
self care component in disease
management and to know the economic ,
social , and psychological impact of above
diseases on the family.
Method of Study
A. Observation
B. Questioning
C. Clinical Examination
D. Investigation at field level
Outline for Family Study Proforma
1. General information
2. Family composition , socio-economic &socio-demographic profile
3. Environment
A. Physical environment
- Housing ,water supply, waste management
B. Biological Environment
4. Vital events
5. Diet History
6. Social factors influencing health and disease ( beliefs , myths, culture taboos)
7. Medical examination proforma for identified cases
8. Positive & negative points noted in the family
9. Recommendations
FAMILY STUDY SCHEDULE
1 . General Information
a. Name of the Head of the Family:………..
b. Age …… Yrs. c Sex ………
d. Education …………
e. Occupation………..
f. Religion : H/M/C/O
g. Address: …………………………………….
h. Residing since: ……………………………..
2. FAMILY COMPOSITION
a. Demographic profile
Sl. Name Age Sex Marita Relatio Educ Occu Incom Health
No l n to ation patio e (Per status
status HOF n month
)
2. Family size : ……………. (interpret if
above/average/below national
averages)

3.Family type: N/J/3G/O

4. Vulnerable members in family………………

 b. Socio economic history

1. Total family income from all sources Rs….

2. Per capital income Rs ………
(interpret if above poverty line / below poverty line)
3. Socio-economic class ………..(as per modified kuppuswamy's
classification).
Expenditure pattern
• Proportion of total income spent on food ………….%
• proportion of total income spent on medical expenditure ………..%
• Proportion of total income spent for family maintenance…….%
• Savings:
• Debts:
3. ENVIRONMENT
• A. Physical environment
a) Housing :
1. Own / Rented
2. Attached / detached
3. Total area
4. Kuccha/semi pucca /pucca
5. Total number of rooms
6. Overcrowding : Present / Absent (criteria Persons per room/ floor space/sociological
7. Ventilation: Adequate/inadequate
8. Cross ventilation : yes/No
9. Lighting : Adequate/inadequate
Housing contd.
Kitchen
a. Ventilation : Adequate/ inadequate
b. Lighting : Adequate/inadequate
c. Smoke outlet : Present/Absent
d. Floor pervious/impervious
e. Type of fuel used:………………………
f. Cooking platform : Present / absent
g. Storage area for raw and cooked food : Sanitary/In
sanitary
h. Kitchen is :Hazardous / Non hazardous area/it does/does
not pose Health risk
10. Bathing facilities: Adequate/inadequate
11.Washing facilities Adequate/inadequate
12. Perimeter of house
(Any mosquito breeding
places/stagnant
water collection/heaps of refuse etc.,)
( set back areas )
13.Infestiations
b. Water supply

1. Source of drinking water supply: Bore well/Open

well /Sanitary well/ Piped Water supply/Draw well
(interpret sanitary or in sanitary ……………)
2. Method of drinking water collection, transportation,
storage, usage
(interpret sanitary or in sanitary ……………)
c. Waste Management

1. Excreta Management
Lavatory: Exclusive/Combined/Community/
Open air defecation
Sanitary / In sanitary
Separate water supply : Present / Absent
2. Solid Waste Management

a. Collection of solid waste

b. Frequency and place of disposal
c. Distance of the place of disposal
d. Is there any agency for waste collection
Solid waste management is sanitary / in sanitary
B. Biological Environment
• Any pets in the house
• Cattle sheds – inside / outside
C. Psycho-social environment
• Thisincludes factors affecting health, health care that stem from
psychosocial makeup of individuals and the family. This includes
cultural values, customs habits, beliefs attitudes etc etc
• Thefavorable psycho social environment can you improve health,
provide opportunities for sense of fulfillment and quality of life.
Contd.
• Theunfavorable psycho socio environment leads to
anxiety,depression,anger,frustration etc.,
• It
may also lead to psycho somatic disorders like peptic
ulcer, asthma ,hypertension, CHD, mental disorders etc.,
4.VITAL EVENTS
• History
of any deaths, births or marriages in the family during last
one year .
• History of diseases in the family during the last year
5. Diet History (Oral Questionnaire)
24 Hour Recall Method
1. Food stuffs consumed
Cereals, Pulses , Green leafy vegetables , root
vegetables , other vegetables, milk ,oil, Sugar/Jaggery ,
beverages , any others. (Comment on the above food
stuffs consumed)
2. Total calorie (Consumption unit) consumed by the family
……….
3. Total Calorie required for the family ……
4. RDA of nutrients to different individual of the family
5. Comment /give suggestion on diet (Based on standard
required and actual consumption)
6.Social factors influencing health
and disease.
1. Knowledge, attitude, practice regarding the causation ,
prevention and cure of the disease.
a. Causation of disease:
Rationale/Supernatural /Fatalistic
b. Regarding cure of the disease:
Rationale/Supernatural /Fatalistic
2. Social and religious customs if any which effects health
Contd.
3. Addictions in the family
4. Recreations
5. Health care seeking behaviour of the family members
6. List the health problems, needs, demands , identified
8.List the Positive and Negative Aspects
Noted

POSITIVE NEGATIVE
9.Recommendations
1. Individual
2. Family Level
If the index case is antenatal case
1. General information
2. Obstetric Score: Gravida, Para, Living, Abortions
LMP … EDD ……
3. Clinical History: History of present pregnancy (trimester wise ),
past medical history, family history
4. Menstrual history
5. Significant events during the past pregnancy
6. Diet history
7. Comment on knowledge regarding : Personal Hygiene, Breast
feeding, Immunization, Family planning
Contd.
8. General Physical examination
9. Obstetric examination
10. Systemic examination
11. Investigation
12. Summary
13. Advice : to mother and family
If the index case is Pediatrics case
1. Name of the child
2. Informant
3. History of any illness during the visit
4. Past history
5. Family history (Pedigree chart)
6. Immunization history
7. Attendance at anganwadi, school-regular/irregular,
8. Diet history
Contd.
9. Examination
a. Anthropometry: Weight, Height , Mid
upper arm circumference
b. Systemic examination
10. Summarize
11. Advice
If the index case is Postnatal case
1. General information
2. Specify events during antenatal, perinatal and
postnatal period
3. Details of the baby
4. Family planning
5. Examinations: mother ,baby
6. Summarize
7. Advice: to mother, for the baby & to the family
If the index case is Morbidity case
1. General information
2. Clinical Picture
a. Presenting complaints
b. History of present illness
c. Significant past medical and surgical
history
3. General examination
4. Systemic examination
5. Provisional diagnosis
6. Investigations : Done, recommended
7. Final Clinical diagnosis
Contd.
8. Epidemiological Investigations:
eg: similar case in the family/
Neighbourhood
9. Environmental factors influencing this condition
10. Socio-Economic factors influencing this condition
11. Patients knowledge, attitude
12. Management at individual , family and
community level.
Must know topics
• FAMILY
Definition, types of family, Functions of family and its role in health
and disease
Environment
• Physical Environment
1. Water – Drinking water quality
Waste water Management
2. Housing
3. Sewage treatment
4. Perimeter of the house
- Vector control measures
 HOUSING STANDARDS & INDICATORS (both rural and urban)

With respect to physical, economic and social indicators.

Eg: for physical indicators:
Site, set back, persons per room, kitchen, lighting ,
ventilation, windows, privy water supply, garbage and refuse
disposal etc.
• Eg for economic indicators
cost of the building, rental levels, taxes,
expenditures , debts.

Eg for social indicators

- related to prevention of illness
- related to comfort
- related to mental health and social well being.B
• B. overcrowding – classification and
impact on health
• C. lighting and ventilation
Socio Economic Scales
Methods of social classifications: Prasad’s method ,
kuppuswamy’s method,Pareek’s method etc.,
NUTRITION
1. Assessment of nutritional status
2. Assessment of energy
requirement and intake
IMMUNIZATION
• Immunization schedules
• Knowledge regarding common vaccines, their dose, site of
administration complication etc.
SOCIOLOGY
• Know terminology society, community , socialization, custom ,
cultural , acculturation, social pathology , social defense
• Cultural factors influencing health and disease
BASIC KNOWLEDGE REGARDING CLINICAL
EXAMINATION AND TREATMENTS FOR
COMMON EPIDEMIC AND ENDEMIC
DISEASES.
List of probable index cases
1. Antenatal & postnatal – high risk or low risk
2. Infant , preschool, school going children with or without
morbidity
3. Cases – TB , DM , HTN , PNEUMONIA ,GE , malnutrition , ( any
communicable & non communicable diseases ! )

4. Geriatric population
TO SUMMARISE
• Family composition
• Vital events
• Socio-economic profile
• Vital events
• Social factors
• Environment

- Physical
- Biological
- Psycho Social
Contd.
• KAP Study
• Dietary practices
• Growth monitoring Under fives
• Immunization
• Supplementary nutrition
• Health checkup
• Health care utilization
• Common illnesses and management
• Cost of morbidity