World leprosy day 2021: Beat Leprosy; Leprosy is curable

What is the need?

Despite all efforts taken by GOI, out of 36 states/ UTs, 34 states and UTs achieved elimination. One State (Chhattisgarh) and one U.T. (Dadra & Nagar Haveli) are yet to achieve elimination. Five more states/UTs wherein elimination was achieved earlier, namely Odisha, Bihar, Chandigarh, Goa, and Lakshadweep have reported with PR>1/10,000 population, as of 31st March 2017. Therefore, early diagnosis and treatment of leprosy are essential for reducing the burden of this disease in our country.

When is it celebrated?

World Leprosy Day is observed on the last Sunday of January every year. This year, it takes place on 31 January 2021. *In India, World Leprosy Day is celebrated on 30 January, the anniversary of Mahatma Gandhi’s death.

We unite around one goal: #BeatLeprosy. This World Leprosy Day, we are going to help spread the word that #LeprosyIsCurable, joining hands in the fight to #EndStigma, and advocate for the #MentalWellbeing of persons who have experienced leprosy and other neglected tropical diseases.

It is a celebration of the leprosy community and an opportunity for enhanced efforts and commitment for the elimination/ eradication of this debilitating disease at the earliest. 

It focuses on the target of zero cases of leprosy-related disabilities in children. 

Early detection is the prime focus to achieve this target, along with strengthening interventions to prevent leprosy transmission. 

World Leprosy Day was established in 1954 by French journalist and activist, Raoul Follereau. 

He created World Leprosy Day with two goals: to advocate for the equal treatment of persons affected by leprosy and to reeducate the public about leprosy by correcting historical misconceptions surrounding the disease.

Problem statement:

According to WHO, 216108 new leprosy cases were reported globally in 2016. 
India has the  & highest burden of the disease, has reported a decreasing number of new cases.
135,485 cases in 2016 to 120,334 cases in 2017–2018 and a reduction in new pediatric cases, to less than 10,000 (9227 in 2018) from more than 10,000 (10,287 in 2017) previously.

Leprosy/ Hansen's disease:

It is a chronic infectious disease caused by a bacterium, Mycobacterium leprae (M. laprae). The symptoms occur generally after a long period of getting an infection on average 5 years, as M. leprae multiplies very slowly. It mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes.

Classification:

Paucibacillary (PB)- few (up to 5) skin lesions (pale or reddish)

Multibacillary (MB)- multiple (>5) skin lesions, nodules, plaques, thickened dermis, or skin infiltration

The spread of the disease:

The only known source for transmission of the bacteria is an untreated leprosy-affected person.

• From the respiratory tract of the infected person into the environment (in the form of droplets from the nose/mouth).
• The organism enters the healthy body through the respiratory system.
• Organism migrates to nerves and skin (may cause permanent disability, if not treated).

Signs and symptoms:

Leprosy should be suspected if a person shows the following

• Pale-skinned people have darker or reddish patches while dark-skinned people might have light patches on the skin.
• Loss or decrease of sensation in the skin patches
• Numbness or tingling in hand or feet
• A weakness of hands, feet, or eyelids
• Painful nerves
• Swelling or lumps in the face or earlobes
• Painless wounds or burns on hands or feet.

What to do in case of suspicion?

In case of the presence of signs and symptoms of leprosy, contact ASHA or ANM of your area or visit the nearest dispensary/ PHC. Treatment of leprosy is available free of cost at all government dispensaries/ PHCs in India.

MDT (multidrug therapy):

MDT is a combination of different drugs  

• One should complete the full course of MDT as prescribed by a trained health worker according to the type of leprosy. 
• MDT is available free of charge at most health facilities including in remote areas.

National Leprosy Eradication Programme (NLEP):

The National Leprosy Control Programme was launched by the Government of India in 1955. 

• After the introduction of Multi-Drug Therapy in 1982, the program was converted into National Leprosy Eradication Programme (NLEP) in the year 1983. 
• Till 31st March 2018, 29 States/ UTs had attained the level of leprosy elimination i.e., the prevalence rate of less than 1 case of leprosy per 10000 population, and 572 districts (81.13%) out of total 705 districts also achieved elimination level.
• ASHAs are helping in case detection and to assure complete treatment at the community level; for that they are being paid an incentive.
• Post Exposure Prophylaxis has been started for all contacts of leprosy cases from 2nd October 2018 under NLEP.

Sparsh Leprosy Awareness Campaign, 2018: 

It was conducted as an annual activity during the fortnight from 30th January to 13th February to create awareness about leprosy.

Sparsh Leprosy Elimination Campaign (SLEC): 

In order to pay homage to our Father of the Nation, Mahatma Gandhi, on his 150th Birth Anniversary, Central leprosy Division, MoHFW, GOI had committed to achieve the new cases with Grade II disability < 1 case/ million population by introducing SLEC from 2nd October 2018 to till 2nd Oct 2019.

Important points:

• Leprosy is curable with MDT (multidrug therapy).
• It is taken regularly to ensure complete cure of leprosy which prevents deformities and stops transmission to other individuals.
• Early diagnosis, appropriate treatment, and completion of a full course will prevent disability due to leprosy.
• Leprosy is not hereditary; it does not transmit from parents to children.
• Leprosy does not spread through casual touch like shaking hands or playing together, or working in the same office. Close and frequent contacts with untreated cases favor the spread.
• Leprosy is not the result of past sins or immoral behavior. It is caused by a bacterium called Mycobacterium leprae.
• People affected by leprosy have the right to livelihood and the right to live with dignity.

Prevention:

Through chemoprophylaxis:

• Use of single-dose rifampicin (SDR) is recommended as a preventive treatment for contacts of leprosy patients (adults and children 2 years of age and above), after excluding leprosy and TB disease, and in the absence of other contraindications. 
• Post-exposure prophylaxis with SDR for all contacts of leprosy cases has been provided under NLEP.

Through immunoprophylaxis (vaccines):

• BCG vaccination at birth is effective at reducing the risk of leprosy.

Reference:

1. https://zeroleprosy.org/world-leprosy-day/
2. https://www.who.int/news-room/events/world-leprosy-day
3. https://www.awarenessdays.com/awareness-days-calendar/world-leprosy-day-2021/
4. https://www.nhp.gov.in/world-leprosy-day-2020_pg
5. https://leprosymission.org.nz/world-leprosy-day
6. https://www.leprosy-information.org/leprosy/world-leprosy-day-2021
7. https://www.nhp.gov.in/disease/skin/leprosy
8. http://nlep.nic.in/
9. https://es.123rf.com/photo_94219992_stock-vector-world-leprosy-day-.html photo credit
10. https://microbewiki.kenyon.edu/index.php/Mycobacterium_leprae_in_India photo credit

Clinico-social-case format (Index case- ANC/ PNC)

1. Identification & demographic details:

Name: 

Age: 

Sex: 

Marital status: 

Husband's name:

Blood group & Rh type:

Gravida____Para_____Living____Abortions____ 

MTP: Yes_____/ No

Religion and caste:

Education: 

Occupation:

Address: 

Nearest health facility: 

Place opted for delivery: Home/ Hospital/ Not decided

(If admitted in hospital)

Ward/ Unit/ Treating doctor:________________________

Date of admission:____/______/____

IP/OP No:_______

Mode of admission: Self/ Referral

2. Presenting/ Chief complaints:

Complaints of____________since______days/ months/ years. (In chronological order)

3. History of presenting illness:

My patient was apparently alright then he developed _____________(name of the symptom) which was insidious/ sudden in onset, progressive/ non-progressive in nature. (describe each symptom in detail with treatment history if taken). There is no history of _______________________. (Ask & write the negative history based on probable causes.)

4. Past history: 

Write down if any history of past surgeries, illnesses, blood transfusions, allergies, or trauma.

H/O Fever with rash: Yes/ No

TORCH infections: Yes_____/ No

HIV/ STD: Yes/ No

Diabetes/ Hypertension: Yes_____ since____years/ No

Any h/o drug reactions: Yes/ No

5.Menstrual history: 

Age of menarche___________years

Menstrual cycle: Regular/ irregular

Passing clots: Yes/ No

Used____Pads/ day

6. Obstetric history:

G___P___L_____A

Age of marriage:_____________Years

Type of marriage: Consanguinous/ Non-consanguinous

Duration of active married life:__________Months/ Years

Interval between previous & present pregnancy:_____months/ years

LMP:_______/________/________

EDD_______/_________/________

POG (Period of gestation):_____________Months

Sexually active up to:________Months POG

Registration of pregnancy done at:_______________

(Name of place & date)

History of present pregnancy:

Antenatal care:

1. Time of registration________(in months)

2. Confirmation of pregnancy: UPT at home/ a health center/ other

3. Source of Antenatal care__________

4. No.of Home visits___________

5. Antenatal period____________

First trimester:

• Registration details_____________
• Excessive vomiting: Yes/ No 
• Bleeding p/v: Yes/ No  
• Fever with rashes: Yes/ No 
• Drug intake: Yes_______________________/ No
• Weight gain: __________Kg
• Investigations-Hb%, CBC, Urine routine & microscopy, USG , blood grouping & Rh typing, VDRL, HBsAg, HIV, RBS, TFT, LFT, etc.
• Folate supplementation: Yes since______/ No
• TT: Taken/ Not taken/ 1st dose/ Both doses

Second trimester:

• Quickening: Felt at_________ weeks/ Not felt
• Weight gain: Yes__________Kg/ No
• Blurring of vision: Yes/ No 
• Epigastric pain: Yes/ No 
• Pedal edema: Yes/ No 
• Headache: Yes/ No 
• Iron and calcium supplementation: Taking daily OD/ BD/ No
• Side effects because of IFA supplementation: Yes Nausea/  vomiting/ loss of appetite/ change in the colour of stools/ No
• Hours of sleep/rest: Afternoon___hours and night___hours
• Tetanus toxoid immunization: Yes 1st dose/ 2nd dose/ No
• Investigations: Hb%, CBC, Urine routine & microscopy, Blood suger-FBS & PPBS, USG Abdomen, LFT, KFT, TFT, etc.

Third trimester:

ANC visits: Yes ______times/ No

Weight gain: Yes_____Kg/ No

Warning signs: Present/ Absent

• Pain abdomen: Yes/ No
• Decreased perception of fetal movements: Yes/ No
• Leaking / Bleeding pv: Yes/ No
• Any high risk status: Yes_____________/ No

Intranatal care:

Date of delivery/ abortion/ MTP: _____/_____/______

Place of delivery/ MTP: Home/ institutional (HSC/ PHC

/ CHC/ Private)

Typeof delivery: Vaginal/ C-section/ Instrumental 

Any complications: Yes/ No

Attended by:________________ 

No.of days of hospitalization:______

Outcome of Pregnancy: Spontaneous Abortion/ MTP/ Stillborn/ Livebirth

Baby details:

Sex: Male/ Female/ Third gender

Weight: ____________Kg

Length:___________cm

Cried at birth: Yes/ No

Birth injury: Yes/ No

Congenital defects: Yes/ No

Postnatal care:

Home visits during the postnatal period: Yes_____times/ No

Post obstetric history:

Family planning:

• Do the couple know that it is possible to prevent or postpone pregnancy: Husband: Yes/ No; Wife: Yes/ No 
• Are they aware of any methods of  preventing or postponing pregnancy: Husband: Yes/ No; Wife: Yes/ No
• If yes, which method(s):_____________________
• Attitude towards family planning: Husband Willing: Yes/ No;
• Wife Willing: Yes/ No
• Are they practicing any method: Yes/ No
• If yes, which method:__________
• If no, did they ever practice: Yes_________/ No
• Describe how they decided on a particular method and reason for changing if any___________
• Are they satisfied with the method used: Yes/ No
• If no, give reasons:_________

Sexually Transmitted Infections:

Condition:________________

Received treatment for STI - Yes/ No

Place of treatment - Public/ Private hospital

Husband treated - Yes/ No

7. Personal history:

Diet: Veg/ Mixed/ Vegan

Appetite: Normal/ Increased/ Decreased

Bowel & bladder: Regular/ Irregular

Sleep: Normal/ Increased/ Decreased

Physical activity: Sedentary/ Moderate/ Heavy worker

Duration of work:________hours

Addiction: Yes/ No

(If yes, then specify Gutkha/ Pan-mashala/ Tobacco chewing/ Smoking/ Alcohol/ IV drugs)

8. Family history: 

Family type: Nuclear/ Joint/ 3 generation

Family composition (draw a family tree)

Any history of consanguinity: Yes/ No

Family relationships: Good/ Not good

The response of family towards the illness:_____________

(No need to write if it is included in the family details)

9. Environmental history:

Housing:

Toilet:

Waste disposal:

Drinking water:

Animals/ pets:

Occupational environment:

(No need to write if it is included in the family details)

10. Socio-economic history:

Interaction with society: Yes/ No

The response of society towards the person: Good/ Bad/____ 

Presence of stigma: Yes/ No

if yes specify____________________

Participation in festivals, marriages and other social activities & involvement in social groups: Yes/ No

Total family income:______________

Expenditure on diet and medical care:__________

Savings or debts_____________________

Family tensions due to the economic situation: Yes/ No

(No need to write if it is included in the family details)

Social welfare measures:

PDS/ JSY/ Anganwadi/ others__________

11. Nutritional history (as relevant to the case):

Calculation of calories, carbohydrates, proteins & fats (& salts) being supplied to the person by 24-hour diet recall method (tabular format for breakfast, lunch, evening snacks & dinner) and required amount by the person through diet. Mention the deficiency or excess.

(No need to write if it is included in the family details)

12. Psychosocial history:

Mental changes: Memory loss/ Depression/ Any other______

Living with: Spouse/ Son/ Daughter/ Relative/ Others

Emotional disorders: Loneliness/ Feeling unwanted/ Insecurity/ Other________

13. General physical examination:

Vitals:

Blood pressure (BP): ___________ mm Hg Right/ Left arm sitting/ supine position.

Pulse rate(PR): __________ beats/ min regular/ irregular

Respiratory rate (RR): __________ cycles/ min

Temperature: ___________ degree F

Pallor: Yes/ No

Icterus: Yes/ No

Clubbing: Yes/ No

Cyanosis: Yes/ No

Lymphadenopathy: Yes/ No

Edema: Yes/ No

Anthropometry: 

Built: 

Nourishment:

Height: _________m

Weight: ________kg

BMI:__________ kg/ m2

Head to toe examination:

General cleanliness: Good/ Bad

Hair: clean/Unclean/ Combed/ Uncombed

Eye: Vision: Normal/ Decreased; Using spectacles: Yes/ No; Senile cataract: Yes/ No/ Mature/ Imature; Glaucoma: Yes/ No; Operated: Yes/ No

Ear: Hearing: Normal/ Decreased; if decreased ,type of hearing loss: Conductive/ SNHL/ Mixed; Ear discharge: Yes/ No

Oral: No of teeth:______; Using dentures: Yes/ No; Oral hygiene: Good/ Poor

Thyroid swelling: Yes/ No

Breats: Normal/ Abnormal________

Any other significant finding____________________

14. Systemic examination:

Obstetric Examination:

Inspection:

Linea nigra: Present/ Absent

Striae gravidarum: Present/ Absent

Any scar: Present/ Absent

Prominent veins: Present/ Absent

Palpation:

Abdominal girth:____cm

Fundal grip:____________________________

Lateral grip:_____________________________

1st Pelvic grip:____________________________

2nd Pelwic grip:___________________________

Auscultation:

Fetal heart sound:_____beats/min

Important clinical findings:

1.

2.

Respiratory system:

Inspection:

Palpation:

Percussion:

Auscultation: 

Cardiovascular system:

Inspection:

Palpation:

Auscultation: 

Gastrointestinal system:

Inspection:

Palpation:

Percussion:

Auscultation: 

CNS examination:

Inspection:

Palpation:

Musculoskeletal system: 

Inspection:

Palpation:

Provisional clinical diagnosis:

15. Laboratory investigations:

Hb%, CBC, Urine routine & microscopy, Urine albumin, USG, Viral markers, Blood grouping & Rh typing, KFT, LFT, TFT, Blood sugar-FBS, PPBS, Pap smear test, etc.

(already done and planned in future)

Summary:

Mrs. X, -------year-old, married since------------, is currently in 1st/ 2nd/ 3rdpregnancy in ------months of gestation with ------ such complaints (high risk or not) is planning for safe confinement in ______ center.

Positive and Negative Factors:________

Level of failures:________

16. Comprehensive Diagnosis/ Clinico-social diagnosis:

This is the family of Mr.____________residing in ________ (name of the area), having______membered, nuclear/ 3-generation/ joint family,  belonging to socioeconomic status class __________ according to _____________ (name of the classification), a BPL/ APL card holder. The health problems, health demands & health needs of the family are _______________________. (Disease with/without complication, Social problem, Mental problems). The vulnerable individuals identified in the family are ________ (why are they vulnerable?)

17.Comprehensive management plan:

Advice to mother:

Health promotion: Diet, self-care, personal hygiene, mental preparation, child care, breastfeeding, use of Anganwadi & social benefits, etc.

Specific protection: TT & IFA

Early diagnosis: Warning signs/ Any other unusual symptoms  

World cancer day 2021: I Am and I Will

What is the need?

Cancer is the second leading cause of death globally & about 1 in 6 deaths are due to cancer.

• Globally about 8.8 million people die from cancer each year.
• If left unchecked, the number of deaths will increase to 13.2 million per year by 2030. 
• The five most frequent cancers in India are breast cancer, cervical cancer, oral cancer, lung, and colorectal cancer. 
• Approximately 70% of deaths from cancer occur in low- and middle-income countries.
• Late-stage presentation and inaccessible diagnosis and treatment are common. 
• More than 90% of high-income countries reported treatment services are available compared to less than 30% of low-income countries.
• The economic impact of cancer is significant and is increasing. The total annual economic cost of cancer in 2010 was estimated at approximately US$ 1.16 trillion.

When is it celebrated?

World Cancer Day takes place every year on 4th February to unite the people worldwide in the fight against cancer. 

Its aim is to raise awareness and education about cancer, sensitize governments and individuals across the world to take action.

It was established by the Paris Charter at the World Summit against Cancer for the New Millennium in Paris on 4 February 2000.

I Am and I Will

This World Cancer Day, ‘I Am and I Will’ campaign –shows us that our actions have an impact on everyone around us, within our neighborhoods, communities, and cities. When we choose to come together, we can achieve what we all wish for: a healthier, brighter world without cancer. Together, all our actions matter.

What is cancer/ Malignant tumors/ Neoplasms? 

Cancer is a general name for a group of diseases, in which some of the cells within the body due to some reason grow into an uncontrolled fashion. 

Untreated cancers can spread into the surrounding normal tissue, or to other parts of the body, and cause serious illness, disability, and death.

Causes:

Cancer is a multifactorial disease (-there is no single cause for any one type of cancer). Some external agents may act as cancer-causing agents (carcinogens), these are:

• Physical carcinogens, such as ultraviolet and ionizing radiation
• Chemical carcinogens, such as asbestos, tobacco, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant)
• Biological carcinogens, such as infections from certain viruses, bacteria, or parasites such as Hepatitis B and C virus and Human papillomavirus (HPV)
• Aging is another important  factor for the development of cancer
• Tobacco use, alcohol use, unhealthy diet, and physical inactivity are major cancer risk factors.

Warning signs:

• new mass or changes in the breast
• A change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge from any opening in the body
• Unexplained weight loss and loss of appetite
• Difficulty in swallowing
• An obvious change in wart or mole
• A nagging cough or persistent hoarseness of voice

Preventive measures: 

• Eat a wide variety of vegetables and fruits, legumes, nuts, and whole grains.
• Involve in regular physical activity.
• Avoid overweight/obesity.
• Adopt safe sexual practices.
• Avoid tobacco use including cigarettes and smokeless tobacco.
• Limit alcohol use.
• Get vaccination against HPV and hepatitis B virus
• Avoid/limit exposure to known environmental carcinogens.
• Be aware of warning signs.
• Take regular health checkups and cancer screening.

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS): 

It was launched in 2010 to prevent and control major non-communicable diseases (NCDs). Population-based Screening of common NCDs like diabetes, hypertension, and common cancers is being initiated under the umbrella of the National Health Mission (NHM).

Points to remember: 

• Everyone can make healthy lifestyle choices to reduce their risk of cancer.
•  Diagnosis of cancer at its initial stages and seeking timely care can save lives.
•  People living with cancer and their caregivers can ask for support to help them cope with cancer.
• With the right support, people living with cancer can return to work successfully.

References:

1. https://www.nhp.gov.in/world-cancer-day-_pg
2. http://www.worldcancerday.org/sites/wcd/files/private/130128_Cancer_Backgrounder.pdf
3. https://www.who.int/en/news-room/fact-sheets/detail/cancer
4. http://cancerindia.org.in/
5. http://cancerindia.org.in/busting-the-myths/
6. https://www.worldcancerday.org/about/2019-2021-world-cancer-day-campaign
7. https://www.uicc.org/events/world-cancer-day-2021
8. https://www.worldcancerday.org/faqs#:~:text=The%202019%2D2021%20World%20Cancer,now%20to%20impact%20the%20future.

National girl child day 2021: Education, Equality and Empowerment

What is the need?

There is decreasing sex ratio in India among the age group of 0-6 years which has created an imbalance. It is a significant indicator of women's disempowerment. It reflects both, pre-birth discrimination manifested through gender-based sex selection, and post-birth discrimination against girls. People prefer a boy over a girl child and kill the female fetuses during the early stages of pregnancy. Hence, there is a huge need to create awareness regarding the rights of the girl child as well as on the importance of girl education, their health, and nutrition.

Celebrated on:

• The National Girl Child Day is celebrated on January 24  in India every year.  
• The National Girl Child Week is observed from January 21st to January 26th. 
• This was initiated by the Ministry of Women and Child Development, Government of India in 2008. 
• This also marks the anniversary of the Beti Bachao Beti Padhao (BBBP) Scheme.

What are the objectives?

The objectives are as follows:

• To highlight the inequalities faced by girls in our country.
• To promote awareness about the rights of a girl child.
• To generate awareness on the importance of girl education, health, and nutrition.
• To generate awareness on the issue of declining Child Sex Ratio (CSR) and create a positive environment around valuing the girl child (objective in 2021)

Announcements by the governments:

• The state of Punjab has announced January 2021 to be the "month of Girl Child". The scheme Dheeiyan Di Lohri has also been launched. 
• The Odisha state government honors the individuals and organizations who have worked towards the cause of child marriage free villages on January 24 - the National Girl Child Day. 

References:

1. https://vikaspedia.in/social-welfare/women-and-child-development/child-development-1/girl-child-welfare/national-girl-child-day#:~:text=The%20state%20of%20Punjab%20has,the%20National%20Girl%20 Child%20Day.
2. https://entri.app/blog/national-girl-child-day/
3. https://es.123rf.com/photo_106364695_stock-vector-vector-illustration-of-happy-school-girl-go-to-school-welcome-back-to-school-cute-school-girl-with-b.html photo credit
4. https://www.pinterest.ru/pin/716072409486466876/ photo credit
5. https://www.en.etemaaddaily.com/world/national/national-girl-child-day-being-observed-today:54302 photo credit

Clinico-social-case format (Index case- Adolescents)

1. Identification & demographic details:

Name: 

Age: 

Sex: 

Religion and caste:

Education: 

Address: 

Nearest health facility: 

2. Presenting/ Chief complaints:

Complaints of____________since______days/ months/ years. (In chronological order)

(Complaints are mainly 

3. History of presenting illness:

My patient was apparently alright then he developed _____________(name of the symptom) which was insidious/ sudden in onset, progressive/ non-progressive in nature. (describe each symptom in detail with treatment history if taken). There is no history of _______________________. (Ask & write the negative history based on probable causes.)

4. Past history: 

Write down if any history of past surgeries, illnesses, blood transfusions, allergies, or trauma.

Immunization history: ________________________

5.Menstrual history: 

(if female patient)

Menarche attained: Yes/ No

Age of menarche___________years

Menstrual cycle: Regular/ irregular

Menstrual irregularities: Dysmenorrhea/ Menorrhagia/ Metrorrhagia/ Others_________

Passing clots: Yes/ No

Menstrual hygiene/ Use of Sanitary pads: Yes/ No

H/o white discharge P/V: Yes/ No

6. Reproductive health issues:

Have you attended any workshop/ lecture/ health talk pertaining to sex education: Yes/ No

Have you heard about sexually transmitted infections/ HIV & AIDS: Yes/ No

7. Personal history:

Diet: Veg/ Mixed/ Vegan

Appetite: Normal/ Increased/ Decreased

Food fads: Yes/ No

If yes specify: ____________________

Bowel & bladder: Regular/ Irregular

Sleep: Normal/ Increased/ Decreased

Physical exercise: Regularly/ Infrequently/ No

Outdoor playing activities: Yes/ No

Addiction: Yes/ No

(If yes, then specify Gutkha/ Pan-mashala/ Tobacco chewing/ Smoking/ Alcohol/ IV drugs)

Duration: ______________________

Reason for initiation: __________________

8. Family history: 

Family type: Nuclear/ Joint/ 3 generation

Family composition (draw a family tree)

Any history of consanguinity: Yes/ No

Family relationships: Good/ Not good

The response of family towards the illness:_____________

(No need to write if it is included in the family details)

9. Environmental history:

Housing:

Toilet:

Waste disposal:

Drinking water:

Animals/ pets:

Occupational environment:

(No need to write if it is included in the family details)

10. Socio-economic history:

Interaction with society: Yes/ No

The response of society towards the person: Good/ Bad/____ 

Presence of stigma: Yes/ No

if yes specify____________________

Participation in festivals, marriages and other social activities & involvement in social groups: Yes/ No

Total family income:______________

Expenditure on diet and medical care:__________

Savings or debts_____________________

Family tensions due to the economic situation: Yes/ No

(No need to write if it is included in the family details)

11. Nutritional history (as relevant to the case):

Calculation of calories, carbohydrates, proteins & fats (& salts) being supplied to the person by 24-hour diet recall method (tabular format for breakfast, lunch, evening snacks & dinner) and required amount by the person through diet. Mention the deficiency or excess.

(No need to write if it is included in the family details)

12. Psychosocial history & behavioral issues:

(To be asked from parent/ Guardian of the adolescents)

Has she/ he ever indulged in anti-social/ criminal activities (eg. theft, etc.): Yes/ No

Is the adolescent's interaction with peers/neighbors/ opposite sex normal: Yes/ No 

If no, specify:___________________

Is he/ she currently going to school: Yes/ No

If yes, does he/ she has any difficulties in the school/ studies: Yes/ No

If yes, specify:_________________________

Mental adjustment to physiological changes in the body: Yes/ No

13. General physical examination:

Vitals:

Blood pressure (BP): ___________ mm Hg, 

Pulse rate(PR): __________ beats/ min

Respiratory rate (RR): __________ cycles/ min

Temperature: ___________ degree F

Pallor: Yes/ No

Icterus: Yes/ No

Clubbing: Yes/ No

Cyanosis: Yes/ No

Lymphadenopathy: Yes/ No

Edema: Yes/ No

Anthropometry: 

Built: 

Nourishment:

Height: _________m

Weight: ________kg

BMI:__________ kg/ m2

Head to toe examination:

General cleanliness: Good/ Bad

Hair: clean/Unclean/ Combed/ Uncombed

Eye: Vision: Normal/ Decreased; Using spectacles: Yes/ No

Ear: Hearing: Normal/ Decreased; if decreased ,type of hearing loss: Conductive/ SNHL/ Mixed; Ear discharge: Yes/ No

Oral hygiene: Good/ Poor

No of teeth:______

Skin: Normal/ Abnormal (papules/ pustules/ eczema/ macules/ patches, etc.)

Any other significant findings:___________________

14. Systemic examination:

Respiratory system:

Inspection:

Palpation:

Percussion:

Auscultation: 

Cardiovascular system:

Inspection:

Palpation:

Auscultation: 

Gastrointestinal system:

Inspection:

Palpation:

Percussion:

Auscultation: 

CNS examination:

Inspection:

Palpation:

Musculoskeletal system: 

Inspection:

Palpation:

Signs of puberty:

For boys: Voice change/ Testicular enlargement/ Pubic & axillary hair/ Facial hair

For girls: Breast enlargement/ Pubic & axillary hair

Provisional clinical diagnosis:

Laboratory investigations:

(already done and planned in future)

Clinico-social diagnosis:

This is the family of Mr.____________residing in ________ (name of the area), having nuclear/ 3-generation/ joint family,  belonging to socioeconomic status class __________ according to _____________ (name of the classification), a BPL/ APL card holder. The health problems, health demands & health needs of the family are _______________________. (Disease with/without complication, Social problem, Mental problems). The vulnerable individuals identified in the family are ________ (why are they vulnerable?)

Comprehensive management plan: