Format for Clinico-Social Case Taking in Community Medicine
The objective of clinico-social case (CSC) taking is to examine the "index case” in the milieu of
- His/her family and
- Environment
The aim is to make a comprehensive diagnosis and to suggest a comprehensive treatment.
Therefore in addition to clinical history and examination of the index case, information should also be collected about important health issues of other family members and also the living environment of the case.
There are several formats in use in various institutes.
As long as complete information is gathered, none of the formats can be regarded as superior to the other. One such format is suggested here for collection and presentation of information regarding the allotted CSC.
The case information can be collected under the following broad headings:
- Identification and family data
- Clinical history, general, and systemic examination of the index case
- Family health and Housing Environment
- Clinico-social diagnosis
- Effect of the illness on the family
- Management suggested (curative, preventive, and promotive)
Identification and Family Information
- Identification data of the index case
- Name
- Age
- Sex
- Marital status
- Religion
- Address
Family details
- Type of family: Nuclear/joint/three generation
- Composition of the family
Total number of family members
Decide who is the 'Head of the family' (HOF)
- Description of the family members indicating the allotted case's position as per the following table:
- Socioeconomic data of the family
Per capita income per month (of the family):Rs______________, above/below poverty line
Socioeconomic status (SES) of the family: __________________ class (____________ scale)
MEDICAL HISTORY AND EXAMINATION of the index case
History
- Presenting complaints
- History of present illness till date, including treatment taken
- Past history
- Family history
- Dietary history
- Menstrual history (where relevant)
- Obstetric history (where relevant)
- Developmental history (where relevant)
- Immunization history
- Personal history
Examination
- General physical examination—Anthropometry, pulse, RR, BP, etc.
- Systemic examination
- Medical provisional diagnosis
- Attitude of the patient toward his/her illness
FAMILY HEALTH STUDY
General
- Health problems in other family members
- Immunization status of other family members
Sanitary assessment of the house and environment
- House
Type of house—Pucca/kutcha/etc.
Overcrowding—Present/absent
Ventilation—Adequate/inadequate
Lighting
■ Natural light—Adequate/inadequate
■ Artificial light—Adequate/inadequate
Mosquito Breeding
Potential Mosquito breeding areas—Present/ absent
Actual Mosquito breeding – Present/Absent
Fly breeding areas—Present/absent
Cattle distance from the living room
Rodents in the house—Present/absent
Pets in the house—Present/absent
- Kitchen
Separate/open/living room
Floor type
Clean/dirty
Storage of cooked food
Storage of uncooked food
Fuel used
Smoke outlet—Present/absent
Drainage—Open/closed
- Water supply
Intermittent/continuous
Source of drinking water
Source of water for other purposes
Storage of drinking water
Method of drawing out water for drinking from the container
Check for evidence of mosquito breeding in the stored water. (You can see mosquito larvae which move to the bottom in response to any disturbance): see here: https://youtu.be/O3Q7r4nLkvo
- Refuse disposal
How stored inside house
How disposed out of the house
Frequency of disposal
- Latrine
Own/shared/community type
Type of latrine
- Social environment
Any cause of psychological stress.
How does the family manage situations of crisis?
Is the family generally accepted by the community?
Personal hygiene of the family members.
- Customs and health practices
System of marriage
Usual age at marriage of boys
Usual age at marriage of girls
Average expenditure on marriage
Dowry prevalent or not
Any other significant custom regarding marriage
- Maternal and child health practices
Pregnancy—Special diet, physical activity, antenatal care taken routinely
or not, any other significant custom during pregnancy
Lactation—Special diet, physical activity, any other significant custom during lactation
Is isolation observed during puerperium?
Usual period of lying-in
Any other significant custom
- Child rearing practices
Special practices such as oil bath and kajal application
Usual time of commencement of breastfeeding
Colostrum given or not
Prelacteal feed
Artificial milk introduced during breastfeeding—yes/no, method of feeding, dilution
Usual age at which weaning is started
Usual weaning foods
Any other custom
Attitude regarding childhood immunization
- Health practices
Which system of medicine is followed?
Where do they avail the services in time of illness?
Knowledge, attitude, and practices (KAP) regarding common illness
Recreational facilities.
Knowledge, Attitude and Practice (KAP) regarding contraception
- Knowledge that births can be planned.
- If yes, what are the methods?
- Do they know where to avail the services for contraception?
- Are they using contraception?
- Which method?
- If no, why not?
Identify all the eligible couples in the household and assess their contraceptive use.
CLINICO-SOCIAL DIAGNOSIS
- Medical diagnosis: This is the diagnosis of the medical condition in the index case, e.g., Type 2 diabetes mellitus.
2)Social diagnosis: This is an enumeration of adverse social factors in the family. These may have, directly or indirectly, influenced the precipitation of the disease or its appropriate management and rehabilitation. For example, low socioeconomic level, illiteracy, no regular follow-ups, alcoholism, having to bring up four children and not using any contraception.
Enumerate the inadequacies found in the family health study, e.g., overcrowding, illiteracy in any family member, children not fully immunized, not studying in age appropriate class, school dropout, poor ventilation, and not using iodized salt.
3)Strengths: This involves an analysis of the support system for the case. For example, a nearby health facility holding weekly diabetes clinic and patient's positive attitude toward following medical advice.
The history taking and examination in a CSC may be considered adequate if after analyzing the information, the following questions can be answered satisfactorily:
- What were the factors responsible for this stage of the illness?
- Which levels of prevention have failed and how this could have been prevented?
MANAGEMENT SUGGESTED
- Individual level
Curative: Medical management of the index case and
Preventive: i.e. Advise to prevent further progression, complications, and disability limitation
Practical advice for rectifying deficiencies observed in the environment so as to prevent other diseases in the family members
Promotive: This includes advice for improving general health, e.g., improving the dietary habits, vocational advice to improve SES, health education, information regarding Anganwadi and other facilities in the area.
- Family level: Write down what should be done and what can be done for the family in the given circumstances.
- Community level: Write down if you feel that any intervention at the community level may help in preventing such cases or improve the management, e.g., organizing health education camps may reduce social stigma and enable patients to utilize treatment facilities, or see if there is a need for a PHC.
References
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Poornima Tiwari, Shashank Tiwari. Chapter 17: Format for Clinico-Social Case Taking. Mastering Practicals: Community Medicine. Lippincott Williams & Wilkins; Gurugram, Haryana, India
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Bhalwar R, Parashar SSL. Family health history & individual medico – social history – taking. In: Vaidya R, Tilak R, Gupta R, Kunte R, editors. Text Book of Public Health and Community Medicine. Pune: Dept. Community Medicine, AFMC, in collaboration with WHO, India office, Delhi; 2009:613–8.
3.Jerome G. Mosquito borne diseases. In: Infectious Diseases and Arthropods, 2nd ed. Totowa, NJ: Humana Press; 2008.
For more detailed explanation listen to the lectures. Both Hindi and English versions are available:
English lecture on CSC taking: https://www.youtube.com/watch?v=rKxXIyJuBz8&t=24s
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Hindi lecture on the definitions and explanations of terms used in Family Health Study: Terms used in Family Health Study: Definitions and Explanations in HINDI
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Modified Kuppuswamy Classification of Socio - Economic Class: MODIFIED KUPPUSWAMY SCALE
PRASAD’S SCALE
Dependency Ratio
Assessment Of Overcrowding in a household
Family and the Types of Family:
Checking for Mosquito Breeding Areas in a Household
Housefly Breeding Sites: Checking for Fly Breeding Sites in a Household
Life Cycle of Housefly
Types of Piped Water supply
Reference Indian Adult Man and Woman
Concept of the “Consumption Unit”
Methods of Dietary Survey
24-Hour Recall (Questionnaire) Method
Determination of Socio-economic Status of a Family in a Rural Area (the Uday Pareekh Scale): DETERMINATION OF SES OF A FAMILY IN A RURAL AREA (the Uday Pareekh Scale)
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