 My dear students in this video we are going to discuss about some of the commonly asked questions and answers in your clinical social case presentation while appearing community medicine practical exams. In this presentation I have selected important 20 questions for the discussion. The first one is socio-economic scales. These are the socio-economic scales which is commonly used. Basically when we are applying the socio-economic scales we need to apply based on the residential area whether it is the urban area, a rural area or some scales which can be used in both the settings. The commonly recommended scale is a modified Kuppusami scale for urban area. Uday Pariks and Kulashayitras classifications will be for rural area. The other classifications which can be used in both the settings are standard of living index by Parashuraman et al, APL and BPL that is above poverty line, below poverty line classification, wealth index and modified BG Prasad's classification. First is about the modified Kuppusami scale. This socio-economic status classifies families based on income, occupation and literacy. I give the mnemonic IOL that is income, occupation and literacy. Each category has separate scores as given here. So based on the education of the head of the family I repeat based on the education of the head of the family the following scores will be given and based on the occupation of the head the following scores can be given and the family income per month will be given like this. So the scores will be here, the income will be raised based on the recent consumer price index update. So usually you will get a updated modified Kuppusami scale based on this CPA. So the recent version which I am using here is for the March 2023 CPA. Based on this the classification cut-offs will be like this. We have online calculators for this modified Kuppusami scale you can use and the scores will be like this. So after this each scores of IOL that is income, occupation and literacy should be added and based on that we need to classify the socio-economic status into upper, upper middle, lower middle, upper lower and lower. Then the most commonly used scale is modified BG Prasad's classification. This can be used for both urban and rural settings. So the original classification is like this. This is based on per capita income of the family. So original classification has the cut-offs level like this. There is a latest revision based on the consumer price index of March 2023. So the cut-offs has been revised. Based on that socio-economic class will be divided into class 1, class 2, 3, 4 and 5. One is the topmost class and 5 is the lowest class. The second most important question is how will we identify a rural area and urban area. The definition for urban area has been taken from the census document and urban area is the one which fulfills the following criteria. Whenever the municipality, corporation, containment board or notified town area has been declared as an urban area or a place satisfying following three criteria simultaneously will be considered as the urban area. Those three criteria are the minimum population of 5000 in that area and at least 75% of the male working population will be engaged in the non-agricultural occupation. And the third criteria is a density of at least 400 persons per square kilometer or roughly 1000 per square mile. If these three criteria are simultaneously satisfied you can consider that area as urban area even if the place was not declared as a urban area and whenever the area is not fitting into the any of the definition of this urban area then you can call that area as the rural area. So according to the same census document 2001 all those areas who do not fulfill the criteria for urban area can be grouped as rural area. Now what is a slum? We can use the term underprivileged areas rather than using slums. The same census document defines slum as all specified areas in a town or a city notified as a slum by the local estate government union territory administration under the slum act. All areas recognized as slum by the administration housing and slum boards which may not have been formally notified as slum under any act. A compact area of population of at least 300 should be there are about 60 to 70 households of poorly built congested tenements in unhygienic environment usually with inadequate infrastructure and lacking in proper sanitary and drinking water facilities then you call those areas as a slum. The next important question is what is a family? Family is defined as a group of individuals who are biologically related or by the institution of marriage living together and eating from the same kitchen. So here there are two important points that is group of individuals who are related either biologically or by marriage they live together and eat from the same common kitchen. Now there are various types of families the most common types of families are nuclear family three generation family and joint family. When a question is asked what is a nuclear family you have to answer it. A nuclear family is one which consists of a married couple living with their children while the children are still regarded as the dependent on the couple. They share the common dwelling place husband plays a dominant role usually greater burden in terms of responsibilities for child rearing is is observed in nuclear families more intimate relationship between husband and wife will be there in a nuclear family new families or nuclear families that are less than 10 years old. Now what is a joint family? A joint family is the one where in a number of married couples and their children live together in the same house the men are all related by blood the property is held in common usually there is a common purse to which all money goes and family expenditure is met by that common purse the senior most male member will be the head of the family and takes all decisions. Here you have to remember a head of the family is a person who takes the major decisions in the form family and not necessarily the eldest member or the male member or more earning member here in this case in the joint family the male member senior most member will be commonly the head of the family his wife is the head of the woman in the family the family relations enjoys primacy over marital relations now the last category of the type of the family is three generation family it is a family where representatives of three generations are living together that is grandparents parents and their children young married couples continue to stay with their parents and have their own children as well this is fairly common in countries like India where married couples find it difficult to find separate accommodation it has some of the advantages of the joint family with regards to the responsibility in upbringing of the children in urban areas with working women it has more relevance the grandparents can take care of the children in the absence of their parents also senior citizens of the family stay with the young couple they are taken care by supporting them then the next question is about the degree of consignority there are four degrees of consignority identified the first degree is the marriage between siblings that will be called as incest and will not be followed in anywhere in this globe the second degree consignority is usually the marriage between the uncle and the niece that is girl marrying her mother's brother the third degree consignority is the marriage between first cousins that is girl marrying her uncle son or aunts son the fourth degree consignority that is the marriage between second cousins or between the people with the relationship beyond second cousins or a far off relationship all fall under this category so we have four degrees of consignority now the next question is the type of house that is pakka house or kaccha house pakka house is the one where floor roof wall are all made of impervious material the pakka house usually last long and does not allow rain water insects snakes and other animals to come into the house it gives good shelter to the inmates it protects from cold heat and dampness on the other hand kaccha house floor roof or wall is made up of a pervious material then you consider it as a kaccha house unburned bricks bamboos mud grass touch loosely packed stone all comes under this kaccha house category that is about pakka house and kaccha house next is about overcrowding overcrowding refers to the situation in which the people are living within a single dwelling compared to the space which they have so that the movement is restricted privacy is compromised hygiene is impossible and the rest and sleep will be difficult in those conditions operationally overcrowding can be identified using three criteria person per room criteria and gender separation criteria and the last one that is per capita floor space so person per room we have the categories like this that is one room two person two room three person three room five person four room seven person and five or more rooms ten persons additionally two room for each room for gender separation the definition is male and female greater than nine years of age other than husband and wife living in the same room will be considered as overcrowding for per capita floor space for the calculation babies under 12 months will not be considered and children between 1 to 10 years of age will be counted or half from a unit per capita floor space should be 7200 so anything which is less than this will be considered as overcrowding so overcrowding can be operationally identified using person per room criteria or gender separation criteria or your per capita floor space criteria now when do you call the lighting is adequate in the house lighting is adequate if the inmates of the house are able to read small letters of a newsprint in all corners and in the center of the room then it will be considered as the adequate lighting if the person is illiterate you have to check whether the person can pick stones from the grains in all corners and in the center of the room then you can call the lighting is adequate in that room the daylight factor should exceed one percent over half the floor area so daylight factor is the daylight availability metric that expresses as a percentage the amount of daylight available inside a room compared to the amount of unobstructed daylight available outside under overcast skies conditions for casual reading we need 100 lux of illumination and for general office work 400 lux of illumination for fine assembly we need 900 lux of illumination very severe task more than 1000 it can go up to 3000 depends upon the work so that is about adequate lighting criteria then we have adequate ventilation criteria when do we call a house adequately ventilated window area should be at least one-fifth of the floor area in urban areas and one-tenth in the rural area doors and windows combined they should have two-fifth of the floor area so depending upon the window floor area and window door floor area we will identify adequacy of ventilation next is about the sources of water the various types of sources include rain or surface water from impounding reservoirs rivers and streams tanks ponds and lakes then we have ground water which can be divided into shallow wells deep wells and springs the most commonly used source of waters will be either shallow well or deep well now what are the different household methods used for purification of water you can recommend boiling chlorine tablet single tablet of 0.5 grams that is 500 milligram for 20 liters of water then you can add chlorine solution high-test hypochlorate then you can add iodine tablet you can recommend filters then the RO filters the most efficient highly recommended method of household purification of water then you can recommend bleaching powder potassium permanganate storage and sieving also can reduce the impurities present in the water these are all the methods that can be recommended as a household purification of water when a latent can be called as a sanitary latent to tell a latent to be sanitary there should be a water seal present then the sewage should be connected to the sewage tank then there should be a 24-hour water supply the purpose of water seal is to prevent odour from escaping out and to prevent the breeding of flies and insects from outside then it should be well connected to the distribution system or to the septic tank in order to prevent the pollution of water and soil in the surrounding area and of course the 24-hour water supply so water seal should be present it should be connected to either a proper distribution system or a septic tank the third one is the 24-hour water supply for the criteria of sanitary latent and what are the breeding habits of mosquito usually anaphyllis prefers fresh flowing water aides prefers artificial collections of water kulaks prefers dirty stagnant water myonsonia prefers the root lids of certain aquatic plants then the common question is about the dietary requirement for dietary requirement we have separate energy requirement and protein requirement this is for adult male and this is for the adult female an adult sedentary male requires 2,110 kilocalories moderate activity adult male requires 2,710 kilocalories heavy activity adult male requires 3,470 kilocalories protein requirement is as per the weight of the individual that is 0.83 gram per kilogram which is same for female also for adult female doing sedentary activity she needs 1,660 kilocalories moderate activity needs 2,330 kilocalories heavy activity 2,720 kilocalories needed infants about 100 kilocalories per kilogram is needed 125 years it is 79 kilocalories 6 to 10 years it is 68 kilocalories per kilogram 11 to 17 years male it is 56 kilocalories per kilogram 11 to 17 years female it is 51 kilocalories per kilogram the same way the protein requirement also gets reduced that is from for infants it ranges between 1.5 to 2 grams per kilogram which gradually reduces to about 0.86 grams per kilogram in case of 11 to 7 years female pregnancy usually 350 kilocalories of energies recommended additionally and for the protein it is 9.5 grams during the second trimester additionally and 22 grams during the third trimester is recommended additionally above the normal recommendations based on the physical activity and during lactation first six months 600 kilocalories additionally needed and 17 grams of protein is additionally needed the next six months it is 520 and 13 grams which is additionally needed then about the BMA classifications we have two classification our one is the WHO classification of BMA that is the body mass index which is expressed in weight divided by height 18 kilogram divided by 18 meter square so when it is less than 18.5 you call it as under weight normal range is 18.5 to 24.99 over weight is 25 to 29.99 for every five increase it will be from normal range will be over weight over weight obesity grade 1 obesity class 2 obesity class 3 so the class interval here is 5 but for Asians the body mass index is slightly reduced under weight it is less than 18.5 normal range is 18.5 to 22.9 that is anything above 23 BMA is considered as over weight up to 25 it is considered as over weight about 25 to 29.9 it is obesity grade 1 and above 30 is obesity grade 2 that is about BMA classifications based on WHO and Asian population now waste circumference how to measure this waste circumference for WHO protocol the measure is taken at the midpoint between the highest point of the iliac crest and the last floating rib so this is the WHO point which recommends the midpoint between the last floating rib and highest point of the iliac crest whereas the NIH protocol recommends waste circumference should be taken at the highest point of the iliac crest that is here we need to take for hip circumference it should be measured around the widest portion of the buttocks with the tape parallel to the floor for both hip circumference and waist circumference the subject should stand with the feet close together arms at the side and the body weight evenly distributed and should wear little clothing the subject should be relaxed the measurement should be taken at the end of the normal expiration each measurement should be repeated twice if the measurements are within one centimeter of one another then the average should be calculated now what are the cutoff points for this waist circumference and hip circumference WHO classification mentions waist circumference greater than one or two centimeter for males and greater than 88 centimeters for women is considered abnormal whereas waist hip ratio greater than or equal to 0.9 and greater than or equal to 0.85 is considered abnormal how to calculate the weight of the baby based on the age that is the expected weight and height based on the age the most commonly used to formula for this calculation is the reaches formula so it gives you the expected weight in kilograms up to one year of age you have to go with this formula that is age in months plus nine divided by two one to six years it is age in years into two plus eight six to twelve years it is age into seven minus five by two then we can calculate the expected height up to twelve years height in centimeter will be derived using age in years into eight plus seventy seven formula that is six six plus seventy seven will give height in centimeter so based on this we calculate the expected and expected weight and height of the child so from there we go to the IAP classification for weight for age and water load classification for height for age then we classify the degree of malnutrition degree of stunting etc then about the midterm circumference midterm circumference is commonly used for children between one to five years because it is an age independent parameter of measurement normal is above 13.5 centimeters when it is less than 13.5 up to 12.5 centimeter it can be called as mild malnutrition or mild malnutrition 11.5 to 12.5 is at risk and less than 11.5 will be considered as severe malnutrition or severe malnourishment now the last one is the national immunization schedule which is very important not only for your exams but also for your life and practice i'm not going to tell about national immunization schedule in this slide because i have separate video for this national immunization schedule to easily remember age site route of administration of different vaccines for different age groups is given in a separate video it is provided in the description cards and also in end screen also check out the video and learn about national immunization schedule thanks for watching this video hope this video was useful to you if you like this video please click on the like button if you find it will be useful to 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