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2
1

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CASES

PATIENTS NAME

group= 1, group=2

AGE IN YEARS

SEX (1 = MALE, 2 FEMALE)

DEVELOPMENTALH/O (1 = DELAYED, 2 NORMAL)

BIRTH H/O (1 = PERINATAL ASPHYXIA, 2 = NORMAL, 3 = OTHERS

SUCH AS HYPOGLYCEMIC)

FAMILY HISTORY (1 = YES, 2 = NO)

HEAD EDUCATION (1 = ILLITERATE, 2 PRI. SCHOOL, 3 = MIDDLE

SCHOOL, 4 HIGH SCHOOL, 5 = DIPLOMA, 6 = GRADUATE, 7 =
PROFESSIONAL DEGREE)
MASTER CHART

HEAD OCCUPATION (1 = UNEPMPLOYED, 2 = UNSKILLED, 3 = SEMI

SKILLED, 4 = SKILLED, 5 = CLERICAL / SHOP OWNER, 6 = SEMI
PROFESSIONAL, 7 = PROFESSIONA)

PER CAPITA INCOME (1 = <2390, 2 = RS. 2391-7101, 3 = 7102-11836,

4 = 11837-17755, 5 = 17756 - 23673, 6 = 23674-47347, 7 = 47348 AND
ABOVE)

SOCIOECONOMIC STATUS (1 = UPPER CLASS, 2 = UPPER MIDDLE, 3 =

LOWER MIDDLE, 4 = UPPER LOWER, 5 = LOWER)

GENERAL CONDITION (1 = AVERAGE, 2 = SICK)

ANTHROPIOMETRY (1 = NORMAL, 2 = ABNORMAL)

X-RAY ABDOMEN (1-IMPACTION 2-NO-IMPACTION)

NO OF STOOLS/WEEK @ 0WEEK

NO OF STOOLS/WEEK @ 4WEEK

NO OF STOOLS/WEEK @ 3MONTHS

CONSISTENCY OF STOOLS @0WEEK (1=HARD, 2=-SOFT)

CONSISTENCY OF STOOLS @4WEEK (1=HARD, 2=-SOFT)

CONSISTENCY OF STOOLS @ 3MONTHS (1=HARD, 2=-SOFT)

PAIN ON DEFECATION @0WEEK (1=PRESENT, 2=ABSENT)

PAIN ON DEFECATION @4WEEK (1=PRESENT, 2=ABSENT)

PAIN ON DEFECATION @3MONTHS (1=PRESENT, 2=ABSENT)

PALPATION OF HARD STOOL@0WEEK (1=PALPABLE, 2=NON-

PALPABLE)
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 PALPATION OF HARD STOOL@4WEEK (1=PALPABLE, 2=NON-
PALPABLE)

PALPATION OF HARD STOOL@3MONTHS (1=PALPABLE, 2=NON-

PALPABLE)

FECAL INCONTINENCE @0WEEK (1=PRESENT, 2=ABSENT)

FECAL INCONTINENCE @4WEEK (1=PRESENT, 2=ABSENT)

FECAL INCONTINENCE @3MONTH (1=PRESENT, 2=ABSENT)

BLOOD IN STOOL @0WEEK (1=PRESENT, 2=ABSENT)

BLOOD IN STOOL @4WEEK (1=PRESENT, 2=ABSENT)

BLOOD IN STOOL @3MONTH (1=PRESENT, 2=ABSENT)

ADVERSE EFFECTS @2WEEK (1=PRESENT, 2=ABSENT)

ADVERSE EFFECTS @4WEEK (1=PRESENT, 2=ABSENT)

ADVERSE EFFECTS @6WEEK (1=PRESENT, 2=ABSENT)

ADVERSE EFFECTS @8WEEK (1=PRESENT, 2=ABSENT)

ADVERSE EFFECTS @10WEEK (1=PRESENT, 2=ABSENT)

ADVERSE EFFECTS @12WEEK (1=PRESENT, 2=ABSENT)