37 Families 170 individuals Gender Age 0 -5 6 -10 11 15 16 20 21 25 25 30 31 35 36 40 41 45 46 50 51 55 56 60 61 65 66 70 71 75 76 80 TOTAL: Male 10 11 7 9 6 10 8 6 5 6 2 1 0 0 1 0 82 Female 16 13 11 4 9 5 11 5 3 5 2 1 0 1 1 1 88 26 24 18 13 15 15 19 11 8 11 4 2 0 1 2 1 170 TOTAL

Size of the Family 1 3 members: 4 6 members: 7 9 members: Family Structure Nuclear: Extended: Residence Permanent: Temporary: Sources of income: Salary: Fees: Sales: Pension: Relatives Others:

10 19 8

29 8

32 5

24 5 8 0 0 0

Monthly Income Head of the Family Father: 37 Mother: 0 999 below 1000 5000: 5001 8000: 8001 10,000: 10000 15000 150000 20000 Health Insurance PhilHealth Private Insurance None Transportation Facilities None: Public: Private:

3 26 2 4 1 1

16 1 20

5 26 6

Communication: With cellphone: Without:

31 6

General Family Relationship

Presence of any obviously readily observable conflicts Yes: 6 No: 31 Affected Development stage of: Childhood: 5 Adolescence 1 Housing Type Bungalow Apartment: Makeshift: Up and Down 2 storey 3 storey or more Flooring Cemented Ground Wood Lot ownership Owned Rented Free Squatter Housing Materials Concrete Wood Makeshift Mixed No. of rooms All purpose One bedroom 2 or more

26 0 8 3 0

17 15 5

6 2 29 0

9 12 5 11

9 15 13

Ventilation Door only 1 window 2 or more Lighting Sufficient Insufficient Home ownership Owned Rented: Free Types of electricity Electric: Kerosene: Others: Kandila Water Supply Level 1: Level 2: Level 3:

5 3 29

29 8

14 2 21

29 9 3

26 8 3

Type of water storage Type Jug Drum Bottle Pail Earthen Jar

With cover 20 6 15 11

Without cover 2 3 3 7

Water Usage Sources Deep well Drinking Cooking Gen. Household 33 34 34 Delivered by Truck 2 NAWASA 2 3 3

Food Handling With cover Refrigerator Cup Board Hanging in a Basket On the Table 4 6 7 28 Without cover

Refuse Disposal (Method) Burning Burying Dumping Collected None Waste Disposal Septic Water sealed Pit privy Wrapped

29 5 2 0 1

11 16 8 2

Overhang None Type of Toilet Public Private Shared Pets: Dog Chicken Cat Bird Rabbit Cow Duck With vaccine: Without vaccine: 6 21`

0 0

21 14 2

22 14 14 1 1 1 1

Health and illness Presently Pregnant

1. Antepartum: Villes Rose Ann G 2 P Trimester: 2nd Trimester Weight: 40 kg BP: 110/80 1 TPAL --------

Referred to Health Center after Health Teaching: 2. Antepartum: Rosenda Perater G 1 P nd Trimester: 2 Trimester Weight: 40 kg BP: 90/70

Yes

TPAL 0000

Referred to Health Center after Health Teaching: 3. Antepartum: Joseline Arellano G 3 P Trimester: ------------------------Weight: 52 kg BP: 120/90

Yes

TPAL --------

Referred to Health Center after Health Teaching:

Yes

Prenatal Care With: Without: Received FeSO4: Yes: No:

3 0

3 0

Plan at Delivery: At home: 3 In a hospital: 0 Lying in clinic: 0 Had prepared for her pregnancy Yes: 2 No: 1

Utilization of Facilities
Provider consulted when sick Private: 1 Public: 26 None: 4 Self medicated: 6 Satisfaction in the service of Health Facilities Satisfied Hospital 19 Clinic 16 Health Center 21

Not Satisfied 18 21 16

Family Planning
Contraceptive Methods Using: 15 Satisfied: 14 Not Satisfied: 1

Reasons for Dissatisfaction: Side effects: 1 Not Using: Why? 22 Side effects, unknowledgeable

Type of Contraceptive Method Natural: LAM: 2 Withdrawal: 3 CMM 1 Artificial: Pills IUD 10 4

Morbidity
Present Health Status for the Past 3 months No. Probable Confinement Diagnosis with Without 5 Lagnat 5 3 8 4 1 Sipon Ubo Diarrhea pagsusuka 3 7 4 2 Herbal used 2 katas ng kamote 1 oregano 4 Lagundi 1 oregano Remarks

Does the mother know how to take: Respiratory rate of the child: Yes: 4 No: Body Temperature: Yes: 17 No:

32 20

State the usual home management of the mother if the child has diarrhea: 9 out of 22 families responded. Dinadala sa Center Pinaparesetahan sa Center Pinapakain ng Saging Herbal Plants Pinapainom ng tubig na maligamgam Bring to the nearest hospital Pinapa inom ng gamot (unrecalled) Self medication

Bring to the nearest hospital Pina painitan ang tubig at pina iinom Increase fluid intake

Lifestyle
Smoking Yes: No: Duration: Week: Month: Years: 17 20

0 2 15

Consumption: 1 5 sticks: 6 10 sticks: 11 15 sticks: 16 20 sticks: 1 pack: 2 packs or more: Alcohol Yes: No:

4 3 1 3 5 1

22 15

Frequency Day: 1 Week: 4 Occasionally: 22 Drug Usage: Yes: 0 No: 37 Food Preference: Vegetarian: Non Vegetarian: Specify Food Preference: Drinking water consumption Less than 5 glasses per day:

11 25 1

6 10 glasses per day: 11 12 glasses per day: Exercise Daily: 23 3-4x a week: 2 2x a week: 1 Seldom:11 Hours of sleep Less than 3: 4 5: 6 8: 9 12:

19 10

1 9 18 10

Field of activities/home visit Personnel MD RN RM BHW Others: Health Center Program Immunization Pre natal Post Natal Nutrition Diarrhea Control Program Neonatal Anti Smoking Campaign Rabies Control Program Follow up Medical Care Operation Timbang Brgy. Dialogue TB Control Program Control of Acute Respiratory Infection National AIDS Program Others: Orange Card Family Planning Church Attendance: Frequency: Every Sunday: 2x a month:

YES 4 18 11 8 0

NO 33 19 26 29 0

23 12 10 8 8 4 4 10 11 2 2 2 0 1 1

7 11

1x a month: Seldom:

7 9