Q1

FHSIS REPORT for the QUARTER ________ YEAR: _______

Name of Municipality/City:
Name of Province:

RHU
Projected Population of the Year: _________________________________
For submission to PHO/CHO
Section B. Maternal Care and Services
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
Total Pop x 2.056% (Col. 3) Actions to be Taken
10-14 15-19 20-49 Total
(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) (Col. 5)
B1. Prenatal Care
1. No. of pregnant women w/ at least 4 prenatal check-ups - Total
• NHTS
• Non-NHTS
2. No. of pregnant women assessed of their nutritional status during
the 1st trimester - Total
• NHTS
• Non-NHTS
a. Number of pregnant women seen in the first trimester who have
normal BMI - Total
• NHTS
• Non-NHTS
b. No. of pregnant women seen in the first trimester who have low
BMI - Total
• NHTS
• Non-NHTS
 Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
Total Pop x 2.056% (Col. 3) Actions to be Taken
10-14 15-19 20-49 Total
(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) (Col. 5)
B1. Prenatal Care
c. No. of pregnant women seen in the first trimester who have high
BMI - Total
• NHTS
• Non-NHTS
3. No. of pregnant women for the first time given 2 doses of Td
vaccination - Total
• NHTS
• Non-NHTS
4. No. of pregnant women for the 2nd or more times given at least 3
doses of Td vaccination (Td2 Plus) - Total
• NHTS
• Non-NHTS
5. No. of pregnant women who completed the dose of iron with folic
acid supplementation - Total
• NHTS
• Non-NHTS
6. No. of pregnant women who completed doses of calcium
carbonate supplementation - Total
• NHTS
• Non-NHTS
7. No. of pregnant women given iodine capsules – Total
• NHTS
• Non-NHTS
8. No. of pregnant women given one dose of deworming tablet - Total
• NHTS
• Non-NHTS
9. No. of pregnant women screened for syphilis - Total
• NHTS
• Non-NHTS
10. No. of pregnant women tested positive for syphilis - Total
• NHTS
• Non-NHTS
11. No. of pregnant women screened for Hepatitis B - Total
• NHTS
• Non-NHTS
 Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
Total Pop x 2.056% (Col. 3) Actions to be Taken
10-14 15-19 20-49 Total
(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) (Col. 5)
B1. Prenatal Care
12. No. of pregnant women tested positive for Hepatitis B - Total
• NHTS
• Non-NHTS
13. No. of pregnant women screened for HIV - Total
• NHTS
• Non-NHTS
14. No. of pregnant women tested for CBC or Hgb&Hct count - Total
• NHTS
• Non-NHTS
15. No. of pregnant women tested for CBC or Hgb&Hct count
diagnosed with anemia - Total
• NHTS
• Non-NHTS
16. No. of pregnant women screened for gestational diabetes – Total
• NHTS
• Non-NHTS
17. No. of pregnant women tested positive for gestational diabetes –
Total
• NHTS
• Non-NHTS
B2. Intrapartum Care and Delivery Outcome
18. No. of deliveries – Total
• NHTS
• Non-NHTS
19. No. of live births – Total
• NHTS
• Non-NHTS
20a. No. of live births with normal birth weight - Total
• NHTS
• Non-NHTS
20b. No. of live births with low birth weight - Total
• NHTS
• Non-NHTS
20c. No. of live births with unknown birth weight- Total
• NHTS
• Non-NHTS
 Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
Total Pop x 2.056% (Col. 3) Actions to be Taken
10-14 15-19 20-49 Total
(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) (Col. 5)
B2. Intrapartum Care and Delivery Outcome
26b. No. of deliveries by cesarean section – Total
• NHTS
• Non-NHTS
27a. No. of full-term births – Total
• NHTS
• Non-NHTS
27b. No. of pre-term births – Total
• NHTS
• Non-NHTS
27c. No. of fetal deaths - Total
• NHTS
• Non-NHTS
27d. No. of abortion/miscarriage - Total
• NHTS
• Non-NHTS
B3. Postpartum and Newborn Care
28. No. of postpartum women together with their newborn who
completed at least 2 postpartum check-ups - Total
• NHTS
• Non-NHTS
29. No. of postpartum women who completed iron with folic acid
supplementation - Total
• NHTS
• Non-NHTS
30. No. of postpartum women with Vitamin A supplementation – Total
• NHTS
• Non-NHTS