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1 | Outreach(OR) FORMAT Name of Facility providing Outreach:……………………………………….. State:……………………………………………………………. District:………………………………………………………….. Type of Outreach Sevice:………………………………………………... Reporting Month:……………………………………………….. FY:……………………………………………………………… Name & Designation of the person reported data:................................................. Date of reporting Data: | |||||||||||||||||||
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6 | Facity Type | Data Item | Numbers reported during the month | |||||||||||||||||
7 | OR | REPRODUCTIVE AND CHILD HEALTH | ||||||||||||||||||
8 | OR | Ante Natal Care (ANC) Services & High Risk Pregnancies | ||||||||||||||||||
9 | OR | Total number of NEW Pregnant Women registered for ANC | ||||||||||||||||||
10 | OR | Out of total number of NEW pregnant women registered with age <15 years | ||||||||||||||||||
11 | OR | Out of total number of NEW pregnant women registered with age 15-19 years | ||||||||||||||||||
12 | Out of total number of NEW pregnant women registered with age >19 to 49 years | |||||||||||||||||||
13 | OR | Out of total number of NEW pregnant women registered with age >49 years | ||||||||||||||||||
14 | OR | Out of the total NEW ANC registered, number registered within 1st trimester (within 12 weeks) | ||||||||||||||||||
15 | OR | Total ANC footfall (Old cases + New Registration) attended | ||||||||||||||||||
16 | OR | ANC services | ||||||||||||||||||
17 | OR | Number of PW given Td1(Tetanus Diptheria dose 1) | ||||||||||||||||||
18 | OR | Number of PW given Td2(Tetanus Diptheria dose 2) | ||||||||||||||||||
19 | OR | Number of PW given Td Booster (Tetanus Diptheria dose booster) | ||||||||||||||||||
20 | OR | Number of PW provided full course 180 Iron Folic Acid (IFA) tablets | ||||||||||||||||||
21 | OR | Number of PW provided full course 360 Calcium tablets | ||||||||||||||||||
22 | OR | Number of PW given one Albendazole tablet after 1st trimester | ||||||||||||||||||
23 | OR | Number of PW received 4 or more ANC check ups | ||||||||||||||||||
24 | OR | Number of PW given ANC Corticosteroids in Pre-Term Labour | ||||||||||||||||||
25 | OR | Pregnant Women (PW) with Hypertension (BP>140/90) | ||||||||||||||||||
26 | OR | New cases of PW with hypertension detected | ||||||||||||||||||
27 | OR | Pregnant Women (PW) with Anaemia | ||||||||||||||||||
28 | OR | Number of PW tested for Haemoglobin (Hb ) 4 or more than 4 times for respective ANCs | ||||||||||||||||||
29 | OR | Number of PW having Hb level<11(7.1 to 10.9) (Out of total tested cases) | ||||||||||||||||||
30 | OR | Number of PW having Hb level<=7 (Out of total tested cases) | ||||||||||||||||||
31 | OR | Pregnant Women (PW) with Syphilis | ||||||||||||||||||
32 | OR | Syphilis test conducted for Pregnant Women | ||||||||||||||||||
33 | OR | Number of pregnant/Direct-In-Labor (DIL) women screened/tested (with VDRL/RPR/TPHA/RDT/PoC) for Syphilis | ||||||||||||||||||
34 | OR | Number of pregnant/DIL women found seropositive for Syphilis by VDRL/RPR/TPHA/RDT/PoC test | ||||||||||||||||||
35 | OR | High Risk /Complicated Pregnancies | ||||||||||||||||||
36 | OR | Total High Risk Pregnancy (HRP)Intrapartum | ||||||||||||||||||
37 | OR | Deliveries | ||||||||||||||||||
38 | OR | Deliveries conducted at Home | ||||||||||||||||||
39 | OR | Number of Home Deliveries attended by | ||||||||||||||||||
40 | OR | Number of Home Deliveries attended by Skill Birth Attendant(SBA) (Doctor/Nurse/ANM) | ||||||||||||||||||
41 | OR | Number of Home Deliveries attended by Non SBA (Trained Birth Attendant(TBA) /Relatives/etc.) | ||||||||||||||||||
42 | OR | Number of PW given Tablet Misoprostol during home delivery | ||||||||||||||||||
43 | OR | Number of newborns received 7 Home Based Newborn Care (HBNC) visits in case of Home delivery | ||||||||||||||||||
44 | OR | Total number of delivery (Home +Institutional) reported | ||||||||||||||||||
45 | OR | Out of total number of delivery, PW with age <15 years | ||||||||||||||||||
46 | OR | Out of total number of delivery, PW with age 15-19 years | ||||||||||||||||||
47 | OR | Out of total number of delivery, PW with age >19-49 years | ||||||||||||||||||
48 | OR | Out of total number number of delivery, PW with age > 49 years | ||||||||||||||||||
49 | OR | Number of newborns received 6 HBNC visits after Institutional Delivery | ||||||||||||||||||
50 | OR | No. of identified Sick new-borns referred by ASHA to facility under HBNC Program | ||||||||||||||||||
51 | OR | Total number of Children received all scheduled 5 Home visits under HBYC | ||||||||||||||||||
52 | OR | Pregnancy outcome & details of new-born | ||||||||||||||||||
53 | OR | Pregnancy Outcome (in number) | ||||||||||||||||||
54 | OR | Live Birth | ||||||||||||||||||
55 | OR | Live Birth - Male | ||||||||||||||||||
56 | OR | Live Birth - Female | ||||||||||||||||||
57 | OR | Number of Pre-Term newborns ( < 37 weeks of pregnancy) | ||||||||||||||||||
58 | OR | Still Birth | ||||||||||||||||||
59 | OR | Intrapartum (Fresh) Still Birth | ||||||||||||||||||
60 | OR | Antepartum (Macerated) Still Birth | ||||||||||||||||||
61 | OR | Abortion (spontaneous) | ||||||||||||||||||
62 | OR | Details of Newborn children | ||||||||||||||||||
63 | OR | Number of newborns weighed at birth | ||||||||||||||||||
64 | OR | Number of newborns having weight less than 2500 gm | ||||||||||||||||||
65 | OR | Out of the above, number of newborns having weight less than 1800 gm | ||||||||||||||||||
66 | OR | Number of Newborns breast fed within 1 hour of birth | ||||||||||||||||||
67 | OR | Rashtriya Bal Swasthaya Karyakram (RBSK) | ||||||||||||||||||
68 | OR | Number of newborn screened for defects at birth (as per Comprehensive Newborn Screening, RBSK) | ||||||||||||||||||
69 | OR | Number of newborns identified with visible birth defects (including Neural tube defect, Down’s Syndrome, Cleft Lip & Palate, Club foot and Developmental dysplasia of the hip) | ||||||||||||||||||
70 | OR | Anaemia Mukt Bharat | ||||||||||||||||||
71 | OR | IFA Coverage | ||||||||||||||||||
72 | OR | Number of women of reproductive age (WRA) 20-49 years (non-pregnant, non-lactating), provided 4 Red Iron and folic acid (IFA) tablets in a month | ||||||||||||||||||
73 | OR | Number of children (6-59 months old) provided 8-10 doses (1ml) of IFA syrup (Bi weekly) | ||||||||||||||||||
74 | OR | Number of children 5-9 years provided Weekly Iron Folic Acid (IFA Pink) tablets in a month | ||||||||||||||||||
75 | OR | Number of out of school children (5 -9 years) given 4-5 IFA Pink tablets at Anganwadi Centres | ||||||||||||||||||
76 | OR | Anaemia- Identified & Treated | ||||||||||||||||||
77 | OR | Beneficiaries identified with Mild and Moderate Anaemia | ||||||||||||||||||
78 | OR | Number of out of school adolescent girls (10-19 years) having anaemia (Hb 8.1-11.9 g/dl) | ||||||||||||||||||
79 | OR | Number of lactating mothers (of 0-6 months old child) having anaemia (Hb 8.1-11.9 g/dl) | ||||||||||||||||||
80 | OR | Number of women of reproductive age (non-pregnant, non-lactating) (20-49 years) having anaemia (Hb 8.1-11.9 g/dl) | ||||||||||||||||||
81 | OR | Beneficiaries identified with Severe Anaemia | ||||||||||||||||||
82 | OR | Number of out of school adolescent girls (10-19 years) having severe anaemia (Hb <8 g/dl) | ||||||||||||||||||
83 | OR | Number of lactating mothers (of 0-6 months old child) having severe anaemia ((Hb <8 g/dl) | ||||||||||||||||||
84 | OR | Number of women of reproductive age (non-pregnant, non-lactating) (20-49 years) having severe anaemia (Hb <8 g/dl) | ||||||||||||||||||
85 | OR | Post Natal Care (PNC) | ||||||||||||||||||
86 | OR | In case of home delivery, number of women receiving 1st post partum checkups within 48 hours | ||||||||||||||||||
87 | OR | Number of mothers provided full course of 180 IFA tablets after delivery | ||||||||||||||||||
88 | OR | Number of mothers provided full course 360 Calcium tablets after delivery | ||||||||||||||||||
89 | OR | Family Planning | ||||||||||||||||||
90 | OR | Number of Combined Oral Pill cycles distributed to the beneficiary | ||||||||||||||||||
91 | OR | Number of Condom pieces distributed to the beneficiary | ||||||||||||||||||
92 | OR | Number of Centchroman (weekly) pill strips distributed to the beneficiary | ||||||||||||||||||
93 | OR | Number of Emergency Contraceptive Pills (ECP) given to the beneficiary | ||||||||||||||||||
94 | OR | Number of Pregnancy Test Kits (PTK) utilized | ||||||||||||||||||
95 | OR | CHILD IMMUNISATION | ||||||||||||||||||
96 | OR | Number of Infants 0 to 11 months old who received: | ||||||||||||||||||
97 | OR | Child immunisation - BCG | ||||||||||||||||||
98 | OR | Child immunisation - Pentavalent 1 | ||||||||||||||||||
99 | OR | Child immunisation - Pentavalent 2 | ||||||||||||||||||
100 | OR | Child immunisation - Pentavalent 3 | ||||||||||||||||||