ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
2
BIRTH REGISTRY
3
4
REGISTRATION DATE
(d/m/y)
FIRST AND LAST NAME OF CHILDDATE OF BIRTH
(d/m/y)
SEXMOTHER'S NAMEAGE OF MOTHERNAME OF HEAD OF HOUSEHOLDCOMMUNITYHOUSE NUMBER LOCATION OF BIRTHWHO ATTENDED? FIRST WEIGHT <30 DaysINTRAGESTA-TIONAL TIME PERIOD SINCE LAST PREGNANCY PERSON RESONSIBLE FOR DETECTING THE EVENT
5
MFHealth PersonnelTrained MidwifeTrained Family MemberUntrained PersonDATEGrams
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100