2.20.1 Maternal Care FHSIS v.

2012 - Q Form (page 1 of

FHSIS REPORT for the _________________ YEAR: _________ 2018

logo Municipality/City Name: Gonzaga
Sta. Teresita
Province: Cagayan Projected Population of the Year: ____________
2017 19, 866

- MATERNAL CARE -
Elig
Indicators No. % Interpretation
Pop.
Col. 1 Col.2 Col. 3 Col.4 Col. 5

Pregnant women with 4 or more prenatal visits ♣ 536/134 86 64%

Pregnant women given 2 doses of Tetanus Toxoid♣ 536/134 32 24%
Pregnant Women given TT2plus♣ 536/134 15 11.00%

Pregnant women given complete iron with folic acid supplementation♣ 536/134
70 52%

Post partum women with at least 2 post-partum visits♣ 536/134

76 57%

Post partum women given complete iron supplementation♣ 536/134

79 59%
Proportion of Post partum women given Vitamin A supplementation♣ 536/134
82 61%
536/134
Proportion Postpartum women initiated breastfeeding within 1 hour after giving birth♣ 82 61%
Women 10-49 years old given Iron supplementation♥

STI Surveillance No.

No. of pregnant women seen 43

No. of pregnant women tested for Syphilis 0
No. of pregnant women positive for Syphilis 0
No. of pregnant women given Penicillin 0
Eligible Population: ♣ TP x 2.7% ♥ TP x 24.6%

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 FHSIS v. 2012 - Q Form (page 1 of 8)
FHSIS ver 2012

TERNAL CARE -
Recommendation/
Actions Taken
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2.20.2 Family Planning FHSIS v. 2012 - Q Form

- FAMILY PLANNING-

Acceptors New
Current Current
Acceptors CPR = (Col. 5/TP
Indicators User (Beg. Dropout Users End Interpretation
of the x 12.325%)
of Quarter) New Other of Quarter
(end of (end Quarter
Qtr) of Qtr)
Col. 1 Col.2 Col.3 Col.4 Col.5 Col.6 Col.7 Col.8

a. Female Ster/BTL
264 1 0 15 250 0
b. Male Ster/Vasectomy
0 0 0 0 0 0
c. Pills
1,211 1 0 36 1,196 23
d. IUD (P-IUD and I-IUD)
252 0 0 7 246 1
e. Injectables (DMPA/CIC)
352 5 2 13 355 19
f. NFP-CM
0 0 0 0 0 0
g. NFP-BBT
0 0 0 0 0 0
h. NFP-STM
0 0 0 0 0 0
i. NFP-SDM
0 0 0 0 0 0
j. NFP-LAM
122 8 0 40 122 42 90.70%
k. Condom
34 0 0 0 34 1
l. Implants
22 0 0 0 18 0

2221

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 FHSIS v. 2012 - Q Form (page 2 of 8)

ILY PLANNING-

Recommendations/
Actions Taken

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2.20.3 Child Care FHSIS v. 2012 - Q Form (page 3

- CHILD CARE -
Elig. Number
Indicators % Interpretation
Pop. Male Female Total
Col. 1 Col.2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7
Infants given BCG☻ 536/134 54 43 97 72%
w/in 24 hours 536/134 11 11 22 16%
Infants given Hepatitis B1☻
> 24 hours 536/134 0 0 0 0
1 536/134 58 50 108 81%
Infants given PENTA☻ 2 536/134 52 50 102 76%
3 536/134 37 49 86 64%
1 536/134 61 40 101 75%
Proportion of Infants given OPV☻ 2 536/134 38 50 88 66%
3 536/134 28 37 65 49%
MCV1 (AMV) 536/134 40 46 86 64%
Proportion of Infants given MCV☻
MCV2 (MMR) 536/134 35 27 62 46%
1 0 0 0 0 0
Proportion of Infants given ROTA☻
2 0 0 0 0 0
1 536/134 49 50 99 74%
Proportion of Infants given PCV☻ 2 536/134 48 58 106 79%
3 536/134 45 52 97 72%
Proportion of Fully Immunized Child (0-11 mos)☻ 536/134 40 46 86 64%
Proportion of Completely Immunized Child (12-23 mos)☻ 0 0 0 0
Total Livebirths 43 39 82
Proportion of Child Protected at Birth (CPAB)♣ 536/134 21 24 45 33%
Proportion of Infants age 6 mos. seen 29 29 58
Proportion of Infants exclusively breastfed until 6th month old☻ 536/134 29 29 58 43%
Infants given complimentary food from 6-8 months♣ 536/134 27 35 62 46%
Proportion of Infants for newborn screening
- referred 43 39 82
- done 43 39 82
Eligible Population: ☻TP x 2.7% ♣Total Livebirths

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 FHSIS v. 2012 - Q Form

- CHILD CARE -
Elig. Number
Indicators Pop. Male Female Total % Interpretation
Col. 1 Col.2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7
Infant 6-11 months old received Vitamin A ☼ 0 0 0
Children 12-59 months old received Vitamin A ♠ 0 0 0
Infant 6-11 months old received Iron 0 0 0
Children 12-59 months old received Iron 0 0 0
Infant 6-11 months old received MNP ☼ 0 0 0
Children 12-23 months old received MNP © 0 0 0
Sick Children 6-11 mos. seen 0 0 0
Sick Children 6-11 mos. received Vit. A♣ 0 0 0
Sick Children 12-59 mos. seen 0 0 0
Sick Children 12-59 mos. received Vit.A♣♣ 0 0 0
Children 12-59 mos. old given de-worming tablet 0 0 0
Infant 2-5 mos.w/ low birthweight seen 0 0 0
Infant 2-5 mos.w/ low birthweight received full dose iron♥ 0 0 0
Anemic Children 6-11 months old seen 0 0 0
Anemic Child. 6-11 months received iron ● 0 0 0
Anemic Children 12-59 months old seen 0 0 0
Anemic Child. 12-59 months received iron ▲ 0 0 0
Diarrhea cases 0-59 months old seen
Diarrhea cases 0-59 mos old received ORS☻
Diarrhea 0-59 mos old received ORS/ORT w/ zinc☻
Pneumonia cases 0-59 mos. old seen
Pneumonia cases 0-59 mos. old completed Tx♦
Eligible Pop: ☼TP x 1.35% ♠TP x 10.8% ♣Sick Child 6-11 mos. seen ♣♣Sick Child 12-59 mos. seen ● Anemic Children 6-11 mos. seen
♥Infant 2-5 mos.w/LBW seen ▲ Anemic Child 12-59 mos. old seen ☻No.Diarrhea cases 0-59 mos old seen ♦No.Pneumonia cases 0-59 mos seen

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FHSIS v. 2012 - Q Form (page 4 of 8)

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2.20.4 Dental Care FHSIS v. 2012 - Q Form (page 5 of 8

- DENTAL CARE -
Indicators Elig. Number % Interpretation
Pop. Male Female Total
Col. 1 Col.2 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7
Orally Fit Children 12-71 months
old♠ 0 #DIV/0!
Children 12-71 months old

/ A
provided with BOHC♠ 0 #DIV/0!

N
Adolescent & Youth(10-24 years)
given BOHC☻ 0 #DIV/0! NO DENTIST
Pregnant women provided
with BOHC♥ 0 #DIV/0!
Older Person 60 yrs old & above
provided with BOHC♣ 0 #DIV/0!

Eligible Population: ♠TP x 13.5% ☻TP x 30% ♥TP x 2.7% ♣TP x 6.9%

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SIS v. 2012 - Q Form (page 5 of 8)

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2.20.5 Disease Control FHSIS v. 2012- Q Form (page 6 of

- DISEASE CONTROL -
Number
TUBERCULOSIS Interpretation
Male Female Total
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5
1. TB symptomatics who underwent DSSM
20 6 26
2. Smear positive discovered and identified
2 0 2
3. New smear positive cases initiated tx and registered 2 0 2
4. New smear (+) cases cured
0 0 0
5. Smear(+) retreatment cases cured
0 0 0
6. Smear (+) retreatment cases initiated tx and registered

● Relapse 0 0 0
● Treatment failure 0 0 0
● Return after default 0 0 0 CDR= 71.4%
● Other type of TB 0 0 0
7. No, of Smear (+) retreatment cured
● Relapse 0 0 0
● Treatment failure 0 0 0
● Return after default 0 0 0

8.. Total No. of TB cases (all forms) initiated treatment

12 8 20
9. TB All forms identified 12 8 20
10. Case Detection Ratet 12 8 20
Number
LEPROSY Rate Interpretation
Male Female Total
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6
1. Total Population
2. Total No. of Leprosy cases (undergoing Treatment) 2 0 2
3. No. of Newly detected
Leprosy cases
► < 15 yo
► Grade 2 disability 1 0 1
4. No of Leprosy Cases cured

Denominator t TP x 0.00554 (estimated TB All Forms)

FHSIS v. 2012- Q Form (page 6 of 8 )

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Recommendation/
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 FHSIS v. 2012- Q Form (page

- DISEASE CONTROL -
MALARIA Number
Rate Interpretation
(Endemic Areas) Male Female Total
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6
Total Population
Population at risk
Annual Parasite
Morbidity Rate
Incidence
Confirmed Malaria Cases

By age group
● < 5 yo ☻

● > =5 yo ☻

By pregnancy

●Pregnant ☻

By species NONE
● P.falciparum ☻
● P. vivax ☻
● P.ovale ☻
● P.malariae ☻
By Method
● Slide☻
● RDT☻

Total no. of LLIN given♦

Mortality Case Fatality
Rate ♪ Ratio
Total no. of Malaria Deaths

Denominator: ♣Morbidity Rate=No. of confirmed Mal. Cases/TP x 100,000 Annual Parasite Incidence = Tot. confirmed Mal.Cases/Pop. At risk x 1,000

112
 Case Fatality Ratio = No. of Malaria Deaths/ Total Malaria confirmed cases
☻Total Confirmed Malaria Case ♦Population at risk ♪Mortality rate=TP;
Mortality RateCase Fatality
= Total no. ofRatio=Total Malaria Pop.
Mal. Deaths/Total Casesx 100,000

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 FHSIS v. 2012- Q Form (page 7 of 8)

-
Recommendation/
Actions Taken
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t. confirmed Mal.Cases/Pop. At risk x 1,000

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al. Deaths/Total Pop. x 100,000

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 FHSIS v. 2012 - Q Form (page 8 of 8)

- DISEASE CONTROL -
SCHISTOSOMIASIS Number
Rate Interpretation
(endemic areas) Male Female Total
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6
Symptomatic cases
Case examined ♥
Positive Cases ☻
● Low intensity ♣
● Medium intensity ♣ NONE
● High intensity ♣
Cases treated ♣
Complicated Cases ♣
Complicated Cases referred ♣
FILARIASIS Number
Rate Interpretation
(endemic areas) Male Female Total
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6
Clinical
1.No. Cases with hydrocele, Rate
lymphedema, Elephantiasis, Chyluria

2. No. of Cases examined

3. No. of Cases examined found Positive
for MF ☻
NONE

4. Average MFD ♣
5. Eligible population given MDA (94.6%
of TP)
6. Total population given MDA ☺
Denominator for Schistosomiasis: ☻Case examined ♣ Positive Schistosomiasis cases ♥ Symptomatic cases ♠Total Pop. Given MDA
Filariasis : Clinical Rate = No. Cases with hydrocele,lymphedema,Elephantiasis, chyluria/ No. of Cases examined

☻ No. of Cases examined ♣ Total Count of microfilaria in slides found positive / No. of slides found positive ☺ Total Population

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 FHSIS v. 2012 - Q Form (page 8 of 8)

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positive ☺ Total Population

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2.21.2 Form 2 Other Diseases FHSIS v. 2012 - Qmor
.
FHSIS QUARTERLY REPORT for: 1st Quarter Year: 2018
Municipality/City of: Sta. Teresita
ProvInce Cagayan
MORBIDITY DISEASES REPORT
For submission to the PHO

ICD 10 Under 1 1 - 4 5 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45- - 49 50 - 54 55 - 59 60 - 64

DISEASE
CODE M F M F M F M F M F M F M F M F M F M F M F M F M F M F

URTI 38 34 98 89 57 74 23 27 12 10 3 6 6 10 1 10 1 22 7 15 2 9 3 18 0 14 4 5

APD 0 0 0 0 3 1 0 3 0 0 0 4 1 0 0 0 0 1 2 1 2 0 2 0 3 1 1
0

AGE 4 1 8 4 1 0 1 1 0 0 0 2 0 0 0 0 2 1 1 0 1 0 0 0 0 0 1
1

SVI 1 2 1 1 1 1 1 3 2 1 3 1 1 1 2
2

UTI 0 0 1 0 1 1 0 2 0 1 0 1 0 1 1 0 0 5 0 1 0 4 1 1 1 0 0 0

HPN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 1 1 3 1
0 0 2 0 0

PTB 1

COPD 1

DM
1
1
PKI
1
ACUTE BRONCHITIS
Qmorbid (page 1 of 2)

65 & above TOTAL

M F M F
9 20 264 363

2 9 9 27

0 1 16 14

3 2 11 18

0 0 5 17

1 7 8 11

0 1

1 1 0

1 0

1 0

1 0
2.22.3.2 Demographic Profile (A1-RHU)

FHSIS ANNUAL REPORT FOR YEAR: _____________1st Quarter

Municipality/City Name: _ Sta. Teresita
No. of Health Centers _________4__________
Province: Cagayan Projected Population of the Year: 19,866_______

- DEMOGRAPHIC PROFILE -
Number Ratio to
Indicators Interpretation
Male Female Total Pop.
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6

Barangays 1
Barangay Health Stations 4
Health Centers 1
Households 3585
Physicians/Doctors 0 1 1 1:20,000 pop
Dentist 0 0 0
Nurses 0 1 1 1:20,000 pop
Midwives 0 4 4 1:20,000 pop
Medical Technologists 0 1 1 1:20,000 pop
Sanitary Engineers 0 0 0
Sanitation Inspectors 0 1 1 1:20,000 pop
Nutritionist 0 0 0
Active Barangay Health Workers 0 91 91 1:20 household
 2.22.3.3 Environmental
FHSIS version 2012
- ENVIRONMENTAL -
Indicators No. % Interp

Col. 1 Col 2 Col. 3 Co

Total number of Households (HH) 3,585

HH w/ access to improved
water supply♣
- Level I♣ 3,447 96.15%
- Level II♣ 33 0.92%
Recommendation/ - Level III♣ 105 2.93%
Actions Taken HH w/ sanitary toilet facilities♣ 3,402 94.90%
Col. 7 HH w/satisfactory disposal of solid waste♣
HH w/complete basic sanitation facilities♣ 3,402 94.90%
Food Establishment 12
Food Establishment w/Sanitary Permit♥ 12 100.00%
Food Handlers 30
Food Handlers w/Health Certificate☻ 30 100.00%
Salt Samples Tested
Salt Samples Tested (+) for Iodine
Denominator: ♣No. Households ♥No.Food Establishments ☻No.Food Handlers
 FHSIS v. 2012 - A Form (page 2 of 5 ) 2.22.3.4 Natality - Livebirths
NTAL - NATALITY - LIVE
Recommendation/ Number
Interpretation Indicators
Actions Taken Male Female Total
Col. 4 Col. 5 Col. 1 Col 2 Col 3 Col 4

No. of Pregnancies 43 39 82
Pregnancies by outcome
Livebirths (LB) 43 39 82
Fetal Death 0 0 0
Abortion 0 0 0
No. of Deliveries
NSD 42 39 81
Operative 1 0 1
LB w/weights 2500 grams & greater☻ 43 39 82
LB w/weights less than 2500 grams☻ 0 0 0
LB - Not known weight☻ 0 0 0
LB delivered by doctors☻ 27 28 55
LB delivered by nurses☻ 3 2 5
LB delivered by midwives☻ 13 9 22
LB delivered by hilot/TBA☻ 0 0 0
LB delivered by others☻ 0 0 0

Denominator: ☻Livebirths
 FHSIS v. 2012- A Form (page 3 of 5) 2.22.3.5 Natality - Deliveries
- LIVEBIRTHS - NATALIT
Recommendation/
% Interpretation Indicators
Actions Taken
Col. 5 Col. 6 Col. 7 Col. 1

Total No. of Pregnancies♣

Outcome of Pregnancy♣
• Live Births
• Fetal death
• Abortion
Normal Deliveries ♣
● Deliveries at Home♥
● Deliveries at Health Facility♥
● Deliveries - Other Place♥

100% Operative Deliveries ♣

0 ● Deliveries at Health Facility♠

0 ● Deliveries-Other Place♠

67.00%
6.00%
27.00%
0
0

Denominator: ☻Livebirths ♣Pregnancies ♥Normal Deliveries ♠Oth

 FHSIS v. 2012- A Form (page 4 of 5) 2.22.3.6 Mortality
- NATALITY - DELIVERIES -
Recommendation/
No. % Interpretation Indicators
Actions Taken
Col 2 Col. 3 Col. 4 Col. 5 Col. 1

82 Deaths♣
Maternal Deaths☻
82 100% Perinatal Deaths☻
0 0 Fetal Deaths☻
0 0 Neonatal Deaths☻
Infant Deaths☻
0 0 Deaths among children Under 5 yrs o
81 98.70% Deaths due to Neonatal Tetanus☻
0 0

1 1.30%
0 0

Denominator: ♣ Population ☻Livebirt

♥Normal Deliveries ♠Other Type of Deliveries

 FHSIS v. 2012 - A Form (page 5 of 5)

- MORTALITY -
Number Recommendation/
ators Rate Interpretation
Male Female Total Actions Taken
l. 1 Col 2 Col 3 Col 4 Col. 5 Col. 6 Col. 7
12 8 20
0 0
0 0 0
0 0 0
0 0 0
0 0 0
n Under 5 yrs old☻ 0 0 0
al Tetanus☻ 0 0 0

n ☻Livebirths
 - ELDERLY -
Number
Indicators % Interpretation
Male Female Total

Col. 1 Col. 3 Col. 4 Col. 5 Col. 6 Col. 7

Elderly 1,560 1,800 3,360
Elderly given
Pneumococcal 0 1 1 2.97%
Vaccine
Elderly given flu
vaccine
0 0 0
- TEENAGE PREGNANCY-
# of
Age Total
Pregnant

10-14 0 0
Teenage Pregnant
15-19 13 13
 Recommendation/

Actions Taken
Col. 8

Y-