Upazilawise periodical
Distribution & Performed		  


Select:     Select:     Select:      Reporting Period:       To     

Upazillawise Maternal & Child Health, Reproductive health Services
District: 
Reporting Month: , 

Sl No. Month & Year Newly married couple Reproductive Health Services
Pregnant Mother
(current month)		 Pregnant Mother (previous month) Total Pregnant Mother ANC Services Delivery Services No. of services post abortion care No. of pre-eclampsia
patient
Home Hospital/Clinic No. of mother feeding Misoprostol
Old
New
Total
ANC-1
ANC-2
ANC-3
ANC-4
Counseling
on
FP method
after Post Partum
Receive Misoprostol
7.1% chlorhexidine
digluconate
for umbilical cord care
No. of mother Suffering from APH
No. of mother receive Inj.antenatal carotid costeroides in(24-34 weeks)
Trained Person
Non-Trained Person
Normal
C-Section
Others (Forcep/
Vacuum/
Breech
No. of delivery follow (AMTSL)
No. of uses Partograph
No. of mother Suffering from IPH
1
Coloumn No.
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
Periodical Total

Reporting Upazila/Thana:   Out of:  Upazila/Thana


Sl.No Month & Year Reproductive Health Services
PNC Services Reffered Infertile Couple
Mother Neonatal
PNC-1
PNC-2
PNC-3
PNC-4
Postnatal care till two days in Home Delivery
Counseling on FP method after Post-partum
No. of mothers suffaring from IPH in Delivery period
Wrapping after Birth within 1 minute
No. of uses 7.1% chlorhexidine
digluconate
for umbilical cord care
No. of newborn touch skin-care after Gluconate for umbilical cord care
No. of newborn breastfeeding(First 24 hours)
No. of newborn resisated with bag-mask
Visit-1
Visit-2
Visit-3
Visit-4
No. of Risk/ Complicated Pregnant Mother
No. of Reffered eclampsia patient in taken Inj MgS04
No. of Reffered Complicated Pregnant Mother in Delivery period
No. of Reffered Complicated Pregnant Mother in Postnatal period
No. of Referred Newborn for comlication
Treatment/ Advised
Reffered
    111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133
Periodical Total


Sl No. Month & Year Reproductive Health Services
Woman Received TT No. of ECP Acceptors Adolescent
service
(10-19 years)		 No. of Treatment on RTI/STI infection No. of MR(MVA) services No. of MR Service By Medicine Screening breast cancer and Vaginal
1st 2nd 3rd 4th 5th Counseling on Adolescence change Counseling on avoiding Child marriage No. of adolescent girl counseled on IFA No. of adolescent girl received IFA No. of adolescent girl counseled on RTI/STI Treatment on RTI/STI Received counseling on diversified food Counseling on prevention of adolescent violence Counseling on prevention and cure for mental problems and drug addiction No. of adolescent girl counseled on Sanitary Pad Reffered Total VIA Possitive Total VIA Negative Total CBE Possitive Total CBE Negative
    134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157
Periodical Total


Sl. No Month & Year Child Services (0-5 Years) Birth-Death
No. of Newborn received KMC Services No. of Immunized Child (0-15Months) No. of reffered child Total Live Birth Low birth weight Newborn
(weight <2500gm)		 Low birth weight Newborn
(weight <2000gm)		 Immature
Newborn
(Before 37 weeks)		 Still birth No.of Death
BCG OPV & Pentavalent
(DPT,Hep-B,Hib)		 PCV BOPV IPV
(Fractional)		 MR No. of death childbirth (<1year) No. of death Childbirth (1-5Year) Maternal Death Others Death Total Death
1 2 3 1 2 3 1 2 3 1 2 1 2 Disease Pneumonia Diarrhoeal 0-7 Days 8-28 Days 29Days to below 1Year Total
    158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188
Periodical Total