Tripuratripuranrhm.gov.in/report/RBSK.pdf · Rashtriya Bal Swasthya Karyakram (RBSK) MONTHLY...

Name of State: Name of District Name of BlockNumber of ASHAs Reporting Month JANUARY Reporting Year 2020-2021

Male Female Total

1701 1623 3324

1701 1623 33242627 2554 5181

14464 14021 28485

18562 17693 36255

3 0 3

Sl No 3 0 31 0 0 02 0 0 03 2 0 24 1 0 15 0 0 0

No of children visited in current month 0 0 06.1 06.2 06.3 06.4 0

6.5 0

Primary care (PHC/CHC)

Secondary Care

(DH/SDH/SNCU)

Tertiary Care (DEIC)

/MCTotal

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 2 2

0 0 0 0

0 0 1 1

0 0 0 0

0 0 0 0

0 0 0 0Male 0 0 0 0Female 0 0 0 0

Ministry of Health & Family WelfareGovernment of India

Rashtriya Bal Swasthya Karyakram (RBSK)

MONTHLY REPORTING FORMAT (ASHA,HBNC) - FORM No - II

Tripura

Cleft Lip & Palate

ASHA, HBNCBirth-6 weeks

Total number of deliveries reported in catchment area of ASHA in the reporting month

Total number of New borns to be visited in the current monthNumber of newborn visited by the ASHA in HBNC visit in the month

Cumulative Number of deliveries in the year 2020-2021 From APRIL To JANUARY

Cumulative Number of Children screened for defects at birth during HBNC visits in the year 2020-2021 From APRIL To JANUARY

Total Number of Children identified with Defect at Birth by ASHA

Defects at Birth: Neural tube defectDown’s Syndrome

Neural tube defectMale

Female

Club footDevelopmental dysplasia of the hip

6Developmental Delay identified as per revised MCP card

Age of child

At 3 monthsAt 6 monthsAt 9 monthsAt 12 months

At 15 months

Total Children Refered

Down’s SyndromeMale

Female

Cleft Lip & Palate Male

Female

Club footMale

Female

Developmental dysplasia of the hip

Male

Female

3 Months

Male 0 0 0 0Female 0 0 0 0Male 0 0 0 0Female 0 0 0 0Male 0 0 0 0Female 0 0 0 0Male 0 0 0 0Female 0 0 0 0Male 0 0 0 0Female 0 0 0 0

Report verified by ANM

Name

Signature

Date

Developmental Delay

6 Months

9 Months

12 Months

15 Months

Total Referred

Report prepared by Asha Report verified by ASHA supervisor

State: District Name of Block MHT Team Code Reporting Year

Male 93753 3927 21750 23% 126 126 99588 3395 14702 15% 244 244 246553 9976 13737 6% 693 693Female 90102 3722 21205 23% 106 106 96961 3267 14674 15% 225 225 250652 10265 14421 6% 722 722Total 183855 7649 42955 23% 232 232 196549 6662 29376 15% 469 469 497205 20241 28158 6% 1415 1415

Annual plan : Total visit to be planned in this

year

Total AWC/School visit planned in this

month by Mobile Health Teams

Total AWC/School visit conducted this

month by Mobile Health Teams

Cumulative gap including carry forward from

previous month of the current

year

Male Female Male Female Male Female Doctors Pharmacist ANM/SN

Visit 1 9911 Approved 48 48 48 48 0 0 48 96 48 48Visit 2 0 In-place 48 37 45 29 4 0 23 82 33 23

4638 Trained 22 19 19 13 1 0 0 38 14 0

Functional 48 37 45 29 4 0 23 82 33 23

Male Female Total Male Female Total Male Female Total Male Female Total

3927 3722 7649 3395 3267 6662 9976 10265 20241 17298 17254 34552

13 14 27 5 1 6 11 12 23 29 27 56

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

6 3 9 0 0 0 1 0 1 7 3 10

1 1 2 2 1 3 1 1 2 4 3 7

0 0 0 0 0 0 0 0 0 0 0 0

1 1 2 0 0 0 2 1 3 3 2 5

0 0 0 0 0 0 0 3 3 0 3 3

5 9 14 3 0 3 7 7 14 15 16 31

0 0 0 0 0 0 0 0 0 0 0 0

Microcephaly 0 0 0 0 0 0 0 0 0 0 0 0

Macrocephaly 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 5 4 9 17 26 43 22 30 52

0 0 0 0 0 0 5 11 16 5 11 16

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 1 1 0 0 0 0 1 1

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 4 5 9 4 5 9

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 5 3 8 8 10 18 13 13 26

121 100 221 228 209 437 551 496 1047 900 805 1705

72 56 128 69 58 126 171 155 326 312 269 581

7 9 16 13 9 22 17 15 32 37 33 70

0 0 0 0 0 0 0 0 0 0 0 0

19 18 37 37 36 73 59 54 113 115 108 223

22 17 39 109 106 215 303 272 575 434 395 829

1 0 1 0 0 0 1 0 1 2 0 2

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

3 5 8 4 5 9 87 87 174 94 97 191

1 2 3 0 1 1 56 56 112 57 59 116

0 0 0 3 0 3 5 4 9 8 4 12

0 0 0 0 1 1 5 2 7 5 3 8

1 0 1 0 0 0 1 3 4 2 3 5

0 2 2 0 0 0 5 6 11 5 8 13

1 1 2 1 1 2 4 2 6 6 4 10

0 0 0 0 2 2 0 2 2 0 4 4

0 0 0 0 0 0 0 2 2 0 2 2

0 0 0 0 0 0 1 1 2 1 1 2

0 0 0 0 0 0 10 9 19 10 9 19

0 0 0 0 0 0 3 67 70 3 67 70

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 5 5 0 5 5

0 0 0 0 0 0 0 28 28 0 28 28

0 0 0 0 0 0 3 5 8 3 5 8

0 0 0 0 0 00 0 0 0 0 0

0 0 0 0 0 0 0 29 29 0 29 29


Secondary Care (DH/SDH/

SNCU)

Tertiary Care (DEIC)/MC



SNCU)




SNCU)



Secondary Care

(DH/SDH/SNCU)


Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 1 0 0 1Male 0 1 4 0 0 0 0 0 1 0 1 5Female 0 0 3 0 0 0 0 0 0 0 0 3Male 0 1 1 0 0 2 0 1 0 0 2 3Female 0 0 1 0 0 1 0 0 1 0 0 3Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 1 0 0 0 0 0 2 0 0 3Female 0 0 1 0 0 0 0 0 1 0 0 2Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 1 2 0 1 2Male 0 2 2 0 0 3 0 0 7 0 2 12Female 0 0 8 0 0 0 0 0 8 0 0 16Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0


Rashtriya Bal Swasthya Karyakram (RBSK)MONTHLY REPORTING FORMAT (MHT) - FORM No - III

Tripura West Tripura Reporting Month JANUARY 2020-2021

6 weeks to 3 years (MHT) 3-6 years enrolled in Govt and Govt aided schools (MHT) 6-18 years enrolled in Govt and Govt aided schools (MHT)

Target : Total children to be screened in

complete year by M.H.T.

No. of children screened in

current month /Yearby M.H.T.

No. of children screened

cumulative till current month

Percentage of total children

screened till this month

(Cumulative)

Found positive for selected

health conditions in current month/year

Referred for this current month/year

Screening details at AWCs Composition of Mobile Health Team

MHT Details Total Number of MHT

Doctors Pharmacist ANM/ Staff nurse Total

Referred for this current

month/year




current month/year by

M.H.T.





(Cumulative)


health conditions in current month





current month/year by

M.H.T.

No. of children screened cumulative

till current month

Percentage of total children screened

till this month (Cumulative)

Found positive for selected health

conditions in current month

Remarks by MHT TeamScreened Children with Health Condition Screened Children with Health Condition Screened Children with Health Condition Screened Children with Health Condition

AWCs

Govt and Govt aided schools

Number of Children screened in

……………………………….

(Reporting Month)

6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Number of Children Screened


Congenital cataract

Congenital deafness

Congenital heart diseases

Retinopathy of Prematurity

Deficiencies:Total

Defects at Birth: Total Defect at BirthNeural tube defect

Down’s Syndrome

Cleft Lip & Palate

Club foot

A) SAM

B) Severe Thinning

C) Obesity

DeficienciesSevere Anaemia

Vitamin A deficiency (Bitot spot)

Vitamin D Deficiency, (Rickets)

Skin conditions

Otitis Media

Rheumatic heart disease

Goitre

Severe Stunting

Vitamin B complex deficiency.

Childhood Diseases:Total Childhood Diseases

Childhood leprosy Disease

Childhood T.B.

Childhood Extra Pulmonary T. B.

Developmental Delays including Disabilities:Total Developmental Delays including Disabilities

Vision impairment

Reactive airway disease

Dental Conditions

Convulsive disorders

Cognitive delay

Language delay

Behaviour disorder (Autism)

Hearing Impairment

Neuro motor impairment

Motor delay

Adolescent Health:Total Adolescent HealthGrowing up concerns

Substance abuse

Learning disorder

Attention deficit hyperactivity disorder

Others

Pain or burning sensation while urinating

Discharge/ foul smelling discharge from the genitor-urinary area

Pain during menstruation

Feel depressed

Delay in menstruation cycles

Irregular periods

Neural tube defect

Down’s Syndrome

Total Children Refered with Heatlth Conditions

6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Number of Children Refered at

Refer Children for Health Conditions at facility


Congenital cataract

Cleft Lip & Palate

Club foot


Microcephaly

Macrocephaly

Congenital deafness


Male 0 0 0 0 0 0 4 1 0 4 1 0Female 0 0 0 0 0 0 10 1 0 10 1 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 1 0 0 0 0 0 1 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 4 0 2 4 0 2Female 0 0 0 0 0 0 4 1 1 4 1 1Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 3 0 2 4 0 4 0 0 6 7 0Female 0 1 0 2 4 0 6 0 0 8 5 0Male 52 12 0 46 20 0 105 59 0 203 91 0Female 42 11 0 38 16 0 97 52 0 177 79 0Male 5 0 0 11 2 0 14 2 1 30 4 1Female 5 0 0 9 0 0 10 5 0 24 5 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 20 0 0 35 2 0 56 6 0 111 8 0Female 18 0 0 35 0 0 56 4 0 109 4 0Male 18 3 2 77 25 5 180 90 21 275 118 28Female 14 2 1 73 25 5 157 83 20 244 110 26Male 0 1 0 0 0 0 0 1 0 0 2 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 1 0 0 0 12 13 31 12 13 32Female 0 0 3 0 0 1 11 11 34 11 11 38Male 0 0 0 0 0 3 0 0 6 0 0 9Female 0 0 0 0 0 0 0 2 2 0 2 2Male 0 0 0 0 0 0 0 0 5 0 0 5Female 0 0 1 0 0 1 0 0 2 0 0 4Male 0 0 1 0 0 0 0 0 1 0 0 2Female 0 0 0 0 0 0 0 0 3 0 0 3Male 0 0 1 0 0 0 0 0 5 0 0 6Female 0 0 2 0 0 0 0 0 6 0 0 8Male 0 0 0 0 0 1 0 0 4 0 0 5Female 0 0 1 0 0 1 0 0 2 0 0 4Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 2 0 0 2 0 0 4Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 2 0 0 2Male 0 0 0 0 0 0 0 0 1 0 0 1Female 0 0 0 0 0 0 0 0 1 0 0 1Male 0 0 0 0 0 0 33 0 2 33 0 2Female 0 0 0 0 0 0 35 2 2 35 2 2Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 5 0 0 5 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 8 8 12 8 8 12Male 0 0 0 0 0 0 3 0 0 3 0 0Female 0 0 0 0 0 0 5 0 0 5 0 0Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 20 9 0 20 9 0Male 0 4 8 0 0 5 0 1 10 0 5 23Female 0 0 13 0 0 1 0 1 13 0 1 27Male 0 3 0 2 4 0 12 1 2 14 8 2Female 0 1 0 3 4 0 20 2 1 23 7 1Male 95 16 2 169 49 5 355 158 22 619 223 29Female 79 13 1 155 41 5 320 144 20 554 198 26

Male 0 0 3 0 0 4 45 13 55 45 13 62

Female 0 0 7 0 0 5 46 15 56 46 15 68

Male 0 0 0 0 0 0 3 0 0 3 0 0

Female 0 0 0 0 0 0 38 17 12 38 17 12

Male 95 23 8 171 53 20 415 173 105 681 249 133Female 79 10 17 158 45 22 424 179 119 661 234 158

Severe Anaemia

A)SAM

B)Severe Thinning



Severe Stunting


Skin conditions

Ottis Media

C)Obesity

Goitre

Dental Conditions

Convulsive Disorders

Rheumatic Heart Disease

Reactive Airway Disease

Hearing Impairment



Childhood T.B.


Vision impairment

Language delay


Motor delay

Cognitive delay

Others

Growing up concerns

Learning disorder



Irregular periods

Substance abuse

Feel depressed


Defects at Birth



Developmental Delays

Adolescent Health

Grand Total

Deficiencies

Childhood Diseases

Date

Report prepared by Report verified by Block/ District / State Nodal person

Name of the Nodal PersonSignature

Designation

Male 93753 3927 21750 0.23 126 126 99588 3395 14702 0.15 244 244 246553 9976 13737 0.06 693 693Female 90102 3722 21205 0.23 106 106 96961 3267 14674 0.15 225 225 250652 10265 14421 0.06 722 722

Total 183855 7649 42955 0.2336352 232 232 196549 6662 29376 0.149459 469 469 497205 20241 28158 0.0566326 1415 1415

Male Female Total Male Female Total Male Female Total

Number Number Number Number Approved 48 48 48 96 48 0 48 48 48Visit 1 9911 0 0 0 In-place 48 37 45 82 29 4 33 23 23Visit 2 0 0 0 0 Trained 22 19 19 38 13 1 14 0 0

4638 0 0 0 Operational 48 37 45 82 29 4 33 23 23

Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total1701 1623 3324 3927 3722 7649 3395 3267 6662 9976 10265 20241 18999 18877 37876

3 0 3 13 14 27 5 1 6 11 12 23 32 27 590 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 02 0 2 6 3 9 0 0 0 1 0 1 9 3 121 0 1 1 1 2 2 1 3 1 1 2 5 3 80 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 1 2 0 0 0 2 1 3 3 2 50 0 0 0 0 0 0 3 3 0 3 35 9 14 3 0 3 7 7 14 15 16 310 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 5 4 9 17 26 43 22 30 520 0 0 0 0 0 5 11 16 5 11 160 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 1 0 1 1

0 0 0 0 0 00 0 0 4 5 9 4 5 9

0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 5 3 8 8 10 18 13 13 26

0 0 0 121 100 221 228 209 437 551 496 1047 900 805 170572 56 128 69 58 127 171 155 326 312 269 5817 9 16 13 9 22 17 15 32 37 33 70

0 0 0 0 0 019 18 37 37 36 73 59 54 113 115 108 22322 17 39 109 106 215 303 272 575 434 395 8291 0 1 0 0 0 1 0 1 2 0 20 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0

0 0 0 3 5 8 4 5 9 87 87 174 94 97 191

1 2 3 0 1 1 56 56 112 57 59 1160 0 0 3 0 3 5 4 9 8 4 120 0 0 0 1 1 5 2 7 5 3 81 0 1 0 0 0 1 3 4 2 3 50 2 2 0 0 0 5 6 11 5 8 131 1 2 1 1 2 4 2 6 6 4 100 0 0 0 2 2 0 2 2 0 4 4

0 2 2 0 2 21 1 2 1 1 210 9 19 10 9 19

Adolescent Health:Total 0 0 0 0 0 0 0 0 0 3 67 70 3 67 700 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 5 5 0 5 50 0 0 0 28 28 0 28 28

0 0 0 3 5 8 3 5 8

0 0 0 0 0 0 0 0 00 0 0 0 29 29 0 29 29

Primary care

(PHC/CHC)

Secondary Care (DH/SDH/MC)

Tertiary Care (DEIC)


Secondary Care

(DH/SDH/SNCU)

Tertiary Care

(DEIC)/MC

Primary care

(PHC/CHC)

Secondary Care

(DH/SDH/SNCU)


Primary care

(PHC/CHC)

Secondary Care

(DH/SDH/SNCU)

Tertiary Care

(DEIC)/MC

Primary care

(PHC/CHC)


SNCU)


Male 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Female 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1

Male 0 0 2 0 1 4 0 0 0 0 0 1 0 1 7Female 0 0 0 0 0 3 0 0 0 0 0 0 0 0 3Male 0 0 1 0 1 1 0 0 2 0 1 0 0 2 4

Female 0 0 0 0 0 1 0 0 1 0 0 1 0 0 3

Male 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 1 0 0 0 0 0 2 0 0 3Female 0 0 1 0 0 0 0 0 1 0 0 2

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 1 2 0 1 2

Male 0 2 2 0 0 3 0 0 7 0 2 12

Female 0 0 8 0 0 0 0 0 8 0 0 16

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0


Rashtriya Bal Swasthya Karyakram (RBSK)MONTHLY REPORTING FORMAT (BLOCK/ DISTRICT/ STATE) - FORM-IV

Name of State/UT: Tripura No of Reported Districts: No of Blocks : 58 Reporting Month JANUARY Reporting Year 2020-20216 weeks to 3 years (MHT) 3-6 years years enrolled in Govt and Govt aided schools (MHT) 6-18 years enrolled in Govt and Govt aided schools (MHT)

Target :

Total children to be screened in


No. of children

screened in current

month /Yearby M.H.T.



Percentage of total children screened till this month

(Cumulative)


conditions in current month


Screening details at AWCs DEIC and MHT Information Annual

plan :

Total visit

to be planned in

this year

Total AWC/School visit planned in this month by Mobile Health

Teams

Total AWC/School visit conducted this month by Mobile Health

Teams

Cumulative gap including carry forward from

previous month of the current year

Percentage of total children screened till this month

(Cumulative)


conditions in current

month


Target :

Total children to

be screened in complete

year by M.H.T.

No. of children

screened in current

month/year by M.H.T.





(Cumulative)


health conditions in current month/year


Target :

Total children to

be screened in complete

year by M.H.T.

No. of children

screened in current

month/year by M.H.T.



Total MHT

Doctors Pharmacist ANM/ Staff nurse Remarks by State RBSK Team

6 years to 18 years Total childrenScreened Children with Health

Condition Screened Children with Health Condition

Defects at Birth: Total Defect at BirthNeural tube defectDown’s Syndrome

AWC

Govt and Govt aided schools

Number of Children screened in the year : Current Reporting Month (From) APRIL (To) End of Rerpoting Month JANUARY

Birth-6 weeks 6 weeks to 3 years 3 years to 6 years

ASHA, HBNC Screened Children with Health Condition Screened Children with Health Condition

Congenital cataractCongenital deafnessCongenital heart diseases

Cleft Lip & Palate Club footDevelopmental dysplasia of the hip

Deficiencies:Total DeficienciesSevere AnaemiaVitamin A deficiency (Bitot spot)

Retinopathy of PrematurityMicrocephaly Macrocephaly

C) ObesityGoitre Severe Stunting

Vitamin D Deficiency, (Rickets)A) SAM B) Severe Thinning

Otitis MediaRheumatic heart disease Reactive airway disease


Childhood Diseases:Total Childhood DiseasesSkin conditions

Childhood T.B. Childhood Extra Pulmonary T. B.

Developmental Delays including Disabilities:Total

Developmental Delays including Disabilities

Dental Conditions Convulsive disordersChildhood leprosy Disease

Motor delay Cognitive delayLanguage delay

Vision impairmentHearing ImpairmentNeuro motor impairment

Others

Adolescent HealthGrowing up concernsSubstance abuse

Behaviour disorder (Autism)Learning disorderAttention deficit hyperactivity disorder


Discharge/ foul smelling discharge from the genitor-urinary areaPain during menstruation

Feel depressedDelay in menstruation cyclesIrregular periods

Neural tube defect

Down’s Syndrome

Refer Children for Health Conditions at other facility

ASHA, HBNC Refered Children with Health Condition Refered Children with Health Condition Refered Children with Health Condition Refered Children with Health Condition

Total Children Refered

Birth-6 weeks 6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Children Referred from Facilities


Congenital cataract

Cleft Lip & Palate

Club foot


Microcephaly

Congenital deafness


Macrocephaly

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 4 1 0 4 1 0

Female 0 0 0 0 0 0 10 1 0 10 1 0

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0

Female 0 0 0 1 0 0 1 0 0

Male 0 0 0 0 0 0

Female 0 0 0 0 0 0

Male 0 0 0 0 0 0 4 0 2 4 0 2

Female 0 0 0 0 0 0 4 1 1 4 1 1

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 3 0 2 4 0 4 0 0 6 7 0

Female 0 1 0 2 4 0 6 0 0 8 5 0

Male 52 12 0 46 20 0 105 59 0 203 91 0

Female 42 11 0 38 16 0 97 52 0 177 79 0

Male 5 0 0 11 2 0 14 2 1 30 4 1

Female 5 0 0 9 0 0 10 5 0 24 5 0

Male 0 0 0 0 0 0

Female 0 0 0 0 0 0

Male 20 0 0 35 2 0 56 6 0 111 8 0

Female 18 0 0 35 0 0 56 4 0 109 4 0

Male 18 3 2 77 25 5 180 90 21 275 118 28

Female 14 2 1 73 25 5 157 83 20 244 110 26

Male 0 1 0 0 0 0 0 1 0 0 2 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 1 0 0 0 12 13 31 12 13 32

Female 0 0 3 0 0 1 11 11 34 11 11 38

Male 0 0 0 0 0 3 0 0 6 0 0 9

Female 0 0 0 0 0 0 0 2 2 0 2 2

Male 0 0 0 0 0 0 0 0 5 0 0 5

Female 0 0 1 0 0 1 0 0 2 0 0 4

Male 0 0 1 0 0 0 0 0 1 0 0 2

Female 0 0 0 0 0 0 0 0 3 0 0 3

Male 0 0 1 0 0 0 0 0 5 0 0 6

Female 0 0 2 0 0 0 0 0 6 0 0 8

Male 0 0 0 0 0 1 0 0 4 0 0 5

Female 0 0 1 0 0 1 0 0 2 0 0 4

Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 2 0 0 2 0 0 4

Male 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 2 0 0 2

Male 0 0 0 0 0 1 0 0 1

Female 0 0 0 0 0 1 0 0 1

Male 0 0 0 33 0 2 33 0 2

Female 0 0 0 35 2 2 35 2 2

Male 0 0 0 0 0 0

Female 0 0 0 0 0 0

Male 0 0 0 0 0 0

Female 0 0 0 0 0 0

Male 0 0 0 0 0 0

Female 0 0 0 0 0 0

Male 0 0 0 0 0 0

Female 5 0 0 5 0 0

Male 0 0 0 0 0 0

Female 8 8 12 8 8 12

Male3 0 0

3 0 0

Female 5 0 0 5 0 0

Male 0 0 0 0 0 0

Female 0 0 0 0 0 0

Male 0 0 0 0 0 0

Female 20 9 0 20 9 0

Male 0 0 3 0 4 8 0 0 5 0 1 10 0 5 26

Female 0 0 0 0 0 13 0 0 1 0 1 13 0 1 27

Male 0 0 0 0 3 0 2 4 0 12 1 2 14 8 2

Female 0 0 0 0 1 0 3 4 0 20 2 1 23 7 1

Male 0 0 0 95 16 2 169 49 5 355 158 22 619 223 29

Female 0 0 0 79 13 1 155 41 5 320 144 20 554 198 26

Male 0 0 0 0 0 3 0 0 4 45 13 55 45 13 62



Severe Anaemia

C)Obesity

Goitre

A)SAM

B)Severe Thinning

Skin conditions

Ottis Media

Severe Stunting


Dental Conditions

Convulsive Disorders

Rheumatic Heart Disease

Reactive Airway Disease

Hearing Impairment



Childhood T.B.


Vision impairment

Language delay


Motor delay

Cognitive delay

Others

Growing up concerns

Learning disorder



Irregular periods

Substance abuse

Feel depressed


Defects at Birth




Deficiencies

Childhood Diseases

Female 0 0 0 0 0 7 0 0 5 46 15 56 46 15 68

Male 0 0 3 95 23 13 171 53 14 412 173 89 678 249 119

Female 0 0 0 79 14 21 158 45 11 386 162 90 623 221 122


Grand Total

Date

Report prepared by Report verified by Block/ District / State Nodal personName

Signature Designation

58 Reporting Year

Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Birth-6 weeksASHA,HBNC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Birth-6 weeksASHA,HBNC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Birth-6 weeksASHA,HBNC 2 0 0 0 0 0 2 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 06 Weeks- 3 Yrs 7 2 0 0 1 0 4 2 0 0 0 0 6 3 0 0 0 1 1 1 0 0 5 13- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0Birth-6 weeksASHA,HBNC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 2 1 0 0 2 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 13- 6 Yrs 2 1 0 0 0 0 2 1 0 0 0 0 2 1 0 0 0 0 0 0 0 0 2 16-18 Yrs 2 1 0 0 2 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1Birth-6 weeksASHA,HBNC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Birth-6 weeksASHA,HBNC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 13- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 2 1 0 0 0 0 2 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1Birth-6 weeksASHA,HBNC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 0 4 0 0 0 2 0 2 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 3Birth-6 weeksASHA,HBNC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 6 9 0 0 2 0 1 8 0 0 0 0 4 8 0 0 1 0 0 0 0 0 4 63- 6 Yrs 3 0 0 0 0 0 3 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2 06-18 Yrs 4 5 0 0 0 0 4 6 0 0 0 0 1 2 0 0 0 0 0 2 0 0 1 2Birth-6 weeksASHA,HBNC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 5 11 4 10 1 1 0 0 0 0 0 0 5 11 5 11 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 6 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 03- 6 Yrs 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 5 6 6 5 0 1 2 1 0 0 0 0 3 5 1 2 0 0 0 0 0 0 2 36 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Years 67 53 49 43 10 8 0 0 0 0 0 0 67 55 59 47 0 0 0 0 0 0 7 53- 6 Yrs 73 63 52 41 20 15 0 0 0 0 0 0 65 52 60 47 0 0 0 0 0 0 2 26-18 yrs 187 172 117 110 56 50 0 0 0 0 0 0 140 124 116 102 0 0 0 0 0 0 10 156 Weeks- 3 Years 11 15 7 7 0 0 0 0 0 0 0 0 7 8 2 2 0 0 0 0 0 0 5 63- 6 Yrs 17 15 15 15 2 0 0 0 0 0 0 0 8 8 5 4 0 0 0 0 0 0 3 46-18 yrs 18 15 16 10 2 5 0 0 0 0 0 0 14 13 11 10 0 0 0 0 0 0 3 36 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Years 9 5 5 5 0 0 0 0 0 0 0 0 7 4 4 3 0 0 0 0 0 0 1 13- 6 Yrs 27 27 25 25 2 0 0 0 0 0 0 0 25 25 17 21 0 0 0 0 0 0 8 36-18 yrs 42 33 36 29 6 4 0 0 0 0 0 0 39 29 25 21 0 0 0 0 0 0 14 86 Weeks- 3 Years 19 15 16 13 3 2 0 0 0 0 0 0 24 23 22 23 0 0 0 0 0 0 2 03- 6 Yrs 113 110 82 77 23 24 4 3 0 0 0 0 92 89 84 84 0 0 0 0 0 0 8 76-18 yrs 322 302 202 190 86 80 19 18 0 0 0 0 256 239 202 191 4 3 9 6 0 0 36 396 Weeks- 3 Years 1 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 1 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 06 Weeks- 3 Years 1 2 0 0 0 0 1 3 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 03- 6 Yrs 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 16-18 yrs 60 57 16 12 13 11 31 34 0 0 0 0 54 53 15 16 0 0 24 24 0 0 12 96 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 3 0 0 0 0 0 3 0 0 0 0 0 3 0 1 0 0 0 1 0 0 0 1 06-18 yrs 5 5 0 1 0 2 5 2 0 0 0 0 4 3 1 1 0 0 1 1 0 0 2 16 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


Rashtriya Bal Swasthya Karyakram (RBSK)MONTHLY REPORTING FORMAT (BLOCK/ DISTRICT/ STATE) - FORM-V

JANUARY 2020-2021

S.No Health Condition Details

Number of children with selected health conditions

Identified through screeningReferal

ConfirmedManaged

Name of State/UT: Tripura No of Reported Districts: 8 No of Blocks : Reporting Month

Waiting for service accessPrimary care (PHC/CHC)

Secondary Care (DH/Medical)

Tertiary Care (DEIC) District TB programme District Leprosy programme Medical Surgery Early Intervention AFHC counselling

4 Club foot

5 Developmental dysplasia of the hip

6 Congenital cataract

1 Neural tube Defect

2 Down Syndrome

3 Cle Lip & Palate

10 Severe Anaemia

11 Vitamin A deficiency (Bitot spot)

12 Vitamin D Deficiency, (Rickets)

7 Congenital Deafness

8 Congenital Heart Diseases

9 Retinopathy of Prematurity

16 Otitis Media

17 Rheumatic heart disease

18 Reactive airway disease

A) SAM

B) Severe Thinning

C) Obesity

14 Goitre

15 Skin conditions

22 Hearing Impairment

23 Neuro motor impairment

19 Dental Condi ons

20 Convulsive disorders

21 Vision impairment

6-18 yrs 5 2 0 0 0 0 5 2 0 0 0 0 5 2 0 0 0 0 0 0 0 0 5 26 Weeks- 3 Years 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 1 3 0 0 0 0 1 3 0 0 0 0 1 3 0 0 0 0 0 0 0 0 1 36 Weeks- 3 Years 0 2 0 0 0 0 0 2 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 5 6 0 0 0 0 5 6 0 0 0 0 5 6 0 0 0 0 0 0 0 0 4 46 Weeks- 3 Years 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 13- 6 Yrs 1 1 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 16-18 yrs 4 2 0 0 0 0 4 2 0 0 0 0 4 2 0 0 0 0 0 0 0 0 4 26 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 2 0 0 0 0 0 2 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 16-18 yrs 0 2 0 0 0 0 0 2 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 13- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 2 0 0 0 0 0 2 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 13- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 12 10 10 6 0 2 2 2 0 0 0 0 11 9 11 8 0 0 0 0 0 0 0 2

31 Growing up concerns 6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 032 Substance abuse 6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 033 Feel depressed 6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 034 Delay in menstruation cycles 6-18 yrs 0 5 0 5 0 0 0 0 0 0 0 0 0 5 0 5 0 0 0 0 0 0 0 035 Irregular periods 6-18 yrs 0 29 0 8 0 9 0 12 0 0 0 0 0 27 0 27 0 0 0 0 0 0 0 136


6-18 yrs 3 5 3 5 0 0 0 0 0 0 0 0 3 5 3 5 0 0 0 0 0 0 0 0

37Discharge/ foul smelling discharge from the genitor-urinary area

6-18 yrs

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0

38 Pain during menstruation 6-18 yrs 0 33 0 20 0 13 0 0 0 0 0 0 0 28 0 25 0 0 0 0 0 0 0 36 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

41 6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Birth-6 weeks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Birth-6 weeks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 03- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06 Weeks- 3 Years 0 0 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 03- 6 Yrs 5 3 2 2 4 4 0 0 0 0 0 0 5 3 5 3 0 0 0 0 0 0 0 06-18 yrs 8 10 4 6 0 0 0 0 0 0 0 0 8 10 8 10 0 0 0 0 0 0 0 0Birth-6 weeksASHA,HBNC 2 0 0 0 0 0 2 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 06 Weeks- 3 Yrs 16 13 0 0 5 0 6 12 0 0 0 0 12 14 0 1 1 1 1 2 0 0 11 103- 6 Yrs 5 1 0 0 0 0 5 1 0 0 0 0 4 1 0 0 0 0 0 0 0 0 4 16-18 Yrs 9 11 0 0 2 2 7 10 0 0 0 0 4 7 0 0 0 0 0 3 0 0 4 76 Weeks- 3 Years 0 0 0 0 3 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 03- 6 Yrs 5 4 2 3 4 4 0 0 0 0 0 0 5 4 5 4 0 0 0 0 0 0 0 06-18 yrs 18 27 14 21 1 2 2 1 0 0 0 0 16 26 14 23 0 0 0 0 0 0 2 36 Weeks- 3 Years 107 88 77 68 14 10 0 0 0 0 0 0 106 90 88 75 0 0 0 0 0 0 15 123- 6 Yrs 230 215 174 158 47 39 4 3 0 0 0 0 190 174 166 156 0 0 0 0 0 0 21 166-18 yrs 570 522 371 339 151 139 19 18 0 0 0 0 450 405 355 324 4 3 9 6 0 0 63 65ASHA Visited As per MCP Card 0 0 0 0 0 06 Weeks- 3 Years 3 5 0 0 0 0 3 6 0 0 0 0 2 4 0 0 0 0 2 1 0 0 0 13- 6 Yrs 4 5 0 0 0 0 4 5 0 0 0 0 3 4 1 0 0 0 1 0 0 0 1 36-18 yrs 93 90 26 19 13 15 54 56 0 0 0 0 85 81 27 25 0 0 25 25 0 0 30 25

Adolescent Health 6-18 yrs 3 72 3 38 0 22 0 12 0 0 0 0 3 65 3 62 0 0 0 0 0 0 0 4Birth-6 weeksASHA,HBNC 3 0 0 0 0 0 3 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0

6 Weeks- 3 Years 126 106 77 68 22 20 27 18 0 0 0 0 120 109 88 77 1 1 3 3 0 0 28 283- 6 Yrs 244 225 176 161 51 43 17 21 0 0 0 0 202 183 172 160 0 0 1 0 0 0 29 236-18 yrs 693 722 414 445 167 180 112 97 0 0 0 0 558 584 399 434 4 3 34 34 0 0 121 113

24 Motor delay

28 Learning disorder

29Attention deficit hyperactivity disorder

30 Others

25 Cognitive delay

26 Language delay

27 Behaviour disorder (Autism)

Severe Stunting

42 Microcephaly

43 Macrocephaly

44 Vitamin B complex deficiency

39 Childhood leprosy Disease

40 Childhood T.B.

40.1 Childhood Extra Pulmonary T. B.

Developmental Delays including Disabilities

Total Children identified

Report prepared by

Defect at Birth

Deficiency

Childhood Diseases

Report verified by Block/ District / State Nodal person

Name

Signature

Designation

Date

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