Ministry of Health & Family Welfare

Government of India
Rashtriya Bal Swasthya Karyakram (RBSK)
MONTHLY REPORTING FORMAT (ASHA,HBNC) - FORM No - II

Name of State: Tripura Name of District Name of Block

Number of ASHAs Reporting Month May Reporting Year 2021
Birth-6 weeks
ASHA, HBNC
Male Female Total
Total number of deliveries reported in catchment area of ASHA in the reporting
1135 1110 2245
month

Total number of New borns to be visited in the current month 1169 1141 2310
Number of newborn visited by the ASHA in HBNC visit in the month 1518 1483 3001
Cumulative Number of deliveries in the year ___2021_____ From ____April____ To
2208 2270 4478
__May___________

Cumulative Number of Children screened for defects at birth during HBNC visits in the year
__2021______ From ____April____ To _____May________
2736 2768 5504

Total Number of Children identified with Defect at Birth by ASHA 96 106 202

Sl No Defects at Birth: 1 4 5
1 Neural tube defect 0 0 0
2 Down’s Syndrome 0 0 0
3 Cleft Lip & Palate 0 1 1
4 Club foot 1 3 4
5 Developmental dysplasia of the hip 0 0 0
Developmental Delay identified as per revised MCP card
6
Age of child No of children visited in current month 1 4 5
6.1 At 3 months 0 0 0
6.2 At 6 months 0 0 0
6.3 At 9 months 0 1 1
6.4 At 12 months 1 3 4
6.5 At 15 months 0 0 0

Secondary Care Tertiary Care (DEIC)

Total Children Refered Primary care (PHC/CHC) Total
(DH/SDH/SNCU) /MC

Male 0 0 0 0
Neural tube defect
Female 0 0 0 0

Male 0 0 0 0
Down’s Syndrome
Female 0 0 0 0
Male 0 0 0 0
Cleft Lip & Palate
Female 0 0 1 1

Male 0 0 1 1
Club foot
Female 0 0 3 3

Developmental Male 0 0 0 0
dysplasia
of the hip Female 0 0 0 0
Male 0 0 0 0
3 Months
Female 0 0 0 0
Male 0 0 0 0
6 Months
Female 0 0 0 0
Male 0 0 0 0
9 Months
Female 0 0 1 1
Developmental Delay
Male 0 0 1 1
12 Months
Female 0 0 3 3
Male 0 0 0 0
15 Months
Female 0 0 0 0
 Male 0 0 0 0
Total Referred
Female 0 0 0 0
Report prepared by Asha Report verified by ANM Report verified by ASHA supervisor

Name

Signature

Date
 Ministry of Health & Family Welfare
Government of India
Rashtriya Bal Swasthya Karyakram (RBSK)
MONTHLY REPORTING FORMAT (MHT) - FORM No - III
State: Tripura District Name of Block MHT Team Code Reporting Month May Reporting Year 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 : Target :
Target : Total Percentage of Found positive No. of children No. of children Percentage of Found positive
No. of children No. of children Total Percentage of total Found positive for Total No. of children
children to be total children for selected screened in No. of children Referred for this screened in total children for selected Referred for
screened in screened Referred for this children to be children screened selected health children to be screened
screened in screened till this health conditions current screened cumulative current current screened till this health this current
current month cumulative till current month/year screened in till this month conditions in current screened in cumulative till
complete year month in current month/year by till current month month/year month/year by month conditions in month/year
/Yearby M.H.T. current month complete year by (Cumulative) month complete year by current month
by M.H.T. (Cumulative) month/year M.H.T. M.H.T. (Cumulative) current month
M.H.T. M.H.T.

Male 93753 2357 5416 6% 142 142 99588 2379 5798 6% 274 274 246553 1495 8778 4% 255 255
Female 90102 2252 5203 6% 110 110 96961 2223 5555 6% 217 217 250652 1630 9163 4% 266 266
Total 183855 4609 10619 6% 252 252 196549 4602 11353 6% 491 491 497205 3125 17941 4% 521 521
Screening details at AWCs Composition of Mobile Health Team
Doctors Pharmacist ANM/ Staff nurse Total

Total Cumulative gap

Annual plan :
Total AWC/School AWC/School including carry Total Number
visit planned in this visit conducted forward from MHT Details
Total visit to be of MHT Male Female Male Female Male Female Doctors Pharmacist ANM/SN
month by Mobile this month by previous month
planned in this
Health Teams Mobile Health of the current
year
Teams year

Visit 1 9911 148 72 Approved 48 48 48 48 0 0 48 96 48 48

AWCs
Visit 2 0 0 In-place 48 36 42 26 2 0 28 78 28 28
Govt and Govt aided schools 4638 63 23 Trained 48 36 42 26 2 0 28 78 28 28
Functional 48 36 42 26 2 0 28 78 28 28
6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Number of Children Screened
Number of Children screened in
Screened Children with Health Condition Screened Children with Health Condition Screened Children with Health Condition Screened Children with Health Condition
Remarks by MHT Team
………May 2021……………………….
Male Female Total Male Female Total Male Female Total Male Female Total
(Reporting Month)
2357 2252 4609 2379 2223 4600 1495 1630 3125 6231 6105 12336
Defects at Birth: Total 18 7 25 1 4 5 4 10 14 23 21 44 Defect at Birth
Neural tube defect 0 0 0 0 0 0 0 0 0 0 0 0

Down’s Syndrome 1 0 1 0 0 0 0 2 2 1 2 3

Cleft Lip & Palate 3 1 4 0 0 0 1 1 2 4 2 6

Club foot 5 1 6 0 0 0 0 1 1 5 2 7

Developmental dysplasia of the hip 0 1 1 0 0 0 0 0 0 0 1 1

Congenital cataract 1 0 1 0 0 0 0 0 0 1 0 1

Congenital deafness 2 0 2 0 0 0 0 0 0 2 0 2

Congenital heart diseases 6 4 10 1 4 5 3 6 9 10 14 24

Retinopathy of Prematurity 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
Deficiencies:Total 7 11 18 17 17 34 11 15 26 35 43 78 Deficiencies
Severe Anaemia 3 5 8 7 4 11 1 4 5 11 13 24
Vitamin A deficiency (Bitot spot) 0 0 0 2 1 3 2 1 3 4 2 6
Vitamin D Deficiency, (Rickets) 0 0 0 0 0 0 1 0 1 1 0 1
A) SAM 4 6 10 3 8 11 0 0 0 7 14 21
B) Severe Thinning 0 0 0 0 0 0 4 7 11 4 7 11
C) Obesity 0 0 0 0 0 0 1 1 2 1 1 2
Goitre 0 0 0 0 0 0 0 0 0 0 0 0
Severe Stunting 0 0 0 0 0 0 0 0 0 0 0 0
Vitamin B complex deficiency. 0 0 0 5 4 9 2 2 4 7 6 13
Childhood Diseases:Total 100 83 183 250 191 441 201 187 388 551 461 1012 Childhood Diseases
Skin conditions 52 51 103 80 66 145 45 40 85 177 157 334
Otitis Media 4 2 6 11 2 13 7 3 10 22 7 29
Rheumatic heart disease 0 0 0 0 0 0 0 0 0 0 0 0
Reactive airway disease 22 18 40 19 11 29 10 9 19 51 38 89
Dental Conditions 20 12 32 140 112 252 139 135 274 299 259 558
Convulsive disorders 2 0 2 0 0 0 0 0 0 2 0 2
Childhood leprosy Disease 0 0 0 0 0 0 0 0 0 0 0 0
Childhood T.B. 0 0 0 0 0 0 0 0 0 0 0 0
Childhood Extra Pulmonary T. B. 0 0 0 0 0 0 0 0 0 0 0 0

Developmental Delays
17 9 26 6 5 11 39 31 70 62 45 107 Developmental Delays including Disabilities
including Disabilities:Total

Vision impairment 4 5 9 1 1 2 20 22 42 25 28 53

Hearing Impairment 0 1 1 1 0 1 2 2 4 3 3 6

Neuro motor impairment 4 2 6 0 0 0 4 1 5 8 3 11

Motor delay 3 1 4 0 2 2 1 2 3 4 5 9

Cognitive delay 0 0 0 1 0 1 0 0 0 1 0 1

Language delay 5 0 5 2 2 4 4 1 5 11 3 14

Behaviour disorder (Autism) 1 0 1 1 0 1 1 0 1 3 0 3

Learning disorder 0 0 0 0 0 0 0 0 0 0 0 0

Attention deficit hyperactivity disorder 0 0 0 0 0 0 1 1 2 1 1 2

Others 0 0 0 0 0 0 6 2 8 6 2 8
Adolescent Health:Total 0 0 0 0 0 0 0 23 23 0 23 23 Adolescent Health
Growing up concerns 0 0 0 0 0 0 0 0 0 0 0 0

Substance abuse 0 0 0 0 0 0 0 0 0 0 0 0
Feel depressed 0 0 0 0 0 0 0 0 0 0 0 0

Delay in menstruation cycles 0 0 0 0 0 0 0 5 5 0 5 5

Irregular periods 0 0 0 0 0 0 0 11 11 0 11 11

Pain or burning sensation while urinating 0 0 0 0 0 0 0 0 0 0 0 0

Discharge/ foul smelling discharge from

0 0 0 0 0 0 0 1 1
the genitor-urinary area 0 1 1

Pain during menstruation 0 0 0 0 0 0 0 6 6 0 6 6

6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Number of Children Refered at
Total Children Refered with Heatlth Secondary
Conditions Primary care
Secondary Care
Tertiary Care Primary care
Secondary Care
Tertiary Care Primary care
Secondary Care
Tertiary Care Primary care Care Tertiary Care
Refer Children for Health Conditions at facility
(DH/SDH/ (DH/SDH/ (DH/SDH/
(PHC/CHC) (DEIC)/MC (PHC/CHC) (DEIC)/MC (PHC/CHC) (DEIC)/MC (PHC/CHC) (DH/SDH/ (DEIC)/MC
SNCU) SNCU) SNCU)
SNCU)
Male 0 0 0 0 0 0 0 0 0 0 0 0
Neural tube defect
Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 1 0 0 0 0 0 0 0 0 1 0 0
Down’s Syndrome
Female 0 0 0 0 0 0 0 0 2 0 0 2
Male 1 0 2 0 0 0 0 0 1 1 0 3
Cleft Lip & Palate
Female 0 0 1 0 0 0 0 0 1 0 0 2
Male 0 0 5 0 0 0 0 0 0 0 0 5
Club foot
Female 0 0 1 0 0 0 0 0 1 0 0 2
Developmental dysplasia Male 0 0 0 0 0 0 0 0 0 0 0 0
of the hip Female 0 0 1 0 0 0 0 0 0 0 0 1
Male 0 0 1 0 0 0 0 0 0 0 0 1
Congenital cataract
Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 0 0 2 0 0 0 0 0 0 0 0 2
Congenital deafness
Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 0 0 6 0 0 1 0 0 3 0 0 10
Congenital heart diseases
Female 0 0 4 0 0 4 0 0 6 0 0 14
Male 0 0 0 0 0 0 0 0 0 0 0 0
Retinopathy of Prematurity
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
Microcephaly
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
Macrocephaly
Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 3 0 0 7 0 0 0 1 0 10 1 0
Severe Anaemia
Female 5 0 0 4 0 0 4 0 0 13 0 0
Vitamin A deficiency Male 0 0 0 0 0 2 1 0 1 1 0 3
(Bitot spot)
(Bitot spot) Female 0 0 0 0 0 1 0 0 1 0 0 2
Vitamin D Deficiency, Male 0 0 0 0 0 0 0 1 0 0 1 0
(Rickets) Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 4 0 0 2 1 0 0 0 0 6 1 0
A)SAM Female 3 1 2 4 2 2 0 0 0 7 3 4
Male 0 0 0 0 0 0 2 2 0 2 2 0
B)Severe Thinning Female 0 0 0 0 0 0 0 6 1 0 6 1
Male 0 0 0 0 0 0 0 0 0 0 0 0
C)Obesity Female 0 0 0 0 0 0 1 1 0 1 1 0
Male 0 0 0 0 0 0 0 0 0 0 0 0
Goitre 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
Severe Stunting Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 0 0 0 2 3 0 2 0 0 4 3 0
Vitamin B complex deficiency. Female 0 0 0 1 3 0 2 0 0 3 3 0
Male 44 8 0 60 22 0 32 13 0 136 43 0
Skin conditions Female 38 13 0 54 10 0 26 14 0 118 37 0
Male 4 0 0 8 3 0 5 2 0 17 5 0
Ottis Media Female 2 0 0 2 0 0 2 1 0 6 1 0
Male 0 0 0 0 0 0 0 0 0 0 0 0
Rheumatic Heart Disease Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 21 1 0 16 3 0 7 3 0 44 7 0
Reactive Airway Disease Female 18 0 0 11 0 0 6 3 0 35 3 0
Male 14 6 0 87 44 9 85 44 10 186 94 19
Dental Conditions Female 9 3 0 67 34 11 83 42 10 159 79 21
Male 0 2 0 0 0 0 0 0 0 0 2 0
Convulsive Disorders 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
Childhood leprosy Disease 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
Childhood T.B. 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
Childhood Extra Pulmonary T. B. Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 0 1 3 0 0 1 2 5 13 2 6 17
Vision impairment Female 1 1 3 0 0 1 3 2 17 4 3 21
Male 0 0 0 0 0 1 0 1 1 0 1 2
Hearing Impairment Female 0 0 1 0 0 0 0 0 2 0 0 3
Male 1 0 3 0 0 0 0 1 3 1 1 6
Neuro motor impairment Female 0 0 2 0 0 0 0 0 1 0 0 3
Male 0 0 3 0 0 0 0 0 1 0 0 4
Motor delay Female 0 0 1 0 0 2 0 1 1 0 1 4
Male 0 0 0 0 0 1 0 0 0 0 0 1
Cognitive delay Female 0 0 0 0 0 0 0 0 0 0 0 0
Male 0 0 5 0 0 2 0 0 4 0 0 11
Language delay Female 0 0 0 0 0 2 0 0 1 0 0 3
Behaviour disorder Male 0 0 1 0 0 1 0 0 1 0 0 3
(Autism) Female 0 0 0 0 0 0 0 0 0 0 0 0
Learning disorder 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
Attention deficit hyperactivity Male 0 0 0 0 0 0 0 0 1 0 0 1
disorder Female 0 0 0 0 0 0 0 0 1 0 0 1
Others Male 0 0 0 0 0 0 4 0 0 4 0 0
Female 0 0 0 0 0 0 4 0 0 4 0 0
Growing up concerns 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
Substance abuse 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
Feel depressed 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
Delay in menstruation cycles Male 0 0 0 0 0 0 0 0 0 0 0 0
Female 0 0 0 0 0 0 0 5 0 0 5 0
Irregular periods Male 0 0 0 0 0 0 0 0 0 0 0 0
Female 0 0 0 0 0 0 3 8 0 3 8 0
Pain or burning sensation while Male 0 0 0 0 0 0 0 0 0 0 0 0
urinating Female 0 0 0 0 0 0 0 0 0 0 0 0
Discharge/ foul smelling discharge Male 0 0 0 0 0 0 0 0 0 0 0 0
from the
genitor-urinary area Female 0 0 0 0 0 0 0 1 0 0 1 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Pain during menstruation
Female 0 0 0 0 0 0 3 3 0 3 3 0
Male 2 0 16 0 0 1 0 0 4 2 0 21
Defects at Birth
Female 0 0 7 0 0 4 0 0 10 0 0 21
Male 7 0 0 11 4 2 5 4 1 23 8 3
Deficiencies
Female 8 1 2 9 5 3 7 7 2 24 13 7
Male 83 17 0 171 72 9 129 62 10 383 151 19
Childhood Diseases
Female 67 16 0 134 44 11 117 60 10 318 120 21

Male 1 1 15 0 0 6 6 7 24 7 8 45
Developmental Delays
Female 1 1 7 0 0 5 7 3 23 8 4 35

Male 0 0 0 0 0 0 0 0 0 0 0 0
Adolescent Health
Female 0 0 0 0 0 0 6 17 0 6 17 0

Grand Total
Male 93 18 31 182 76 18 140 73 39 415 167 88
Female 76 18 16 143 49 23 137 87 45 356 154 84

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

Name of the Nodal Person

Signature
Designation
Date
 Ministry of Health & Family Welfare
Government of India
Rashtriya Bal Swasthya Karyakram (RBSK)
MONTHLY REPORTING FORMAT (BLOCK/ DISTRICT/ STATE) - FORM-IV
Name of State/UT: Tripura No of Reported Districts: 8 No of Blocks : 58 Reporting Month May Reporting Year 2021
6 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 : No. of No. of children Percentage of Found positive for Referred for Target : No. of No. of children Percentage of Found Referred for Target : No. of No. of children Percentage of Found positive for Referred for this
children screened total children selected health this current children screened total children positive for this current children screened total children selected health current month/year
Total screened cumulative till screened till this conditions in month/year Total screened in cumulative till screened till selected month/year Total screened in cumulative till screened till conditions in
children to be in current current month month current month/year children to current current month this month health children to current current month this month current month
screened in month (Cumulative) be screened month/year (Cumulative) conditions be screened month/year (Cumulative)
complete year by /Yearby in complete by M.H.T. in current in complete by M.H.T.
M.H.T. M.H.T. year by month year by
M.H.T. M.H.T.

Male 93753 2357 5416 6% 142 142 99588 2379 5798 6% 274 274 246553 1495 8778 4% 255 255
Female 90102 2252 5203 6% 110 110 96961 2223 5555 6% 217 217 250652 1630 9163 4% 266 266

Total
183855 4609 10619 6% 252 252 196549 4602 11353 6% 491 491 497205 3125 17941 4% 521 521
Screening details at AWCs DEIC and MHT Information
Annual Total AWC/School Total AWC/School Cumulative gap Doctors Pharmacist ANM/ Staff nurse Remarks by State RBSK Team
plan : visit planned in visit conducted including carry
this month by this month by forward from
Mobile Health Mobile Health previous month of
Total MHT
Total visit Teams Teams the current year Male Female Total Male Female Total Male Female Total
to be
planned in
this year

Number Number Number Number Approved 48 48 48 96 48 0 48 0 48 48

Visit 1 9911 148 72 In-place 48 36 42 78 26 2 28 0 28 28
AWC
Visit 2 0 0 Trained 48 36 42 78 26 2 28 0 28 28
Govt and Govt aided schools 4638 63 23 Operational 48 36 42 78 26 2 28 0 28 28
Birth-6 weeks 6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total children
Number of Children screened in the Screened Children with Health
year : Current Reporting Month (From) ASHA, HBNC Screened Children with Health Condition Screened Children with Health Condition Screened Children with Health Condition
Condition
__________ (To) End of Rerpoting
Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total
Month ______May 2021_______
1169 1141 2310 2357 2252 4609 2379 2223 4602 1495 1630 3125 7400 7246 14646
Defects at Birth: Total 1 4 5 18 7 25 1 4 5 4 10 14 24 25 49 Defect at Birth
Neural tube defect 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Down’s Syndrome 0 0 0 1 0 1 0 0 0 0 2 2 1 2 3
Cleft Lip & Palate 0 1 1 3 1 4 0 0 0 1 1 2 4 3 7
Club foot 1 3 4 5 1 6 0 0 0 0 1 1 6 5 11
Developmental dysplasia of the hip 0 0 0 0 1 1 0 0 0 0 0 0 0 1 1
Congenital cataract 1 0 1 0 0 0 0 0 0 1 0 1
Congenital deafness 2 0 2 0 0 0 0 0 0 2 0 2
Congenital heart diseases 6 4 10 1 4 5 3 6 9 10 14 24
Retinopathy of Prematurity 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
Deficiencies:Total 0 0 0 7 11 18 17 17 34 11 15 26 35 43 78 Deficiencies
Severe Anaemia 3 5 8 7 4 11 1 4 5 11 13 24
Vitamin A deficiency (Bitot spot) 0 0 0 2 1 3 2 1 3 4 2 6
Vitamin D Deficiency, (Rickets) 0 0 0 0 0 0 1 0 1 1 0 1
A) SAM 4 6 10 3 8 11 7 14 21
B) Severe Thinning 4 7 11 4 7 11
C) Obesity 0 0 0 1 1 2 1 1 2
Goitre 0 0 0 0 0 0 0 0 0 0 0 0
Severe Stunting 0 0 0 0 0 0 0 0 0
Vitamin B complex deficiency. 0 0 0 5 4 9 2 2 4 7 6 13
Childhood Diseases:Total 0 0 0 100 83 183 250 191 441 201 187 388 551 461 1012 Childhood Diseases
Skin conditions 52 51 103 80 66 146 45 40 85 177 157 334
Otitis Media 4 2 6 11 2 13 7 3 10 22 7 29
Rheumatic heart disease 0 0 0 0 0 0
Reactive airway disease 22 18 40 19 11 30 10 9 19 51 38 89
Dental Conditions 20 12 32 140 112 252 139 135 274 299 259 558
Convulsive disorders 2 0 2 0 0 0 0 0 0 2 0 2
Childhood leprosy Disease 0 0 0 0 0 0 0 0 0 0 0 0
Childhood T.B. 0 0 0 0 0 0 0 0 0 0 0 0
Childhood Extra Pulmonary T. B. 0 0 0 0 0 0 0 0 0 0 0 0

Developmental Delays including Developmental Delays including

1 4 5 17 9 26 6 5 11 39 31 70 63 49 112
Disabilities:Total Disabilities
Vision impairment 4 5 9 1 1 2 20 22 42 25 28 53
Hearing Impairment 0 1 1 1 0 1 2 2 4 3 3 6
Neuro motor impairment 4 2 6 0 0 0 4 1 5 8 3 11
Motor delay 3 1 4 0 2 2 1 2 3 4 5 9
Cognitive delay 0 0 0 1 0 1 0 0 0 1 0 1
Language delay 5 0 5 2 2 4 4 1 5 11 3 14
Behaviour disorder (Autism) 1 0 1 1 0 1 1 0 1 3 0 3
Learning disorder 0 0 0 0 0 0
Attention deficit hyperactivity disorder 1 1 2 1 1 2
Others 6 2 8 6 2 8
Adolescent Health:Total 0 0 0 0 0 0 0 0 0 0 23 23 0 23 23 Adolescent Health
Growing up concerns 0 0 0 0 0 0 0 0 0
Substance abuse 0 0 0 0 0 0 0 0 0
Feel depressed 0 0 0 0 0 0 0 0 0
Delay in menstruation cycles 0 0 0 0 5 5 0 5 5
Irregular periods 0 0 0 0 11 11 0 11 11
Pain or burning sensation while urinating 0 0 0 0 0 0 0 0 0
Discharge/ foul smelling discharge from
0 0 0 0 1 1 0 1 1
the genitor-urinary area
Pain during menstruation 0 0 0 0 6 6 0 6 6
Birth-6 weeks 6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Children Referred from Facilities

Refered Children with Health

ASHA, HBNC Refered Children with Health Condition Refered Children with Health Condition Refered Children with Health Condition
Condition Refer Children for Health Conditions
Total Children Refered
Secondary Secondary Primary Secondary at other facility
Primary Tertiary Primary Tertiary Primary Secondary Care
Secondary Care Tertiary Care Primary care Care Care Tertiary Care care Care Tertiary Care
care Care care Care care (DH/SDH/
(DH/SDH/MC) (DEIC) (PHC/CHC) (DH/SDH/ (DH/SDH/ (DEIC)/MC (PHC/CHC (DH/SDH/ (DEIC)/MC
(PHC/CHC) (DEIC)/MC (PHC/CHC) (DEIC)/MC (PHC/CHC) SNCU)
SNCU) SNCU) ) SNCU)
Neural tube defect 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
Down’s Syndrome
Male 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0
Female 0 0 0 0 0 0 0 0 0 0 0 2 0 0 2
Cleft Lip & Palate
Male 0 0 0 1 0 2 0 0 0 0 0 1
1 0 3
Female 0 0 1 0 0 1 0 0 0 0 0 1 0 0 3
Club foot Male 0 0 1 0 0 5 0 0 0 0 0 0 0 0 6
Female 0 0 3 0 0 1 0 0 0 0 0 1
0 0 5
Developmental dysplasia
Male 0 0 0 0 0 0 0 0 0 0 0 0
of the hip 0 0 0
Female 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1
Congenital cataract
Male 0 0 1 0 0 0 0 0 0
0 0 1
Female 0 0 0 0 0 0 0 0 0 0 0 0
Congenital deafness
Male 0 0 2 0 0 0 0 0 0
0 0 2
Female 0 0 0 0 0 0 0 0 0
0 0 0
Congenital heart diseases
Male 0 0 6 0 0 1 0 0 3
0 0 10
Female 0 0 4 0 0 4 0 0 6
0 0 14
Retinopathy of
Male 0 0 0 0 0 0 0 0 0
Prematurity 0 0 0
Female 0 0 0 0 0 0 0 0 0
0 0 0
Microcephaly
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
Macrocephaly
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
Severe Anaemia
3 0 0 7 0 0 0 1 0
Male 10 1 0
5 0 0 4 0 0 4 0 0
Female 13 0 0
Vitamin A deficiency
0 0 0 0 0 2 1 0 1
(Bitot spot) Male 1 0 3
0 0 0 0 0 1 0 0 1
Female 0 0 2
Vitamin D Deficiency,
0 0 0 0 0 0 0 1 0
(Rickets) Male 0 1 0
0 0 0 0 0 0 0 0 0
Female 0 0 0
A)SAM
4 0 0 2 1 0
Male 6 1 0
3 1 2 4 2 2
Female 7 3 4
B)Severe Thinning
2 2 0
Male 2 2 0

0 6 1
Female 0 6 1
C)Obesity
0 0 0 0 0 0 0 0 0
Male 0 0 0
0 0 0 0 0 0 1 1 0
Female 1 1 0
Goitre
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
Severe Stunting
0 0 0 0 0 0
Male 0 0 0
0 0 0 0 0 0 0 0 0
Female 0 0 0
Vitamin B complex
0 0 0 2 3 0 2 0 0
deficiency. Male 4 3 0
0 0 0 1 3 0 2 0 0
Female 3 3 0
Skin conditions
44 8 0 60 22 0 32 13 0
Male 136 43 0
38 13 0 54 10 0 26 14 0
Female 118 37 0
Ottis Media
4 0 0 8 3 0 5 2 0
Male 17 5 0
2 0 0 2 0 0 2 1 0
Female 6 1 0
Rheumatic Heart Disease
0 0 0
Male 0 0 0

0 0 0
Female 0 0 0
Reactive Airway Disease
21 1 0 16 3 0 7 3 0
Male 44 7 0
18 0 0 11 0 0 6 3 0
Female 35 3 0
Dental Conditions
14 6 0 87 44 9 85 44 10
Male 186 94 19
9 3 0 67 34 11 83 42 10
Female 159 79 21
Convulsive Disorders
0 2 0 0 0 0 0 0 0
Male 0 2 0
0 0 0 0 0 0 0 0 0
Female 0 0 0
Childhood leprosy
0 0 0 0 0 0 0 0 0
Disease Male 0 0 0
0 0 0 0 0 0 0 0 0
Female 0 0 0
Childhood T.B.
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
Childhood Extra
0 0 0 0 0 0 0 0 0
Pulmonary T. B. Male 0 0 0
0 0 0 0 0 0 0 0 0
Female 0 0 0
Vision impairment
0 1 3 0 0 1 2 5 13
Male 2 6 17
1 1 3 0 0 1 3 2 17
Female 4 3 21
Hearing Impairment
0 0 0 0 0 1 0 1 1
Male 0 1 2
0 0 1 0 0 0 0 0 2
Female 0 0 3
Neuro motor impairment
1 0 3 0 0 0 0 1 3
Male 1 1 6
0 0 2 0 0 0 0 0 1
Female 0 0 3
Motor delay
0 0 3 0 0 0 0 0 1
Male 0 0 4
0 0 1 0 0 2 0 1 1
Female 0 1 4
Cognitive delay
0 0 0 0 0 1 0 0 0
Male 0 0 1
0 0 0 0 0 0 0 0 0
Female 0 0 0
Language delay
0 0 5 0 0 2 0 0 4
Male 0 0 11
0 0 0 0 0 2 0 0 1
Female 0 0 3
Behaviour disorder
0 0 1 0 0 1 0 0 1
(Autism) Male 0 0 3
0 0 0 0 0 0 0 0 0
Female 0 0 0
Learning disorder
0 0 0 0 0 0
Male 0 0 0
0 0 0 0 0 0
Female 0 0 0
Attention deficit
0 0 0 0 0 1
hyperactivity disorder Male 0 0 1

0 0 0 0 0 1
Female 0 0 1
Others
0 0 0 4 0 0
Male 4 0 0

0 0 0 4 0 0
Female 4 0 0
Growing up concerns
0 0 0
Male 0 0 0

0 0 0
Female 0 0 0
Substance abuse
0 0 0
Male 0 0 0

0 0 0
Female 0 0 0
Feel depressed
0 0 0
Male 0 0 0

0 0 0
Female 0 0 0
Delay in menstruation
0 0 0
cycles Male 0 0 0

0 5 0
Female 0 5 0
Irregular periods
0 0 0
Male 0 0 0

3 8 0
Female 3 8 0
Pain or burning sensation
while urinating 0 0 0
Male 0 0 0

0 0 0
Female 0 0 0
Discharge/ foul smelling
0 0 0
discharge from the Male 0 0 0
genitor-urinary area
0 1 0
Female 0 1 0
Pain during menstruation
0 0 0
Male 0 0 0

3 3 0
Female 3 3 0

Male 0 0 1 2 0 16 0 0 1 0 0 4 2 0 22
Defects at Birth
Female 0 0 4 0 0 7 0 0 4 0 0 10 0 0 25

Male 0 0 0 7 0 0 11 4 2 5 4 1 23 8 3
Deficiencies
Female 0 0 0 8 1 2 9 5 3 7 7 2 24 13 7

Childhood Male 0 0 0 83 17 0 171 72 9 129 62 10 383 151 19

Diseases
Female 0 0 0 67 16 0 134 44 11 117 60 10 318 120 21

Male 0 0 0 1 1 15 0 0 6 6 7 24 7 8 45
Developmental Delays
Developmental Delays
Female 0 0 0 1 1 7 0 0 5 7 3 23 8 4 35

Male 0 0 1 93 18 31 182 76 18 140 73 39 415 167 89

Grand Total
Female 0 0 4 76 18 16 143 49 23 131 70 45 350 137 88
Report prepared by Report verified by Block/ District / State Nodal person
Name
Signature
Designation
Date
 Ministry of Health & Family Welfare
Government of India
Rashtriya Bal Swasthya Karyakram (RBSK)
MONTHLY REPORTING FORMAT (BLOCK/ DISTRICT/ STATE) - FORM-V
Name of State/UT: Tripura No of Reported Districts: 8 No of Blocks : 58 Reporting Month May Reporting Year 2021

Number of children with selected health conditions

Referal Managed
Identified through screening Secondary Care Confirmed Waiting for service access
S.No Health Condition Details Primary care (PHC/CHC) Tertiary Care (DEIC) District TB programme District Leprosy programme Medical Surgery Early Intervention AFHC counselling
(DH/Medical)

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

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC
6 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Neural tube Defect
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC

6 Weeks- 3 Yrs 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0
2 Down Syndrome
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 Yrs 0 2 0 0 0 0 0 2 0 2 0 0 0 0 0 2 0 0 0 0
Birth-6 weeks
ASHA,HBNC 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1
6 Weeks- 3 Yrs 3 1 1 0 0 0 2 1 3 1 0 0 0 0 0 0 0 0 3 1
3 Cle Lip & Palate
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 Yrs 1 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1
1 3 0 0 0 0 1 3 1 3 0 0 0 0 1 3 0 0 0 0
Birth-6 weeks
ASHA,HBNC

6 Weeks- 3 Yrs 5 1 0 0 0 0 5 1 5 1 0 0 0 0 5 1 0 0 0 0
4 Club foot
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 Yrs 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC

6 Weeks- 3 Yrs 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1
5 Developmental dysplasia of the hip
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC

6 Weeks- 3 Yrs 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0
6 Congenital cataract
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC

6 Weeks- 3 Yrs 2 0 0 0 0 0 2 0 2 0 0 0 0 0 0 2 0 0 0 0
7 Congenital Deafness
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC

6 Weeks- 3 Yrs 6 4 0 0 0 0 6 4 6 4 0 0 0 0 0 0 0 0 6 4
8 Congenital Heart Diseases
3- 6 Yrs 1 4 0 0 0 0 1 4 1 4 0 0 0 0 0 0 0 0 1 4
6-18 Yrs 3 6 0 0 0 0 3 6 3 6 0 0 0 0 0 0 0 0 3 6
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC

6 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Retinopathy of Prematurity
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Yrs 3 5 3 5 0 0 0 0 3 5 3 5 0 0 0 0 0 0 0 0
10 Severe Anaemia 3- 6 Yrs 7 4 7 4 0 0 0 0 7 4 7 4 0 0 0 0 0 0 0 0
6-18 yrs 1 4 0 4 1 0 0 0 1 4 1 4 0 0 0 0 0 0 0 0
6 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Vitamin A deficiency (Bitot spot) 3- 6 Yrs 2 1 0 0 0 0 2 1 2 1 2 1 0 0 0 0 0 0 0 0
6-18 yrs 2 1 1 0 0 0 1 1 2 1 2 1 0 0 0 0 0 0 0 0
6 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Vitamin D Deficiency, (Rickets) 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 1 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0
13 6 Weeks- 3 Yrs 4 6 4 3 0 1 0 2 4 6 0 0 0 0 4 6 0 0 0 0
A) SAM 3- 6 Yrs 3 8 2 4 1 2 0 2 3 8 0 0 0 0 3 8 0 0 0 0
6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B) Severe
3- 6 Yrs
Thinning

6-18 yrs 4 7 2 0 2 6 0 1 4 7 0 0 0 0 4 7 0 0 0 0
6 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C) Obesity 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 1 1 0 1 0 1 0 0 1 1 0 0 0 0 1 1 0 0 0 0
6 Weeks- 3 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Goitre 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 52 51 44 38 8 13 0 0 52 51 52 51 0 0 0 0 0 0 0 0
15 Skin conditions 3- 6 Yrs 80 66 60 54 20 12 0 0 80 66 80 66 0 0 0 0 0 0 0 0
6-18 yrs 45 40 32 26 13 14 0 0 45 40 45 40 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 4 2 4 2 0 0 0 0 4 2 4 2 0 0 0 0 0 0 0 0
16 Otitis Media 3- 6 Yrs 11 2 8 2 3 0 0 0 11 2 11 2 0 0 0 0 0 0 0 0
6-18 yrs 7 3 5 2 2 1 0 0 7 3 7 3 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Rheumatic heart disease 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 22 18 21 18 1 0 0 0 22 18 22 18 0 0 0 0 0 0 0 0
18 Reactive airway disease 3- 6 Yrs 19 11 16 11 3 0 0 0 19 11 19 11 0 0 0 0 0 0 0 0
6-18 yrs 10 9 7 6 3 3 0 0 10 9 10 9 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 20 12 14 9 6 3 0 0 20 12 20 12 0 0 0 0 0 0 0 0
19 Dental Condi ons 3- 6 Yrs 140 112 87 67 44 34 9 11 140 112 133 103 7 9 0 0 0 0 0 0
6-18 yrs 139 135 85 83 44 42 10 10 139 135 129 130 10 5 0 0 0 0 0 0
6 Weeks- 3 Years 2 0 0 0 2 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0
20 Convulsive disorders 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 4 5 0 1 1 1 3 3 4 5 0 0 0 0 4 5 0 0 0 0
21 Vision impairment 3- 6 Yrs 1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 0 0
6-18 yrs 20 22 2 3 5 2 13 17 20 22 0 0 0 0 20 22 0 0 0 0
6 Weeks- 3 Years 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0
22 Hearing Impairment 3- 6 Yrs 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0
6-18 yrs 2 2 0 0 1 0 1 2 2 2 0 0 0 0 2 2 0 0 0 0
6 Weeks- 3 Years 4 2 1 0 0 0 3 2 4 2 0 0 0 0 4 2 0 0 0 0
23 Neuro motor impairment 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 4 1 0 0 1 0 3 1 4 1 0 0 0 0 4 1 0 0 0 0
6 Weeks- 3 Years 3 1 0 0 0 0 3 1 3 1 0 0 0 0 3 1 0 0 0 0
24 Motor delay 3- 6 Yrs 0 2 0 0 0 0 0 2 0 2 0 0 0 0 0 1 0 0 0 0
6-18 yrs 1 2 0 0 0 1 1 1 1 2 0 0 0 0 1 2 0 0 0 0
6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Cognitive delay 3- 6 Yrs 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0
6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 5 0 0 0 0 0 5 0 5 0 0 0 0 0 5 0 0 0 0 0
26 Language delay 3- 6 Yrs 2 2 0 0 0 0 2 2 2 2 0 0 0 0 2 2 0 0 0 0
6-18 yrs 4 1 0 0 0 0 4 1 4 1 0 0 0 0 4 1 0 0 0 0
6 Weeks- 3 Years 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0
27 Behaviour disorder (Autism) 3- 6 Yrs 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0
 6-18 yrs 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Learning disorder
6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Attention deficit hyperactivity
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29

1 1 0 0 0 0 1 1 1 1 0 0 0 0 1 1 0 0 0 0
disorder
6-18 yrs

3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Others
6-18 yrs 6 2 6 2 0 0 0 0 6 2 6 2 0 0 0 0 0 0 0 0
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
32 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
33 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
34 Delay in menstruation cycles 6-18 yrs 0 5 0 0 0 5 0 0 0 5 0 5 0 0 0 0 0 0 0 0
35 Irregular periods 6-18 yrs 0 11 0 3 0 8 0 0 0 11 0 11 0 0 0 0 0 0 0 0
Pain or burning sensation while
36
urinating
6-18 yrs
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Discharge/ foul smelling
37 discharge from the 6-18 yrs
genitor-urinary area 0 1 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0
38 Pain during menstruation 6-18 yrs 0 6 0 3 0 3 0 0 0 6 0 6 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Childhood leprosy Disease 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Childhood T.B. 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40.1 Childhood Extra Pulmonary T. B. 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 yrs 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
Severe Stunting
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Microcephaly
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Birth-6 weeks 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Macrocephaly
3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Weeks- 3 Years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Vitamin B complex deficiency 3- 6 Yrs 5 4 2 1 3 3 0 0 5 4 5 4 0 0 0 0 0 0 0 0
6-18 yrs 2 2 2 2 0 0 0 0 2 2 2 2 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC 2 8 0 0 0 0 2 8 0 0 0 0 2 8 0 0 0 0 1 3 0 0 1 5
6 Weeks- 3 Yrs 18 7 2 0 0 0 16 7 0 0 0 0 18 7 0 0 0 0 6 4 0 0 10 6
Defect at Birth
3- 6 Yrs 1 4 0 0 0 0 1 4 0 0 0 0 1 4 0 0 0 0 0 0 0 0 1 4
6-18 Yrs 4 10 0 0 0 0 4 10 0 0 0 0 4 10 0 0 0 0 0 3 0 0 4 7
6 Weeks- 3 Years 7 11 7 8 0 1 0 2 0 0 0 0 7 11 3 5 0 0 4 6 0 0 0 0
Deficiency 3- 6 Yrs 17 17 11 9 4 5 2 3 0 0 0 0 17 17 14 9 0 0 3 8 0 0 0 0
6-18 yrs 11 15 5 7 4 7 2 1 0 0 0 0 11 15 6 7 0 0 5 8 0 0 0 0
6 Weeks- 3 Years 100 83 83 67 17 16 0 0 0 0 0 0 100 83 100 83 0 0 0 0 0 0 0 0
Childhood Diseases 3- 6 Yrs 250 191 171 134 70 46 9 11 0 0 0 0 250 191 243 182 7 9 0 0 0 0 0 0
6-18 yrs 201 187 129 117 62 60 10 10 0 0 0 0 201 187 191 182 10 5 0 0 0 0 0 0
ASHA Visited As per
MCP Card 1 4 1 4 0 0
Developmental Delays including
6 Weeks- 3 Years 17 9 1 1 1 1 15 7 0 0 0 0 17 9 0 0 0 0 17 9 0 0 0 0
Disabilities
3- 6 Yrs 6 5 0 0 0 0 6 5 0 0 0 0 6 5 0 0 0 0 6 4 0 0 0 0
6-18 yrs 39 31 8 5 7 3 24 23 0 0 0 0 39 31 6 2 0 0 33 29 0 0 0 0
Adolescent Health 6-18 yrs 0 23 0 6 0 17 0 0 0 0 0 0 0 23 0 23 0 0 0 0 0 0 0 0
Birth-6 weeks
ASHA,HBNC 3 12 0 0 0 0 3 12 0 0 0 0 2 8 0 0 0 0 1 3 0 0 1 5

Total Children identified

6 Weeks- 3 Years
142 110 93 76 18 18 31 16 0 0 0 0 142 110 103 88 0 0 27 19 0 0 10 6
3- 6 Yrs 274 217 182 143 74 51 18 23 0 0 0 0 274 217 257 191 7 9 9 12 0 0 1 4
6-18 yrs 255 266 142 135 73 87 40 44 0 0 0 0 255 266 203 214 10 5 38 40 0 0 4 7
Report prepared by Report verified by Block/ District / State Nodal person
Name
Signature
Designation
Date