Q1

FHSIS REPORT for the QUARTER ____FIRST____ YEAR: ____2021___

Name of Municipality/City: _________DARAM_________________________
Name of Province: _______SAMAR___________________________
Projected Population of the Year: _______45,565___________________________
For submission to PHO/CHO RHU
Section A. Family Planning Services and Deworming for Women of Reproductive Age
A1. Modern FP Unmet Need Age Total for WRA 15-49 y/o Interpretation Recommendation /
(Col. 1) (Col. 2) (Col. 3) (Col. 4) Action
(Col.Taken
5)
10-14 y/o 15-19 y/o 20-49 y/o
1. Proportion of WRA with unmet need for modern FP
(No.1.1/No.1.2 X 100) 0
1.1  Number of WRA with unmet need for MFP - Total 0
1.2  Total No. of Estimated WRA
(Total Population X 25.854%)
11,475 11,475 63
Current Users Acceptors Drop-outs Current Users New Acceptors CPR Interpre Recom
A2. Use of FP Method tation menda
tions/
(Beginning of Qtr) New (end of Qtr) Other (end of Qtr) (Present Quarter) (End of Quarter) (Last Month of Col. 6/TP x 25.854% Actions
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) Present Qtr) (Col. 7) (Col. 8) to be
Taken
(Col.
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total (Col. 9)
10)
a. BTL -Total 253 253 0 37 37 3 3 0 0 287 287 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 52 52 0 2 2 0 0 0 54 54 0
d. Pills - Total 871 871 0 1 62 63 1 1 0 1 932 933 0
d.1 Pills-POP - Total 97 97 0 0 0 1 1 0 0 96 96 0
d.2 Pills-COC - Total 774 774 0 1 62 63 0 0 0 1 836 837 0
e. Injectables (DMPA/POI) - Total 11 522 533 0 49 49 5 5 0 6 571 577 0
f. Implant - Total 5 399 404 0 0 24 24 0 5 375 380 0
g. IUD (IUD-I and IUD-PP) - Total 62 62 0 29 29 0 0 0 91 91 0
g.1 IUD-I- Total 21 21 0 18 18 0 0 0 39 39 0
g.2 IUD-PP - Total 41 41 0 11 11 0 0 0 52 52 0
h. NFP-LAM - Total 5 96 101 0 0 2 18 20 0 3 78 81 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 2276 0 180 53 0 0 0 2403 0 20.94
Section B. Maternal Care and Services
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendati
(Col. 3) ons /
Actions to be
 Indicators Eligible Population Interpretation

10-14 15-19 20-49 Total Actions to be

(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) Taken
(Col. 5)
B1. Prenatal Care
1. No. of pregnant women w/ at least 4 prenatal check-ups - Total 1 3 107 111 11.95
2. No. of pregnant women assessed of their nutritional status during the 1st
3 55 58 6.24
trimester
a. Number- Total
of pregnant women seen in the first trimester who have normal
4 75 79 8.50
BMI - Total
b. No. of pregnant women seen in the first trimester who have low BMI-Total 20 20 0.22
c. No. of pregnant women seen in the first trimester who have high BMI-Total 1 1 2 0.22
3. No. of pregnant women for the first time given at least 2 doses of Td
4 42 46 4.95
4. vaccination - Total
No. of pregnant women for the 2nd or more times given at least 3 doses of Td
60 60 6.46
5. vaccination (Td2women
No. of pregnant Plus) - who
Totalcompleted the dose of iron with folic acid
1 71 72 7.75
supplementation - Total
6. No. of pregnant women who completed doses of calcium carbonate
0 0 0.00
supplementation - Total
7. No. of pregnant women given iodine capsules – Total 28 28 0.00
8. No. of pregnant women given one dose of deworming tablet - Total
929 1 6 7 0.75
9. No. of pregnant women screened for syphilis - Total 7 7 0.00
10. No. of pregnant women tested positive for syphilis - Total 1 28 29 0.00
11. No. of pregnant women screened for Hepatitis B - Total 0 0 0.00
12. No. of pregnant women tested positive for Hepatitis B - Total 0 0 0.00
13. No. of pregnant women screened for HIV - Total 10 10 1.08
14. No. of pregnant women tested for CBC or Hgb&Hct count - Total 6 105 111 11.95
15. No. of pregnant women tested for CBC or Hgb&Hct count diagnosed with
2 20 22 0.00
anemia - Total
16. No. of pregnant women screened for gestational diabetes – Total 10 10 0.00
17. No. of pregnant women tested positive for gestational diabetes – Total 0 0 0.00
B2. Intrapartum Care and Delivery Outcome
10-14 15-19 20-49 Total
M F M F M F No. %
18. No. of deliveries – Total 2 2 41 60 105
19. No. of live births – Total 2 2 41 59 104 100.00
a. No. of live births with normal birth weight - Total 2 2 40 57 101 97.12
104
b. No. of live births with low birth weight - Total 0 0 1 2 3 2.88
c. No. of live births with unknown birth weight - Total 0 0 0 0 0 0.00
20. No. of deliveries attended by skilled health professionals - Total 2 2 41 59 104 100.00
a. No. of deliveries attended by a doctor - Total 0 0 4 6 10 9.62
104
b. No. of deliveries attended by a nurse – Total 0 0 6 6 12 11.54
c. No. of deliveries attended by midwives - Total 2 2 31 47 82 78.85
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
(Col. 3) Actions to be Taken
10-14 15-19 20-49 Total
(Col. 1) (Col. 2) M F M F M F No. % (Col. 4) (Col. 5)
21. No. of health facility-based deliveries - Total 1 1 41 60 103 98.10
a. No. of deliveries in public health facility - Total 1 1 41 60 103 98.10

105
 b. No. of deliveries in private health facility - Total 0 0 0 0 0 0.00
22. No. of non-facility-based deliveries - Total 1 1 0 0 2 1.90
23a. No. of vaginal deliveries – Total 105 2 2 41 60 105 100
23b. No. of deliveries by cesarean section – Total 0 0 0 0 0 0
24a. No. of full-term births – Total 2 2 40 59 103 98.10
24b. No. of pre-term births – Total 0 0 1 1 2 #DIV/0!
24c. No. of fetal deaths - Total 0 0 0 1 1 #DIV/0!
24d. No. of abortion/miscarriage - Total 0 0 1 1 #DIV/0!
B3. Postpartum and Newborn Care
25. No. of postpartum women together with their newborn who completed at
3 103 106 11.41
26. least
No. of2postpartum
postpartumwomen
check-ups
who-completed
Total iron with folic acid
929 1 55 87 9.36 Not disaggregated by sex
supplementation - Total
27. No. of postpartum women with Vitamin A supplementation – Total 3 96 99 10.66
Section C. Child Care and Services
Indicators Eligible Population Counts % Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Male Female Total 100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents
1. CPAB - Total 9 6 15 1.49
2. BCG - Total 50 57 107 10.62
3. HepB, within 24 hours. - Total 34 41 75 7.44
4. DPT-HiB-HepB 1 - Total 60 80 140 13.89
5. DPT-HiB-HepB 2 - Total 77 61 138 13.69
6. DPT-HiB-HepB 3 - Total 66 52 118 11.71
7. OPV 1 - Total 67 74 141 13.99
8. OPV 2 - Total 66 52 118 11.71
9. OPV 3 - Total 1008 56 43 99 9.82
10. IPV - Total 56 53 109 10.81
11. PCV 1 - Total 64 67 131 13.00
12. PCV 2 - Total 77 60 137 13.59
13. PCV 3 - Total 55 55 110 10.91
14. MCV 1 - Total 48 49 97 9.62
15. MCV 2 - Total 24 28 52 5.16
16. FIC - Total 26 39 65 6.45
17. CIC - Total 17 16 33 3.27
Indicators Eligible Population Counts % Interpretation Recommendation
(Col.5/E.Pop s/
Male Female Total Actions to be
x 100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) Taken
(Col. 8)
18. Td, Grade 1 (November) - Total 0 0
19. MR, Grade 1 (November) - Total 0 0
20. Td, Grade 7 (November) - Total 0 0
21. MR, Grade 7 (November) - Total 0 0
22. Newborns initiated on breastfeeding immediately after birth lasting to 90 C2. Nutrition Services for Infants and Children
mins - Total 104 43 61 104 100.00
23. Preterm/LBW infants given iron supplementation - Total 0 0 0
24. Infants exclusively breastfed until 6th month - Total 10 4 14 #DIV/0!
25. Infants 6 mos. old initiated to complementary
26. comp, feeding w/feeding
continued breastfeeding
but no - Total
longer or never 1 3 4 #DIV/0!
been breastfed - Total 1 3 4 #DIV/0!
27. Infants 6-11 mos. given 1 dose of Vit. A 100,000 I.U. - Total 10 10
28. Children 12-59 mos. old given 2 doses of Vit. A 200,000 I.U. - Total 0
29. Infant 6-11 months old who completed MNP supplementation - Total 0
30. Children 12-23 mos. who completed MNP supplementation - Total 0
C3. Deworming Services for Infants, Children and Adolescents
31. 1-19 y/o given 2 doses of deworming drug - Total 0
a. PSAC, 1-4 y.o. dewormed (2 doses) - Total 0
b. SAC, 5-9 y.o. dewormed (2 doses) - Total 0
c. Adolescents, 10-19 y.o. dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total 21 14 35
33. Sick Infants 6-11 mos. old received Vitamin A - Total 35 21 14 35 100.00
34. Sick Children 12-59 mos. old seen - Total 44 45 89
35. Sick Children 12-59 mos. old received Vitamin A - Total 89 44 85 129 100.00
36. Diarrhea cases 0-59 months old seen - Total 10 15 25
37. Diarrhea cases 0-59 months old received ORS - Total 25
10 15 25 100
38. Diarrhea cases 0-59 mos. received ORS w/ zinc - Total 10 15 25 100
39. Pneumonia cases 0-59 mos. old seen - Total 18 11 29
40. Pneumonia cases 0-59 mos. old completed treatment - Total 29 18 11 29 100
Section D. Oral Health Care and Services
Indicators Eligible Population Counts % Interpretation Recommendati
(Col.5/ ons /
Male Female Total E.Pop x Actions to be
100)
examination plus orally fit(Col.
after1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) Taken
(Col. 8)
rehabilitation - Total
2. Clients 5 years old and above with cases of DMFT - T
3. Infants 0-11 months old who received BOHC - Total No visiting Dentist

4. Children 1-4 years old (12-59 mos.) who received BO

 No visiting Dentist

5. Children 5-9 years old who received BOHC - Total

Indicators Eligible Population Counts %
(Col.5/
Interpretation Recommendati
ons /
Male Female Total E.Pop x Actions to be
100) Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
6. Adolescents who received BOHC - Total
a. Adolescents 10-14 years old who received BOHC - Tota
b. Adolescents 15-19 years old who received BOHC - Tota No Visiting Dentist
7. Senior
8. Adults 20-59
citizensyears old who
60 years old received
and aboveBOHC - Total
who received
BOHC - Total
Indicators Eligible Population Counts Interpretation Recommendati
10-14 y/o 15-19 y/o 20-49 y/o Total % ons /
(Col.6/ E.Pop x 100) Actions to be
Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8) (Col. 9)
9. Pregnant women who received BOHC - Total No visiting Dentist
Section E. Infectious Disease Prevention and Control Services
Indicators Denominator Counts % Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Male Female Total 100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
E1. Filariasis (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total
2. No. of suspected cases seen – Total
3. No. of acute clinically diagnosed cases - Total
4. No. of confirmed acute cases - Total
5. No. of chronic clinically diagnosed cases - Total
6. No. of confirmed chronic cases - Total
7. No. of confirmed cases (acute and chronic) - Total
8. No. of cases treated - Total
9. No. of confirmed chronic cases referred to a hospital facility - Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 2 doses of deworming tablet -
E4.Total
HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total 16
 3 MDR-RR pts are registered in
2. Number of registered bacteriologically confirmed drug resistant TB 16 Calbayog STC
3. (RR/MDR-TB
Number of TB,Cases) - Total
all forms that are cured and completely treated - Total 14
4. Number of registered bacteriology confirmed drug resistant TB Cases
E6.(RR/MDR-TB) cured and Control
Malaria Prevention completed treatment - Total
1. No. of patients with probable/clinically diagnosed Malaria and confirmed
case
• < 5 -y/o
Total
- Total
• ≥ 5 y/o - Total
2. No. of lab-confirmed Malaria deaths - Total
• < 5 y/o - Total
• ≥ 5 y/o - Total
Indicators Denominator Counts % Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Male Female Total 100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

E7. Leprosy Prevention and Control

1. No. of Leprosy cases on treatment during reporting period - Total 0 0 0
2. No. of newly detected cases during reporting period - Total 0 0 0
E8. Rabies Prevention and Control
1. No. of animal bites - Total 3 17 20
2. No. of deaths due to Rabies - Total
Section F. Non-Communicable Disease Prevention and Control Services
Indicators Eligible Population/Denominator Counts % Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Male Female Total 100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
1. No. of adults risk-assessed using PhilPEN - Total
2. Current smokers - Total
3. Alcohol binge drinkers - Total
4. Overweight/Obese-Total
5. No. of adult women screened for Cervical Cancer using VIA/Pap
Smear
6. No. of- adult women found positive/suspect for Cervical Cancer using
VIA/Pap
7. No. Smear-
of adult Total
women screened for breast mass - Total
8. No. of adult women with suspicious breast mass - Total
9. No. of newly-identified hypertensive adults - Total
10. No. of newly-identified adults with Type 2 DM - Total
11. No. of senior citizens screened for visual acuity - Total
12. No. of senior citizens diagnosed with eye disease/s - Total
13. No. of senior citizens who received one (1) dose of PPV - Total
14. No. of senior citizens who received one (1) dose of influenza vaccine
- Total Section G. Environmental Health and Sanitation Services
Indicators Target/Denominator Total % Interpretation Recommendations /
(Col.5/Target x 100) Actions to be Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6)

1. No. of HHs with access to basic safe water supply - Total

a. No. of HHs with Level I - Total
b. No. of HHs with Level II - Total
c. No. of HHs with Level III - Total
2. No. of HHs using safely managed drinking-water services - Tot
3. No of HHs with basic sanitation facility - Total
a. No. of HH with pour/flush toilet connected to septic tank - Tot
b. No. of HHs with pour/flush toilet connected to community
sewer/sewerage
c. No. of HHs with ventilated improved pit latrine (VIP) - Total
4. No. of HHs using safely managed sanitation services - Total
5. No. of industrial establishments issued with sanitary permit - To
6. No. of barangays declared ZOD - Total
Section H. Mortality
Indicators Denominator Counts % Interpretation Recommendations /
Male Female Total Actions to be Taken

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

1. Total Deaths 21 23 44
2. Maternal Deaths - Total 1 1 1 BHS death
3. Under-five Deaths - Total 0 1 1 1 home death
4. Infant Deaths - Total 2 1 3 1 home death, 2 hosp death
5. Neonatal Deaths - Total 0 1 1 hospital death
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
Section I. Natality
Indicators Denominator Counts % Interpretation Recommendations /
Male Female Total Actions to be Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
1. Livebirths - Total 43 61 104
a. Livebirths among 15-19 y/o women - Total 104 2 2 4 3.85
 FHSIS REPORT for the QUARTER ____
Name of Municipality/City: _________DARA
Name of Province: _______SAMAR
Projected Population of the Year: _______45,565_

Section A. Family Plann

A1. Modern FP Unmet Need
(Col. 1)
10-14 y/o
1. Proportion of WRA with unmet need for modern FP
(No.1.1/No.1.2 X 100)
1.1  Number of WRA with unmet need for MFP - Total
1.2  Total No. of Estimated WRA
(Total Population X 25.854%)
Current Users Acceptor
A2. Use of FP Method

(Beginning of Qtr) New (end of Qtr)

(Col. 1) (Col. 2) (Col. 3)
10-14 15-19 20-49 Total 10-14 15-19 20-49

a. BTL -Total 287 287

b. NSV - Total 0 0
c. Condom - Total 54 54
d. Pills - Total 1 932 933
d.1 Pills-POP - Total 96 96
d.2 Pills-COC - Total 1 836 837
e. Injectables (DMPA/POI) - Total 6 571 577
f. Implant - Total 5 375 380
g. IUD (IUD-I and IUD-PP) - Total 91 91
g.1 IUD-I- Total 39 39
g.2 IUD-PP - Total 52 52
h. NFP-LAM - Total 3 78 81
i. NFP-BBT - Total 0
j. NFP-CMM - Total 0
k. NFP-STM - Total 0
l. NFP-SDM - Total 0
m. Total Current Users 2403

Indicators

(Col. 1)
B1. Prenatal Care
1. No. of pregnant women w/ at least 4 prenatal check-ups - Total
2. No. of pregnant women assessed of their nutritional status during the 1st
trimester
a. Number- Total
of pregnant women seen in the first trimester who have normal
BMI - Total
b. No. of pregnant women seen in the first trimester who have low BMI-Total
c. No. of pregnant women seen in the first trimester who have high BMI-Total
3. No. of pregnant women for the first time given at least 2 doses of Td
4. vaccination - Total
No. of pregnant women for the 2nd or more times given at least 3 doses of Td
5. vaccination (Td2women
No. of pregnant Plus) - who
Totalcompleted the dose of iron with folic acid
6. supplementation - Total who completed doses of calcium carbonate
No. of pregnant women
supplementation - Total
7. No. of pregnant women given iodine capsules – Total
8. No. of pregnant women given one dose of deworming tablet - Total
9. No. of pregnant women screened for syphilis - Total
10. No. of pregnant women tested positive for syphilis - Total
11. No. of pregnant women screened for Hepatitis B - Total
12. No. of pregnant women tested positive for Hepatitis B - Total
13. No. of pregnant women screened for HIV - Total
14. No. of pregnant women tested for CBC or Hgb&Hct count - Total
15. No. of pregnant women tested for CBC or Hgb&Hct count diagnosed with
anemia - Total
16. No. of pregnant women screened for gestational diabetes – Total
17. No. of pregnant women tested positive for gestational diabetes – Total

18. No. of deliveries – Total

19. No. of live births – Total
 a. No. of live births with normal birth weight - Total
b. No. of live births with low birth weight - Total
c. No. of live births with unknown birth weight - Total
20. No. of deliveries attended by skilled health professionals - Total
a. No. of deliveries attended by a doctor - Total
b. No. of deliveries attended by a nurse – Total
c. No. of deliveries attended by midwives - Total
Indicators

(Col. 1)
21. No. of health facility-based deliveries - Total
a. No. of deliveries in public health facility - Total
b. No. of deliveries in private health facility - Total
22. No. of non-facility-based deliveries - Total
23a. No. of vaginal deliveries – Total
23b. No. of deliveries by cesarean section – Total
24a. No. of full-term births – Total
24b. No. of pre-term births – Total
24c. No. of fetal deaths - Total
24d. No. of abortion/miscarriage - Total

25. No. of postpartum women together with their newborn who completed at
leastof2postpartum
26. No. postpartumwomen
check-ups
who-completed
Total iron with folic acid
supplementation - Total
27. No. of postpartum women with Vitamin A supplementation – Total

Indicators

(Col. 1)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents
1. CPAB - Total
2. BCG - Total
3. HepB, within 24 hours. - Total
4. DPT-HiB-HepB 1 - Total
5. DPT-HiB-HepB 2 - Total
6. DPT-HiB-HepB 3 - Total
7. OPV 1 - Total
8. OPV 2 - Total
9. OPV 3 - Total
10. IPV - Total
11. PCV 1 - Total
12. PCV 2 - Total
13. PCV 3 - Total
14. MCV 1 - Total
15. MCV 2 - Total
16. FIC - Total
17. CIC - Total
Indicators

(Col. 1)
18. Td, Grade 1 (November) - Total
19. MR, Grade 1 (November) - Total
20. Td, Grade 7 (November) - Total
21. MR, Grade 7 (November) - Total
22. Newborns initiated on breastfeeding immediately after birth lasting to 90 C
mins - Total
23. Preterm/LBW infants given iron supplementation - Total
24. Infants exclusively breastfed until 6th month - Total
25.
26. Infants 6 mos. old initiated to comp, feeding w/feeding
complementary continued breastfeeding
but no - Total
longer or never
been breastfed - Total
27. Infants 6-11 mos. given 1 dose of Vit. A 100,000 I.U. - Total
28. Children 12-59 mos. old given 2 doses of Vit. A 200,000 I.U. - Total
29. Infant 6-11 months old who completed MNP supplementation - Total
30. Children 12-23 mos. who completed MNP supplementation - Total
C3. Deworming Services for Infants, Children and Adolescents
31. 1-19 y/o given 2 doses of deworming drug - Total
a. PSAC, 1-4 y.o. dewormed (2 doses) - Total
b. SAC, 5-9 y.o. dewormed (2 doses) - Total
 c. Adolescents, 10-19 y.o. dewormed (2 doses) - Total
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
33. Sick Infants 6-11 mos. old received Vitamin A - Total
34. Sick Children 12-59 mos. old seen - Total
35. Sick Children 12-59 mos. old received Vitamin A - Total
36. Diarrhea cases 0-59 months old seen - Total
37. Diarrhea cases 0-59 months old received ORS - Total
38. Diarrhea cases 0-59 mos. received ORS w/ zinc - Total
39. Pneumonia cases 0-59 mos. old seen - Total
40. Pneumonia cases 0-59 mos. old completed treatment - Total
Secti
Indicators

examination plus orally fit after

(Col. 1)
rehabilitation - Total
2. Clients 5 years old and above with cases of DMFT - Tota
3. Infants 0-11 months old who received BOHC - Total
4. Children 1-4 years old (12-59 mos.) who received BOHC
5. Children 5-9 years old who received BOHC - Total
Indicators

(Col. 1)
6. Adolescents who received BOHC - Total
a. Adolescents 10-14 years old who received BOHC - Total
b. Adolescents 15-19 years old who received BOHC - Total
7. Adults 20-59 years old who received BOHC - Total
8. Senior citizens 60 years old and above who received BOHC
- Total
Indicators

(Col. 1)
9. Pregnant women who received BOHC - Total
Section E. Infe
Indicators

(Col. 1)
E1. Filariasis (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total
2. No. of suspected cases seen – Total
3. No. of acute clinically diagnosed cases - Total
4. No. of confirmed acute cases - Total
5. No. of chronic clinically diagnosed cases - Total
6. No. of confirmed chronic cases - Total
7. No. of confirmed cases (acute and chronic) - Total
8. No. of cases treated - Total
9. No. of confirmed chronic cases referred to a hospital facility - Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Chil
1. No. of WRA, 20-49 years old, who completed 2 doses of deworming tablet -
E4.Total
HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
2. Number of registered bacteriologically confirmed drug resistant TB
3. (RR/MDR-TB
Number of TB,Cases) - Total
all forms that are cured and completely treated - Total
4. Number of registered bacteriology confirmed drug resistant TB Cases
E6.(RR/MDR-TB) cured and Control
Malaria Prevention completed treatment - Total
1. No. of patients with probable/clinically diagnosed Malaria and confirmed
case - Total
 • < 5 y/o - Total
• ≥ 5 y/o - Total
2. No. of lab-confirmed Malaria deaths - Total
• < 5 y/o - Total
• ≥ 5 y/o - Total
Indicators

(Col. 1)

E
1. No. of Leprosy cases on treatment during reporting period - Total
2. No. of newly detected cases during reporting period - Total
E8. Rabies Prevention and Control
1. No. of animal bites - Total
2. No. of deaths due to Rabies - Total
Section F. Non-C
Indicators

(Col. 1)
1. No. of adults risk-assessed using PhilPEN - Total
2. Current smokers - Total
3. Alcohol binge drinkers - Total
4. Overweight/Obese-Total
5. No. of adult women screened for Cervical Cancer using VIA/Pap Smear -
6. Total
No. of adult women found positive/suspect for Cervical Cancer using
7. VIA/Pap Smear-
No. of adult womenTotal
screened for breast mass - Total
8. No. of adult women with suspicious breast mass - Total
9. No. of newly-identified hypertensive adults - Total
10. No. of newly-identified adults with Type 2 DM - Total
11. No. of senior citizens screened for visual acuity - Total
12. No. of senior citizens diagnosed with eye disease/s - Total
13. No. of senior citizens who received one (1) dose of PPV - Total
14. No. of senior citizens who received one (1) dose of influenza vaccine -
Total Section G. En
Indicators

(Col. 1)

1. No. of HHs with access to basic safe water supply - Total

a. No. of HHs with Level I - Total
b. No. of HHs with Level II - Total
c. No. of HHs with Level III - Total
2. No. of HHs using safely managed drinking-water services - Total
3. No of HHs with basic sanitation facility - Total
a. No. of HH with pour/flush toilet connected to septic tank - Total
b. No. of HHs with pour/flush toilet connected to community
sewer/sewerage
c. No. of HHs with ventilated improved pit latrine (VIP) - Total
4. No. of HHs using safely managed sanitation services - Total
5. No. of industrial establishments issued with sanitary permit - Total
6. No. of barangays declared ZOD - Total
Indicators

(Col. 1)
1. Total Deaths
2. Maternal Deaths - Total
3. Under-five Deaths - Total
4. Infant Deaths - Total
5. Neonatal Deaths - Total
6. Fetal Deaths - Total
7. Early Neonatal Deaths - Total
8. Perinatal Deaths - Total
Indicators

(Col. 1)
1. Livebirths - Total
a. Livebirths among 15-19 y/o women - Total
 QUARTER ____SECOND____ YEAR: ____2021___
_________DARAM_________________________
_______SAMAR___________________________
_______45,565___________________________
For submission to PHO/CHO

A. Family Planning Services and Deworming for Women of Reproductive Age

Age Total for WRA 15-49 y/o
(Col. 2) (Col. 3)
0-14 y/o 15-19 y/o 20-49 y/o

0
0
11,475 11,475
Acceptors Drop-outs Current Users

end of Qtr) Other (end of Qtr) (Present Quarter) (End of Quarter)

Col. 3) (Col. 4) (Col. 5) (Col. 6)
Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total

0 0 28 28 0 0 259 259
0 0 0 0 0 0 0
0 0 2 2 0 0 52 52
0 177 177 1 98 99 0 0 1011 1011
0 78 78 0 0 0 174 174
0 99 99 1 98 99 0 0 837 837
0 0 3 181 184 0 3 390 393
0 0 5 103 108 0 0 272 272
0 12 12 11 11 0 0 92 92
0 0 11 11 0 0 28 28
0 12 12 0 0 0 64 64
0 2 2 8 8 0 5 70 75
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
0 191 440 0 0 0 2154
Section B. Maternal Care and Services
Eligible Population Age of Pregnant/Postpartum Women
(Col. 3)
10-14 15-19 20-49
(Col. 2) No. % No. % No. %

6 76
1 12 55
1 12 55

4
7 35
2 66
57
29

929 29
21

31
5
15
4 67
3 16
13

B2. Intrapartum Care and Delivery Outcome

10-14 15-19 20-49
M F M F M F
0 1 2 0 66 51
0 1 2 0 66 51
120
 0 1 1 0 66 51
120
0 0 1 0 0 0
0 0 0 0 0 0
0 1 2 0 65 51
0 0 0 0 4 5
120
0 0 0 0 8 7
0 1 2 0 53 39
Eligible Population Age of Pregnant/Postpartum Women
(Col. 3)
10-14 15-19 20-49
(Col. 2) M F M F M F
0 1 2 0 65 51
0 1 2 0 65 51
0 0 0 0 0 0
0 0 0 0 1 0
120 0 1 2 0 66 51
0 0 0 0 0 0
0 1 2 0 66 51
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0
B3. Postpartum and Newborn Care
1 2 108
929 1 2 75
1 2 95
Section C. Child Care and Services
Eligible Population Counts
Male Female Total
(Col. 2) (Col. 3) (Col. 4) (Col. 5)
dolescents
15 12 27
53 55 108
68 52 120
61 88 149
77 94 171
90 85 175

1008
 59 78 137
81 97 178
1008 96 102 198
92 95 187
55 77 132
70 88 158
88 81 169
60 74 134
65 77 142
47 79 126
13 20 33
Eligible Population Counts
Male Female Total
(Col. 2) (Col. 3) (Col. 4) (Col. 5)
0 0
0 0
0 0
0 0
C2. Nutrition Services for Infants and Children
120 68 52 120
1 1 2
6 7 13
22 32 54
4 3 7
23 21 44
6 15 21
0 0 0
0 0 0

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

23 23 46
46 23 23 46
41 39 80
80 0 0 0
23 17 40
23 17 40
40
23 17 40
17 5 22
22 17 5 22
Section D. Oral Health Care and Services
Eligible Population Counts
Male Female Total
(Col. 2) (Col. 3) (Col. 4) (Col. 5)

Eligible Population Counts

Male Female Total

(Col. 2) (Col. 3) (Col. 4) (Col. 5)

 Eligible Population Counts
10-14 y/o 15-19 y/o 20-49 y/o Total

(Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6)

ection E. Infectious Disease Prevention and Control Services

Denominator Counts
Male Female Total
(Col. 2) (Col. 3) (Col. 4) (Col. 5)

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
eflected under Child Care and Maternal Care)

15 8 23

11 5 16

0 0 0
 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Denominator Counts
Male Female Total
(Col. 2) (Col. 3) (Col. 4) (Col. 5)

E7. Leprosy Prevention and Control

0 0 0
0 0 0

8 6 14
0 0 0
ction F. Non-Communicable Disease Prevention and Control Services
Eligible Population/Denominator Counts
Male Female Total
(Col. 2) (Col. 3) (Col. 4) (Col. 5)
226 212 438

168 12 180

175 88 263

98 65 163

6 4 10

0 0 0

0 0 0

0 0 0
 0 0 0

0 0 0

ection G. Environmental Health and Sanitation Services

Target/Denominator Total %
(Col.5/Target x
(Col. 2) (Col. 3) (Col. 4)

tal

ces - Total

ank - Total
unity
- Total
Total
rmit - Total

Section H. Mortality
Denominator Counts
Male Female Total

(Col. 2) (Col. 3) (Col. 4) (Col. 5)

0
0 0 0
2 1 3
0 0 0
1 1 2
0 0 0
 0 0 0
0 0 0
Section I. Natality
Denominator Counts
Male Female Total
(Col. 2) (Col. 3) (Col. 4) (Col. 5)

68 52 120
120 2 0
 Q1
RHU
ductive Age
RA 15-49 y/o Interpretation Recommendation / Action
ol. 3) (Col. 4) Taken
(Col. 5)

0
0
,475 63
New Acceptors CPR Interpreta Recom
tion menda
(Last Month of Col. 6/TP x 25.854% tions/
Present Qtr) (Col. 7) (Col. 8) Actions
to be
(Col.
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total (Col. 9)
10)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0 18.77

Postpartum Women Interpretation Recommendation

ol. 3) s/
Total Actions to be
No. % (Col. 4) Taken
(Col. 5)

82 8.83
68 7.32
68 7.32
0 0.43
4 0.43
42 4.52
68 7.32
57 6.14
29 3.12
0 0.00
29 3.12
21 0.00
0 0.00
31 0.00
5 0.00
15 1.61
71 7.64
19 0.00
13 0.00
0 0.00

Total
No. %
120
120 100.00
 119 99.17
1 0.83
0 0.00
119 99.17
9 7.50
15 12.50
95 79.17
Postpartum Women Interpretation Recommendations /
Actions to be Taken
ol. 3)
Total
No. % (Col. 4) (Col. 5)
119 99.17
119 99.17
0 0.00
1 0.83
120 100
0 0
120 100.00
0 0.00
0 0.00
0 0.00

111 11.95
87 9.36 Not disaggregated by sex
98 10.55

% Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Total 100)
(Col. 5) (Col. 6) (Col. 7) (Col. 8)

27 2.68
108 10.71
120 11.90
149 14.78
171 16.96
175 17.36
 137 13.59
178 17.66
198 19.64
187 18.55
132 13.10
158 15.67
169 16.77
134 13.29
142 14.09
126 12.50
33 3.27
% Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Total
100)
(Col. 5) (Col. 6) (Col. 7) (Col. 8)

120 100.00
2
13
54
7
44
21
0
0

0
0
0
 0

46
46 100.00
80
0 100.00
40
40 100
40 100
22
22 100

% Interpretation Recommendation
(Col.5/E.Pop s/
Total Actions to be
x 100)
(Col. 5) (Col. 6) (Col. 7) Taken
(Col. 8)

No visiting Dentist

% Interpretation Recommendation
(Col.5/E.Pop s/
Total Actions to be
x 100)
Taken
(Col. 5) (Col. 6) (Col. 7) (Col. 8)

No Visiting Dentist
 No Visiting Dentist

ts Interpretation Recommendation
Total % s/
(Col.6/ E.Pop x 100) Actions to be
Taken
(Col. 6) (Col. 7) (Col. 8) (Col. 9)
No visiting Dentist
ces
% Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Total 100)
(Col. 5) (Col. 6) (Col. 7) (Col. 8)

0
0
0
0
0
0
0
0
0

23

16

0
 0
0
0
0
0
% Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Total 100)
(Col. 5) (Col. 6) (Col. 7) (Col. 8)

0
0

14
0
vices
% Interpretation Recommendations /
(Col.5/E.Pop x Actions to be Taken
Total 100)
(Col. 5) (Col. 6) (Col. 7) (Col. 8)
438

180

263

163

10

0
 0

ces
% Interpretation Recommendations /
(Col.5/Target x 100) Actions to be Taken
(Col. 4) (Col. 5) (Col. 6)

% Interpretation Recommendations /
Total Actions to be Taken

(Col. 5) (Col. 6) (Col. 7) (Col. 8)

0
0
3 1 home, 2 hosp
0
2 1 RHU, 1 hosp
0
 0
0

% Interpretation Recommendations /
Total Actions to be Taken
(Col. 5) (Col. 6) (Col. 7) (Col. 8)

120
0.00
 Q1
FHSIS REPORT for the QUARTER ____THIRD____ YEAR: ____2021___
Name of Municipality/City: _________DARAM_________________________
Name of Province: _______SAMAR___________________________
Projected Population of the Year: _______45,565___________________________
For submission to PHO/CHO RHU
Section A. Family Planning Services and Deworming for Women of Reproductive Age
A1. Modern FP Unmet Need Age Total for WRA 15-49 y/o Interpretation Recommendation /
(Col. 1) (Col. 2) (Col. 3) (Col. 4) Action
(Col.Taken
5)
10-14 y/o 15-19 y/o 20-49 y/o
1. Proportion of WRA with unmet need for modern FP
(No.1.1/No.1.2 X 100) 0
1.1  Number of WRA with unmet need for MFP - Total 0
1.2  Total No. of Estimated WRA
(Total Population X 25.854%)
11,475 11,475 63
Current Users Acceptors Drop-outs Current Users New Acceptors CPR Interpre Recom
A2. Use of FP Method tation menda
tions/
(Beginning of Qtr) New (end of Qtr) Other (end of Qtr) (Present Quarter) (End of Quarter) (Last Month of Col. 6/TP x 25.854% Actions
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) Present Qtr) (Col. 7) (Col. 8) to be
Taken
(Col.
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total (Col. 9)
10)
a. BTL -Total 259 259 0 25 25 10 10 0 0 274 274 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 52 52 0 25 25 0 0 0 0 77 77 0
d. Pills - Total 1011 1011 0 1 100 101 74 74 0 1 1037 1038 0
d.1 Pills-POP - Total 174 174 0 0 74 74 0 0 100 100 0
d.2 Pills-COC - Total 837 837 0 100 100 0 0 0 937 937 0
e. Injectables (DMPA/POI) 3 390 393 0 6 75 81 3 4 7 0 6 461 467 0
f. Implant - Total 272 272 0 5 5 3 3 0 5 269 274 0
g. IUD (IUD-I and IUD-PP) - Total 92 92 0 0 7 7 0 0 85 85 0
g.1 IUD-I- Total 28 28 0 0 7 7 0 0 21 21 0
g.2 IUD-PP - Total 64 64 0 0 0 0 0 0 64 64 0
h. NFP-LAM - Total 5 70 75 0 1 1 1 1 0 4 71 75 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 2154 0 238 102 0 0 0 2290 0 19.96
Section B. Maternal Care and Services
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendati
(Col. 3) ons /
10-14 15-19 20-49 Total Actions to be
(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) Taken
(Col. 5)
B1. Prenatal Care
1. No. of pregnant women w/ at least 4 prenatal check-ups - Total 49 49 5.27
2. No. of pregnant women assessed of their nutritional status during the 1st
4 28 32 3.44
trimester
a. Number- Total
of pregnant women seen in the first trimester who have normal
3 30 33 3.55
BMI - Total
b. No. of pregnant women seen in the first trimester who have low BMI-Total 1 1 0.00
c. No. of pregnant women seen in the first trimester who have high BMI-Total 0 0.00
3. No. of pregnant women for the first time given at least 2 doses of Td
37 37 3.98
4. vaccination - Total
No. of pregnant women for the 2nd or more times given at least 3 doses of Td
32 32 3.44
vaccination (Td2women
5. No. of pregnant Plus) - who
Totalcompleted the dose of iron with folic acid
11 11 1.18
6. supplementation - Total who completed doses of calcium carbonate
No. of pregnant women
2 2 0.22
supplementation - Total
7. No. of pregnant women given iodine capsules – Total 13 13 0.00
8. No. of pregnant women given one dose of deworming tablet - Total
929 2 28 30 3.23
9. No. of pregnant women screened for syphilis - Total 20 20 0.00
10. No. of pregnant women tested positive for syphilis - Total 45 45 0.00
11. No. of pregnant women screened for Hepatitis B - Total 0 0.00
12. No. of pregnant women tested positive for Hepatitis B - Total 26 26 0.00
13. No. of pregnant women screened for HIV - Total 46 46 4.95
14. No. of pregnant women tested for CBC or Hgb&Hct count - Total 2 2 0.22
15. No. of pregnant women tested for CBC or Hgb&Hct count diagnosed with
0 0.00
anemia - Total
16. No. of pregnant women screened for gestational diabetes – Total 0 0.00
17. No. of pregnant women tested positive for gestational diabetes – Total 0 0.00
B2. Intrapartum Care and Delivery Outcome
10-14 15-19 20-49 Total
M F M F M F No. %
18. No. of deliveries – Total 3 1 26 40 70
19. No. of live births – Total 3 1 26 40 70 100.00
a. No. of live births with normal birth weight - Total 3 1 26 40 70 100.00
70
b. No. of live births with low birth weight - Total 0 0 0 0 0 0.00
c. No. of live births with unknown birth weight - Total 0 0 0 0 0 0.00
20. No. of deliveries attended by skilled health professionals - Total 3 1 26 40 70 100.00
a. No. of deliveries attended by a doctor - Total 1 0 2 4 7 10.00
70
b. No. of deliveries attended by a nurse – Total 0 0 3 3 6 8.57
c. No. of deliveries attended by midwives - Total 2 1 21 33 57 81.43
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
Actions to be Taken
(Col. 3)
10-14 15-19 20-49 Total
(Col. 1) (Col. 2) M F M F M F No. % (Col. 4) (Col. 5)
21. No. of health facility-based deliveries - Total 3 1 26 40 70 100.00
a. No. of deliveries in public health facility - Total 3 1 26 40 70 100.00
b. No. of deliveries in private health facility - Total 0 0 0 0 0 0.00
22. No. of non-facility-based deliveries - Total 0 0 0 0 0 0.00
23a. No. of vaginal deliveries – Total 70 3 1 26 40 70 100
23b. No. of deliveries by cesarean section – Total 0 0 0 0 0 0
24a. No. of full-term births – Total 3 1 26 40 70 100.00
24b. No. of pre-term births – Total 0 0 0 0 0 #DIV/0!
24c. No. of fetal deaths - Total 0 0 0 0 0 #DIV/0!
24d. No. of abortion/miscarriage - Total 0 0 0 0 #DIV/0!
B3. Postpartum and Newborn Care
25. No. of postpartum women together with their newborn who completed at
3 67 70 100.00
leastof2postpartum
26. No. postpartumwomen
check-ups
who-completed
Total iron with folic acid
70 2 29 31 44.29 Not disaggregated by sex
supplementation - Total
27. No. of postpartum women with Vitamin A supplementation – Total 5 64 69 98.57
Section C. Child Care and Services
Indicators Eligible Population Counts % Interpretation Recommendations /
Actions to be Taken
Male Female Total (Col.5/E.Pop x 100)

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents
1. CPAB - Total 6 14 20 1.90
2. BCG - Total 44 52 96 9.13
3. HepB, within 24 hours. - Total 22 26 48 4.57
4. DPT-HiB-HepB 1 - Total 65 45 110 10.47
5. DPT-HiB-HepB 2 - Total 53 64 117 11.13
6. DPT-HiB-HepB 3 - Total 32 41 73 6.95
7. OPV 1 - Total 68 48 116 11.04
8. OPV 2 - Total 51 56 107 10.18
9. OPV 3 - Total 1051 41 59 100 9.51
10. IPV - Total 41 46 87 8.28
11. PCV 1 - Total 61 49 110 10.47
12. PCV 2 - Total 55 59 114 10.85
13. PCV 3 - Total 35 48 83 7.90
14. MCV 1 - Total 66 59 125 11.89
15. MCV 2 - Total 51 61 112 10.66
16. FIC - Total 37 41 78 7.42
17. CIC - Total 11 44 55 5.23
Indicators Eligible Population Counts % Interpretation Recommendation
(Col.5/E.Pop x s/
Male Female Total Actions to be
100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) Taken
(Col. 8)
18. Td, Grade 1 (November) - Total 0 0
19. MR, Grade 1 (November) - Total 0 0
20. Td, Grade 7 (November) - Total 0 0
21. MR, Grade 7 (November) - Total 0 0
22. Newborns initiated on breastfeeding immediately after birth lasting to 90 C2. Nutrition Services for Infants and Children
mins - Total 70 29 41 70 100.00
23. Preterm/LBW infants given iron supplementation - Total 0 0 0
24. Infants exclusively breastfed until 6th month - Total 12 11 23 #DIV/0!
25.
26. Infants 6 mos. old initiated to comp, feeding w/feeding
complementary continued breastfeeding
but no - Total
longer or never 18 16 34 #DIV/0!
been breastfed - Total 1 1 2 #DIV/0!
27. Infants 6-11 mos. given 1 dose of Vit. A 100,000 I.U. - Total 17 17 34
28. Children 12-59 mos. old given 2 doses of Vit. A 200,000 I.U. - Total 37 41 78
29. Infant 6-11 months old who completed MNP supplementation - Total 0 0 0
30. Children 12-23 mos. who completed MNP supplementation - Total 0 0 0
C3. Deworming Services for Infants, Children and Adolescents
31. 1-19 y/o given 2 doses of deworming drug - Total 0
a. PSAC, 1-4 y.o. dewormed (2 doses) - Total 0
b. SAC, 5-9 y.o. dewormed (2 doses) - Total 0
c. Adolescents, 10-19 y.o. dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total 9 12 21
33. Sick Infants 6-11 mos. old received Vitamin A - Total 21 8 10 18 100.00
34. Sick Children 12-59 mos. old seen - Total 17 16 33
35. Sick Children 12-59 mos. old received Vitamin A - Total 33 17 16 33 100.00
36. Diarrhea cases 0-59 months old seen - Total 2 3 5
37. Diarrhea cases 0-59 months old received ORS - Total 5
2 3 5 100
38. Diarrhea cases 0-59 mos. received ORS w/ zinc - Total 2 3 5 100
39. Pneumonia cases 0-59 mos. old seen - Total 2 2 4
40. Pneumonia cases 0-59 mos. old completed treatment - Total 4 2 2 4 100
Section D. Oral Health Care and Services
Indicators Eligible Population Counts % Interpretation Recommendati
(Col.5/E.Pop x ons /
Male Female Total Actions to be
100)
plus orally fit after (Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) Taken
(Col. 8)
rehabilitation - Total
2. Clients 5 years old and above with cases of DMFT - Total
3. Infants 0-11 months old who received BOHC - Total No visiting Dentist

4. Children 1-4 years old (12-59 mos.) who received BOHC - Tot
5. Children 5-9 years old who received BOHC - Total
Indicators Eligible Population Counts % Interpretation Recommendati
(Col.5/E.Pop x ons /
Male Female Total Actions to be
100)
Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
6. Adolescents who received BOHC - Total
a. Adolescents 10-14 years old who received BOHC - Total
b. Adolescents 15-19 years old who received BOHC - Total No Visiting Dentist
7.
8. Adults
Senior 20-59
citizensyears old who
60 years old received
and aboveBOHC - Total BOHC -
who received
Total
Indicators Eligible Population Counts Interpretation Recommendati
ons /
 Indicators Interpretation
ons /
10-14 y/o 15-19 y/o 20-49 y/o Total %
(Col.6/ E.Pop x 100) Actions to be
Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8) (Col. 9)
9. Pregnant women who received BOHC - Total No visiting Dentist
Section E. Infectious Disease Prevention and Control Services
Indicators Denominator Counts % Interpretation Recommendations /
Actions to be Taken
Male Female Total (Col.5/E.Pop x 100)

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

E1. Filariasis (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total
2. No. of suspected cases seen – Total
3. No. of acute clinically diagnosed cases - Total
4. No. of confirmed acute cases - Total
5. No. of chronic clinically diagnosed cases - Total
6. No. of confirmed chronic cases - Total
7. No. of confirmed cases (acute and chronic) - Total
8. No. of cases treated - Total
9. No. of confirmed chronic cases referred to a hospital facility - Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 2 doses of deworming tablet -
E4.Total
HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total 12 9 31
2. Number of registered bacteriologically confirmed drug resistant TB 9 8 17
3. (RR/MDR-TB
Number of TB,Cases) - Total
all forms that are cured and completely treated - Total 14
4. Number of registered bacteriology confirmed drug resistant TB Cases
E6.(RR/MDR-TB) cured and Control
Malaria Prevention completed treatment - Total
1. No. of patients with probable/clinically diagnosed Malaria and confirmed
case
• < 5 -y/o
Total
- Total
• ≥ 5 y/o - Total
2. No. of lab-confirmed Malaria deaths - Total
• < 5 y/o - Total
• ≥ 5 y/o - Total
Indicators Denominator Counts % Interpretation Recommendations /
Actions to be Taken
Male Female Total (Col.5/E.Pop x 100)

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

E7. Leprosy Prevention and Control

1. No. of Leprosy cases on treatment during reporting period - Total 0 0 0
2. No. of newly detected cases during reporting period - Total 0 0 0
E8. Rabies Prevention and Control
1. No. of animal bites - Total
2. No. of deaths due to Rabies - Total
Section F. Non-Communicable Disease Prevention and Control Services
Indicators Eligible Population/Denominator Counts % Interpretation Recommendations /
Actions to be Taken
Male Female Total (Col.5/E.Pop x 100)

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

1. No. of adults risk-assessed using PhilPEN - Total
2. Current smokers - Total
3. Alcohol binge drinkers - Total
4. Overweight/Obese-Total
5. No. of adult women screened for Cervical Cancer using VIA/Pap Smear -
Totalof adult women found positive/suspect for Cervical Cancer using
6. No.
VIA/Pap
7. No. Smear-
of adult Total
women screened for breast mass - Total
8. No. of adult women with suspicious breast mass - Total
9. No. of newly-identified hypertensive adults - Total
10. No. of newly-identified adults with Type 2 DM - Total
11. No. of senior citizens screened for visual acuity - Total
12. No. of senior citizens diagnosed with eye disease/s - Total
13. No. of senior citizens who received one (1) dose of PPV - Total
14. No. of senior citizens who received one (1) dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Target/Denominator Total % Interpretation Recommendations /
(Col.5/Target x 100) Actions to be Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6)

1. No. of HHs with access to basic safe water supply - Total

a. No. of HHs with Level I - Total
b. No. of HHs with Level II - Total
c. No. of HHs with Level III - Total
2. No. of HHs using safely managed drinking-water services - Total
3. No of HHs with basic sanitation facility - Total
a. No. of HH with pour/flush toilet connected to septic tank - Total
b. No. of HHs with pour/flush toilet connected to community
sewer/sewerage
c. No. of HHs with ventilated improved pit latrine (VIP) - Total
4. No. of HHs using safely managed sanitation services - Total
5. No. of industrial establishments issued with sanitary permit - Total
6. No. of barangays declared ZOD - Total
 Section H. Mortality
Indicators Denominator Counts % Interpretation Recommendations /
Male Female Total Actions to be Taken

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

1. Total Deaths 0
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
Section I. Natality
Indicators Denominator Counts % Interpretation Recommendations /
Male Female Total Actions to be Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
1. Livebirths - Total 29 41 70
a. Livebirths among 15-19 y/o women - Total 70 3 1 4 5.71
 Q1
FHSIS REPORT for the QUARTER ____FOURTH____ YEAR: ____2021___
Name of Municipality/City: _________DARAM_________________________
Name of Province: _______SAMAR___________________________
Projected Population of the Year: _______45,565___________________________
For submission to PHO/CHO
RHU
Section A. Family Planning Services and Deworming for Women of Reproductive Age
A1. Modern FP Unmet Need Age Total for WRA 15-49 y/o Interpretation Recommendation /
(Col. 1) (Col. 2) (Col. 3) (Col. 4) Action
(Col.Taken
5)
10-14 y/o 15-19 y/o 20-49 y/o
1. Proportion of WRA with unmet need for modern FP
(No.1.1/No.1.2 X 100) 0
1.1  Number of WRA with unmet need for MFP - Total 0
1.2  Total No. of Estimated WRA
(Total Population X 25.854%)
11,475 11,475 63
Current Users Acceptors Drop-outs Current Users New Acceptors CPR Interpre Recom
A2. Use of FP Method tation menda
tions/
(Beginning of Qtr) New (end of Qtr) Other (end of Qtr) (Present Quarter) (End of Quarter) (Last Month of Col. 6/TP x 25.854% Actions
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) Present Qtr) (Col. 7) (Col. 8) to be
Taken
(Col.
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total (Col. 9)
10)
a. BTL -Total 271 271 0 0 0 0 0 271 271 0
b. NSV - Total 2 2 0 0 0 0 0 2 2 0
c. Condom - Total 58 58 0 1 1 0 0 0 59 59 0
d. Pills - Total 1027 1027 0 1 1 0 0 0 1028 1028 0
d.1 Pills-POP - Total 71 71 0 0 0 0 0 71 71 0
d.2 Pills-COC - Total 956 956 0 1 1 0 0 0 957 957 0
e. Injectables (DMPA/POI) - Total 4 496 500 1 1 0 0 0 4 497 501 0
f. Implant - Total 2 273 275 1 1 0 0 0 2 274 276 0
g. IUD (IUD-I and IUD-PP) - Total 91 91 0 0 0 0 0 91 91 0
g.1 IUD-I- Total 20 20 0 0 0 0 0 20 20 0
g.2 IUD-PP - Total 71 71 0 0 0 0 0 71 71 0
h. NFP-LAM - Total 7 69 76 2 2 3 3 6 6 0 7 68 75 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 2300 4 5 6 0 0 0 2303 0 20.07
Section B. Maternal Care and Services
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendati
(Col. 3) ons /
10-14 15-19 20-49 Total Actions to be
(Col. 1) (Col. 2) No. % No. % No. % No. % (Col. 4) Taken
(Col. 5)
B1. Prenatal Care
1. No. of pregnant women w/ at least 4 prenatal check-ups - Total 3 92 95 10.23
2. No. of pregnant women assessed of their nutritional status during the 1st
9 62 71 7.64
trimester
a. Number- Total
of pregnant women seen in the first trimester who have normal
8 60 68 7.32
BMI - Total
b. No. of pregnant women seen in the first trimester who have low BMI-Total 3 3 0.22
c. No. of pregnant women seen in the first trimester who have high BMI-Total 2 2 0.22
3. No. of pregnant women for the first time given at least 2 doses of Td
2 34 36 3.88
vaccination
4. No. - Total
of pregnant women for the 2nd or more times given at least 3 doses of Td
1 69 70 7.53
vaccination
5. No. (Td2women
of pregnant Plus) - who
Totalcompleted the dose of iron with folic acid
3 59 62 6.67
supplementation
6. No. - Total who completed doses of calcium carbonate
of pregnant women
8 8 0.86
supplementation - Total
7. No. of pregnant women given iodine capsules – Total 0 0.00
8. No. of pregnant women given one dose of deworming tablet - Total
929 14 14 1.51
9. No. of pregnant women screened for syphilis - Total 12 12 0.00
10. No. of pregnant women tested positive for syphilis - Total 0 0.00
11. No. of pregnant women screened for Hepatitis B - Total 1 31 32 0.00
12. No. of pregnant women tested positive for Hepatitis B - Total 0 0.00
13. No. of pregnant women screened for HIV - Total 12 12 1.29
14. No. of pregnant women tested for CBC or Hgb&Hct count - Total 10 63 73 7.86
15. No. of pregnant women tested for CBC or Hgb&Hct count diagnosed with
8 29 37 0.00
anemia - Total
16. No. of pregnant women screened for gestational diabetes – Total 7 7 0.00
17. No. of pregnant women tested positive for gestational diabetes – Total 3 3 0.00
B2. Intrapartum Care and Delivery Outcome
10-14 15-19 20-49 Total
M F M F M F No. %
18. No. of deliveries – Total 3 7 62 40 112
19. No. of live births – Total 3 7 62 40 112 100.00
a. No. of live births with normal birth weight - Total 3 7 60 40 110 98.21
112
b. No. of live births with low birth weight - Total 0 0 2 0 2 1.79
c. No. of live births with unknown birth weight - Total 0 0 0 0 0 0.00
20. No. of deliveries attended by skilled health professionals - Total 3 7 61 39 110 98.21
a. No. of deliveries attended by a doctor - Total 1 0 5 1 7 6.25
112
b. No. of deliveries attended by a nurse – Total 0 4 3 8 15 13.39
c. No. of deliveries attended by midwives - Total 2 3 53 30 88 78.57
Indicators Eligible Population Age of Pregnant/Postpartum Women Interpretation Recommendations /
(Col. 3) Actions to be Taken

10-14 15-19 20-49 Total

(Col. 1) (Col. 2) M F M F M F No. % (Col. 4) (Col. 5)
21. No. of health facility-based deliveries - Total 3 7 61 39 110 104.76
a. No. of deliveries in public health facility - Total 3 7 61 39 110 104.76
b. No. of deliveries in private health facility - Total 0 0 0 0 0 0.00
22. No. of non-facility-based deliveries - Total 0 0 1 1 2 1.90
23a. No. of vaginal deliveries – Total 105 3 7 62 40 112 107
23b. No. of deliveries by cesarean section – Total 0 0 0 0 0 0
24a. No. of full-term births – Total 0 0 0 0 0 0.00
24b. No. of pre-term births – Total 0 0 0 0 0 #DIV/0!
24c. No. of fetal deaths - Total 0 0 0 0 0 #DIV/0!
24d. No. of abortion/miscarriage - Total 0 0 #DIV/0!
B3. Postpartum and Newborn Care
25. No. of postpartum women together with their newborn who completed at
10 100 110 11.84
leastof2postpartum
26. No. postpartumwomen
check-ups
who-completed
Total iron with folic acid
929 28 87 9.36 Not disaggregated by sex
supplementation - Total
27. No. of postpartum women with Vitamin A supplementation – Total 10 102 112 12.06
Section C. Child Care and Services
Indicators Eligible Population Counts % Interpretation Recommendations /
Actions to be Taken
Male Female Total (Col.5/E.Pop x 100)

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents
1. CPAB - Total 11 8 19 1.81
2. BCG - Total 81 54 135 12.84
3. HepB, within 24 hours. - Total 69 45 114 10.85
4. DPT-HiB-HepB 1 - Total 43 51 94 8.94
5. DPT-HiB-HepB 2 - Total 41 41 82 7.80
6. DPT-HiB-HepB 3 - Total 51 41 92 8.75
7. OPV 1 - Total 41 46 87 8.28
8. OPV 2 - Total 46 40 86 8.18
9. OPV 3 - Total 1051 47 46 93 8.85
10. IPV - Total 52 46 98 9.32
11. PCV 1 - Total 42 55 97 9.23
12. PCV 2 - Total 51 41 92 8.75
13. PCV 3 - Total 44 50 94 8.94
14. MCV 1 - Total 34 26 60 5.71
15. MCV 2 - Total 39 48 87 8.28
16. FIC - Total 33 36 69 6.57
17. CIC - Total 2 5 7 0.67
Indicators Eligible Population Counts % Interpretation Recommendation
(Col.5/E.Pop x s/
Male Female Total Actions to be
100)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) Taken
(Col. 8)
18. Td, Grade 1 (November) - Total 0 0
19. MR, Grade 1 (November) - Total 0 0
20. Td, Grade 7 (November) - Total 0 0
21. MR, Grade 7 (November) - Total 0 0
22. Newborns initiated on breastfeeding immediately after birth lasting to 90 C2. Nutrition Services for Infants and Children
mins - Total 112 65 47 112 100.00
23. Preterm/LBW infants given iron supplementation - Total 0 0 0
24. Infants exclusively breastfed until 6th month - Total 3 3 6 #DIV/0!
25. Infants 6 mos. old initiated to complementary
26. comp, feeding w/feeding
continued breastfeeding
but no - Total
longer or never 1 2 3 #DIV/0!
been breastfed - Total 0 0 0 #DIV/0!
27. Infants 6-11 mos. given 1 dose of Vit. A 100,000 I.U. - Total 0 2 2
28. Children 12-59 mos. old given 2 doses of Vit. A 200,000 I.U. - Total 0 0 0
29. Infant 6-11 months old who completed MNP supplementation - Total 0 0 0
30. Children 12-23 mos. who completed MNP supplementation - Total 0 0 0
C3. Deworming Services for Infants, Children and Adolescents
31. 1-19 y/o given 2 doses of deworming drug - Total 8 14 22
a. PSAC, 1-4 y.o. dewormed (2 doses) - Total 0 0 0
b. SAC, 5-9 y.o. dewormed (2 doses) - Total 0 0 0
c. Adolescents, 10-19 y.o. dewormed (2 doses) - Total 8 14 22
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total 6 4 10
33. Sick Infants 6-11 mos. old received Vitamin A - Total 10 6 4 10 100.00
34. Sick Children 12-59 mos. old seen - Total 11 9 20
35. Sick Children 12-59 mos. old received Vitamin A - Total 20 11 9 20 100.00
36. Diarrhea cases 0-59 months old seen - Total 2 3 5
37. Diarrhea cases 0-59 months old received ORS - Total 5
2 3 5 100
38. Diarrhea cases 0-59 mos. received ORS w/ zinc - Total 2 3 5 100
39. Pneumonia cases 0-59 mos. old seen - Total 4 1 5
40. Pneumonia cases 0-59 mos. old completed treatment - Total 5 4 1 5 100
Section D. Oral Health Care and Services
Indicators Eligible Population Counts % Interpretation Recommendati
(Col.5/E.Pop x ons /
Male Female Total Actions to be
100)
orally fit after (Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) Taken
(Col. 8)
rehabilitation - Total
2. Clients 5 years old and above with cases of DMFT - Total
3. Infants 0-11 months old who received BOHC - Total No visiting Dentist

4. Children 1-4 years old (12-59 mos.) who received BOHC - Total
5. Children 5-9 years old who received BOHC - Total
Indicators Eligible Population Counts % Interpretation Recommendati
(Col.5/E.Pop x ons /
Male Female Total Actions to be
100)
Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
6. Adolescents who received BOHC - Total
a. Adolescents 10-14 years old who received BOHC - Total
b. Adolescents 15-19 years old who received BOHC - Total No Visiting Dentist
7. Adults 20-59 years old who received BOHC - Total
8. Senior citizens 60 years old and above who received BOHC - Total
Indicators Eligible Population Counts Interpretation Recommendati
10-14 y/o 15-19 y/o 20-49 y/o Total % ons /
(Col.6/ E.Pop x 100) Actions to be
Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8) (Col. 9)
9. Pregnant women who received BOHC - Total No visiting Dentist
Section E. Infectious Disease Prevention and Control Services
Indicators Denominator Counts % Interpretation Recommendations /
Actions to be Taken
Male Female Total (Col.5/E.Pop x 100)

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

E1. Filariasis (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total
2. No. of suspected cases seen – Total
3. No. of acute clinically diagnosed cases - Total
4. No. of confirmed acute cases - Total
5. No. of chronic clinically diagnosed cases - Total
6. No. of confirmed chronic cases - Total
7. No. of confirmed cases (acute and chronic) - Total
8. No. of cases treated - Total
9. No. of confirmed chronic cases referred to a hospital facility - Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 2 doses of deworming tablet - 19
E4.Total
HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total 16 8
2. Number of registered bacteriologically confirmed drug resistant TB 13 8 3 MDR-RR pts are registered in Calbayog STC

(RR/MDR-TB
3. Number of TB,Cases) - Total
all forms that are cured and completely treated - Total 16 6 8 14 87.50
4. Number of registered bacteriology confirmed drug resistant TB Cases 0 0
E6.(RR/MDR-TB) cured and Control
Malaria Prevention completed treatment - Total
1. No. of patients with probable/clinically diagnosed Malaria and confirmed
case
• < 5 -y/o
Total
- Total
• ≥ 5 y/o - Total
2. No. of lab-confirmed Malaria deaths - Total
• < 5 y/o - Total
• ≥ 5 y/o - Total
Indicators Denominator Counts % Interpretation Recommendations /
Actions to be Taken
Male Female Total (Col.5/E.Pop x 100)

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

E7. Leprosy Prevention and Control

1. No. of Leprosy cases on treatment during reporting period - Total 0 0 0
2. No. of newly detected cases during reporting period - Total 0 0 0
E8. Rabies Prevention and Control
1. No. of animal bites - Total
2. No. of deaths due to Rabies - Total
Section F. Non-Communicable Disease Prevention and Control Services
Indicators Eligible Population/Denominator Counts % Interpretation Recommendations /
Actions to be Taken
Male Female Total (Col.5/E.Pop x 100)

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

1. No. of adults risk-assessed using PhilPEN - Total
2. Current smokers - Total
3. Alcohol binge drinkers - Total
4. Overweight/Obese-Total
5. No. of adult women screened for Cervical Cancer using VIA/Pap Smear -
Totalof adult women found positive/suspect for Cervical Cancer using
6. No.
VIA/Pap
7. No. Smear-
of adult Total
women screened for breast mass - Total
8. No. of adult women with suspicious breast mass - Total
9. No. of newly-identified hypertensive adults - Total
10. No. of newly-identified adults with Type 2 DM - Total
11. No. of senior citizens screened for visual acuity - Total
12. No. of senior citizens diagnosed with eye disease/s - Total
13. No. of senior citizens who received one (1) dose of PPV - Total
14. No. of senior citizens who received one (1) dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Target/Denominator Total % Interpretation Recommendations /
(Col.5/Target x 100) Actions to be Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6)

1. No. of HHs with access to basic safe water supply - Total

a. No. of HHs with Level I - Total
b. No. of HHs with Level II - Total
c. No. of HHs with Level III - Total
2. No. of HHs using safely managed drinking-water services - Total
3. No of HHs with basic sanitation facility - Total
a. No. of HH with pour/flush toilet connected to septic tank - Total
b. No. of HHs with pour/flush toilet connected to community sewer/sewerage
system
c. No. or with
of HHs any other approved
ventilated treatment
improved system
pit latrine - Total
(VIP) - Total
4. No. of HHs using safely managed sanitation services - Total
5. No. of industrial establishments issued with sanitary permit - Total
6. No. of barangays declared ZOD - Total
Section H. Mortality
Indicators Denominator Counts % Interpretation Recommendations /
Male Female Total Actions to be Taken

(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)

1. Total Deaths 0
2. Maternal Deaths - Total 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 2 2
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
Section I. Natality
Indicators Denominator Counts % Interpretation Recommendations /
Male Female Total Actions to be Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7) (Col. 8)
1. Livebirths - Total 65 47
a. Livebirths among 15-19 y/o women - Total 3 7 #DIV/0!
 Q2
FHSIS QUARTERLY REPORT FOR THE YEAR: FIRST QUARTER, 2021
Municipality/City of: DARAM
Province: SAMAR
MORBIDITY REPORT
For submission to the PHO
RHU
29days to
ICD 0-7days 8-28days 11mos. 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 65 - 69 70y.o. & above TOTAL GRANDT
DISEASE 10
CODE OTAL
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 M F M F M F M F M F
Hypertension 5 3 2 9 9 10 28 43 82 49 122 81 215 97 183 107 236 194 541 67 194 660 1617 2277
No Pneumonia 1 1 53 57 111 107 68 63 35 37 26 28 17 91 26 68 20 53 16 81 23 63 22 39 20 42 21 33 19 32 15 34 8 19 500 849 1349
URTI 1 1 22 25 66 69 62 61 32 22 16 30 12 27 8 31 10 22 10 15 16 28 11 53 9 19 12 19 1 15 6 18 4 294 459 753
ARI 22 12 37 26 22 21 7 13 3 10 10 8 11 3 10 3 1 4 2 4 1 3 1 4 1 3 3 5 3 2 1 6 135 127 262
Diabetes Mellitus 1 12 6 7 8 1 11 6 9 13 25 17 35 17 52 13 22 73 182 255
Wounds 5 7 16 5 10 2 10 5 9 4 9 4 6 2 5 2 13 10 7 9 4 10 6 4 3 4 5 4 19 8 127 80 207
Diarrhea 1 4 6 19 20 7 13 3 7 2 2 2 1 3 4 3 6 4 5 0 2 4 3 3 2 2 3 0 4 0 2 2 4 58 85 143
Skin Infections 2 9 3 10 3 5 2 3 4 2 5 1 1 2 5 2 7 2 4 2 12 12 13 10 8 0 4 2 2 0 0 62 75 137
Pneumonia 7 7 24 17 7 8 3 1 3 1 0 1 1 4 0 2 0 2 0 1 2 2 1 0 4 2 0 3 1 6 53 57 110
Fever 3 5 13 13 10 5 5 5 1 3 2 3 1 1 2 5 1 4 1 3 3 2 2 38 55 93
Bronchial Asthma 7 7 2 4 1 1 3 2 1 4 2 4 1 2 5 4 3 4 6 2 4 1 5 2 4 5 4 36 54 90
Muskulo-skeletal Disorder 1 2 2 2 5 2 4 6 4 3 4 4 6 6 7 4 6 1 2 28 43 71
Influenza-like Illness 1 7 9 2 4 3 2 6 8 1 1 2 1 2 4 3 1 3 1 1 2 1 20 45 65
Hyperacidity 1 1 2 1 3 6 2 2 4 1 3 3 4 1 4 1 4 1 3 2 5 1 1 20 36 56
Dental Problem 3 1 3 1 2 2 2 4 4 3 4 5 2 4 3 2 1 1 1 1 1 19 31 50
UTI 1 2 1 3 1 4 1 5 2 7 3 2 5 2 3 2 1 14 31 45
Abdominal Pain 2 1 1 2 2 1 2 1 2 1 1 1 1 1 1 1 7 14 21
Arthritis 1 2 7 1 3 4 2 7 13 20
Animal Bite 1 2 1 1 1 1 1 2 1 1 2 2 2 9 9 18
Ear Infection 1 1 2 3 1 1 1 1 1 6 6 12
Mental Illness 1 1 2 1 1 4 2 6
PPTB 2 1 1 1 1 4 2 6
Peripheral Neuropathy 2 1 2 1 1 5 6
Allergy 1 1 1 1 1 1 2 4 6
Abortion 1 2 1 0 4 4
Anemia 1 0 1 1
TOTAL 112 114 298 281 211 198 111 103 72 100 56 161 77 150 78 135 64 181 110 224 123 280 148 336 173 297 161 369 254 686 128 267 2176 3882 6058
 Q2
FHSIS QUARTERLY REPORT FOR THE YEAR: SECOND QUARTER, 2021
Municipality/City of: DARAM
Province: SAMAR
MORBIDITY REPORT
For submission to the PHO
RHU
29days to
ICD 0-7days 8-28days 11mos. 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 65 - 69 70y.o. & above TOTAL GRANDT
DISEASE 10
OTAL
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 M F M F M F M F M F
HYPERTENSION 0 2 2 0 6 5 2 20 8 39 21 61 42 156 66 106 64 189 92 305 106 265 409 1148 1557
NO PNEUMONIA 75 90 48 60 36 29 17 15 8 36 6 73 18 57 5 46 9 44 11 20 9 29 16 25 13 16 9 29 14 27 9 21 303 617 920
URTI 13 19 45 34 15 25 8 14 2 7 6 10 7 14 7 13 3 11 4 5 4 21 3 19 4 15 12 16 1 7 14 12 148 242 390
DIABETIS MELLITUS 1 0 0 13 6 8 1 9 2 13 4 4 9 36 6 25 11 24 11 18 51 150 201
WOUNDS 1 1 7 3 13 7 11 7 5 5 4 4 10 2 5 4 6 6 4 7 8 5 7 7 3 3 9 7 5 2 3 3 101 73 174
DIARRHEA 7 9 39 27 2 5 2 7 1 2 3 4 2 5 1 2 4 3 2 1 4 3 4 4 1 2 1 1 1 4 0 0 74 79 153
SKIN INFECTION 1 7 4 13 6 7 3 4 2 4 2 9 2 3 2 2 0 7 3 1 0 3 1 2 0 3 1 1 0 0 3 4 30 70 100
MSD 0 6 0 4 3 1 1 10 2 5 0 6 0 1 6 9 0 3 2 14 1 2 2 4 17 65 82
ARI 3 1 14 14 9 9 1 3 3 0 0 1 0 0 1 3 0 2 0 1 1 0 2 0 3 2 0 4 1 4 0 0 38 44 82
HYPERACIDITY 2 0 0 1 2 1 3 3 2 4 4 5 7 5 3 6 5 5 1 1 3 5 0 4 0 2 1 3 0 1 33 46 79
PNEUMONIA 7 5 17 14 2 1 1 4 0 0 1 0 3 1 0 1 2 5 3 2 0 2 2 0 0 1 1 0 1 0 0 0 40 36 76
FEVER 9 7 3 5 4 3 0 2 2 1 1 2 1 10 1 2 2 1 0 1 0 2 2 2 3 3 0 2 0 1 0 2 28 46 74
BRONCHIAL ASTHMA 9 3 0 8 1 2 1 2 0 0 1 2 2 1 0 2 0 2 3 2 2 0 1 0 5 0 2 4 7 4 34 32 66
DENTAL PROBLEM 1 0 2 1 1 3 0 2 1 2 0 2 1 3 1 2 0 1 1 1 0 1 1 0 0 0 0 0 0 0 9 18 27
MENTAL ILLNESS 0 3 0 0 6 3 3 3 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 12 9 21
EAR INFECTION 1 2 0 2 0 2 0 1 0 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 0 0 1 0 0 1 2 12 14
ALLERGY 0 2 2 0 1 2 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 4 8 12
PULMONARY TUBERCULOSIS 0 1 2 0 0 1 0 0 0 0 3 1 0 0 0 1 0 0 0 0 0 1 5 5 10
ANEMIA 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3
PERIPHERAL NEUROPATHY 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 2
HEART DISEASE 1 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 1 1 2
LIVER DISEASE 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1
DEWORMING 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 0 0 0 1 1
0 0 0
0 0 0
0 0 0
0 0 0
TOTAL 116 141 192 175 90 101 48 65 28 74 26 117 62 107 43 117 40 122 44 102 58 145 94 234 104 195 110 290 131 385 155 336 1341 2706 4047
 FHSIS QUARTERLY REPORT FOR THE YEAR: FIRST QU
Municipality/City of:
Province:
MORTALITY REPORT
For submission to the PHO
29days to
0-7days 8-28days 11mos. 1-4 5-9 10 - 14 15 - 19 20 - 24 25 -29
DISEASE ICD 10
CODE
M F M F M F M F M F M F M F M F M F
CVA
Hypertension
Unknown
Cancer
Pneumonia
Chronic Kidney Failure 1
Acute Myocardial Infarction
Menigitis 1 1
AGE 1 1
Pulmonary TB
Decubitus Ulcer
Cerebral Concussion
Extra-pulmonary TB 1
Bronchial Asthma
Bronchiectasis
CAD
Schistosomiasis
Presumptive PTB
Chronic Gastritis
COPD
Diabetes Mellitus

TOTAL 0 2 1 1 1 0 0 0 0 0 0 1 0 0
 Q3
PORT FOR THE YEAR: FIRST QUARTER, 2021
/City of: DARAM
SAMAR
MORTALITY REPORT
For submission to the PHO
RHU
30 -34 35 -39 40 -44 45 -49 50 -54 55 - 59 60 - 64 65 - 69 70y.o. & above TOTAL GRANDT
OTAL
M F M F M F M F M F M F M F M F M F M F
1 1 1 1 2 3 3 6
1 2 1 2 2 4
1 3 1 3 4
1 1 1 3 0 3
1 2 3 0 3
1 1 2 1 3
1 1 1 1 2
1 1 2
0 2 2
1 1 1 1 2
1 0 1 1
1 1 0 1
1 0 1
1 0 1 1
1 0 1 1
1 0 1 1
1 1 0 1
1 1 0 1
1 0 1 1
1 0 1 1
1 0 1 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1 0 1 1 0 0 0 2 0 3 2 1 1 4 0 8 12 21 21 42
MORTALITIES, 2021 (First Quarter, 2021)
Date & Time
Name of Deceased Age Address of Delivery Place of Delivery
INFANT DEATH
2mos & 27 So. Cagutsan, Casab-
Melvie Rose Matic Nov. 9, 2020 SPH
days ahan
7mos & 22
Renan A. Manosa P1 Marupangdan, Daram Feb. 5, 2021 RHU - Daram
days

Ma. Ramelda B. Ibanez 5mos P3 Bagacay, Daram Sept. 29, 2020 RHU - Daram

MATERNAL DEATH

Jennifer Montabon 25 y.o. P4 Cagboboto, Daram Jan. 18, 2021 RHU - Daram

MORTALITIES, 2021 (Second Quarter, 2021)

Name of Deceased Age Address Date & Time Place of Delivery

of Delivery
NEONATAL DEATH
Bb. Girl Reso 1 day old P2 Astorga, Daram May 1, 2021 SPH
Bb. Boy Alaga 1 day old P2 Poso, Daram June 28, 2021 Others (MB)
INFANT DEATH
Jimuel Rence Sabulao 10 mos. P1 Lucob-lucob, Daram June 18, 2020 SPH

Regina D. Sanilla 7 mos. P1 Bayog, Daram Nov. 16, 2020 Gandara, Samar
UNDER-FIVE DEATH
James Michael Espino 52 mos. P1 Beta-ug, Daram Dec. 3, 2016 RHU - Daram

Marlyn M. Latoja 1 yr. & 7 mos. P3 Bagacay, Daram Aug. 30, 2019 RHU - Daram

Jaira Mae Garcia 1 y.o. P1 Cagboboto, Daram June 4,2020 SPH

MORTALITIES, 2021 (Third Quarter, 2021)

Date & Time
Name of Deceased Age Address of Delivery Place of Delivery
NEONATAL DEATH
Jafferson Subalisid 2 days old P1 Campelipa, Daram July 2, 2021 RHU - Daram

Bb. Boy Granada 0 mos. Mayabay

Bb. Boy Fuentes 0 mos. P1 Marupangdan, Daram

INFANT DEATH
 2 mos. & 4
Darex D. Luzon P5 Pob. 02, Daram May 12, 2021 RHU - Daram
days
Liam Rick Reyes 6 mos. P5 Bagacay, Daram Jan. 12, 2021 RHU - Daram
Jessa s. Merin 12 mos. P6 Bagacay, Daram 08/31/2020 RHU - Daram
UNDER-FIVE DEATH
Sean Gabriel R. Lucgoiao 2 y.o. P1 Rizal, Daram Mar. 5, 2019 SPH

MORTALITIES, 2021 (Fourth Quarter, 2021)

Date & Time
Name of Deceased Age Address of Delivery Place of Delivery
NEONATAL DEATH

INFANT DEATH
Niqueera Eloisa Castillo 4 mos. Mabini, Daram

Irish Pones 10 mos. Mayabay, Daram

UNDER-FIVE DEATH
 Cause of Date & Time 0f
Attended by: Death/Symptoms Place of Death Death Attended by:
before Death

Doctor Pneumonia SPH 6/2/2021 Doctor

Midwife EVRMC 02/28/2021 Doctor

P3-Bagacay,
Midwife 10/3/2021 Family
Daram

Midwife RHU - Daram 01/27/2021 RHM

Cause of
Attended by: Death/Symptoms Place of Death Date & Time 0f Attended by:
before Death Death

Doctor Heart problem SPH 2/5/2021 Doctor

RHM DOB RHU - Daram 06/29/2021 RHM

Doctor Pediatric CAP, very SPH 04/15/2021 Doctor

severe
Hilot RHU - Daram 06/24/2021 RHM

Midwife Beta-ug, Daram 5/4/2021 Family

Midwife SPH 04/24/2021 Doctor

Menigitis vs.
Doctor Encephalitis SPH 06/16/2021 Doctor

Cause of Date & Time 0f

Attended by: Death/Symptoms Place of Death Death Attended by:
before Death

Campelipa,
Midwife 3/7/2021 family
Daram
08/11/2021`

SPH 08/22/2021`
Midwife Pob. 02, Daram 11/7/2021

Midwife RHU - Daram 07/29/2021 Nurse

RHM SAM home 08/29/2021 family

P1 Brgy. Rizal,
Doctor 08/27/2021 family
Daram

Cause of Date & Time 0f

Attended by: Death/Symptoms Place of Death Death Attended by:
before Death

Severe DHN 10/15/2021

Asthma 12/19/2021
Registered at LCR
(Y/N)

Yes

No

Registered at LCR
(Y/N)

No

Registered at LCR
(Y/N)
No
No

Registered at LCR
(Y/N)