FORMAT A

BARANGAY PROFILE --- I. HEALTH AND NUTRITION SITUATION

Region: ______ Province: ___________________ Municipality: ___________________________ Barangay: _______________________
Part A PRESCHOOL (PSC)
SCHOOL CHILDREN (SC) 25.) Total No. of PSC: ______________________________
1)
Total No. Of Puroks: ___________________________ 13) Total No. of School Children: ____________________________ 26.) Most Recent date of OPT: ________________________
2)
Total Population: ______________________________ 14) Total Number Weighed: _________________________________ 27.) % OPT Coverage of PSC: ________________________
3)
Total No. of Households: ________________________ 15) Percent Weighed: ________________________________________ 29.) Total No. of PSC Weighed: _______________________
4)
Total No. of Families: __________________________ 16) No. of Normal weighed: __________________________________ 30.) No. of Normal weighed: _________________________
5)
Common Occupation: ___________________________ 17) No. of Overweight: _______________________________________ 31.) No. of Overweight: _____________________________
6)
Age Specific Proportionate Mortality Rate: _________ 18) No. of Underweight (UW): _______________________________ 32.) No. of Underweight (UW): _______________________
No. of Severely Underweight (SUW):
7)
Total No. of Pregnant Women: ___________________ 19) No. of Severely Underweight (SUW): ____________________ 33.)
______________________
No. of Stunted (ST):
8)
Total No. of Lactating Women: ___________________ 20.) No. of Wasted (W): _______________________________ 34.)
________________________________________
No. of Severely Stunted (Sst):
9)
No. of Household using Iodized Salt/Fortified Foods: _ 21.) No. of Severely Wasted (SW): _______________________________ 35.)
_______________________________
10)
No. of HH with Home Gardens: ___________________ 22.) Total No. of UW + SUW SC: ________________________________ 36.) Total No. of UW + SUW PSC: ____________________
11)
Total No. of HH with poultry/livestock/fishpond: ____ 23.) Total No. of W + SW SC: ________________________________
12)
No. of Families practicing Family Planning: ________ 24.) OPT Period: _______________________________________________

5 TOTAL
TOTA TOTA No. of Cases with Nutritional Deficiencies
Purok Severely L TOTAL TOTAL
TOTAL L
Severely Stunted Severely Wasted
(Name/
No. of Normal Underweight (UW) Underweight Stunted (ST) Wasted (W) Overweight PSC (UW + (ST+SST (W + Night Blindness Anemia Goiter
(Sst) (SW) SW) No.
No.)
PSC (SUW) Weigh SUW)
No.
) No.
Boys Girls TOTAL Boys Girls TOTAL Boys Girls TOTAL Boys Girls TOTAL Boys Girls TOTAL Boys Girls TOTAL Boys Girls TOTAL Boys ed
Girls TOTAL No. No. No. No. SC PSC SC PSC SC 14+

TOTAL
Percent