FORMAT B

HEALTH AND NUTRITION SITUATION OF OTHER RELEVANT INFORMATION

Name of Barangay: _________________________________________________

PART A

I. GENERAL INFORMATION II. PRESCHOOL (PS) AND SCHOOL CHILDREN (SC) PS SC

(1) Total No. of Puroks: _______________________________ (1) Total No. of Surveyed / Enrolled: ________ ________
(2) Total Population: _________________________________ (2) Total No. Weighed: ________ ________
(3) Total No. of Households: ___________________________ (3) % Weighed: ________ ________
(4) Total No. of Infants (0-11 months): __________________ (4) Total No. with Normal Weights: ________ ________
(5) Total No. of Pregnant Women: ______________________ (5) Total No. with Underweight/Wasted ________ ________
Severely Underweight/Severely Wasted:
Underweight Wasted
(6) Total No. of Lactating Women: ______________________ (6) Total No. with Overweight/Obese & Overweight: ________ ________
(7) No. of Households with Home Gardens: _______________ (7) Total No. of Children with
(8) Total No. of Households with Cleft Palate/Harelip: ________ ________
Sanitary Toilet: _____________________________ (8) Total No. of Households with ________ ________
(9) Total No. of Households with Children Underweight/Wasted:
Potable Water Supply: _______________________ (9) Prevalence Rate of Underweight/Wasted Children ________ ________
(10) Most Common Occupation: ________________________