CATHOLIC DIOCESE OF ELDORET

HEALTH DEPARTMENT QUARTERLY REPORTING TOOL

HEALTH FACILITY _______________________________ COUNTY_____________
SUB/COUNTY ______________________________QUARTER____________________

A) OUTPATIENT DEPARTMENT

I) ATTENDANCE
HEALTH FACILITY MOBILE/OUTREACH CLINICS
NEW REVISIT TOTAL NEW REVISIT TOTAL
Under 5 Yrs male
Under 5 Yrs Female
Total Under 5 Yrs
Above 5 Yrs Male
Above 5 Yrs Female
Total Above 5 Yrs
CWC
ANC
OVC Male
OVC Female
School Health
Others specify

II MORBIDITY

DISEASES & CONDITIONS NUMBER OF CASES

Malaria
Diseases of the Respiratory system
Accidents & Injuries(incl. Burns, fractures etc)
Diseases of skin incl. Ulcers
Diarrhea diseases
Dental disorders
Eye infections
Ear infections
Rheumatism, joint pains etc
Urinary tract infections
Others
Total cases

B) INPATIENT DEPARTMENT

I) WORKLOAD/UTILITY
General General female Pediatrics Maternity Total
male
Beds
Admissions
Discharges
Deaths
Bed occupancy rate
Length of stay
Referrals
II) MORBIDITY & CAUSES OF HOSPITALIZATION

Diseases & Causes of Hospitalization No. of Cases

Malaria
Diseases of respiratory system
Accidents and emergency
Pregnancy, childbirth and puerperium
Diarrhea diseases and gastro enteritis
Dehydration (volume depletion)
Tuberculosis
HIV/AIDS
Hearth Diseases
Diabetes
Others
Total
C) LABORATORY
Specialty No. of Tests
Parasitology
Microbiology
Biochemistry
Immunology
Serology
Hematology
Histology/cytology
Total Test
D) THEATRE OPERATIONS
Type of operation Male Female Total
Major operations 0 0 0
Minor operations 0 0 0
Total operations 0 0 0
E) MATERNITY SERVICES
Admissions Other
Deliveries Twin delivery
Normal delivery (SVD) Still birth
Caesarian section Neonatal death
Vacuum extraction Maternal death
Breech delivery Under weight
F) VOLUNTARY COUNSELLING AND TESTING SERVICES
HEALTH FACILITY MOBILE/OUTREACH CLINIC
No. counseled No. Tested No. Positive No. Counseled No. Tested No. Positive
Male
Female
Total

G) PMTCT SERVICES
ANC MATERNITY
Women registered Deliveries
First visit No. Counseled
Revisit No. Tested
No. Counseled No. Positive
No. Tested No. given Nevirapine
No. Positive

Compiled and Reported by:

Name: Designation: Date: