Weekly Aggregate Reporting form for Health Facilities, WoHO, ZHD and RHB

Health Facility
Zone Gamo Woreda AMZW Region SNNPR
Name and Type
Start of week from Monday 4 /07 /2015 to Sunday 10/07/2015 E.C WHO EPI-Wk Monday to Sunday

1.       Record below the total number of cases and deaths for each disease/condition for the current week
Name of Health Facilities
Indicator
Z/ Denbile HC Shele HC G/Bonke Hc Lante Hc

OPD 0 0 12 0
Total malaria cases IN 0 0 0 0
Death 0 0 0 0

Total malaria suspected fever cases tested by RDT or OPD 0 0 45

Microscopy IN 0 0
OPD 0 0 6 0
P. falciparum IN 0 0 0 0
Number of cases
positive for malaria Death 0 0 0 0
parasites (either by
RDT or OPD 0 0 6 0
Microscopy)
P. vivax IN 0 0 0 0
Death 0 0 0 0
OPD 0 0 0 0
Meningitis IN 0 0 0 0
Death 0 0 0 0
OPD 0 0 0 0
Dysentery IN 0 0 0 0
Death 0 0 0 0
OPD 1 0 0 0
Scabies
IN 0 0 0 0
opd 0 0 0 0

Severe Acute Malnutrition /MUAC < 11.5cm and/or Bilateral

IN 0 0 0 0
Edema in under 5 years children (new cases only)

Death 0 0 0 0
Moderate Acute Malnutrition: U5C 0 0
Moderate Acute Malnutrition: PLW 0 0
OPD 0 0 0 0
Diarrhea with dehydration in children less than 5 years of age IN 0 0 0 0
Death 0 0 0 0
OPD 0 0 0 0
Acute jaundice syndrome within 14 days of illness IN 0 0 0 0
Death 0 0 0 0
OPD 0 0 0 0
Severe pneumonia in children under 5 years age IN 0 0 0 0
Death 0 0 0 0
OPD 0 0 0 0
Diabetic Mellitus new cases
Diabetic Mellitus new cases IN 0 0 0 0
Death 0 0 0 0
OPD 0 0 0 0
HIV new cases IN 0 0 0 0
Death 0 0 0 0
OPD 3 0 0 0
Tuberculosis new cases IN 0 0 0 0
Death 0 0 0 0
OPD 0 0 0 0
Hypertension new cases IN 0 0 0 0
Death 0 0 0 0

2. Summary for Immediately Notifiable Disease / Conditions: (Total cases and deaths reported on case-based forms or line lists during the reporting week)
Name of Health Facilities
Indicaters
Z/Denbile HC Shele HC G/Bonke HC Lante HC Woreda Total

AFP/Polio 0 0 0 0 0
Anthrax 0 0 0 0 0
Brucellosis 0 0 0 0 0
Cholera 0 0 0 0 0
Suspected rabies
0 0 0 0 0
exposure
M 0 0 0 0 0
COVID-19 F 0 0 0 0 0
Vaccinated 0 0 0 0 0
Adverse events
following
0 0 0 0 0
immunization
(AEFI)
Measles 0 0 0 0 0
Neonatal Tetanus 0 0 0 0 0
Human influenza
caused by new 0 0 0 0 0
subtype
SARS 0 0 0 0 0
Maternal death 0 0 0 0 0
Perinatal death 0 0 0 0 0
Obstetric fistula 0 0 0 0 0
Other
(specify)_________ 0 0 0 0 0
____
3. Report timeliness and completeness (to be filled only by Woreda Health Office and Zone/Regional Health Bureaus/regional public health institutes)
Government
Private
NGO Health
Hospital (Primary/ Health Others
Indicator Health Post Health Center Facility
Secondary/Tertiary) Facility

Number of sites that

are supposed to 23 4 0 0 0 0
report weekly

Number of sites that

23 4 0 0 0 0
reported on time
4 .Any events notification from community members

Total number of notifications from community

0

Total number of notifications fulfilling case definition utilized

by HEWs
0

Total number of notifications done within 30 minutes of

detection
0

Look at the trends, abnormal increase in cases, deaths, or case fatality ratios? Improving trends? Actions taken and Recommendations:
Date sent by Alemu Menza WrHO PHEM Officer : 21/06/2015E.C Date Send ot Gamo Zone PHEM

Phone 928723007
ties
Woreda
Total
12
0
0
45
0
6
0
0
6
0
0
0
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
3
0
0
0
0
0

the reporting week)

health institutes)
ommendations: