Ministry of Health & Family Welfare

Government of India

Rashtriya Bal Swasthya Karyakram (RBSK)

MONTHLY REPORT (MHT) - FORM No - Ill (CONSOLIDATE MONTHLY REPORT )

MHT
Name of
State KARNATAKA District CHAMARAJANAGARA CHAMARAJA NAGAR Team CHA-CHA-T2 Reporting Month FEB Reporting Year 2024
Block
Code

6 weeks to 3 years (MHT) 3-6 years enrolled in Govt and Govt aided school (MHT) 6-18 years enrolled in Govt and Govt aided school (MHT)

Percentage of Found No. of Percentage of Found No. of Percentage of Found

Total : Total No. of No. of Total : Total No. of Total : Total No. of
total childern positive for Referred for children total childern positive for Referred children total childern positive for
children to be children children children to be children children to be children
screened till selected this current screened screened till selected for this screened screened till selected Referred for
screened in screened in screened screened in screened in screened in screened in
this month health month/Year cumulative this month health current cumulative this month health this current
complete year current cumulative till complete year current complete year current
(cumnulative) conditions in till current (cumnulative) conditions month/Year till current (cumnulative) conditions month/Year
by M.H.T month/Year current month by M.H.T month/Year by M.H.T month/Year
current month in current month in current
by M.H.T by M.H.T by M.H.T
month/Year

Male 2434 962 4076 167.46 35 34 1725 582 3034 175.88 83 80 7223 0 6382 88.36 0 0

Female 2253 852 3767 167.20 29 28 1671 555 2921 174.81 66 58 6858 0 6241 91.00 0 0

Total 4687 1814 7843 167.34 64 62 3396 1137 5955 175.35 149 138 14081 0 12623 89.65 0 0

Screening details at AWCs Composition of Mobile Health Team

Doctors Pharmacist ANM/ Staff nurse Total

Total Total Cumulative
AWC/School AWC/School gap including Total Number
Annual plan:
visit planned visit carry forward MHT Details of MHT
Total visit to Pharmacist
in this month conducted this from previous Male Female Male Female Male Female Doctors ANM/SN
be planned in
by Mobile month by
this year
Health Health Teams

Visite 1 Approved 1 1 1 0 1 0 1 2 1 1
AWCs
Visite 2 266 100 100 0 In-place 1 1 1 0 1 0 1 2 1 1

Govt and Govt aided schools 158 Trained 1 1 1 0 1 0 1 2 1 1

Functional 1 1 1 0 1 0 1 2 1 1

6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Number of Children

Screened Children with Health Condition Screened Children with Health Condition Screened Children with Health Screened Children with Health
Number of Children screened in Condition Condition Remarks by MHT Team
FEB (Reporting Month)
Male Female Total Male Female Total Male Female Total Male Female Total

Defects at birth - Total 1 0 1 2 1 3 0 0 0 3 1 4

Neural Tube Defect 0 0 0 0 0 0 0 0 0 0 0 0

Downs Syndrome 0 0 0 0 0 0 0 0 0 0 0 0

Cleft Lip Palate 0 0 0 0 0 0 0 0 0 0 0 0

Club foot 1 0 1 0 0 0 0 0 0 1 0 1

Developmental Dysplasia of The

0 0 0 0 0 0 0 0 0 0 0 0
Hip

Congenital Cataract 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Deafness 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Heart Disease 0 0 0 2 1 3 0 0 0 2 1 3

Retinopathy of Prematurity 0 0 0 0 0 0 0 0 0 0 0 0

Microcephaly 0 0 0 0 0 0 0 0 0 0 0 0

Macrocephaly 0 0 0 0 0 0 0 0 0 0 0 0

deficiencies - Total 11 13 24 21 18 39 0 0 0 32 31 63

Severe Anaemia 1 1 2 1 0 1 0 0 0 2 1 3

Vitamin A deficiency (Bitot spot)

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

Vitamin D Deficiency, (Rickets)

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

A) SAM 3 5 8 3 2 5 0 0 0 6 7 13

B) Severe Thinning 0 0 0 0 0 0 0 0 0 0 0 0

C) Obesity 0 0 0 0 0 0 0 0 0 0 0 0

Goitre 0 0 0 0 0 0 0 0 0 0 0 0

Severe Stunting 0 0 0 0 0 0 0 0 0 0 0 0

Vitamin B complex deficiency 7 7 14 17 16 33 0 0 0 24 23 47

Childhood Diseases - Total 17 16 33 54 40 94 0 0 0 71 56 127

Skin Conditions 8 7 15 10 8 18 0 0 0 18 15 33

Otitis Media 1 0 1 0 0 0 0 0 0 1 0 1

Rheumatic Heart Disease 0 0 0 0 0 0 0 0 0 0 0 0

Reactive Airway Disease 1 2 3 3 2 5 0 0 0 4 4 8

Dental Conditions 7 7 14 41 30 71 0 0 0 48 37 85

Convulsive disorders 0 0 0 0 0 0 0 0 0 0 0 0

Childhood leprosy Disease 0 0 0 0 0 0 0 0 0 0 0 0

Childhood T.B. 0 0 0 0 0 0 0 0 0 0 0 0

Childhood Extra Pulmonary T. B.

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

Devlopment delay and disablity -

6 0 6 6 7 13 0 0 0 12 7 19
Total

Vision Impairment 1 0 1 2 2 4 0 0 0 3 2 5

Hearing Impairment 0 0 0 1 0 1 0 0 0 1 0 1

Neuro motor impairment 0 0 0 2 2 4 0 0 0 2 2 4

Motor Delay 0 0 0 0 0 0 0 0 0 0 0 0

Cognitive Delay 0 0 0 0 0 0 0 0 0 0 0 0

Language Delay 5 0 5 1 3 4 0 0 0 6 3 9

Behaviour Disorder(Autism) 0 0 0 0 0 0 0 0 0 0 0 0

Learning Disorder 0 0 0 0 0 0 0 0 0 0 0 0

Attention Deficit Hyperactivity

0 0 0 0 0 0 0 0 0 0 0 0
Disorder

Others 0 0 0 0 0 0 0 0 0 0 0 0

Adolescent health concerns -

0 0 0 0 0 0 0 0 0 0 0 0
Total

Growing up concerns 0 0 0 0 0 0 0 0 0 0 0 0

Substance abuse 0 0 0 0 0 0 0 0 0 0 0 0

Feel depressed 0 0 0 0 0 0 0 0 0 0 0 0

Delay in menstruation cycles 0 0 0 0 0 0 0 0 0 0 0 0

Irregular Periods 0 0 0 0 0 0 0 0 0 0 0 0

Pain or burning sensation while

0 0 0 0 0 0 0 0 0 0 0 0
urinating
Discharge/foul smelling discharge
from the genitor-urinary area 0 0 0 0 0 0 0 0 0 0 0 0

Pain during menstruation 0 0 0 0 0 0 0 0 0 0 0 0

6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Number of Children

Total Children Refered with Secondary Secondary Secondary Secondary

Primary care Tertiary Care Primary care Tertiary Care Primary Tertiary Care Primary Tertiary Care Refer Children for Health Conditions at facility
Heatlth Conditions Care Care Care Care
(PHC/CHC) (DEIC)/MC (PHC/CHC) (DEIC)/MC care (DEIC)/MC care (DEIC)/MC
(DH/SDH/ (DH/SDH/ (DH/SDH/ (DH/SDH/
(PHC/CHC) (PHC/CHC)
SNCU) SNCU) SNCU) SNCU)

Neural Tube Male 0 0 0 0 0 0 0 0 0 0 0 0

Defect Female 0 0 0 0 0 0 0 0 0 0 0 0

Downs Syndrome Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Cleft Lip Palate
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 1 0 0 0 0 0 0 0 0 1
Club foot
Female 0 0 0 0 0 0 0 0 0 0 0 0
Developmental Male 0 0 0 0 0 0 0 0 0 0 0 0
Dysplasia of The
Hip Female 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Male 0 0 0 0 0 0 0 0 0 0 0 0
Cataract Female 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Male 0 0 0 0 0 0 0 0 0 0 0 0
Deafness Female 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Heart Male 0 0 0 0 0 2 0 0 0 0 0 2

Disease Female 0 0 0 0 0 1 0 0 0 0 0 1

Retinopathy of Male 0 0 0 0 0 0 0 0 0 0 0 0
Prematurity Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Microcephaly
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Macrocephaly
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 1 0 0 1 0 0 0 0 0 2 0
Severe Anaemia
Female 0 1 0 0 0 0 0 0 0 0 1 0
Vitamin A Male 0 0 0 0 0 0 0 0 0 0 0 0
deficiency (Bitot
spot) Female 0 0 0 0 0 0 0 0 0 0 0 0
Vitamin D Male 0 0 0 0 0 0 0 0 0 0 0 0
Deficiency,
(Rickets) Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 3 0 0 3 0 0 0 0 0 6 0
A) SAM
Female 0 4 0 0 1 0 0 0 0 0 5 0

B) Severe Male 0 0 0 0 0 0 0 0 0 0 0 0
Thinning Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
C) Obesity
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Goitre
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Severe Stunting
Female 0 0 0 0 0 0 0 0 0 0 0 0
Vitamin B complex Male 7 0 0 16 0 0 0 0 0 23 0 0
deficiency
Female 7 0 0 15 0 0 0 0 0 22 0 0

Male 7 0 0 10 0 0 0 0 0 17 0 0
Skin Conditions
Female 7 0 0 7 0 0 0 0 0 14 0 0

Male 0 0 1 0 0 0 0 0 0 0 0 1
Otitis Media
Female 0 0 0 0 0 0 0 0 0 0 0 0

Rheumatic Heart Male 0 0 0 0 0 0 0 0 0 0 0 0

Disease Female 0 0 0 0 0 0 0 0 0 0 0 0

Reactive Airway Male 1 0 0 3 0 0 0 0 0 4 0 0

Disease Female 2 0 0 2 0 0 0 0 0 4 0 0

Dental Conditions Male 7 0 0 39 1 1 0 0 0 46 1 1

Female 7 0 0 27 0 0 0 0 0 34 0 0

Convulsive Male 0 0 0 0 0 0 0 0 0 0 0 0
disorders Female 0 0 0 0 0 0 0 0 0 0 0 0

Childhood leprosy Male 0 0 0 0 0 0 0 0 0 0 0 0

Disease Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Childhood T.B.
Female 0 0 0 0 0 0 0 0 0 0 0 0

Childhood Extra Male 0 0 0 0 0 0 0 0 0 0 0 0

Pulmonary T. B. Female 0 0 0 0 0 0 0 0 0 0 0 0

Vision Impairment Male 0 0 1 0 0 1 0 0 0 0 0 2

Female 0 0 0 0 0 2 0 0 0 0 0 2

Hearing Male 0 0 0 0 0 1 0 0 0 0 0 1
Impairment Female 0 0 0 0 0 0 0 0 0 0 0 0

Neuro motor Male 0 0 0 0 0 1 0 0 0 0 0 1

impairment Female 0 0 0 0 0 1 0 0 0 0 0 1

Male 0 0 0 0 0 0 0 0 0 0 0 0
Motor Delay
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Cognitive Delay
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 5 0 0 1 0 0 0 0 0 6
Language Delay
Female 0 0 0 0 0 2 0 0 0 0 0 2
Behaviour Male 0 0 0 0 0 0 0 0 0 0 0 0
Disorder(Autism)
Female 0 0 0 0 0 0 0 0 0 0 0 0

Learning Disorder Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0
Attention Deficit Male 0 0 0 0 0 0 0 0 0 0 0 0
Hyperactivity
Disorder Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Others
Female 0 0 0 0 0 0 0 0 0 0 0 0

Growing up Male 0 0 0 0 0 0 0 0 0 0 0 0
concerns Female 0 0 0 0 0 0 0 0 0 0 0 0

Substance abuse Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Feel depressed
Female 0 0 0 0 0 0 0 0 0 0 0 0
Delay in Male 0 0 0 0 0 0 0 0 0 0 0 0
menstruation
cycles Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Irregular Periods
Female 0 0 0 0 0 0 0 0 0 0 0 0
Pain or burning Male 0 0 0 0 0 0 0 0 0 0 0 0
sensation while
urinating Female 0 0 0 0 0 0 0 0 0 0 0 0
Discharge/foul Male 0 0 0 0 0 0 0 0 0 0 0 0
smelling discharge
from Female 0 0 0 0 0 0 0 0 0 0 0 0

Pain during Male 0 0 0 0 0 0 0 0 0 0 0 0

menstruation Female 0 0 0 0 0 0 0 0 0 0 0 0

Defects at birth - Male 0 0 1 0 0 2 0 0 0 0 0 3

Total Female 0 0 0 0 0 1 0 0 0 0 0 1

deficiencies - Total Male 7 4 0 16 4 0 0 0 0 23 8 0

Female 7 5 0 15 1 0 0 0 0 22 6 0

Childhood Male 15 0 1 52 1 1 0 0 0 67 1 2
Diseases - Total Female 16 0 0 36 0 0 0 0 0 52 0 0
Devlopment delay Male 0 0 6 0 0 4 0 0 0 0 0 10
and disablity -
Total Female 0 0 0 0 0 5 0 0 0 0 0 5
Adolescent health Male 0 0 0 0 0 0 0 0 0 0 0 0
concerns - Total
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 22 4 8 68 5 7 0 0 0 90 9 15
Grand - Total
Female 23 5 0 51 1 6 0 0 0 74 6 6
 MONTHLY REPORT (MHT) - FORM No - IV

6 weeks to 3 years (MHT) 3-6 years enrolled in Govt and Govt aided school (MHT) 6-18 years enrolled in Govt and Govt aided school (MHT)

Percentage of Found No. of Percentage of Found No. of Percentage of Found

Total : Total No. of No. of Total : Total No. of Total : Total No. of
total childern positive for Referred for children total childern positive for Referred children total childern positive for
children to be children children children to be children children to be children
screened till selected this current screened screened till selected for this screened screened till selected Referred for
screened in screened in screened screened in screened in screened in screened in
this month health month/Year cumulative this month health current cumulative this month health this current
complete year current cumulative till complete year current complete year current
(cumnulative) conditions in till current (cumnulative) conditions month/Year till current (cumnulative) conditions month/Year
by M.H.T month/Year current month by M.H.T month/Year by M.H.T month/Year
current month in current month in current
by M.H.T by M.H.T by M.H.T
month/Year

Male 2434 962 4076 167.46 35 34 1725 582 3034 175.88 83 80 7223 0 6382 88.36 0 0

Female 2253 852 3767 167.20 29 28 1671 555 2921 174.81 66 58 6858 0 6241 91.00 0 0

Total 4687 1814 7843 167.34 64 62 3396 1137 5955 175.35 149 138 14081 0 12623 89.65 0 0

Screening details at AWCs Composition of Mobile Health Team

Doctors Pharmacist ANM/ Staff nurse Total

Total Total Cumulative
AWC/School AWC/School gap including Total Number
Annual plan:
visit planned visit carry forward MHT Details of MHT
Total visit to Pharmacist
in this month conducted this from previous Male Female Male Female Male Female Doctors ANM/SN
be planned in
by Mobile month by
this year
Health Health Teams

Visite 1 Approved 1 1 1 0 1 0 1 2 1 1
AWCs
Visite 2 266 100 100 0 In-place 1 1 1 0 1 0 1 2 1 1

Govt and Govt aided schools 158 Trained 1 1 1 0 1 0 1 2 1 1

Functional 1 1 1 0 1 0 1 2 1 1

6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Number of Children

Screened Children with Health Condition Screened Children with Health Condition Screened Children with Health Screened Children with Health
Number of Children screened in Condition Condition Remarks by MHT Team
null (Reporting Month)
Male Female Total Male Female Total Male Female Total Male Female Total

Defects at birth - Total 1 0 1 2 1 3 0 0 0 3 1 4

Neural Tube Defect 0 0 0 0 0 0 0 0 0 0 0 0

Downs Syndrome 0 0 0 0 0 0 0 0 0 0 0 0

Cleft Lip Palate 0 0 0 0 0 0 0 0 0 0 0 0

Club foot 1 0 1 0 0 0 0 0 0 1 0 1

Developmental Dysplasia of The

0 0 0 0 0 0 0 0 0 0 0 0
Hip

Congenital Cataract 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Deafness 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Heart Disease 0 0 0 2 1 3 0 0 0 2 1 3

Retinopathy of Prematurity 0 0 0 0 0 0 0 0 0 0 0 0

Microcephaly 0 0 0 0 0 0 0 0 0 0 0 0

Macrocephaly 0 0 0 0 0 0 0 0 0 0 0 0

deficiencies - Total 11 13 24 21 18 39 0 0 0 32 31 63

Severe Anaemia 1 1 2 1 0 1 0 0 0 2 1 3

Vitamin A deficiency (Bitot spot)

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

Vitamin D Deficiency, (Rickets)

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

A) SAM 3 5 8 3 2 5 0 0 0 6 7 13

B) Severe Thinning 0 0 0 0 0 0 0 0 0 0 0 0

C) Obesity 0 0 0 0 0 0 0 0 0 0 0 0

Goitre 0 0 0 0 0 0 0 0 0 0 0 0

Severe Stunting 0 0 0 0 0 0 0 0 0 0 0 0

Vitamin B complex deficiency 7 7 14 17 16 33 0 0 0 24 23 47

Childhood Diseases - Total 17 16 33 54 40 94 0 0 0 71 56 127

Skin Conditions 8 7 15 10 8 18 0 0 0 18 15 33

Otitis Media 1 0 1 0 0 0 0 0 0 1 0 1

Rheumatic Heart Disease 0 0 0 0 0 0 0 0 0 0 0 0

Reactive Airway Disease 1 2 3 3 2 5 0 0 0 4 4 8

Dental Conditions 7 7 14 41 30 71 0 0 0 48 37 85

Convulsive disorders 0 0 0 0 0 0 0 0 0 0 0 0

Childhood leprosy Disease 0 0 0 0 0 0 0 0 0 0 0 0

Childhood T.B. 0 0 0 0 0 0 0 0 0 0 0 0

Childhood Extra Pulmonary T. B.

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

Devlopment delay and disablity -

6 0 6 6 7 13 0 0 0 12 7 19
Total

Vision Impairment 1 0 1 2 2 4 0 0 0 3 2 5

Hearing Impairment 0 0 0 1 0 1 0 0 0 1 0 1

Neuro motor impairment 0 0 0 2 2 4 0 0 0 2 2 4

Motor Delay 0 0 0 0 0 0 0 0 0 0 0 0

Cognitive Delay 0 0 0 0 0 0 0 0 0 0 0 0

Language Delay 5 0 5 1 3 4 0 0 0 6 3 9

Behaviour Disorder(Autism) 0 0 0 0 0 0 0 0 0 0 0 0

Learning Disorder 0 0 0 0 0 0 0 0 0 0 0 0

Attention Deficit Hyperactivity

0 0 0 0 0 0 0 0 0 0 0 0
Disorder

Others 0 0 0 0 0 0 0 0 0 0 0 0

Adolescent health concerns -

0 0 0 0 0 0 0 0 0 0 0 0
Total

Growing up concerns 0 0 0 0 0 0 0 0 0 0 0 0

Substance abuse 0 0 0 0 0 0 0 0 0 0 0 0

Feel depressed 0 0 0 0 0 0 0 0 0 0 0 0

Delay in menstruation cycles 0 0 0 0 0 0 0 0 0 0 0 0

Irregular Periods 0 0 0 0 0 0 0 0 0 0 0 0

Pain or burning sensation while

0 0 0 0 0 0 0 0 0 0 0 0
urinating
Discharge/foul smelling discharge
from the genitor-urinary area 0 0 0 0 0 0 0 0 0 0 0 0

Pain during menstruation 0 0 0 0 0 0 0 0 0 0 0 0

6 weeks to 3 years 3 years to 6 years 6 years to 18 years Total Number of Children

Total Children Refered with Secondary Secondary Secondary Secondary

Primary care Tertiary Care Primary care Tertiary Care Primary Tertiary Care Primary Tertiary Care Refer Children for Health Conditions at facility
Heatlth Conditions Care Care Care Care
(PHC/CHC) (DEIC)/MC (PHC/CHC) (DEIC)/MC care (DEIC)/MC care (DEIC)/MC
(DH/SDH/ (DH/SDH/ (DH/SDH/ (DH/SDH/
(PHC/CHC) (PHC/CHC)
SNCU) SNCU) SNCU) SNCU)

Neural Tube Male 0 0 0 0 0 0 0 0 0 0 0 0

Defect Female 0 0 0 0 0 0 0 0 0 0 0 0

Downs Syndrome Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Cleft Lip Palate
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 1 0 0 0 0 0 0 0 0 1
Club foot
Female 0 0 0 0 0 0 0 0 0 0 0 0
Developmental Male 0 0 0 0 0 0 0 0 0 0 0 0
Dysplasia of The
Hip Female 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Male 0 0 0 0 0 0 0 0 0 0 0 0
Cataract Female 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Male 0 0 0 0 0 0 0 0 0 0 0 0
Deafness Female 0 0 0 0 0 0 0 0 0 0 0 0

Congenital Heart Male 0 0 0 0 0 2 0 0 0 0 0 2

Disease Female 0 0 0 0 0 1 0 0 0 0 0 1

Retinopathy of Male 0 0 0 0 0 0 0 0 0 0 0 0
Prematurity Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Microcephaly
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Macrocephaly
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 1 0 0 1 0 0 0 0 0 2 0
Severe Anaemia
Female 0 1 0 0 0 0 0 0 0 0 1 0
Vitamin A Male 0 0 0 0 0 0 0 0 0 0 0 0
deficiency (Bitot
spot) Female 0 0 0 0 0 0 0 0 0 0 0 0
Vitamin D Male 0 0 0 0 0 0 0 0 0 0 0 0
Deficiency,
(Rickets) Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 3 0 0 3 0 0 0 0 0 6 0
A) SAM
Female 0 4 0 0 1 0 0 0 0 0 5 0

B) Severe Male 0 0 0 0 0 0 0 0 0 0 0 0
Thinning Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
C) Obesity
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Goitre
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Severe Stunting
Female 0 0 0 0 0 0 0 0 0 0 0 0
Vitamin B complex Male 7 0 0 16 0 0 0 0 0 23 0 0
deficiency
Female 7 0 0 15 0 0 0 0 0 22 0 0

Male 7 0 0 10 0 0 0 0 0 17 0 0
Skin Conditions
Female 7 0 0 7 0 0 0 0 0 14 0 0

Male 0 0 1 0 0 0 0 0 0 0 0 1
Otitis Media
Female 0 0 0 0 0 0 0 0 0 0 0 0

Rheumatic Heart Male 0 0 0 0 0 0 0 0 0 0 0 0

Disease Female 0 0 0 0 0 0 0 0 0 0 0 0

Reactive Airway Male 1 0 0 3 0 0 0 0 0 4 0 0

Disease Female 2 0 0 2 0 0 0 0 0 4 0 0

Dental Conditions Male 7 0 0 39 1 1 0 0 0 46 1 1

Female 7 0 0 27 0 0 0 0 0 34 0 0

Convulsive Male 0 0 0 0 0 0 0 0 0 0 0 0
disorders Female 0 0 0 0 0 0 0 0 0 0 0 0

Childhood leprosy Male 0 0 0 0 0 0 0 0 0 0 0 0

Disease Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Childhood T.B.
Female 0 0 0 0 0 0 0 0 0 0 0 0

Childhood Extra Male 0 0 0 0 0 0 0 0 0 0 0 0

Pulmonary T. B. Female 0 0 0 0 0 0 0 0 0 0 0 0

Vision Impairment Male 0 0 1 0 0 1 0 0 0 0 0 2

Female 0 0 0 0 0 2 0 0 0 0 0 2

Hearing Male 0 0 0 0 0 1 0 0 0 0 0 1
Impairment Female 0 0 0 0 0 0 0 0 0 0 0 0

Neuro motor Male 0 0 0 0 0 1 0 0 0 0 0 1

impairment Female 0 0 0 0 0 1 0 0 0 0 0 1

Male 0 0 0 0 0 0 0 0 0 0 0 0
Motor Delay
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Cognitive Delay
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 5 0 0 1 0 0 0 0 0 6
Language Delay
Female 0 0 0 0 0 2 0 0 0 0 0 2
Behaviour Male 0 0 0 0 0 0 0 0 0 0 0 0
Disorder(Autism)
Female 0 0 0 0 0 0 0 0 0 0 0 0

Learning Disorder Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0
Attention Deficit Male 0 0 0 0 0 0 0 0 0 0 0 0
Hyperactivity
Disorder Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Others
Female 0 0 0 0 0 0 0 0 0 0 0 0

Growing up Male 0 0 0 0 0 0 0 0 0 0 0 0
concerns Female 0 0 0 0 0 0 0 0 0 0 0 0

Substance abuse Male 0 0 0 0 0 0 0 0 0 0 0 0

Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Feel depressed
Female 0 0 0 0 0 0 0 0 0 0 0 0
Delay in Male 0 0 0 0 0 0 0 0 0 0 0 0
menstruation
cycles Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 0 0 0 0 0 0 0 0 0 0 0 0
Irregular Periods
Female 0 0 0 0 0 0 0 0 0 0 0 0
Pain or burning Male 0 0 0 0 0 0 0 0 0 0 0 0
sensation while
urinating Female 0 0 0 0 0 0 0 0 0 0 0 0
Discharge/foul Male 0 0 0 0 0 0 0 0 0 0 0 0
smelling discharge
from Female 0 0 0 0 0 0 0 0 0 0 0 0

Pain during Male 0 0 0 0 0 0 0 0 0 0 0 0

menstruation Female 0 0 0 0 0 0 0 0 0 0 0 0

Defects at birth - Male 0 0 1 0 0 2 0 0 0 0 0 3

Total Female 0 0 0 0 0 1 0 0 0 0 0 1

deficiencies - Total Male 7 4 0 16 4 0 0 0 0 23 8 0

Female 7 5 0 15 1 0 0 0 0 22 6 0

Childhood Male 15 0 1 52 1 1 0 0 0 67 1 2
Diseases - Total Female 16 0 0 36 0 0 0 0 0 52 0 0
Devlopment delay Male 0 0 6 0 0 4 0 0 0 0 0 10
and disablity -
Total Female 0 0 0 0 0 5 0 0 0 0 0 5
Adolescent health Male 0 0 0 0 0 0 0 0 0 0 0 0
concerns - Total
Female 0 0 0 0 0 0 0 0 0 0 0 0

Male 22 4 8 68 5 7 0 0 0 90 9 15
Grand - Total
Female 23 5 0 51 1 6 0 0 0 74 6 6
 MONTHLY REPORT (MHT) - FORM No - V (SERVICE ACCESS COMPILED)

Number of Children with selected health conditions

Referral Managed
Identified Secondary Waiting For
Sr through District Confirmed Service
Health Condtition Details Primary care(DH/MEDIC DistrictTb Early Afhc
No. screening Deic Leprosy Medical Surgery Access
care(PHC/CHC) AL) Programme Intervention Counselling
Programme

Female Female Female Female Female Female Female Female Female Female Female Female
Male Male Male Male Male Male Male Male Male Male Male Male

Birth-6
1 Neural Tube Defect weeks
ASHA,
6 Weeks-
2 Neural Tube Defect 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

3 Neural Tube Defect 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

4 Neural Tube Defect 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Birth-6
5 Downs Syndrome weeks
ASHA,
6 Weeks-
6 Downs Syndrome 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

7 Downs Syndrome 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

8 Downs Syndrome 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Birth-6
9 Cleft Lip Palate weeks
ASHA,
6 Weeks-
10 Cleft Lip Palate 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

11 Cleft Lip Palate 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

12 Cleft Lip Palate 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Birth-6
13 Club foot weeks
ASHA,
6 Weeks-
14 Club foot 1 0 0 0 0 0 1 0 1 0 1 0 3 0
3 Yrs

15 Club foot 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

16 Club foot 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Birth-6
Developmental Dysplasia of
17 weeks
The Hip
ASHA,
Developmental Dysplasia of 6 Weeks-
18 0 0 0 0 0 0 0 0 0 0 1 0
The Hip 3 Yrs

Developmental Dysplasia of
19 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0
The Hip

Developmental Dysplasia of
20 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0
The Hip
Birth-6
21 Congenital Cataract weeks
ASHA,
6 Weeks-
22 Congenital Cataract 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

23 Congenital Cataract 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

24 Congenital Cataract 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Birth-6
25 Congenital Deafness weeks
ASHA,
6 Weeks-
26 Congenital Deafness 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

27 Congenital Deafness 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

28 Congenital Deafness 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Birth-6
29 Congenital Heart Disease weeks
ASHA,
6 Weeks-
30 Congenital Heart Disease 0 0 0 0 0 0 0 0 0 0 2 2
3 Yrs

31 Congenital Heart Disease 3- 6 Yrs 2 1 0 0 0 0 2 1 2 1 2 1 6 6

32 Congenital Heart Disease 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 3 3

Birth-6
Retinopathy of Prematurity
33 weeks
ASHA,
Retinopathy of Prematurity 6 Weeks-
34 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

Retinopathy of Prematurity
35 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Retinopathy of Prematurity
36 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
37 Severe Anaemia 1 1 0 0 1 1 0 0 1 1 1 1 3 2
3 Yrs

38 Severe Anaemia 3- 6 Yrs 1 0 0 0 1 0 0 0 1 0 1 0 3 3

39 Severe Anaemia 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 311 239

Vitamin A deficiency (Bitot 6 Weeks-

40 0 0 0 0 0 0 0 0 0 0 0 0
spot) 3 Yrs

Vitamin A deficiency (Bitot

41 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0
spot)

Vitamin A deficiency (Bitot

42 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 1
spot)

Vitamin D Deficiency, 6 Weeks-

43 0 0 0 0 0 0 0 0 0 0 0 0
(Rickets) 3 Yrs

Vitamin D Deficiency,
44 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0
(Rickets)

Vitamin D Deficiency,
45 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0
(Rickets)

6 Weeks-
46 A) SAM 3 5 0 0 3 4 0 0 3 4 3 4 21 13
3 Yrs

47 A) SAM 3- 6 Yrs 3 2 0 0 3 1 0 0 3 1 3 1 10 10

48 A) SAM 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
49 B) Severe Thinning 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

50 B) Severe Thinning 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

51 B) Severe Thinning 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
52 C) Obesity 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

53 C) Obesity 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

54 C) Obesity 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
55 Goitre 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

56 Goitre 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

57 Goitre 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
58 Skin Conditions 8 7 7 7 0 0 0 0 7 7 7 7 14 21
3 Yrs

59 Skin Conditions 3- 6 Yrs 10 8 10 7 0 0 0 0 10 7 10 7 36 36

60 Skin Conditions 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 199 214

6 Weeks-
61 Otitis Media 1 0 0 0 0 0 1 0 1 0 1 0 1 0
3 Yrs

62 Otitis Media 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

63 Otitis Media 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 17 13

6 Weeks-
64 Rheumatic Heart Disease 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

65 Rheumatic Heart Disease 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

66 Rheumatic Heart Disease 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
67 Reactive Airway Disease 1 2 1 2 0 0 0 0 1 2 1 2 2 4
3 Yrs

68 Reactive Airway Disease 3- 6 Yrs 3 2 3 2 0 0 0 0 3 2 3 2 5 5

69 Reactive Airway Disease 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 15 10

6 Weeks-
70 Dental Conditions 7 7 7 7 0 0 0 0 7 7 7 7 17 14
3 Yrs

71 Dental Conditions 3- 6 Yrs 41 30 39 27 1 0 1 0 41 27 41 27 148 148

72 Dental Conditions 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 489 538

6 Weeks-
73 Convulsive disorders 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

74 Convulsive disorders 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

75 Convulsive disorders 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 6

6 Weeks-
76 Vision Impairment 1 0 0 0 0 0 1 0 1 0 1 0 7 1
3 Yrs

77 Vision Impairment 3- 6 Yrs 2 2 0 0 0 0 1 2 1 2 1 2 5 5

78 Vision Impairment 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 50 60

6 Weeks-
79 Hearing Impairment 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

80 Hearing Impairment 3- 6 Yrs 1 0 0 0 0 0 1 0 1 0 1 0 3 3

81 Hearing Impairment 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 1 0

6 Weeks-
82 Neuro motor impairment 0 0 0 0 0 0 0 0 0 0 1 1
3 Yrs

83 Neuro motor impairment 3- 6 Yrs 2 2 0 0 0 0 1 1 1 1 1 1 4 4

84 Neuro motor impairment 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
85 Motor Delay 0 0 0 0 0 0 0 0 0 0 1 0
3 Yrs

86 Motor Delay 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

87 Motor Delay 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 1 1

6 Weeks-
88 Cognitive Delay 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

89 Cognitive Delay 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

90 Cognitive Delay 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
91 Language Delay 5 0 0 0 0 0 5 0 5 0 5 0 8 4
3 Yrs

92 Language Delay 3- 6 Yrs 1 3 0 0 0 0 1 2 1 2 1 2 8 8

93 Language Delay 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 10 4

Behaviour Disorder(Autism) 6 Weeks-

94 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

Behaviour Disorder(Autism)
95 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Behaviour Disorder(Autism)
96 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 1 0

97 Learning Disorder 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

98 Learning Disorder 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Attention Deficit
99 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0
Hyperactivity Disorder

Attention Deficit
100 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 1 2
Hyperactivity Disorder

101 Others 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

102 Others 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 32 35

103 Growing up concerns 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0

104 Substance abuse 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0

105 Feel depressed 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0

Delay in menstruation cycles

106 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0

107 Irregular Periods 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 18

Pain or burning sensation

108 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0
while urinating
Discharge/foul smelling
109 discharge from the genitor- 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 5
urinary area

110 Pain during menstruation 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0

Childhood leprosy Disease 6 Weeks-

111 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

Childhood leprosy Disease

112 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Childhood leprosy Disease

113 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

6 Weeks-
114 Childhood T.B. 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

115 Childhood T.B. 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

116 Childhood T.B. 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Childhood Extra Pulmonary 6 Weeks-

117 0 0 0 0 0 0 0 0 0 0 0 0
T. B. 3 Yrs

Childhood Extra Pulmonary

118 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0
T. B.

Childhood Extra Pulmonary

119 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0
T. B.

6 Weeks-
120 Severe Stunting 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

121 Severe Stunting 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Birth-6
122 Microcephaly weeks
ASHA,
6 Weeks-
123 Microcephaly 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

124 Microcephaly 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

125 Microcephaly 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Birth-6
126 Macrocephaly weeks
ASHA,
6 Weeks-
127 Macrocephaly 0 0 0 0 0 0 0 0 0 0 0 0
3 Yrs

128 Macrocephaly 3- 6 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

129 Macrocephaly 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 0 0

Vitamin B complex 6 Weeks-

130 7 7 7 7 0 0 0 0 7 7 7 7 15 17
deficiency 3 Yrs

Vitamin B complex
131 3- 6 Yrs 17 16 16 15 0 0 0 0 16 15 16 15 41 41
deficiency

Vitamin B complex
132 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 75 72
deficiency
Birth-6
133 Defects At Birth weeks
ASHA,
6 Weeks-
134 Defects At Birth 1 0 0 0 0 0 1 0 1 0 1 0 6 2
3 Yrs

135 Defects At Birth 3- 6 Yrs 2 1 0 0 0 0 2 1 2 1 2 1 6 6

136 Defects At Birth 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 3 3

6 Weeks-
137 Deficiencies 11 13 7 7 4 5 0 0 11 12 11 12 46 39
3 Yrs

138 Deficiencies 3- 6 Yrs 21 18 16 15 4 1 0 0 20 16 20 16 70 70

139 Deficiencies 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 386 312

6 Weeks-
140 Childhood Diseases 17 16 15 16 0 0 1 0 16 16 16 16 49 55
3 Yrs

141 Childhood Diseases 3- 6 Yrs 54 40 52 36 1 0 1 0 54 36 54 36 241 241

142 Childhood Diseases 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 720 781

Birth-6
143 Developmental Delays weeks
ASHA,
6 Weeks-
144 Developmental Delays 6 0 0 0 0 0 6 0 6 0 6 0 17 6
3 Yrs

145 Developmental Delays 3- 6 Yrs 6 7 0 0 0 0 4 5 4 5 4 5 20 20

146 Developmental Delays 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 96 102

147 Adolescent Health 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 23

Birth-6
148 TOTAL weeks
ASHA,
6 Weeks-
149 TOTAL 35 29 22 23 4 5 8 0 34 28 34 28 96 79
3 Yrs

150 TOTAL 3- 6 Yrs 83 66 68 51 5 1 7 6 80 58 80 58 269 269

151 TOTAL 6-18 Yrs 0 0 0 0 0 0 0 0 0 0 1205 1221

Report prepared by Report verified by Block/ District / State Nodal person

Name of the Nodal Person

Signature

Designation

Date