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Assessment of equity in provision and utilization of maternal and child health programs in butajira, southern ethiopia


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Format 2: For maternal ANC follow up

Identification number of the format _____/_____/_____

Date of the review:(dd/mm/yy ___________

Name of Reviewer ___________________Code of Reviewer _____/______

Name of health facility ___________________Type of health facility ___________________
NOTE TO THE REVIEWER

This is a format designed to collect data on mothers who attend ANC follow up during hamle 1/1995-sene 30/1996 EC in all public health institutions in Meskan and Mareko woreda, Gurage Zone. The data will be collected from ANC follow up Registers used at respective health facilities. You need to enter only the information available on the register. If the data needed is not recorded, just indicate that by (NR).


S. No

Registration No. of

Pregnant mother
Address of Pregnant

Mother


Age in yrs

Gravidity.

Parity


ANC Follow up status

kebele


House No.




(No of total pregnancy)

(No of total births)

First visit (weeks)

Last visit

(Weeks)

Total Number of Visits







































































































































































































































































































































































































































































































































































































Format 3: For maternal Delivery service
Identification number of the format _____/_____/_____ Date of the review :(dd/mm/yy ___________

Name of Reviewer ___________________ Code of Reviewer _____/______

Name of health facility ___________________ Type of health facility ___________________
NOTE TO THE REVIEWER

This is a format designed to collect data on maternal Delivery service during hamle 1/1995-sene 30/1996 EC in all public health institutions in Meskan and Mareko woreda, Gurage Zone. The data will be collected from Delivery service Registers used at respective health facilities. You need to enter only the information available on the register. If the data needed is not recorded, just indicate that by (NR).



S. No

Registration No. Of

Mothers delivered
Address of

Mother delivered
Age in yrs

Gravidity.

(#total preg)

Parity (No of total births)
Hx of ANC F- up

1.Yes

2. No;

Type of delivery

1.non-operative

2.operative

Outcome

1.Live Birth;

2.Still Birth

kebele

House No.























































































































































































































































































































































































































































































































































































































Format 4: For FP services
Identification number of the format _____/_____/_____

Date of the review :(dd/mm/yy) ___________

Name of Reviewer ___________________Code of Reviewer _____/______

Name of health facility ___________________ Type of health facility ___________________


NOTE TO THE REVIEWER

This is a format designed to collect data on women’s utilization of FP services during hamle 1/1995-sene 30/1996 EC in all public health institutions in Meskan and Mareko woreda, Gurage Zone. The data will be collected from FP services Registers used at respective health facilities. You need to enter only the information available on the register. If the data needed is not recorded, just indicate that by (NR).



S. No

Registration No. Of

FP user


Address of FP user


Age

Parity

Marital status

kebele

House No.

In yrs

(No of total births)

1.single; 2. Married

3.widowed 4. Divorced


















































































































































































































































































































































































































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202.

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205.

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206.

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207.

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209.

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301.

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302.

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303.

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305.

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310

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311

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312.

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313

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316

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318

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320

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322

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323

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324

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  2. u’í

  3. ›L¨






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