Training Manual for Preventive Malaria - Ministry of Health

APPENDIX A:
ANTENATAL CLINIC REPORT BOOK: DATA COLLECTION TOOL FOR DAILY SUMMARIES
Name of Facility_______________District_____________Region____________________Month_____________Year___________
Variable
1 2 3 4 5 6 7 8 9 1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1 Totals
Total ANC attendance
First ANC attendance
Second ANC attendance
IPT1
IPT2
IPT3
ITN use at first visit
ITN use at second visit
All screened for HB in
3 rd . trimester
Primigravidae screened
for HB in 3 rd . trimester
All with severe anaemia
at 3 rd . trimester
Primigravidae with severe
anaemia at 3 rd . trimester
Treatment for malaria
Treatment for other
illness
Referral out of unit
60