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Training Manual for Preventive Malaria - Ministry of Health

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APPENDIX C:<br />

ADDENDUM TO ANTENATAL/MATERNITY MONTHLY DATA RETURNS<br />

Name <strong>of</strong> <strong>Health</strong> Facility________________________________District_______________<br />

Region_______________________Month_________________Year__________________<br />

ANTENATAL RECORD Number<br />

INDICATOR<br />

Total ANC Attendance<br />

First ANC Attendance<br />

Second ANC Attendance<br />

First dose <strong>of</strong> IPT (IPT1)<br />

Second dose <strong>of</strong> IPT (IPT2)<br />

Third dose <strong>of</strong> IPT (IPT3)<br />

ITN use on First ANC visit<br />

ITN use on Second ANC visit<br />

All screened in 3 rd . trimester <strong>for</strong><br />

Hb<br />

Primigravidae screened in 3 rd .<br />

trimester <strong>for</strong> Hb<br />

Primigravidae with severe<br />

anaemia in 3 rd . trimester<br />

(Hb

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