Program Reporting Form

Please fill out one form for each round of treatment in each country you have worked (or intend to work) in since September 2006. Please provide us with as much information as you have. 

This database is updated with new entries to the WHO database maintained by the Partners for Parasite Control group and the WHO.  If you have already reported to the WHO, you do not need to report here. Any information reported here will be shared with the WHO.

We will contact your organization to verify this information before making it available on the internet.


ORGANIZATION AND CONTACT INFO
Organization Name
Contact Name
Contact Email
Contact Phone (+country code - number)
PROGRAM INFORMATION
1. What country is your deworming program in?
2. Has the round of the deworming program already taken place?
Yes
When did the round take place?
 Year
Month

No
When do you intend to carry out the round of deworming?
 Year
 		Month
3. Please list any partners in this particular deworming project (so that we can avoid duplication in our database). Separate each partner with a semi-colon (;)
PROGRAM COVERAGE
4. Who does this round of deworming for Soil Transmitted Helminths (STHs) treat? Please select one or more.
Pre-School Children


Not Applicable
School-Aged Children


Don't Know
Adults
5. Who does this round of deworming for Schistosomiasis treat? Please select one or more.
Pre-School Children


Not Applicable
School-Aged Children


Don't Know
Adults
6. What drug/s were (or will be) used to treat Soil Transmitted Helminths during this round?

Not Applicable
Don't Know
7. How many people were (or will be) dewormed for Soil Transmitted Helminths during this round?
  • Pre-School Children


Not Applicable


Don't Know
  • School-Aged Children
  
  • Adults
8. How many people were (or will be) dewormed for Schistosomiasis during this round?
  • Pre-School Children


Not Applicable


Don't Know
  • School-Aged Children
   
  • Adults
9. If some of the people in question 7 and 8 above were (or will be) dewormed for BOTH Soil Transmitted Helminths and Schistosomiasis during this round, please indicate how many.
  • Pre-School Children


Not Applicable


Don't Know
  • School-Aged Children
 
  • Adults
10. Do you have any assessments of the prevalence or burden of worms?
Yes

No 
If yes, please upload document/s here:
11. Do you have any assessments or reports (i.e. monitoring of coverage, base line surveys, evaluations) of the deworming program?
Yes

No 
If yes, please upload document/s here:
Other comments/remarks concerning any additional information on the deworming program or this round of treatment.