Excellence. Knowledge. Peace.

Development

Upper Nile University

Faculty of Public and Environmental Health
Department of Public Health

RESPONDENT QUESTIONAIRRE

Dear Respondent,

I am Abdulrazig Arabi Sebit, a student of Upper Nile University, Faculty of Public and
Environmental Health, Department of Public Health.
This questionnaire is part of the requirement for the fulfilment in award of Degree in
Accounting, I am investigating the topic “Effects of smoking on the health of pregnant
women and their newly borne ones” Case study: Juba Teaching Hospital.

I would just like to interfere a little bit in your busy day for few minutes just to answer this
booklet. All the information you will provide will be treated confidential and used for
academic purpose only. Your cooperation will have a significant contribution to the award of
my Degree as stated above. If you wish to clarify anything concerning this questionnaire
kindly call me on

Tel: 0920 382 221

Sign: ______________________

Thanks you
………………...........
Abdulrazig Arabi Sebit
Registration No: 012 – 004448

Instructions
1. There is no need to reveal your identity.
2. Answer all questions below by ticking and writing in the space provided.

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 Section A
Participant Profile

Instruction: Put a Tick (√) in the box of the answer appropriate for you

1. Gender
Gender Male Female
Ticks
2. Age:
Age 18 – 25 26 – 30 31 – 40 41 – above
Ticks
3. Marital Status
Marital status Single Married Divorced Separated Others
Tick

4. Religion
Religion Christian Muslim Others
Tick

5. Last Education grade

Level Primary Secondary Technical school Degree Masters Others
Tick
6. Your title in this institution
Title Line Managing Head of Supervisor Other
manager director HR
Tick
7. Department of Work
Department Finance Administration HR Accountant Others
Tick

8. How long have you been in this institution

Years 1-5 6-10 11-15 16 – above
Ticks

Section (B): To identify the health effects of smoking of pregnant mothers and their unborn
babies in Juba Teaching Hospital.

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In this section, the researcher seeks to justify “To identify the health effects of smoking of
pregnant mothers and their unborn babies in Juba Teaching Hospital.”

Please tick (√) the appropriate option.

Key; Where; A = Agree, SA = Strongly Agree, NS = Not Sure, D = Disagree, SD =

Strongly Disagree.

S/No. Statement A S N D S
A S D
1- Smoking while pregnant expose pregnant mothers risk of premature
delivery.
2- Stunted growth of the children can be caused by mothers’ smoking
during pregnancy.
3- The smoking act of pregnant mothers causes vulnerability to their
unborn babies.
4- One of the primary risk of the smoking during pregnancy is the
inability of the child to walk, run or even talk.

Section (C): To find out underlying influences that encourage the pregnant mothers to
smoke in Juba South Sudan. In this section, the researcher seeks to justify “To find out
underlying influences that encourage the pregnant mothers to smoke in Juba South Sudan.”
Please tick (√) the appropriate option.

Key; Where; A = Agree, SA = Strongly Agree, NS = Not Sure, D = Disagree, SD =

Strongly Disagree.

S/No. Statement A S N D S
A S D
1- Peer group is the great motivator in the smoking practice of the
pregnant mothers in South Sudan.
2- Lack of health education on the risk of smoking among pregnant
mothers is one the factor influencing smoking while pregnant in
South Sudan.
3- Inadequate guardian among pregnant mothers can result malpractices
such as smoking among pregnant women in South Sudan.
4- The choice of health among pregnant mothers is not well defined by
ministry of health.

Section (D): To assess the possibilities through which smoking can be reduce among
pregnant mothers. In this section, the researcher seeks to establish “To assess the
possibilities through which smoking can be reduce among pregnant mothers”

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Please tick (√) the appropriate option.
Key; Where; A = Agree, SA = Strongly Agree, NS = Not Sure, D = Disagree, SD =
Strongly Disagree.

S/No. Statement A S N D S
A S D
1- Health education among pregnant mothers is best techniques to
address the problem of smoking while pregnant.
2- Public outlets such as newspapers, Televisions, Radios and magazine
should hired by the government to disseminate the information
regarding risk of smoking while pregnant.
3- The possibility of addressing smoking while pregnant require funding
from both government Non-governmental organization

Section E: Interview guide questions

1. What are the health effects of smoking of pregnant mothers and their unborn babies in
South Sudan?
…………………………………………………………………………………………
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2. Do you believe there are underlying influences that encourage the pregnant mothers to
smoke in Juba South Sudan?
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3. Are there possibilities through which smoking can be reduce among pregnant
mothers?
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4. What are the recommendations on the solutions to effects of smoking on unborn
babies?
…………………………………………………………………………………………………
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Thanks you so much for your time