APPENDIX A: RESEARCH QUESTIONNAIRE

Dear respondents, we are graduating students of Health Science at Salaam University. This is
a questionnaire prepared for data collection concerning factors contributing mother-to-child-
transmission among health workers at Benadir hospital. The purpose of this questionnaire is
for academic reason. Your information will be kept confidentially. Therefore, we kindly
request you to answer these questions to the best of your knowledge.
Instruction
 Do not write your name on this questionnaire
 The research is for academic purpose not money
 Your information will be private
Please circle your answer to the provided answers to the best of your knowledge.
SECTION ONE: BACKGROUND AND SOCIODEMOGRAPHIC CHARACTERISTICS
Number Question Answer
1 What is your age? A. 15-25
B. 25-35
C. 35 above

2 What is your sex? A. Male

B. Female

3 What is your marital status? A. Single

B. Married
C. Divorced
D. widowed

4 What is your education level? A. Primary level

B. Secondary level
C. University level
D. Non formal education

5 What is your occupation? A. Employee

B. Unemployed
C. Student
D. Housewife

6 What is your profession? A. Nurse

B. G.P doctor
C. Midwife
D. Lab technician

7 I have a professional experience of A. 1-3 years

B. More than 3 years

8 Have you ever experienced mother-to-child- A. Yes

transmission of HIV? B. No

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SECTION TWO: HEALTH SYSTEM FACTORS OF MTCT

Number Question Answer

9 Lack of appropriate counselling to mothers with A. Agree
HIV contribute mother to child transmission. B. Disagree
C. Strongly agree
D. Strongly disagree

10 Have you ever seen a mother with HIV seeking A. Yes

counselling? B. No

11 Lack of availability of counselling services can A. Agree

contribute MTCT. B. Disagree
C. Strongly agree
D. Strongly disagree

12 Is there a counselling center for mothers with A. Yes

HIV in this hospital? B. No

13 All services needed for mothers with HIV are A. Agree

available in this hospital. B. Disagree
C. Strongly agree
D. Strongly agree

14 All services of mothers with HIV are free A. Yes

B. No

15 Mothers with HIV can get access of the services A. Yes

at any time from this hospital. B. No

16 Lack of accessibility of the services can A. Agree

contribute MTCT B. Disagree
C. Strongly agree
D. Strongly
disagree

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SECTION THREE: INDIVIDUAL FACTORS

Number Question Answer

17 Maternal knowledge can contribute prevention A. Agree
of MTCT. B. Disagree
C. Strongly agree
D. Strongly disagree

18 Mothers with knowledge is more likely to seek A. Agree

services and counselling B. Disagree
C. Strongly agree
D. Strongly disagree

19 Education of HIV is very important for mothers A. Agree

with HIV. B. Disagree
C. Strongly agree
D. Strongly disagree

20 Trained midwives can help mothers with HIV A. Agree

for the prevention of MTCT. B. Disagree
C. Strongly agree
D. Strongly disagree

21 Lack of trained midwives can increase the risk A. Agree

of MTCT. B. Disagree
C. Strongly agree
D. Strongly disagree

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SECTION FOUR: SOCIO-CULTURAL FACTORS

Number Question Answer

22 Stigma can contribute MTCT. A. Agree
B. Disagree
C. Strongly agree
D. Strongly disagree

23 Stigma to mothers with HIV is more common in A. Agree

our society B. Disagree
C. Strongly agree
D. Strongly disagree

24 Mothers with HIV suffer from discrimination A. Usually

B. Sometimes
C. Never

25 Most mothers with HIV suffer from A. Agree

discrimination. B. Disagree
C. Strongly agree
D. Strongly disagree

26 Lack of social support to mothers with HIV can A. Agree

contribute MTCT. B. Disagree
C. Strongly agree
D. Strongly disagree

27 Most mothers with HIV suffer from lack of A. Agree

social support B. Disagree
C. Strongly agree
D. Strongly disagree

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