QUESTIONNAIRES

RESEARCH OF A PREVALENCE OF ANAEMIA AMONG PREGNANT WOMEN IN

KAPSABET COUNTY REFERRAL HOSPITAL

INSTRUCTIONS

1. Answer all questions.

2. Do not write your name.
3. For multiple choice questions tick the answer in the box provided.
4. Information given is confidential and will be used for study only.

SECTION A: DEMOGRAPHIC INFORMATION

1. What is your age?

a) Below 20 years [ ]
b) 20 – 30 years [ ]
c) 31 – 40 years [ ]
d) 41 – 49 years [ ]
2. Marital status of the respondent?
a) Single [ ]
b) Married [ ]
c) Divorced [ ]
d) Widowed [ ]
3. Level of education?
a) Primary [ ]
b) Secondary [ ]
c) Tertiary [ ]
d) Other specify
4. Are you employed?
a) Yes [ ]
b) No [ ]

If yes, what do you do?

 5. What is your average income in a month?
a) 0 – 1000 [ ]
b) 1001 – 2000 [ ]
c) 2001 – 3000 [ ]
d) 3001 – 4000 [ ]
e) 4001 and above [ ]
6. How many children do you have?
A) One [ ]
B) Two [ ]
C) Three [ ]
D) Four and above [ ]

SECTION B: KNOWLEDGE

7. Have you ever herd of anaemia?

a) Yes [ ]
b) No [ ]
If yes, from what source of information?
i. Radio [ ]
ii. Television [ ]
iii. Church
iv. Hospital
v. Other specify
8. Anaemia is a common problem?
a. Very common [ ]
b. Common [ ]
c. Not very common [ ]
d. Don’t know [ ]
9. Have you seen a person suffering from anaemia?
a) Yes [ ]
b) No [ ]

If yes, how did they present?

i. Fatigued [ ]
 ii. Exhausted [ ]
iii. Breathlessness [ ]
10. Anaemia is a preventable disease?
a) Yes [ ]
b) No [ ]
Which other diseases can be prevented through maternal child health clinic services
?

SECTION D:PRACTICES.

11. Is there a healthy facility where you stay?

a) Yes [ ]
b) No [ ]
12. How far is it from your home?
a) Near [ ]
b) Far [ ]
c) Very far [ ]
d) Too far [ ]
13. Did you visit the maternal and child health clinic for this pregnancy?
a) Yes [ ]
b) No [ ]
14. Were you offered the services you needed?
a) Yes [ ]
b) No [ ]

If yes, which service?

15. Did you comply with what the health care workers told you?
a) Yes [ ]
b) No [ ]

If No, why?

SECTION C: ATTITUDE

16. Are maternal child health clinic services important?

a) Yes [ ]
 b) No [ ]
c) If No, why?
17. Did you attend antenatal clinic in the previous pregnancies?
a) Yes [ ]
b) No [ ]
18. Is it necessary to take the health care workers advice?
a) Yes [ ]
b) No [ ]

If Yes, why?

if No, why?

SECTION D