Appendix

Questionnaire

Gender: Male
( ) Female ( )

Age: 15-24
( ) 24-34 ( ) 35 and above ( )

Marital
status: Married ( ) Single ( ) Divorced (
) Widow/Widower ( )

Religion:
Christian ( ) Islam ( ) Other (
)

Occupation:
Student ( ) Employed ( ) Unemployed ( ) Trading (
)

Section B

1.
Is there any food you are forbidden from eating during pregnancy by your
culture yes( ) no ( ).

Past pregnancy

2.
Parity: How many times have you given birth 1-3 ( ) 3-4 (
) above ( )

3.
Last child birth 1-2yrs ( )
3-4yrs ( )

4.
Have you ever had an abortion or miscarriage before yes ( ) No (
)

5.
Did you have any vaginal bleeding during your last pregnancy? Yes ( ) No (
)

Index Pregnancy

6.
How old was your pregnancy when first came to book at this ANC? 1st
trimester ( ) 2nd ( ) 3rd ( )

7.
How old is this pregnancy? 1-3 months (
) 4-6 month ( ) 7-9 month ( )

8.
How many times have you attended ANC so far? 3-5 times ( ) 5-10 times ( ) 10 and above ( )

9.
In this pregnancy, have you experienced any of the following? A. Vaginal
bleeding Yes ( ) No ( ) / B. Have you had any blood transfusion in
this pregnancy? Yes ( ) NO ( ) / C. Dizziness and fainting? Yes ( ) No (
)

10.
Are you taking any of the following drug? A. Fersolate Yes ( ) No (
) / B. Folic acid Yes ( ) No
( ) / C. Ant malaria Yes ( ) No (
) / D. Native/Herbal drugs Yes (
) NO ( )

Section C

Knowledge on Anaemia

11.
Have you ever heard about anaemia? Yes (
) No ( )

12.
What is anaemia? Shortage of blood (
) Leaking of spiritual attack ( )
Others ( )

13.
What do you think is the cause of anaemia? A. Malaria ( ) Sickle cell disease ( ) Urinary track infection ( ) malnutrition ( ) Spiritual (
) Warm ( )

Section D