Questionnaire
State
School of Midwifery,
School of Midwifery,
P.M.B.
2264,
2264,
Amukpe,
Sapele.
Sapele.
Delta
State.
State.
Dear Respondent,
I am a student of State
School of Midwifery, Amukpe Sapele, I wish to conduct a research study on the
effect of malaria on pregnant women in Government Hospital Agbarho.
School of Midwifery, Amukpe Sapele, I wish to conduct a research study on the
effect of malaria on pregnant women in Government Hospital Agbarho.
This is aimed at improving
the quality of health care delivery services in the life of the pregnant women.
the quality of health care delivery services in the life of the pregnant women.
I hereby solicit for your
assistance by responding to this questionnaire, which will be a source of data
for the above research work.
assistance by responding to this questionnaire, which will be a source of data
for the above research work.
Your response will be used
solely for academic purpose. No name and addresses are required and
confidentiality of the information is highly guaranteed.
solely for academic purpose. No name and addresses are required and
confidentiality of the information is highly guaranteed.
Section A: Instruction
Please tick [√ ] in the
appropriate box where applicable.
appropriate box where applicable.
1. Age in years: 18 – 25 [
], 26 – 35 [ ], 36 and above
[ ]
], 26 – 35 [ ], 36 and above
[ ]
2. Marital status: Married [
], Not married [ ]
], Not married [ ]
3. Religion:
Christian [ ], Islam [ ], Traditional religion [ ], None of the above [ ]
Christian [ ], Islam [ ], Traditional religion [ ], None of the above [ ]
4. Educational
level: Primary school [ ], Secondary
school [ ],
level: Primary school [ ], Secondary
school [ ],
Graduates
[ ], Other institution [ ], Illiterates [ ]
[ ], Other institution [ ], Illiterates [ ]
5. Residence:
Village [ ], Town [ ]
Village [ ], Town [ ]
6. Occupation:
Civil servants [ ], Farmers [ ], Traders [ ],
Civil servants [ ], Farmers [ ], Traders [ ],
House
wife [ ]
wife [ ]
Section B
1. Do you
have idea of what malaria is? Yes [ ],
No [ ]
have idea of what malaria is? Yes [ ],
No [ ]
2. What
are the causes of malaria? tse-tsefly [ ],
Bite of mosquito [ ] Exposure to
excessive sunlight [ ], Lack of sleep
[ ]
are the causes of malaria? tse-tsefly [ ],
Bite of mosquito [ ] Exposure to
excessive sunlight [ ], Lack of sleep
[ ]
3. Have
you been pregnant before? Yes [ ], No
[ ]
you been pregnant before? Yes [ ], No
[ ]
4. How
many children do you have? ……………….……………
many children do you have? ……………….……………
5. Have
you been previously attacked by malaria during pregnancy? Yes [ ], No [
]
you been previously attacked by malaria during pregnancy? Yes [ ], No [
]
6. If
yes, how many times? Once [ ], Twice
[ ], Thrice [ ],
More than 3 times [ ]
yes, how many times? Once [ ], Twice
[ ], Thrice [ ],
More than 3 times [ ]
7. What
was the outcome on the pregnancy? Abortion [
], Anaemia [ ], Premature
delivery [ ], Normal delivery [ ]
was the outcome on the pregnancy? Abortion [
], Anaemia [ ], Premature
delivery [ ], Normal delivery [ ]
8. Do you attend ante-natal classes? Yes [ ], No [
]
]
9. If no, why? Ignorance [
], No money [ ], Distance [ ]
], No money [ ], Distance [ ]
10. If yes, how often? Once in a month [ ], 2
x [ ], 3 x [ ]
x [ ], 3 x [ ]
11. At what
time in pregnancy do you go to the hospital to register? When you first
discover you are pregnant [ ], After 4
months [ ], after 6 months [ ], After 8 months [ ], When I am near delivery [ ] when I’m in labour [ ]
time in pregnancy do you go to the hospital to register? When you first
discover you are pregnant [ ], After 4
months [ ], after 6 months [ ], After 8 months [ ], When I am near delivery [ ] when I’m in labour [ ]
12. Do you always attend on
time? Yes [ ], Sometimes [ ], No [
]
time? Yes [ ], Sometimes [ ], No [
]
13. What is
the major content of the food you take? More carbohydrate [ ], more proteins [ ], carbohydrate, proteins & vitamins
[ ]
the major content of the food you take? More carbohydrate [ ], more proteins [ ], carbohydrate, proteins & vitamins
[ ]
14. How
often do you eat? Once [ ], 2 x [ ], 3 x [
]
often do you eat? Once [ ], 2 x [ ], 3 x [
]
15. Do you
add fruit to your meal? Yes [ ], No
[ ]
add fruit to your meal? Yes [ ], No
[ ]
16. What do
you do to prevent malaria? Clearing of bushes and drainage water [ ], use of coil [ ], use of insecticide [ ], use of net [ ], None of the above [ ]
you do to prevent malaria? Clearing of bushes and drainage water [ ], use of coil [ ], use of insecticide [ ], use of net [ ], None of the above [ ]
17. How do
you dispose or put away your refuse (waste)? Burning [ ], Dumping into bushes [ ], Burying in pits [ ]
you dispose or put away your refuse (waste)? Burning [ ], Dumping into bushes [ ], Burying in pits [ ]
18. How
often do you dispose your waste? Weekly [
], fortnightly [ ], monthly
[ ], none of the above [ ]
often do you dispose your waste? Weekly [
], fortnightly [ ], monthly
[ ], none of the above [ ]
19. How do
you treat malaria? Locally [ ],
hospital [ ], chemist
you treat malaria? Locally [ ],
hospital [ ], chemist
[ ]
