PDF, 1536K - Measure DHS

LAST BIRTH
NAME _______________________
NEXT-TO-LAST BIRTH
NAME ________________________
408 How many months pregnant were you when
you first received antenatal care for this
pregnancy?
MONTHS............................
DON’T KNOW................................ 98
409 How many times did you receive antenatal
care during this pregnancy?
NO. OF TIMES..................
DON’T KNOW................................ 98
410 CHECK 409:
NUMBER OF TIMES RECEIVED
ANTENATAL CARE
ONCE
(SKIP TO 412)
MORE THAN
ONCE OR DON’T
KNOW
411 How many months pregnant were you the
last time you received antenatal care?
MONTHS............................
DON’T KNOW................................ 98
412 During this pregnancy, were any of the
following done at least once?
YES
NO
Were you weighed?
Was your height measured?
Was your blood pressure measured?
Did you give a urine sample?
Did you give a blood sample?
WEIGHT............................1 2
HEIGHT.............................1 2
BLOOD PRESSURE.........1 2
URINE SAMPLE ...............1 2
BLOOD SAMPLE..............1 2
413 Were you told about the signs of pregnancy
complications?
414 Were you told where to go if you had these
complications?
415 During this pregnancy, were you given an
injection in the arm to prevent the baby from
getting tetanus, that is, convulsions after
birth?
YES.................................................. 1
NO...................................................2
(SKIP TO 415)
DON’T KNOW.................................. 8
YES.................................................. 1
NO.................................................... 2
DON’T KNOW.................................. 8
YES.................................................. 1
NO............................................... 2
( SKIP TO 418)
DON’T KNOW............................. 8
415A
During this pregnancy, how many times did
you get this injection? TIMES .................................................
DON'T KNOW ...................................8
418 During this pregnancy, did you have difficulty
with your vision during the daylight?
YES.................................................. 1
NO.................................................... 2
DON’T KNOW.................................. 8
419 During this pregnancy, did you suffer from
night blindness [USE LOCAL TERM]?
YES.................................................. 1
NO.................................................... 2
DON’T KNOW.................................. 8
420 During this pregnancy, were you given or did
you buy any drugs in order to prevent you
from getting malaria?
YES.................................................. 1
NO.................................................2
(SKIP TO 422)
DON’T KNOW...............................8