PDF, 1536K - Measure DHS

LAST BIRTH
NEXT-TO-LAST BIRTH
NAME _______________________
NAME
421 Which drug was that?
RECORD ALL MENTIONED.
422 When (NAME) was born, was he/she:
very large, larger than average, average,
smaller than average, or very small?
FANSIDAR......................................A
CHLOROQUINE .............................B
PROGUANIL...................................C
OTHER______________________X
(SPECIFY)
DON’T KNOW................................. Z
VERY LARGE ................................. 1
LARGER THAN AVERAGE ............ 2
AVERAGE....................................... 3
SMALLER THAN AVERAGE .......... 4
VERY SMALL.................................. 5
DON’T KNOW................................. 8
VERY LARGE .................................. 1
LARGER THAN AVERAGE ............. 2
AVERAGE........................................ 3
SMALLER THAN AVERAGE ........... 4
VERY SMALL................................... 5
DON’T KNOW .................................. 8
423 Was (NAME) weighed at birth? YES................................................. 1
NO.................................................2
(SKIP TO 425)
DON’T KNOW...............................8
YES .................................................. 1
NO.................................................2
(SKIP TO 425)
DON’T KNOW ...............................8
424 How much did (NAME) weigh?
RECORD WEIGHT FROM HEALTH CARD,
IF AVAILABLE.
GRAMS FROM
CARD.............. 1
GRAMS FROM
RECALL .......... 2
DON’T KNOW......................... 99998
GRAMS FROM
CARD .............. 1
GRAMS FROM
RECALL .......... 2
DON’T KNOW .......................... 99998
425 Who assisted with the delivery of (NAME)?
Anyone else?
PROBE FOR THE TYPE OF PERSON AND
RECORD ALL PERSONS ASSISTING.
HEALTH PROFESSIONAL.............A
OTHER PERSON
TRAINED TRADITIONAL BIRTH
ATTENDANT ............................ B
UNTRAINED TRADITIONAL
BIRTH ATTENDANT...............C
RELATIVE/FRIEND/
NEIGHBOUR ...........................D
OTHER______________________X
(SPECIFY)
NO ONE....................................... Y
HEALTH PROFESSIONAL .............. A
OTHER PERSON
TRAINED TRADITIONAL BIRTH
ATTENDANT ............................ B
UNTRAINED TRADITIONAL
BIRTH ATTENDANT................C
RELATIVE/FRIEND/
NEIGHBOUR ...........................D
OTHER ______________________ X
(SPECIFY)
NO ONE ....................................... Y
426 Where did you give birth to (NAME)? HOME
YOUR HOME..........................11
(SKIP TO 428)
OTHER HOME........................12
GOVERNMENT
HOSPITAL ..................................21
HEALTH CENTER......................22
HEALTH STATION/CLINIC ........23
OTHER GOV’T_____________ 26
(SPECIFY)
NONGOVERNMENTAL (NGO)
NGO HEALTH FACILITY.......... 31
PRIVATE MEDICAL
PVT. HOSPITAL .........................41
PVT. DOCTOR/CLINIC...............42
OTHER PVT. _______________46
(SPECIFY)
OTHER____________________96
(SPECIFY)
(SKIP TO 428)
HOME
YOUR HOME ..........................11
(SKIP TO 428)
OTHER HOME........................12
GOVERNMENT
HOSPITAL ................................. 21
HEALTH CENTER ..................... 22
HEALTH STATION/CLINIC ....... 23
OTHER GOV’T _____________ 26
(SPECIFY)
NONGOVERNMENTAL (NGO)
NGO HEALTH FACILITY ........... 31
PRIVATE MEDICAL
PVT. HOSPITAL ........................ 41
PVT. DOCTOR/CLINIC.............. 42
OTHER PVT._______________ 46
(SPECIFY)
OTHER ___________________ 96
(SPECIFY)
(SKIP TO 428)