This Questionnaire will be used to gather data on the effects of iron supplementation on pregnant mothers in a developing country. In order to achieve this goal, the questionnaire will be divided into three segments namely socioeconomic status, to establish the social and economic level of the mothers. Secondly, the use of healthcare services will be established and finally, knowledge and practice concerning the supplements. The inclusion criteria involves Women aged above 16 years conformed to be pregnant and at <16 wk gestation. The women will have to be registered at the local community health facility. Women with high risk pregnancy with a positive confirmation of the same using ultrasound are excluded.
How old are you?
What is your gestation period? .
Do you suffer from any pregnancy related condition? Yes No
If yes, Specify
Socioeconomic Status
What is your annual per capita income?
Less than 1 dollar Less than 200 dollars More than 500 dollars
Obstetric history
Use of health services in pregnancy
How often do you attend hospital during pregnancy?
Never Rarely Regularly
Knowledge on supplements
How often do you take the iron supplements?
Never Rarely Regularly
Factors affecting adherence to supplements
Do you have access to iron supplements during pregnancy?
Yes No
If yes, how often do you use the supplements?
Daily weekly Specify..
Do you experience any side effects with the use of iron supplements?
Yes No
If yes, specify..
What time do you take the iron supplements?
Morning afternoon evening Other Specify
Do you keep the supplements yourself? Yes No specify.
Do you take the tables with meals? Yes No
Do you have a reminder to take the iron supplements? Yes No
Do you have a husband? Yes No
If yes, does your husband, (if you have) remind you to take the supplements?
Yes No
Do you understand the instructions on taking the supplements?
Yes No
How frequent do you experience side effects if any?
Often Rarely Often
Please specify any diagnosed or observed side effects..
Please specify any improved outcomes .
END
References
West, K. P., Shamim, A. A., Mehra, S., Labrique, A. B., Ali, H., Shaikh, S., & Hanif, A. A. (2014). Effect of Maternal Multiple Micronutrient vs Iron–Folic Acid Supplementation on Infant Mortality and Adverse Birth Outcomes in Rural Bangladesh: The JiVitA-3 Randomized Trial. JAMA, 312(24), 2649-2658.
Zimmermann, M. B., & Hurrell, R. F. (2007). Nutritional iron deficiency. The Lancet, 370(9586), 511-520.
