Pregnancy Questionnaire Essay

1738 Words 7 Pages
APPENDICES
Appendix 1: CONSENT FORM
My names are Lucy Wairimu Mugo. I am a student at Aga- Khan University. I am conducting a research study on awareness of danger signs during pregnancy among pregnant women attending Antenatal Care at Gatundu District Hospital. The study is a partial fulfillment for the award of Bachelor’s Degree in Nursing and I can only achieve this through your participation. I will be using a questionnaire to collect data. If you choose to participate in the study, please do not write your name on the questionnaire. No one will know whether you participated in the study. Your responses will be kept confidential and will not be identified with you personally. Your opinion through this questionnaire will be highly appreciated.
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Education status of husband (a) Never attended formal education [ ] (b) Primary [ ] (c) Secondary [ ] (d) Secondary [ ] (e) Tertiary [ ]

8. Occupation of husband (a) No employed [ ] (b) self-employed [ ] (c) Private employed [ ] (d) Government employed [ ]

9. Monthly income in Kenya Shillings (a) No income [ ] (b) Less than 10,000 [ ] (c) 10,000 [ ] (d) 10,000 to 30,000 [ ] (e) 31,000 to 60,000 [ ] (f) 60,000 and above [ ]

(a) Current knowledge on danger signs during pregnancy.

10. Have you heard about danger signs in pregnancy? (a) yes [ ] (b) No [ ]

11. Do you know of any/some serious health problems that can occur during pregnancy that could endanger the life of a pregnant woman? (a) Yes [ ] (b) No [ ]

12. If yes, tick the danger signs that you know in the list below (a) Vaginal bleeding [ ] (b) Decreased fetal movements (c) leakage of amniotic fluid [ ] (d) Headache [ ] (e) Swollen hand, face and feet (f) Severe abdominal pain [ ] (g) persistent vomiting [ ] (f) High fever [ ] (i) Blurred vision [ ]

13. In your own opinion, what are some of the things you do in case you experienced any of the above danger signs in
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Occupation of husband (a) No employed [ ] (b) self-employed [ ] (c) Private employed [ ] (d) Government employed [ ]

9. Monthly income in Kenya Shillings (a) No income [ ] (b) Less than 10,000 [ ] (c) 10,000 [ ] (d) 10,000 to 30,000 [ ] (e) 31,000 to 60,000 [ ] (f) 60,000 and above [ ]

(a) Current knowledge on danger signs during pregnancy.

10. Have you heard about danger signs in pregnancy? (a) yes [ ] (b) No [ ]

11. Do you know of any/some serious health problems that can occur during pregnancy that could endanger the life of a pregnant woman? (a) Yes [ ] (b) No [ ]

12. If yes, tick the danger signs that you know in the list below (a) Vaginal bleeding [ ] (b) Decreased fetal movements (c) leakage of amniotic fluid [ ] (d) Headache [ ] (e) Swollen hand, face and feet (f) Severe abdominal pain [ ] (g) persistent vomiting [ ] (f) High fever [ ] (i) Blurred vision [ ]

13. In your own opinion, what are some of the things you do in case you experienced any of the above danger signs in pregnancy?

(c) Factors associated with knowledge of obstetric danger signs

14. How many antenatal visits have you

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