Equatorial Guinea - Campaign to End Fistula
Equatorial Guinea - Campaign to End Fistula
Equatorial Guinea - Campaign to End Fistula
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QUESTIONNAIRE 2 :<br />
(Addressed <strong>to</strong> delivery assistance personnel (doc<strong>to</strong>rs, gynecologists, surgeons, matronas,<br />
midwives, nurses, delivery auxiliars, traditional midwives and other key community<br />
personnel)<br />
Province: ……....................................................................................................................……..........<br />
District: ..................................................................................................................................……......<br />
Location: ..................................................................................................................................……..<br />
Civil status: ...............................................................................................................................……..<br />
Names:...............................................Family names: ..............................................................……...<br />
Age:….............years Addres:………….............................................................................................<br />
...................................................................................................................................................……..<br />
PROFESSIONAL EXPERIENCE (Number of years of experience): ………………………………….<br />
STATUS:<br />
Generalist-doc<strong>to</strong>r Gyneco-obstetric doc<strong>to</strong>r Surgeon Matron Midwive Nurse <br />
Delivery auxiliar Traditional midwive Health community agent Others (indicate) ………<br />
PLACE OF EXERCICE:<br />
Home <br />
Health post Health center Hospital:<br />
Regional<br />
Provintial<br />
District<br />
<br />
<br />
<br />
ABOUT OBSTETRIC FISTULA:<br />
1. Do you know what is an obstetric fistula? Yes No <br />
If yes, what are the main symp<strong>to</strong>m of obstetric fistula?…………………....................................<br />
...................................................................................................................................................<br />
...................................................................................................................................................<br />
and the causes of obstetric fistula?…........................................................................................<br />
...................................................................................................................................................<br />
2. What do you know about handling and treatement of obstetric fistula?.....................................<br />
...................................................................................................................................................<br />
3. Do you know people with obstetric fistula in your area? Yes No <br />
If yes, please give their names and addresses (continue with questionnaire 3)<br />
...................................................................................................................................................<br />
...................................................................................................................................................<br />
Pollster’s signature,<br />
Date:....…………...............................…………...<br />
Supervisor’s signature,<br />
Date:..................…………................……….....<br />
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