Making Every Baby Count
9789241511223-eng
9789241511223-eng
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SEQUENTIAL NUMBER<br />
<br />
SECTION 1. INTERVIEW AND DEMOGRAPHIC INFORMATION<br />
SECTION 1.1 INTERVIEWER VISITS<br />
1 2 3 FINAL VISIT<br />
DATE<br />
INTERVIEWER’S NAME<br />
RESULT*<br />
__________________<br />
__________________<br />
<br />
TAKE NOTES HERE IF FOLLOW-UP IS NEEDED<br />
(e.g. TELEPHONE, DIRECTIONS ETC)<br />
NEXT VISIT:<br />
DATE<br />
TIME<br />
__________________<br />
__________________<br />
GPS CODES:<br />
(of village)<br />
DECIMAL DEGREES<br />
__________________<br />
__________________<br />
<br />
__________________<br />
__________________<br />
__________________<br />
__________________<br />
<br />
DAY<br />
MONTH<br />
YEAR<br />
<br />
<br />
2 0 1<br />
<br />
INTERVIEWER<br />
# <br />
RESULT<br />
TOTAL NUMBER OF VISITS<br />
* RESULT CODES:<br />
1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED<br />
5 PARTLY COMPLETED 6 NO APPROPRIATE RESPONDENT FOUND 7 OTHER (SPECIFY) _________________________________<br />
SECTION 1.2 ADDITIONAL DEMOGRAPHIC INFORMATION<br />
(PLEASE USE CORRECT SPELLING FROM LIST)<br />
DISTRICT<br />
HEALTH SUBDISTRICT<br />
SUBCOUNTY<br />
PARISH<br />
VILLAGE/LOCALITY<br />
HOUSEHOLD NUMBER (HHN)<br />
NAME OF DECEASED BABY<br />
NAME OF THE BABY’S MOTHER<br />
NAME OF HOUSEHOLD HEAD<br />
LAT N<br />
S<br />
LONG<br />
<br />
<br />
+<br />
–<br />
E 3<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
To be filled by data entry<br />
WHAT IS THE PRIMARY LANGUAGE OF THE INTERVIEW? ENGLISH........................................................................... 1<br />
OTHER (SPECIFY)________________________________ 2<br />
108 MAKING EVERY BABY COUNT: AUDIT AND REVIEW OF STILLBIRTHS AND NEONATAL DEATHS