Annex 2: Instruments used in NMIS Cycle 5
Household questionnaire
Focus group discussion guide for cycle
Check list for review of health facilities
Questionnaire for interview of Traditional Birth Attendant
Check list of interviewing community leaders
Focus group guide for feedback of cycle 4 key findings
1. Household Questionnaire - cycle 5
1. What is the age and sex of the household head?
2. What is the relationship of the respondent to the household head?
3. What is the literacy of the household head? [Ability to read and write
a simple letter]
4. What is the occupation of the household head? [Note the ethnicity of
household]
5. How many people are there in this household altogether?
(Write age and sex of each one, starting with the youngest)
[For each child 5 years and under, write how many doses of polio vaccine s/he received in the recent National Immunisation Days (Marg 21 and Magha 4)]
[For each person 6 years and above, write whether literate or not and source of literacy]
Ask the remainder of questionnaire for each ever-married woman of childbearing age in the household (age 15-49 years) [If none, go to next house]
6. What is your age?
7. Are you able to read and write a simple letter in any language?
8. How many times have you been pregnant? (Including miscarriages)
[If none, go to next eligible woman]
Ask Q9-Q46 for the last pregnancy of each eligible woman (or present
pregnancy if pregnant now)
9. When was your last pregnancy? (How many months/years ago)
[If pregnant now, note how many weeks pregnant]
10. How many antenatal care visits did you have? [If none, skip to Q17]
11. After how many months of pregnancy did you have your first antenatal
visit?
12. Where were the antenatal visits? [Home, SHP,HP,PHC,private facility,hospital]
13. Who provided the care at the antenatal visits? [TBA, MCHW, ANM, doctor
etc]
14. Was the place of delivery discussed with you during the antenatal
visits?
15. Was breastfeeding discussed with you during the antenatal visits?
16. How much did you have to pay (including cash and kind) for each visit? [Rs]
17. If you did not have any antenatal care visits, why not?
18. How many doses of TT did you receive during this pregnancy?
19. For how many months did you take iron/folate tablets during this
pregnancy?
20. How many cigarettes/beedi/tobacco per day did you smoke during this
pregnancy?
21. What health problems, if any, did you have during the pregnancy?
22. Where did you seek help for this problem? [0=did not seek help]
23. If you did not seek help, why not?
24. How satisfied are you with the antenatal care you received?
[not at all, somewhat, very]
25. What do you think are the main problems with the antenatal care
service?
26. How long did you continue working during your pregnancy?
27. How much help and support did you have from your family during this
pregnancy?
[none at all, some, very much]
28. What do you think that services could do to improve care for pregnant
women?
29. What could communities themselves do to help women during pregnancy?
30. Where did you deliver the baby? [In the house, in a shed, in hospital,
in nursing home]
[If delivered in hospital, nursing home etc, skip to Q35]
31. Who assisted with the birth of the baby? [Family only, trained
TBA, untrained TBA, MCHW, ANM etc]
32. Did you use a Home Delivery Kit for the birth?
33. If not, why not?
34. With what was the cord - cut? - treated?
35. How many hours or days was the labour? [hours/days]
36. What problems, if any, occurred during the labour or delivery?
37. Where did you seek help for this problem? [0=did not seek help]
38. How soon did you seek help after the problem started? [hours]
39. If you did not seek help anywhere, why not?
40. How big was the baby? [very small, small, normal, big]
41. Was the baby a boy or a girl?
42. What happened to the baby? [stillbirth, lived short time, survived and
well, survived but apparently disabled]
43. How much did you have to pay (including cash and kind) for the
delivery of the baby [may need to ask someone else as well as mother]
for the HDK or other materials?
for the attendance of the TBA/MCHW/ANM etc?
for transport to get emergency help if needed?
for additional costs at PHCC or hospital?
any other costs?
44. How satisfied are you with the care you received during your labour
and delivery?
[not at all, somewhat, very]
Post-natal period
45. How soon after the birth of the child were you given anything to
eat?[hours]
46. After the birth, what health problems, if any, did you or the baby
have?
47. Where did you seek help for this problem? [0=did not seek help]
48. If you not seek help, why not?
2. NMIS Cycle 5 - Focus Group Guide
Focus group of 8-10 women who have given birth within the last three years.
Introduction
Namaste. We are here in your community to ask about the care women receive during pregnancy and childbirth and to discuss with you any problems you have with the care that is available and how you think this could be improved.
1. Do women in this community usually go for antenatal care visits? Where do they go?
[Probe] If pregnant women do not go for antenatal care, why is this?
[Probe] What problems are there with the present antenatal care services available in this community?
How could the services be improved?
[Probe] How much help do pregnant women get from their families and the community?
What else could families and the community do to help?
2. Where do women in this community usually deliver their babies?
[Probe] What happens if there is an emergency health problem during pregnancy or childbirth?
Where are women taken for emergency help if this happens?
[Probe] Who decides when to seek help for an emergency health problem during pregnancy or delivery?
[Probe] Does the community have any ways of assisting women to get help if there is an emergency problem during pregnancy or delivery?
How well does this work?
3. Are there any special feeding practices in this community for women during pregnancy and after delivery?
[Probe] Are there certain foods that should and should not be eaten?
4. Do you know of any women in this community who have died during pregnancy or delivery or within 6 weeks of delivery in the last three years?
[Probe] What happened?
[Probe] How do you think this could have been prevented?
3. NMIS Cycle 5 - Review of Govt Health Facility
This review is of the facility most used by the community for antenatal care; usually it will be the nearest SHP, HP or PHC.
Speak to the Health Worker in charge and observe the facilities.
1. Note what type of health facility [SHP, HP, PHC]
2. What staff are actually available in this facility? [List titles]
3. Which staff are most concerned with care of women during pregnancy and
delivery?
[Talk to this person if available, otherwise speak to whoever available]
4. Do you have scales for weighing adults? [Observe if in working order]
5. Do you have a sphygmomanometer for measuring blood pressure? [Observe
if working]
6. Do you have a foetal stethoscope? [Check if present]
7. Do you supply pregnant women with iron/folate tablets? [Check if
supply]
8. Do you give pregnant women injections of TT as required? [Check supply,
equipment]
- Do you have sterile syringes supplied with the vaccine?
- Do you have money to purchase kerosene to sterilise syringes? [observe
arrangements]
9. What do you advise pregnant women about nutrition during pregnancy and
breastfeeding?
10. What do you advise pregnant women about the place to deliver their
babies?
11. What do you advise pregnant women about breast feeding?
12. What do you advise pregnant women about Home Delivery Kits?
13. How much do you charge women for registration - initially?
-for subsequent visits?
14. How many pregnant women have you attended in the last 12 months?
[check records if necessary]
15. What health problems during pregnancy have you seen in the last 12
months? [Number with each problem]
16. How many deliveries have you attended in the last 12 months?
17. What do you use to cut the cord of newborn babies?
18. What do you apply to the stump of the cord after cutting it?
19. What emergency health problems have you seen during pregnancy or
delivery in the last 12 months?
[Number with each problem]
20. How many of these were referred to your facility because of problems:
- by the TBA/FCHV
-by the family of the woman
21. Which of these problems did you manage here?
22. Where did you refer the others for help? [Note type of health
facility]
23. Have you seen any women who have died during pregnancy or delivery or
within 6 weeks of delivery in the last 3 years?
[Give number]
24. What was the cause of death in each case? Could any of the deaths have
been prevented?
25. What do you think could be done to improve services for women during
pregnancy and delivery?
26. Do you visit/ provide care for mothers and babies after the child is
born?
27. What advice/service do you offer women after the birth of a child?
NMIS Cycle 5 - Interview with TBA
[This interview with up to three TBAs per site]
1. What is your age?
2. Note caste/ethnicity
3. Are you able to read and write a simple letter in any language?
4. How many years have you been working as a TBA?
5. From whom did you learn your traditional skills?
6. Have you had any training in antenatal and delivery care?
7. If yes, who provided this training?
8. What do you advise pregnant women about the place to deliver their
babies?
9. What do you advise pregnant women about breast feeding?
10. What else do you do during antenatal visits?
NMIS Cycle 5 - Interview with Community Leader
How far is it to the nearest health facility from the centre of the community? [Time to reach]
How do people travel there? How much does the travel cost?
What type of facility is it? Government (SHP, HP, PHC), NGO, private?
In this community/settlement, where do most women get their antenatal care?
In this community/settlement, who attends most of the women during delivery?
What arrangements does this community/settlement have for taking a woman with emergency health problems during pregnancy or delivery for help?
Where are women with emergency problems during pregnancy or delivery taken for care? How long does the journey take?
How many times in the last 12 months has a woman from this community/settlement had to be taken for emergency help because of problems during delivery?
Have any women from this community/settlement died during pregnancy or delivery or within 6 weeks of delivery in the last 3 years? [give number]