| Variables in Previous Pregnancy History FORM (PPH) | ||||||||
| Question# | Question | Field name | Response nature | Response options | ||||
| 1 | PID Number | PID | ### | |||||
| 2 | Initials of the Mother | pph_A | XX | |||||
| 3 | Field worker code | pph _B | ## | |||||
| 4 | Date
of Interview (According to English calender) |
pph _C | ##-XXX-## | dd-mmm-yy | ||||
| 5 | Number of Gravida | pph _1 | ## | |||||
| 6 | Number of Para | pph_2 | ## | |||||
| 7 | H/O abortion/still birth /child death ? | pph _3 | 1=Yes, 2=No | 1=Yes, 2=No, 9=not applicable | ||||
| 8 | If abortion, how many times? | pph_3_a | ## | 99 if pph_3=2 | ||||
| 9 | Specify weeks of gestation of last abortion. | pph_3_b | ## | 99 if pph_3=2 | ||||
| 10 | Reason of abortion | pph_3_c | 1=Spontaneous, 2=Health reasons, 3=Personal choice, 4=Other | 1=Spontaneous, 2=Health reasons, 3=Personal choice, 4=Other, 9= not applicable | ||||
| 11 | If other, specify. | pph_3_c_txt | TEXT
if pph_3_c=4 NA if pph_3_cǂ4 |
TEXT
if pph_3_c=4 NA if pph_3_cǂ4 |
||||
| 12 | If still birth, how many times? | pph _3_d | ## | 99 if not applicable | ||||
| 13 | If child death, how many child? | pph_3_e | ## | 99 if not applicable | ||||
| 14 | Age of the last child who died? (in months)? | pph_3_f | ## | 99 if not applicable | ||||
| 15 | Specify reasons for the last child death | pph_3_g | TXT | TEXT
if last child death NA if no last child death |
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| 16 | Age
of the older children in years? Child1 Child2 Child3 |
pph
_4i pph_4ii pph_4iii |
## ## ## |
##
if older children 99 if no older children |
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| 17 | Preterm labor in previous pregnancies? | pph _5 | # | 1=Yes, 2=No, 9=not applicable | ||||
| 21 | Was any child born preterm? | pph _6 | # | 1=Yes, 2=No, 9=not applicable | ||||
| 22 | Where was the last child born? | pph_7 | # | 1=Home, 2=Health facility, 3=others, 9= not applicable | ||||
| 23 | If others, specify | pph_7txt | TXT | TEXT
if pph_7=3 NA if pph_7ǂ3 |
||||
| 24 | Type of delivery of the last child | pph _8 | # | 1=Normal, 2=Caesarean section, 3=Vacuum forceps, 9=not applicable | ||||
| 25 | Was the last child born full term? | pph_9 | # | 1=Full term, 2=Preterm, 3=Post-term, 9=not applicable | ||||
| 26 | Birth weight of the last child (in kg) according to card/Mother’s recall | pph _10 | #.## | #.## | ||||
| 27 | Has she taken folate regularly during last pregnancy? | pph _11 | # | 1=Yes, 2=No, 9=not applicable | ||||
| 28 | Has she taken iron regularly during last pregnancy? | pph _12 | # | 1=Yes, 2=No, 9=not applicable | ||||
| 29 | Has she taken calcium regularly during last pregnancy? | pph _13 | # | 1=Yes, 2=No, 9=not applicable | ||||
| 30 | Has she taken any vitamins during last pregnancy? | pph _14 | # | 1=Yes, 2=No, 9=not applicable | ||||
| 31 | If yes, specify. | pph _14 txt | TEXT
if pph_14=1 NA if pph_14ǂ1 |
TEXT
if pph_14=1 NA if pph_14ǂ1 |
||||
| 32 | Has she taken any other medicines during last pregnancy? | pph _15 | 1=Yes, 2=No | 1=Yes, 2=No, 9=not applicable | ||||
| 33 | If yes, specify. | pph _15 txt | TEXT
if pph_15=1 NA if pph_15ǂ1 |
TEXT
if pph_15=1 NA if pph_15ǂ1 |
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| 34 | Has she suffered from any illness during last pregnancy? | pph _16 | 1=Yes, 2=No | 1=Yes, 2=No, 9=not applicable | ||||
| 35 | If yes, specify. | pph _16 txt | TEXT
if pph_16=1 NA if pph_16ǂ1 |
TEXT
if pph_16=1 NA if pph_16ǂ1 |
||||
| 36 | Has she been hospitalized during last pregnancy? | pph _17 | 1=Yes, 2=No | 1=Yes, 2=No, 9=not applicable | ||||
| 37 | If yes, specify | pph _17txt | TEXT
if pph_17=1 NA if pph_74ǂ1 |
TEXT
if pph_17=1 NA if pph_74ǂ1 |
||||
| 38 | Was there any other complication during previous deliveries? | pph _18 | 1=Yes, 2=No | 1=Yes, 2=No, 9=not applicable | ||||
| 39 | If yes, specify. | pph _18 txt | TEXT
if pph_14=1 NA if pph_18ǂ1 |
TEXT
if pph_14=1 NA if pph_18ǂ1 |
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| 40 | Remarks | TXT | ||||||