| Variables in Weekly Visit Form (WVF) | |||||
| Question# | Question | Field name | Response nature | Response options | |
| 1 | PID Number | PID | ### | ||
| 2 | Visit month number | Month no | ## | ||
| 3 | Initials of the pregnant mother | wvf _A | XX | ||
| 4 | Date
of Interview (According to English Calender) |
wvf _B | XXX-## | mmm-yy | |
| 5 | Days of Follow-up | mvf_B_i | ## | Each day of the month | |
| 6 | Field worker code | wvf_C | ## | ||
| 7 | Was the mother available during visit? | wvf_1 | # | 1=Yes, 2=No, 3=By phone call | |
| Ask about every days of supplementation since last visit. | |||||
| 8 | Is she taking B12 supplement? | wvf_2 | # | 1=Yes, 2=No | |
| 9 | Vomiting after the B12 supplement? | wvf_3 | # | 1=Yes, 2=No | |
| 10 | Folic acid? | wvf_4 | # | 1=Yes, 2=No | |
| 11 | Iron? | wvf_5 | # | 1=Yes, 2=No | |
| 12 | Calcium? | wvf_6 | # | 1=Yes, 2=No | |
| 13 | Reason for not taking B12 supplement? | wvf_7 | # | 3=Illness, 4= Forget, 5=Travelling, 6=Do not like, 7= Not available supplement, 8=Others | |
| About current health status. Ask about all days since last visit about illness | |||||
| 14 | Vaginal bleeding? | wvf_8 | # | 1=Yes, 2=No | |
| 15 | Oedema? | wvf_9 | # | 1=Yes, 2=No | |
| 16 | Fever? | wvf_10 | # | 1=Yes, 2=No | |
| 17 | Any other health problem? | wvf_11_i | # | 3=Diarrhea, 4=vomiting, 5=Cough/cold/sorethroat, 6=Abdominal pain, 7= Headache, 8=Vertigo, 10=Urination problem, 11=Skin problem, 12= others | |
| 18 | If more other health problem? | wvf_11_ii | # | 3=Diarrhea, 4=vomiting, 5=Cough/cold/sorethroat, 6=Abdominal pain, 7= Headache, 8=Vertigo, 10=Urination problem, 11=Skin problem, 12= others | |
| 19 | Visit to health facility? | wvf_12 | # | 1=Yes, 2=No | |
| About medicines used. Ask about all days since last visit. | |||||
| 20 | If antibiotic in use, which group | wvf_13 | # | 2=No, 3=Penicillin; 4= Cephalosporin; 5= Sulfonamides; 6= Macrolides; 7=Tetracycline; 8= Fluoroquinolones; 9= Not applicable ; 10=Metronidazole; 11= Others | |
| 21 | If use other medicines, specify? | wvf_14 | # | 2= No, 3= A/emetic, 4=A/pyretic or analgesic, 5= Antacid/Ranitidine , 6= antihypertensive, 7= other symptomatic, 8=other, 9= NA | |
| 22 | If more other medicines, specify? | wvf_14_i | # | 2= No, 3= A/emetic, 4=A/pyretic or analgesic, 5= Antacid/Ranitidine , 6= antihypertensive, 7= other symptomatic, 8=other, 9= NA | |
| 23 | Any other vitamins? | wvf_15 | # | 1=Yes, 2=No | |
| 24 | Nutrient supplement? | wvf_16 | # | 1=Yes, 2=No | |
| 25 | Hospitalization? | wvf_17 | # | 1=Yes, 2=No | |
| 26 | Refer to hospital by Field worker? | wvf_18 | # | 1=Yes, 2=No | |
| Ask about food intake of each day since last visit. | |||||
| 27 | Intake of egg? | wvf_19 | # | 1=Yes, 2=No | |
| 28 | Intake of meat? | wvf_20 | # | 1=Yes, 2=No | |
| 29 | Intake fish? | wvf_21 | # | 1=Yes, 2=No | |
| 30 | Intake curd? | wvf_22 | # | 1=Yes, 2=No | |
| 31 | Milk/ milk tea drinking? | wvf_23 | # | 1=Yes, 2=No | |
| 32 | Any Fruits? | wvf_24 | # | 1=Yes, 2=No | |
| 33 | Lentil/pulses? | wvf_25 | # | 1=Yes, 2=No | |
| 34 | Any alcohol? | wvf_26 | # | 1=Yes, 2=No | |
| 35 | Readymade food like horlicks, bournvita? | wvf_27 | # | 1=Yes, 2=No | |
| 36 | Nuts or others? | wvf_28 | # | 1=Yes, 2=No | |
| 37 | Supervisor's Initial | XX | |||
| 38 | Remarks | TXT | |||