Samaj Vikas Sanstha, Chandwa

(Interview Schedule for the Study of maternal and child health care among
the Tribal Rural Population of Palamau Pramandal)

INTERVIEW SCHEDULE

1. Name of the respondent: ……………………………………...2. Age: ………

3. Address:- (i) Village: ……………………………. (ii) Block: ………............

(iii)Post Office: ………………………... (iv) District: …………….

4. Religion: - (i) Hindu  (ii) Muslim 

(iii) Christian  (iv) Sarna 
(v) Others 

5. Caste:- (i) ST  (ii) SC 

(iii)OBC  (iv) Others……………………

6. Family composition: -
Sl. Name of the Sex Age Marital Relation Educat- Occupa-
No members status with the ional tional
respondent status status
(1) (2) (3) (4) (5) (6) (7) (8)
Code for col.-3 Code for col.-5 Code for col.-7 Code for col.-8
(Sex) (Marital status) (Education) (Occupation)

Male- M Married- 1 Illiterate- 1 Farm labour- 1

Female- F Unmarried- 2 Primary-2 Agriculture- 2
Widow- 3 Middle-3 Service- 3
Divorced- 4 Matric- 4 Unemployed- 4
Intermediate- 5 Housewife- 5
Graduate and above -6 Student-6

QUESTIONS FOR MOTHERS

Maternal Health Care

Pre-natal Care
1. How many children do you have?
………………………….
2. Do you have any provision for your health check up during pregnancy?
Yes/No
If Yes where?
(i) PHC  (ii) Private Hospital 
(iii)Govt. Hospital  (iv) Any Other 

3. How often do you go for your check up during pregnancy?

(i) Once  (ii) frequently 
(iii) Never  (iv)Any Remarks ……………
4. Have you taken the injection T.T during your pregnancy and how often?
Yes/No
If Yes how often?
(i) Once  (ii) Twice 

If No, Why ……………………………………………

5. Do you take Iron tablets during your pregnancy? Yes/No

How often? …………………………………………….

6. Were you suffering from any diseases during your pregnancy?

Anemia

Eclampsia

Pneumonia

T.B

Malaria

Any other

7. Did your pregnancy continue for nine months? Yes/No

If Not
Which pregnancy? Ist/ IInd/ IIIrd/IVth

How many months ……………Why? …………………..

8. Where do deliveries take place?

(i) House  (ii) Hospital 
9. If in house who assists delivery?
(i) Untrained Dai  (ii) Trained Dai 
(iii) Nurse  (iv) Others 

10. If in the hospital, which hospital?

(i) Private Hospital  (ii) Govt. Hospital 
(iii) Others ………………….

11. How far is the hospital?

(i) 0-1 km  (ii) 1-2 kms 
(iii) 3-4 kms  (iv) More than 4 kms ……………..

12. What is your preference? And Why?

(i) Hospital  (ii) House 
(iii) Others ………………………………………

13. Have all the deliveries been normal or Caesarian?

(i) Caesarian  Normal 

14. Did you use to rest during the day during the pregnancy period? Yes/No
If yes, If No
How often ………………….. Why? …………….
How long ……………………

15. In your opinion does anybody in normal condition need rest during the
pregnancy? Yes/No

Why? ……………………………

Nutrition of Pregnant Women

16. What type of food do you eat?

(i) Purely Vegetarian 
(ii) Purely Non-vegetarian 
(iii) Predominantly Vegetarian 
(iv) Predominantly Non-vegetarian 
17. If you are a non- vegetarian how often do you eat Non-veg. food?
Once in a Once in a Once a while
month week

18. How many times do you eat during the day?

(i) Once a Day  (ii) Twice a Day 
(iii) Thrice a Day  (iv) More than three times

19. What are the ingredients of your food?

Rice Rice-Dal Rice-Dal, Sabji Maze Others

20. Do you take any supplementary food during your pregnancy? Yes/No
If Yes
What are they? …………………………
………………………………………….

21. Do you take complementary or supplementary food from any government or

Non-government health service centers? Yes/ No
If No Why? …………………………………………….
If Yes how often ………………………………………….

Post-natal Care

22. What are the complications you faced during delivery? .

Bleeding
 Still Birth
Breach Delivery
Any other (specify)

23. Did you suffer from any of the following illness during the two weeks that
followed immediately after delivery?
(i) Fever  (ii) Bleeding 
(iii) Other ……………………………..

24. Has there been any case of abortion (in the family)? Yes/No
If Yes
Induced

Spontaneous

How many times? ………………………………

What was the reason? ……………………………

25. Do you feel the need for rest after the delivery? Yes/No
Why?
………………………………………………..
……………………………………………….

26. How many days after delivery did you resume your normal house-hold and
other works ?
…………………………………………………
…………………………………………………

27. How many days/hours after delivery did you start taking your normal food?
………………………………………………
………………………………………………
28. Did you feel to take additional food after the delivery than the normal?
Yes/No
Why?

29. Where do you prefer to get the food from? And why?
(i) Market  (ii) Govt. and non-govt. centre 
(iii) One’s own garden  (iv) Any other source 

Infant Health Care

Questions related to vaccination of the children

30. Do you know that the children need to receive vaccination after their birth ?
Yes/No

31. Do your children receive all the vaccination? Yes/No

Why?
………………………………………

32. Do your children receive all the vaccinations timely?

Yes/No

33. Which are the vaccinations your child took?

Vaccination 1st 2nd All Some None Number of time
child child
BCG
DPT
POLIO
MEASLES
TETANUS
VITAMIN ‘A’
HEPATITIS B
OTHERS
34. Where do you go for vaccination?

PHC Village Any Other(specify)

Nurse ………………………

35. What are the difficulties you face to get vaccination?

Difficulties Experienced Intensity

Distance of H.C
Absence of Health Staff
Timely Unavailability of
Medicine
Lack of knowledge
Any Other (Specify)

Breast feeding

36. Have you given breast feeding to your child? Yes/No

why?
………………………………………….

37. Do you think the child should be breast-fed immediately after birth ? Yes/No
Why? ………………………………….

38. Did you breast-feed your child immediately after the child was born?
Yes/No
If yes within how many hours?.............and why ?
If ‘no’ why? ……………………………..

39. How long did you feed your child with breast milk? And Why?
(i) Six months (ii) 1 year
(iii) 2 years (iv) More than 2 year

40. How did you stop breast feeding?

(i) Gradual (ii) Abrupt
(iii)Other method ……………………
Why? ………………………………..
41. Did you give something else with the breast milk? Yes/No
If yes then what did you give? ……………………………………………….

42. At what age did you administer complementary food for your child?
…………………………………………

43. Who takes care of your children below 2 years of age?

…………………………………………
Hygiene

44. Do you wash your hands before cooking or feeding the child? Yes/No
Why and How?

45. Do you wash the utensils properly before preparing the food for the child?
Yes/No
Why or How?

46. How often do you change the napkin of the child?

(i) Once a Day (ii) Twice a Day
(iii) As often the child becomes wet ……………………..

47. Do you clean yourself before breast-feeding the child? Yes/No

Child Spacing and Sexual life

48. What is the gap between two pregnancies?

(i) One year (ii) Two years
(iii) Three years (iv) More than three years

49. What method do you use to keep gap between two pregnancies?
(i) Pills (ii) Condom
(iii)Natural family planning (iv) Others

50. Do you feel the need to keep gap between two pregnancies? Yes/No
Why? …………………………….
51. What is the attitude of your husband about child spacing?
…………………………………

52.(a) How often do you have sexual relation?

…………………………………

(b) In general what is your experience of sexual relation?

(i)Pleasant (ii) Painful
(iii) Forced (iv) Not able to say

(c) Do you feel your partner care for your feelings in sexual relation? Yes/No

Health Problems of Women

53. Were you suffering from any kind of STD? Yes/No

54. Have you heard about HIV/AIDS? Yes/No

If Yes when?

55. What do feel when you hear about HIV/AIDS?

(i) Fear (ii) Anxiety
(iii)Indifference

56. Have you seen HIV patient? Yes/No

If yes what is your attitude …………………………..

Health Services

57. Is there any health care facilities available? Yes/No

58. What is the distance between the centres providing such health services?
(i) 0-1 km (ii) 1-2 kms
(iii) 3-4 kms (iv) More than 4 kms

59. Is there any government/non-government centers providing complementary

or supplementary food?
 (i) Anganwadi (ii) NGOs
(iii) Any other

60. Have you benefited by the food provided by these centers? Yes/No
If yes how?
……………………………………..

61. How frequent is the supply from this center?

(i) Daily (ii) Once a week
(iii) Once a months.
Quantity ………………………….

QUESTIONS FOR DAIS

62. Are you trained to conduct delivery? Yes/No

If yes where?

63.(a) Do you have delivery kits? Yes/No

(b)How do you cut the umbilical cord? ………………………………..

64. How many normal delivery did you conduct within the last one year?

(i) 1-5 (ii) 5-10

(iii) 11-15 (iv) More than 15

65. Do you find any difficulties while conducting the deliveries? Yes/No
If yes Then What ……………………………….

66. Is there any complicated delivery you conducted and how did you manage it?
……………………………………………..

67. Can you explain the reasons for complication?

………………………………

68. Do you visit the pregnant mother before her delivery? Yes/No
If yes how often?
(i) Once (ii) Twice
 (iii) Thrice (iv) More than thrice ……………

69. If there is severe bleeding after delivery, how do you manage it?
……………………………..

70. How many children are born dead in one year of time while you conducted
delivery?
(i) One (ii) Two
(iii) Three (iv) More than three………..

71. Is there any death occurred of the children between 0-1 year of birth?
Yes/No
If yes how many?
………………………………

72. Was there any case of maternal death during delivery during the last one
year? Yes/No
If yes, how many ?

73. Do you wash your hands before conducting delivery? Yes/No

QUESTIONS FOR MEN

74. Did you use to help your wife to do house hold work while she is pregnant?
Yes/No
75. Did you use to take initiative to take your wife for the check up during
pregnancy? Yes/No

76. Did you plan with your wife for the child spacing?
Yes/No
77. In your opinion after marriage who should decide for having child?
(i) Husband (ii) Wife (iii) Both

78. Was your wife getting supplementary food to your wife during pregnancy and
after delivery? Yes/No

79. What is your opinion about rest of women during her pregnancy and after
the child birth?
(i) Need to rest (ii) Not necessary (iii) Don’t Know?
Date Signature of investigator