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Table 5 Primary data collection checklist

From: Contextual factors in maternal and newborn health evaluation: a protocol applied in Nigeria, India and Ethiopia

Contextual data checklist Source of information
Code Contextual factor Local area 1
Circle yes/no Circle coverage (language TBD) 1 = limited coverage 2 = 3 = 4 = 5 = all of local area
Other health-related factors
 Have major health programmes, beyond those normally planned, been implemented in the following areas?
  OH 1 Malaria Yes No 1 2 3 4 5  
  OH 2 Micronutrient supplementation Yes No 1 2 3 4 5  
  OH 3 Nutrition Yes No 1 2 3 4 5  
  OH 4 Immunization campaign Yes No 1 2 3 4 5  
  OH 5 Other health programmes? Describe: Yes No 1 2 3 4 5  
 Are the following NGOs active? (Ethiopia/Nigeria)/What are the most active NGOs? (India)
  OH 6 NGO 1 Yes No 1 2 3 4 5  
  OH 7 NGO 2 Yes No 1 2 3 4 5  
  OH 8 NGO 3 Yes No 1 2 3 4 5  
  OH 9 NGO 4 Yes No 1 2 3 4 5  
  OH 10 NGO 5 Yes No 1 2 3 4 5  
  OH 11 NGO 6 Yes No 1 2 3 4 5  
Epidemiological
 OB 1 Have there been any major outbreaks? If yes, specify Disease, time period and proportion of area affected (coverage) for each outbreak below Yes No       
 OB 2 Disease: time period (approx)    1 2 3 4 5  
 OB 3 Disease: time period (approx)    1 2 3 4 5  
 OB 4 Disease: time period (approx)    1 2 3 4 5  
Health system
 HSYS 1 Have there been any MNH policy changes since X policy (refer to desk review)? Yes No       
 Have there been any stockouts of the following commodities (add timeframe)? What proportion of the local area was affected
  HSYS 2 Vaccines Yes No 1 2 3 4 5  
  HSYS 3 Antibiotics Yes No 1 2 3 4 5  
  HSYS 4 Medication (list to be specified) Yes No 1 2 3 4 5  
Infrastructure
 INF 1 Has there been construction of new roads? Yes No 1 2 3 4 5  
 INF 2 Has there been construction of improved water supply? Yes No 1 2 3 4 5  
 INF 3 Have sanitation facilities been improved? Yes No 1 2 3 4 5  
Environment          
 DIS 1 Have there been any major environmental events (droughts/floods, etc.?) Yes No 1 2 3 4 5  
Political, policy and governance
 POL 1 Have there been any major political events? Yes No 1 2 3 4 5  
 POL 2 Have there been any major government policy changes? Yes No 1 2 3 4 5  
Other contextual factors
  OTH 1 Is there anything else you would like to mention that could be influencing maternal and child health in X time period in these areas? Yes No   
 Additional questions as needed
  1. An excel table of the contextual factors identified for primary data collection