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Surveys
2014
October
M
Maternal mortality
Maternal mortality
0%
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Hello:
You are invited to participate in our survey [Maternal Mortality] for my thesis research at Monash University. It will take approximately 10 minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Adeline] at [+27792532635] or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
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button below.
I Agree
Do you know someone close who passed away
(deceased) whilst they were pregnant or during giving birth?
Yes
No
Indicate the age (years) group of the deceased
Less than 18
18 - 25
26 - 39
40 - 54
Your relationship to the deceased
Sister
Friend
Relative
Other
Marital status before the deceased?
Married
Divorced
Single (never married)
How many kids do they have?
-- Select --
1
2
3
4
5
more than 6
What was their occupation at the time of death?
Housewife
Professional
How did they pay for their healthcare?
Cash (no medical aid)
Medical aid
Did they attend antenatal clinic visits? If no why?
What did the doctor say was the probable cause of death?
Hemorrhage
Prolonged labour
Sepsis
Obstructed labour
Pre-eclampsia
Unsafe abortion
Other please specify
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