Table 5.
Primary data collection checklist
| 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 | |||||||||
An excel table of the contextual factors identified for primary data collection