Injection Use and Practices in Uganda - EDM Research Series No. 014
(1994; 54 pages) View the PDF document
Table of Contents
View the documentACKNOWLEDGEMENTS
Open this folder and view contents1. INTRODUCTION
Open this folder and view contents2. METHODOLOGY
Open this folder and view contents3. EXTENT OF INJECTION USE
Open this folder and view contents4. HYGIENE OF INJECTION PRACTICE
View the document5. POPULARITY OF INJECTIONS
Open this folder and view contents6. CONCLUSIONS AND RECOMMENDATIONS
View the documentREFERENCES
Close this folderLIST OF APPENDICES
View the documentAppendix 1
View the documentAppendix 2
View the documentAppendix 3
View the documentOTHER DOCUMENTS IN THE DAP RESEARCH SERIES
 

Appendix 1

Questionnaire A: Household survey

PART I

District

____________________________________________________________

   

RC

4

____________________________________________________________

RC

3

____________________________________________________________

RC

2

____________________________________________________________

RC

1

____________________________________________________________

Household number

   

____________________________________________________________

     

Respondent’s name

_________________________________________________

Sex M/F Age ______

Education level

___________________Occupation____________________

Name of supervisor

_________________________________________________

Name of interviewer

_________________________________________________

Date of interview

_________________________________________________

Date of check back

_________________________________________________

1.

Name of household head________________________________

2.

What is his/her principal source of income?

 

0. Unemployed

 

1. Civil servant (employed by government)

 

2. Employed by a private firm (bank, etc.)

 

3. Self-employed/business

 

4. Farming/fishing

 

5. Others specify_______________________________________

3.

Education level reached by household head (specify)

 

________________________________________________________________

4. Number of members in the household ________

5. Who was the last person to get an injection in this household? (Which household member?)

a)

Name

_______________________

 

Age:

1. 0-4 years

   

2. 5-14 years

   

3. 15 and above

 

Sex:

1. Male

   

2. Female

6. When (time) was this injection received?_______________

7. For what reason was the injection given?

1.

Therapeutic

2.

Drip (infusion)

3.

Contraception

4.

Immunization

8. If it was therapy, what symptoms were being treated? (Please note down the symptoms in local terms)

_________________________________________________________________________
_________________________________________________________________________

9. What medicine was injected? (use local term)

_________________________________________________________________________
_________________________________________________________________________

10. Where was the injection provided? (Use local categorization)

_________________________________________________________________________

11. Who provided the injection?

_________________________________________________________________________

12. Do you have any kind of relationship with the injection provider?

1.

Yes

2.

No

13. If yes, what is the nature of relationship?

1.

Parent

2.

Relative

3.

Friend

4.

Neighbour

5.

Other________________________

EQUIPMENT AT HOME

14. Do you keep needles and syringes in your home?

1.

Yes

2.

No

15. If yes, where did you obtain them?

_________________________________________________________________________

16. Do you keep injectables?

1.

Yes

2.

No

17. If yes, what type of injectables do you have?

1.

Chloroquine

2.

PPF

3.

Others______________

18. Where did you obtain the injectables (1. Yes 2. No)

1.

Government facility

2.

Non-governmental facility

3.

Private clinic

4.

Pharmacy

5.

Drug shop

6.

Shop or market place

7.

Drug pedlar or hawker

8.

Friend, relative or neighbour

COMPLICATIONS

19. Has any member of family ever had any complications with injections?

1.

Yes

2.

No

20. If yes, what kind of injection complications (1. Yes 2. No)

1. Abscess
2. Allergy
3. Lameness

21. From where was that injection obtained? (find out the local categorization of facilities)

1. Governmental hospital
2. Government HC
3. Non-governmental HC
4. Private clinic
5. Non-formal facility
6. At home
7. Others (specify)
_________________________________________________________________________

22. Who provided that injection?

_________________________________________________________________________

23. What do you think was the cause of the complication?

1. Provider
2. Bad injectable
3. Bad equipment
4. I do not know
5. Others specify
_________________________________________________________________________

HYPOTHETICAL TRACER CONDITIONS

24. What treatment should be given for the following illnesses? Please fill in Table I.

Table I: Treatment form for tracer conditions based on hypothetical questions

Tracer Condition

Inject. Only

Inject. &Oral

Oral

Herbal Med.

Non-Medicin.

Nothing

Cough & cold

           

Diarrhoea

           

Intestinal worms

           

Vomiting

           

Fever/rise in body temperature

           

1. Yes
2. No

PART II: TWO WEEK RECALL PERIOD
(PLEASE NOTE IF THERE IS CHANGE IN THE RESPONDENT)

1. Has anyone in this home been sick during the last two weeks?

1. Yes
2. No

2. In the last two weeks has anyone in this home received any form of injection? (1. Yes 2. No)

1.Therapeutic
2. Immunization
3. Drip (infusion)
4. Contraception
5.None

3. If it was a therapeutic injection then fill in Table II.

4. If it was an immunization then fill in Table III.

Table II: Sickness and treatment in two week period

Name

Age

Sex

Symptoms

Tracer condition

Treatment (form)

No. of inject.

Medicine (local term)

Source cost

                 
                 
                 
                 
                 

Table III: Immunization record

Name

Sex

Age

No. of injections

       
       
       
       
       
to previous section to next section
 

Last updated: May 3, 2013