.

Effect of Air pollution on expectant mothers and fetal outcomes

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
Survio
Create a survey
Effect of air pollution on expectant mother and fetal outcomes
1

Have you ever heard of air pollution

Select one answer
2

What is air pollution?

3

Which sector do you operate in?

Select one answer
4

At work, what pollutants are you exposed to?

Select one answer
5

Are there any protective measures against air pollution at work place

Select one answer
6

If yes, please select from below

Select one answer
7

In your own view, what health outcomes do you think are associated with air pollution?

Select one answer
8

Where is your living place located?

Select one answer
9

Does your house have quality ventilation?

Select one answer
10

If yes, what do you use for ventilation?

Select one answer
11

How would you rate the overall air quality in your area?

Select one answer
12

Do you smoke or exposed to passive smoking at home or work

Select one answer
13

What do you think are the main cause of air pollution in your area

Select one or more answers
14

Have you ever been pregnant before

Select one answer
15

Did you get any problems during the gestational period or after

Specify complication
16

Do you have children? If yes, state number and if all are alive and healthy.

Select one answer
17

What do you use as a source of heat when cooking at home

Select one answer
18

What measures do you think can be taken to reduce air pollution

Select one or more answers
Create a survey
Effect of air pollution on expectant mother and fetal outcomes
Create a survey