Monarch Enrolment Form

South Africa, 2015 - 2016

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Reference ID

MO-01.Monarch.Enrolment.Fom

Metadata

Documentation in PDF DDI/XML JSON

Created on

Jun 06, 2017

Last modified

Jun 06, 2017

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Data file: MO-01 MONARCH ENROLMENT FORM

Cases:	3171
Variables:	77

Variables

BarcodedStickerIdDel

Barcoded sticker ID number (M10.........)

RedCapEventName

Red cap Event Name

RedCapDataAccesGroup

BarcodeId

Barcoded sticker ID number (M10 ___)

BarcodeAlternative

Alternative barcode

SecondPreg

Is this the second pregnancy during MONARCH that the mother has participated in?

PrevBarcode

What is the previous pregnancy's final REDCap barcode?

DobMother

DobEstimated

Is the DoB estimated?

SaId

SA Identity Number

DateCollected

Date on which first enrolment happened:

CollectedBy

Data Collector who did first enrolment:

EnrolmentPlace

Place where first enrolment happened?

DateCollected2

Date on which second enrolment happened:

CollectedBy2

Data Collector responsible for second enrolment:

EnrolmentPlace2

Place where second enrolment happened:

Enrol3

Was mother enrolled before?

DateCollected3

Date on which third enrolment happened:

CollectedBy3

Data Collector responsible for third enrolment:

EnrolmentPlace3

Place where third enrolment happened:

ContactNo

ContactAlt

Alternative contact number

ClosKwaMsane

ClosMtubatuba

ClosMpukunyoni

ClosSomkhele

ClosMachibini

ClosGunjaneni

ClosEsiyembeni

ClosNone

AncKwaMsane

AncMtubatuba

AncMpukuny

AncSomkhele

AncMachibini

AncGunjaneni

AncEsiyembeni

AncNone

AncOther

AncDataNot

Data Not entered

OtherAncAttend

If Other, please specify

LastancClinic

If she attended more than one clinic for antenatal visits, which one did she atte

SpecifyOtherLast

If other, please specify

DateLastAncVisit

What was the date of her last antenatal visit? (Approximately)

GestageLastVisit

What was her gestational age when she had her last ANC visit? (Approximately)

DeliveryPlaceEnrol

Place of Delivery

SpecOtherPlaceofBirth

If Other, please specify

DeliverOut

What was the outcome of the delivery?

McrStill

If it was a stillbirth was the Maternity Case Record photographed for capturing?

DateStillBirth

Is the date of stillbirth known?

DateSpecific

What is the date of the stillbirth?

Consent

Consent given for interview at Delivery:

PlaceConsent1

Place of consent for interview at Delivery

Consent2

Consent given for interview at 3-6 days Postnatal visit:

ClrkConsent2

Data clerk who obtain consent for interview at 3-6 days visit:

PlaceConsent2

Place of consent given for 3-6 days Postnatal interview

Consent3

Consent given for interview at 6 weeks Postnatal visit:

ClrkConsent3

Data clerk who obtain consent for interview at 6 weeks Postnatal visit:

PlaceConsen3

Place of consent given for 6 weeks Postnatal interview:

ConsentRthb

Consent given to capture RtHB at Delivery?

PlacetRthb

Place where RtHB was captured at Delivery:

DataCRthb

Data clerk who captured RtHB at Delivery:

ConsentRthb2

Consent given to capture RtHB at 3-6 days Post natal visit?

DataCRthb2

Data clerk who captured RtHB at 3-6 day Post natal visit:

PlaceTRthb2

Place where RtHB was captured at 3-6 days Post natal visit:

ConsentRthb3

Consent given to capture RtHB at 6-weeks Post natal visit?

DatacRthb3

Data clerk who captured RtHB at 6 weeks Post natal visit:

PlaceTRthb3

Place where RtHB was captured at 6 weeks Post natal visit:

Twin

Is the baby a twin?

Triplet

Is the baby a triplet?

InfantDob

InfantGender

Infant's gender

Infant2Dob

Infant2Gender

Infant's gender

Infant3Dob

Infant3Gender

Infant's gender

MonarchEnrolmentFormComplete

Total: 77

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