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QUESTIONNAIRE:

Title: The knowledge of Fetal Alcohol Spectrum Disorder (FASD) amongst pregnant women at the Mount Hope Women’s Maternity Hospital in Trinidad and Tobago.

Instructions: Please tick the appropriate answers and fill in spaces based on your answers to the questions. This is not a test. You will not be graded. Do not put your name on it. No one will know what your answers are. If you don’t know the answer, don’t worry.  This survey is only to collect data.  Before you begin, please fill in the requested demographic information below..

SECTION ONE:  (Demographics)

1. Religion

• Hindu
• Christian
• Muslim
• Other

2. Ethnicity

• East Indian
• African
• Caucasian
• Chinese
• Mixed
• Other

3. Age:

• 18-25
• 26-30
• 31-35
• 36-40

4. Highest level of education:

• Primary
• Secondary
• Certificate /Associate
• Undergraduate
• Postgraduate
• Other

If other,  please specify

5. Corporation:

• Port Of Spain City Corporation
• San Fernando City Corporation
• Chaguanas Borough Corporation
• Arima Borough Corporation
• Diego Martin Regional Corporation
• San Juan-Laventille Regional Corporation
• Sangre Grande Regional Corporation
• Tunapuna / Piarco Regional Corporation
• Other

SECTION TWO:  (Obstetric History)

6. Which trimester are you currently on within your pregnancy timeline?

• I: First – (1 to 12 weeks)
• II: Second – (13-27 weeks )
• III: Third- ( 28 till birth)

7. How many pregnancies have you had, including your current pregnancy?

• 0
• 1-2
• 3-5
• > 5

8. How many children do you have?

• 0
• 1-2
• 3-5
• > 5

SECTION THREE: (Knowledge of  FASD)

9. Have you ever heard of Fetal Alcohol Syndrome?

• Yes
• No

1. If Yes to the previous question, where did the information come from?

• Doctor/health care professional/Clinic
• Media (e.g. TV/magazine)
• School
• Social interactions ( friends, family)
• Internet

10. Do you think women are affected by Fetal alcohol syndrome in Trinidad and Tobago?

• Yes
• No

11. Fetal Alcohol Spectrum Disorder can be defined as which of the following?

• The range of effects that can occur in an individual whose mother drank alcohol during pregnancy.
• A birth defect syndrome caused by maternal alcohol consumption during pregnancy.
• Growth deficiency caused by alcohol consumption.
• All of the above
• None of the above

12. Tick which of the  following statements below are true:

• Fetal alcohol syndrome happens when a women drinks alcohol during her pregnancy.
• The effects of alcohol on a baby can be serious.
• The problems associated with Fetal alcohol syndrome can be cured.
• Fetal alcohol syndrome only happens in certain population groups.

SECTION FOUR:  ( Causes / Risk Factors of FASD)

13. Which of the following harm in the baby do you think are associated with alcohol use during pregnancy? (Tick the appropriate boxes)

• Small eyes
• Brain damage
• Lower IQ/ mental disability
• Missing limbs
• Growth problems

14. What types of alcoholic drinks do you think can cause Fetal alcohol syndrome?

• Wine
• Beer
• Spirits
• Liqueurs
• All of the above
• None of the above

15. How much alcohol during pregnancy do you think would cause Fetal alcohol syndrome, select one answer;

• One drink during the whole 9 months
• One drink a week
• One drink a day
• Many drinks on one occasion
• Many drinks every day

16. What birth defects can alcohol cause? Select all that apply.

• Large birth weight
• heart defects
• vision and hearing problems,
• attention deficit disorder, hyperactivity
• facial abnormalities

SECTION FIVE: ( Signs / Symptoms of FASD)

17. What do you know as the primary symptoms of FASD? Primary symptoms are systemic effects of a disease, these affect the entire body rather than a specific organ.

• Skin rashes
• Poor coordination,
• above average weight,
• Intellectual disability

18. What do you know as the secondary symptoms of FASD? Select all that apply. Secondary symptoms complications of primary symptoms that have the potential to cause a severe problem affecting a specific organ.

• Heart problems, deformed limbs or fingers
• Small head
• Lack of focus
• Skin rashes

19. What features are most identifiable for FASD?

• Facial abnormalities
• Growth abnormalities
• Heart defects
• All of the above

20. How long do the effects of FASD last?

• Lifetime
• 10-20 years
• Cured with medication
• 1-5 years

21. FASD is easier to identify during childhood.

• True
• False

22. Dysmorphology ( ie. Birth defects affecting the anatomy of the individual ) is considered lifelong or permanent in patients with FASD.

• True
• False

SECTION SIX : (  Diagnosis / Management )

23. How is Fetal Alcohol Spectrum Disorder diagnosed? Select all that apply.

• Blood test only
• Drug test
• Blood and drug test
• I don’t know

24. What are the treatment options for Fetal Alcohol Spectrum Disorder?

• Surgery
• Behaviour and Education Therapy
• Medication
• Parent training / counseling programmes
• I don’t know

25. What do you think can be done to increase the knowledge of Fetal Alcohol Spectrum Disorder in Trinidad?

Thank you for participating in this survey. Your efforts are highly appreciated.