Site Assessment Questionnaire | Debre Markos University

PART 1

Ultrasound Equipment & Image Storage

Q 1Does your facility have a functional ultrasound machine for ANC or obstetric services? *

Yes — functional and used regularly Yes — but sometimes out of service / needs repair No — we do not have an ultrasound machine

Q 2Does the ultrasound machine save images digitally or only print on thermal paper? *

Saves images digitally (computer, USB, CD, or server) Thermal paper only — images NOT saved digitally Both digital saving and thermal printing I am not sure

Q 3If images are saved digitally, in what format and where?

DICOM format on a hospital server or PACS system JPEG / PNG images saved on a computer hard drive Saved on USB flash drives or CDs given to patients I do not know the format

Q 4Are saved ultrasound images linked to a patient ID or medical record number? *

Yes — each image is labeled with patient ID or name No — images saved without patient identification Sometimes — depends on the technician

Q 5How long are ultrasound images retained at your facility? *

Less than 6 months 6 months to 1 year 1 to 3 years More than 3 years / permanently Unknown

Q 6Who performs the obstetric ultrasound scan at your facility? *

Radiologist Obstetrician / Gynecologist Midwife or nurse trained in ultrasound Sonographer / ultrasound technician

PART 2

Patient Volume & Case Availability

Q 7How many pregnant women attend ANC at your facility per month? *

Less than 30 women per month 30 – 60 women per month 61 – 100 women per month More than 100 women per month

Q 8How many ANC attendants receive an obstetric ultrasound scan per month? *

Less than 20 scans per month 20 – 50 scans per month 51 – 100 scans per month More than 100 scans per month

Q 9How commonly are the following complications diagnosed at your facility? *

Complication	Common	Occasional	Rare	Never
Preeclampsia / PIH
Placenta Previa
Fetal Growth Restriction
Gestational Diabetes
Placental Abruption
Postpartum Hemorrhage

Q 10Does your facility receive referral cases of high-risk pregnancies? *

Yes — we regularly receive high-risk referrals Yes — occasionally No — we do not receive referrals

PART 3

Patient Records & Documentation

Q 11Are ANC patient records kept on paper, electronic system, or both? *

Paper records only Electronic records only Both paper and electronic records

Q 12Do patient records routinely include the following variables? *

Variable	Yes	No	Sometimes
Blood pressure measurements
Weight and height
Hemoglobin / CBC
Urine protein (dipstick)
Blood glucose
Obstetric history (gravidity, parity)
Final obstetric diagnosis
Gestational age at each visit
Unique patient ID / MRN

Q 13Are past records from the last 2–3 years accessible for research purposes? *

Yes — all past records are accessible Yes — but some records may be incomplete or missing No — past records are not retrievable Partially — only records from the last year available

Q 14Is there a unique patient ID linking ultrasound images to clinical records? *

Yes — a single ID links both image and clinical record No — images and records are kept separately Sometimes — depends on the staff member

PART 4

Research Feasibility & Ethics

Q 15Does your facility have an IRB or Research Ethics Committee? *

Yes — we have our own IRB / Ethics Committee No — we refer to the Zonal Health Bureau or Regional Ethics Committee I am not sure

Q 16Has your facility previously participated in health research? *

Yes — participated in several studies Yes — participated in at least one study No — this would be the first time

Q 17Would your facility be willing to collaborate as a research site? *

Yes — willing and interested Yes — but need to discuss with management first Uncertain — cannot confirm at this time No

Q 18Is an obstetrician or gynecologist available as a clinical advisor? *

Yes — full-time obstetrician / gynecologist available Yes — visiting obstetrician / gynecologist periodically No — only midwives and general practitioners

PART 5

Additional Questions — Private Clinics Only

⚠️ Note: This section applies only to private gynaecology or obstetric clinics. Government hospital respondents may skip this section.

Q 19What obstetric services does the clinic provide? (Select all that apply)

Antenatal care (ANC) Delivery / labour and delivery services Obstetric ultrasound scanning Postnatal care Gynaecological consultations Emergency obstetric care

Q 20Does the clinic use a digital ultrasound machine that stores images electronically?

Yes — images stored digitally No — thermal paper printing only Currently upgrading / not sure

Q 21How many obstetric ultrasound scans are performed per week?

Less than 10 scans per week 10 – 25 scans per week 26 – 50 scans per week More than 50 scans per week

Q 22Does the clinic maintain organized patient records with documented diagnosis?

Yes — every visit documented with a diagnosis Partially — diagnosis not always recorded No — records not systematically maintained

Q 23Would the clinic director be open to a meeting about research collaboration?

Yes — please contact me to arrange a meeting Possibly — director would need to be informed first No

Site Assessment
Questionnaire

Respondent Information

Ultrasound Equipment & Image Storage

Patient Volume & Case Availability

Patient Records & Documentation

Research Feasibility & Ethics

Additional Questions — Private Clinics Only

Thank You for Your Response!