N˚

VARIABLE

CLASS

1

Number of the copy

2

Date of enlistment

3

Group

1 = Case, 2 = Control

4

Site of the study

1 = DRH

Section I: Identification/Socio-demographic Characteristics

1

Initials of the names

2

Age (in year)

3

Profession:

1 = Civil servant

2 = Trader

3 = Housewife

4 = Private worker

5 = Student

6 = Other

4

Other occupation precise

5

Level of education

1 = None

2 = Primary

3 = Secondary

4 = University

6

Marital Status:

1 = Married

2 = Single

3 = Concubine

4 = Widow

7

Nationality

1 = Cameroonian

2 = Other

8

Other nationality precise

9

If Cameroonian region of origin

1 = West

2 = Centre

3 = Littoral

4 = Nord

5 = Nord-west

6 = South-west

7 = South

8 = Extreme-north

9 = Adamawa

10 = East

10

Religion

1 = Christian

2 = Muslim

3 = Other

11

If other religion precise

Section II: Obstetrical History

12

Gravidity

13

Parity

14

Number of preterm

15

Number of abortion

16

Number of children alive