QUESTIONS	ANSWERS
Characteristics of women
1. Last and first names
2. Age	\|___\|___\| years
3. Residence (specific address)	Dakar············································································································ 1 Suburb··········································································································· 2 Region··········································································································· 3 Others……........................ (specify)···························································· 4
4. Occupation	Employee······································································································ 1 Housewife····································································································· 2 Informal········································································································ 3
5. Marital status	Married········································································································· 1 Divorced······································································································· 2 Widow··········································································································· 3 Single············································································································ 4
6. Socio_economic status	Low standard of living················································································· 1 Average standard of living··········································································· 2 High standard of living················································································ 3
7. Time of HIV diagnosis	Before pregnancy························································································· 1 During pregnancy························································································ 2
8- If diagnosis made during pregnancy, specify age of pregnancy at time of diagnosis	1st trimester································································································· 1 2nd trimester································································································ 2 3rd trimester································································································ 3
Obstetric history
1. Number of children	Number of abortions······································································· \|___\|___\| Number of currently alive······························································· \|___\|___\| Number of deceased (after birth)···················································· \|___\|___\| Fetal death in utero·········································································· \|___\|___\|
2. HIV status of children	Number of positive·········································································· \|___\|___\| Number of negative········································································· \|___\|___\|
3. ARV treatment positive children	Yes················································································································ 1 No················································································································· 0
4. Gesture – Parity	··································································································· \|___\|, \|___\|
Method of admission
1. came by itself	Yes················································································································ 1 No : (a- evacuated by ambulance …………b- referred…………….)….0
Obstetric examination
1. Term of pregnancy in week of amenorrhea	premature····································································································· 1 term·············································································································· 2 post term······································································································ 3
2. Number of prenatal consultations	················································································································ \|___\|
Obstetrical treatment
1. Vaginal delivery	Yes················································································································ 1 No················································································································· 0
2. Cesarean section	Yes················································································································ 1 No················································································································· 0
Child prognosis
1. Apgar score	a. 1 mn···································································································· \|___\| b. 5 mn···································································································· \|___\|
2. Birth weight	a. Eutrophic·································································································· 1 b. Hypotrophic····························································································· 2
3. premature	Yes················································································································ 1 No················································································································· 0
4. Reanimated	Yes················································································································ 1 No················································································································· 0
5. Admitted in Neonatology	Yes················································································································ 1 No················································································································· 0
6. Newborn ARV prophylaxis	Yes················································································································ 1 No················································································································· 0
7. Breastfeeding method	Exclusive protected breastfeeding································································ 1 Artificial breastfeeding················································································· 2 Mixed breastfeeding····················································································· 3
8. PCR 1	Yes················································································································ 1 No················································································································· 0
9. Result PCR 1	Positive········································································································· 1 Negative…···································································································· 0
10. Cotrimoxazole prophylaxis	Yes················································································································ 1 No················································································································· 0
11. PCR 2	Yes················································································································ 1 No················································································································· 0
12. Retroviral serology	Yes················································································································ 1 No················································································································· 0
13.Becoming of the newborn	Alive·············································································································· 1 Deceased······································································································· 0