| S/N | VARIABLE | POSSIBLE RESPONSE | RESPONSE | |
| 20 | Age at delivery (weeks) | 28 - 36 + 6 days = 1, 37 - 41+ 6 days = 2, ≥42 = 3 |
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| 21 | Number of babies |
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| 22 | Fetal length in cm |
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| 23 | Birth weight in Kg | <2.5 = 1, 2.5 - 3.4 = 2, 3.5 - 3.9 = 3, ≥4 = 4 |
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| 24 | Sex of neonate | Male = 1 Female = 2 |
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| 25 | State of newborn | Alive = 1 Stillbirth = 2 |
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| 26 | APGAR score at the 5th min | <7 = 1 ≥7 = 2 |
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| 27 | Nursery admission | Yes = 1 No = 2 |
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| 28 | Reason for admission |
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| 29 | Early neonatal death | Yes = 1 No = 2 |
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