15.

4 An example of monitoring checklists for data management field level

Pakistan TB Prevalence Survey 2010-11

Motoring Checklist for Data Management in the Field

Union Council Name: ______________________________ Cluster Code:

Cluster Starting Date: ________________________________ Cluster End Date: _________________

Adequate / Ac-
S.No. Questions ceptance Comments
Yes No
Are all the Standardized Forms/Registers being used for all the
1.1 Data Collection in the field?
Is Data Monitoring being carried during data collection by the
1.2 field Team Leader every evening and also before the end of all
field work activities?
Are the Census data for all individuals correctly written and
easily readable in every Forms/Registers? (That is, PIN Code,
1.3 name, father name, age, sex, ethnicity, occupation, education
and outcome, etc.)
Are all the Forms/Registers being checked for Inconsistent Data
1.4 Error? (That is, there is different / conflicting data of the same
Patient on different forms?
Are all the Data in the Registers correctly mentioning the Range
checks from the Categories [for TB Prevalence Census Register
for One Household (Annex VI) and Tuberculin Survey Census
1.5 Register for One Household (Annex VII)]?
(Range Checks includes Sex (M/F), Relationship (1-17), Ethnic-
ity (1-8), Occupation (1-10) and Education (1-6)
Are the TB Prevalence Survey Census Register for One House-
1.6 hold (Annex VI) completed with all Census, Suspect, and Out-
come data?
Are the Tuberculin Survey Census Register for One Household
1.7 (Annex VII) completed with Census, TST Test and Result data?
Are all the data in the Individual Symptom Form (Annex IX), TB
Suspect In-Depth Questionnaire (Annex X), Household Charac-
1.8 teristics (Annex XIII) and Follow-Up Questionnaire for TB Cases
Registered in NTP Register (Annex XVI) being checked for ac-
curacy, completeness and consistency?
Are Chest X-Ray Form (Annex XII) checked for accuracy, com-
1.9 pleteness and consistency?
Is Field Lab Register (Annex XVII) completed with all data for
1.10 all suspects?
Are all the Forms/Registers being checked for accuracy, com-
1.11 pleteness and consistency by field Team Leader?
Are all the changes for missing, incomplete and incorrect data
1.12 corrected in Forms/Registers with Red pen/highlighted by the
field Team Leader?
Are all Forms/Registers completely secured from theft, unau-
1.13 thorized access, fire and harsh weather conditions?
Is the Privacy of all Forms/Registers strictly followed during
1.14 field work?
1.15 Are copies of all Forms/Registers clear and readable?
Are all the Forms/Registers securely packed and dated before
transport to Central DMU level? Also, is the Count Sheet indi-
1.16 cates number/count of Forms/Registers transport to the Cen-
tral site?
Are all the copies of all Forms/Registers completely secured
1.17 and backed-up in case the Original data gets lost during trans-
portation?
Are the collection, monitor, management and transfer of data
1.18 being carried out under the supervision by the field Team
Leader?

Name of Team Leader: _______________________________ Signature and Date: _______________

Note: During Motoring visit, the visiting Officer/Team Leader has to fill the particular section of that day’s activity.

Source: Prevalence survey Pakistan, setup 2010


Pakistan TB Prevalence Survey 2010 - 2011
COUNT SHEET – FORMS AND REGISTERS
(Sent from Cluster/Field Level to Central DMU)
Union Council Name: ______________________________
Cluster Code:
Completed at Cluster/Field level:
Name: ___________________________________
Designation: ______________________________
Signature: ________________________________
Date: _____ / _____ / __________ (dd/mm/yyyy)

COUNT
NAME Number of Forms/Registers Sent from
Forms and Registers Cluster/Field Level

Annex IV (A): TB Prevalence Survey Consent Form Quantity: __________

Annex V (A): Tuberculin Survey Parental/Guardian Consent Form Quantity: __________

Annex VI: TB Prevalence Survey Census Register for One Household Quantity: __________

Annex VII: Tuberculin Survey Census Register for One Household Quantity: __________

Annex IX: Individual Symptom Screening Form Quantity: __________

Annex X: Tuberculosis Suspect In-Depth Questionnaire Quantity: __________

Annex XI: Suspect Register Quantity: __________

Annex XII (A): Chest Radiograph Field Reading and Reporting Form Quantity: __________

Annex XIII: Household Characteristics (Asset Score) Quantity: __________

Annex XVI: Follow-Up Questionnaire for Smear Positive Pulmonary TB Cases Quantity: __________
Registered in NTP Register
Annex XVII (A): Field Laboratory Form Quantity: __________

Annex XVII (B): Culture and DST Form Quantity: __________

Source: Prevalence survey Pakistan, setup 2010


Pakistan TB Prevalence Survey 2010 - 2011
COUNT SHEET – FORMS AND REGISTERS
(Received at Central Data Management Unit, Islamabad)
Union Council Name: ______________________________
Cluster Code:
Completed at Central Level by:
Name: ___________________________________
Designation: ______________________________
Signature: ________________________________
Date: _____ / _____ / __________ (dd/mm/yyyy)

COUNT
Number of Forms/Regis-
NAME ters Sent from Cluster/ COUNT
Forms and Registers Field Level (Copy the Number of Forms/Registers Re-
number from Field level ceived at Central DMU
Count Sheet)

Annex IV (A): TB Prevalence Survey Census Form Quantity: __________ Quantity: __________
Annex V (A): Tuberculin Survey Parental/Guardian Consent Quantity: __________ Quantity: __________
Form
Annex VI: TB Prevalence Survey Census Register for One Quantity: __________ Quantity: __________
Household
Annex VII: Tuberculin Survey Census Register for One House- Quantity: __________ Quantity: __________
hold
Annex IX: Individual Symptom Screening Form Quantity: __________ Quantity: __________

Annex X: Tuberculosis Suspect In-Depth Questionnaire Quantity: __________ Quantity: __________

Annex XI: Suspect Register Quantity: __________ Quantity: __________

Annex XII (A): Chest Radiograph Field Reading and Reporting Quantity: __________ Quantity: __________
Form
Annex XIII: Household Characteristics (Asset Score) Quantity: __________ Quantity: __________
Annex XVI: Follow-Up Questionnaire for Smear Positive Pulmo- Quantity: __________ Quantity: __________
nary TB Cases Registered in NTP Register
Annex XVII (A): Field Laboratory Form Quantity: __________ Quantity: __________

Annex XVII (B): Culture and DST Form Quantity: __________ Quantity: __________

Source: Prevalence survey Pakistan, setup 2010