Belarus

Child's information panel: UF

This questionnaire is to be administered to all mothers or caretakers (see Household Listing Form, column HL9) who care for a child that lives with them and is under the age of 5 years (see Household Listing Form, column HL6).
A separate questionnaire should be used for each eligible child.

UF1. Cluster number: _ _ _

UF2. Household number: _ _

UF3. Child's name:
Name ____

UF4. Child's line number: _ _

UF5. Mother's / caretaker's name:
Name ____

UF6. Mother's / caretakers line number: _ _

UF7. Interviewer name and number: _ _
Name ____ _ _

UF8. Day / month / year of interview _ _ / _ _ / 2012

Repeat greeting if not already read to this respondent:
We are from the Statistical Department of (city, region). Now the national household survey is organised in the Republic of Belarus to obtain objective information on the situation of children and women. In this respect I would like to ask you several questions. The interview will take about 15 minutes. All the information we obtain will remain strictly confidential and will be used for statistical purposes only.

If greeting at the beginning of the household questionnaire has already been read to this person, then read the following:
Now I would like to talk to you more about (child's name from UF3)'s health and other topics. This interview will take about 15 minutes. Again, all the information we obtain will remain strictly confidential and will be used for statistical purposes only.

May I start now?

UF9. Result of interview for children under 5
UF10. Field edited by (number): _ _

UF11. Data entry clerk (number): _ _

UF12. Record the time.

Age: AG

AG1. In what date, month and year was (name) born?
If the mother/caretaker does not know the exact birth date circle 98. Month and year must be recorded.
AG2. How old is (name) in completed years?
Record "0" if less than 1 year. Compare and correct AG1 and/or AG2 if inconsistent.
Early childhood development: EC

EC1. How many children's books or picture books do you have for (name)?

EC2. I am interested in learning about the things that (name) plays with when he/she is at home.
Read each point and circle the answer before heading to the next point. If the respondent says "yes" to the categories above, then probe to learn specifically what the child plays with to ascertain the response
Does he/she play with:

[A] Homemade toys (such as dolls, cars, or other toys made at home)?

[B] Toys from a shop or manufactured toys?

[C] Household objects (such as bowls or pots) or objects found outside (such as sticks, rocks, animal shells or leaves)?

EC3. Sometimes adults taking care of children have to leave the house to go shopping, or for other reasons and have to leave young children.
On how many days in the past week was (name):
If the child was not left alone or was left alone for less than an hour enter' 0'. If the answer is 'don't know' enter'8'

[A] Left alone for more than an hour?

[B] Left in the care of another child, that is, someone less than 10 years old, for more than an hour?

EC4. Check AG2: Age of child is 3 or 4 year?
EC5. Does (name) participate in any learning or early childhood education programme at home, at preschool education institutions or optional education facilities for children and youth?

EC6. Within the last seven days, to how many hours did (name) learn/attend?

EC7. In the past 3 days, did you or any household member over 15 years of age engage in any of the following activities with (name):
Read each point and circle the answer before heading to the next point. If yes, probe: Who from your household over 15 years of age was engaged in activities with (name)?

[A] Read children's books to or looked at picture books with (name)?

[B] Told stories to (name)?

[C] Sang songs to (name) or with (name), including lullabies?

[D] Took (name) outside the home, compound, yard?

[E] Played with (name)?

[F] Named, counted, or drew things to or with (name)?

EC8. I would like to ask you some questions about the health and development of your child. Children do not all develop and learn at the same rate. For example, some walk earlier than others. These questions are related to several aspects of your child's development.
Can (name) identify or name at least ten letters of the alphabet?

EC9. Can (name) read at least four simple, popular words?

EC10. Does (name) know the name and recognize the symbol of all numbers from 1 to 10?

EC11. Can (name) pick up a small object with two fingers, like a stick or a rock from the ground?

EC12. Is (name) sometimes too sick to play?

EC13. Does (name) follow simple requests / directions on how to do something correctly?

EC14. When asked or given something to do, is (name) able to do it independently?

EC15. Does (name) get along well with other children?

EC16. Does (name) kick, bite, or hit other children or adults?

EC17. Does (name) get distracted easily?

Breastfeeding: BF

BF1. Has (name) ever been breastfed?

BF2. Is he/she still being breastfed?

BF3. I would like to ask you about liquids that (name) may have had yesterday during the day or the night. I am interested in whether (name) had them even if it was combined with other foods.
Did (name) drink plain water yesterday, during the day or night?

BF4. Did (name) drink infant formula yesterday, during the day or night?

BF5. How many times did (name) drink infant formula?

BF6. Did (name) drink milk (not including breastmilk), yesterday, during the day or night?

BF7. How many times did (name) milk?

BF8. Did (name) drink juice or juice drinks yesterday, during the day or night?

BF9. Did (name) drink broth yesterday, during the day or night?

BF10. Did (name) drink or eat vitamin or mineral supplements or any medicines yesterday, during the day or night?

BF11. Did (name) drink ORS (oral rehydration solution) yesterday, during the day or night?

BF12. Did (name) drink any other liquids yesterday, during the day or night?

BF13. Did (name) drink or eat yogurt or other yogurt products for kids yesterday, during the day or night?

BF14. How many times did (name) drink or eat yogurt yesterday, during the day or night?

BF15. Did (name) eat thin porridge yesterday, during the day or night?

BF16. Did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night?

BF17. How many times did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night?

BF18. Yesterday, during the day or night, did (name) drink anything from a bottle with a nipple?

Care of illness: CA

CA1. In the last two weeks, has (name) had diarrhoea?

CA2. I would like to know how much (name) was given to drink during the diarrhoea (including breastmilk).
During the time (name) had diarrhoea, was he/she given less than usual to drink, about the same amount, or more than usual, or nothing to drink?
If less, probe: was he/she given much less than usual to drink, or somewhat less?
CA3. During the time (name) had diarrhoea, was he/she given less than usual to eat, about the same amount, more than usual, or nothing to eat?
If "less", probe: Was he/she given much less than usual to eat or somewhat less?
CA4. During the episode of diarrhoea, was (name) given to drink any of the following:
Read each point and circle the answer before heading to the next point.

[A] A fluid made from a special packet called (for example, rehydron, gastrolit, and alike)?

[B] A pre-packaged ORS fluid for diarrhoea?

[C] Home-made fluid?

CA5. Was any medication given to treat the diarrhoea?

CA6. What medication was given to treat the diarrhoea?
Probe: Anything else? Record all treatments given. Write brand name(s) of all medicines mentioned.
(Name of medication) ____
____
____

CA7. At any time in the last two weeks, has (name) had an illness with a cough?

CA8. When (name) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths or have difficulty breathing?

CA9. Were those symptoms due to a problem in the lower respiratory tracts or a blocked or runny nose?

CA10. Did you seek any advice or treatment for the illness with a cough from any source?

CA11. From where did you seek advice or treatment?
Probe: Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions.
Probe to identify each type of source. If unable to determine if public or private sector, write the name of the place.
(Name of place) ____
____
____

* Individual entrepreneurs engaged in medical activities with a special permit (license).

CA12. Was (name) given any medicine to treat this illness with a cough?

CA13. What medicine was (name) given?
Probe: Anything else? Circle all medicines given. Write brand name(s) of all medicines mentioned.
(Names of medicines) ____
____
____

CA14. Check AG2: Child aged under 3?

CA15. The last time (name) passed stools, what was done to dispose of the stools?

UF13. Record the time.
UF14. Is the respondent the mother or caretaker of another child age 0-4 living in this household?
[] Yes (Go to the next questionnaire for children under five to be administered to the same respondent)
[] No (End the interview with this respondent by thanking him/her for his/her cooperation. Check to see if there are other woman's, man's or under-5 questionnaires to be administered in this household.)

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________