Cote d?Ivoire 2016


Under-five child information panel: UF

This questionnaire is to be administered to all mothers or caretakers (see List of Household Members, column HI15) who care for a child that lives with them and is under the age of 5 years (see List of Household Members, column HL7B).
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:
UF6. Mother's/caretaker's line number: _ _

UF7. Interviewer's name and number:
UF8. Day/month/year of interview
If you have not already done so, introduce yourself to the respondent:
We are from the National Institute of Statistics (INS). We are working on a prokect concerning family, health, and education. I would like to talk to you about (child's name from UF3)'s health and well-being. The interview will take about 30 minutes. All the information we obtain will remain strictly confidential and anonymous.

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 well-being. This interview will take about 30 minutes. Again, all the information we obtain will remain strictly confidential and anonymous.

May I start now?

UF9. Result of interview for children under 5
Codes refer to mother/caretaker.

UF10. Field editor's name and number: Name ____ _ _

UF11. Main data entry clerk's name and number: Name ____ _ _

UF12. Record the time.
Age: AG

AG1. Now I would like to ask you some questions about the development and health of (name).
On what day, month and year was (name) born?
Probe: What is his / her birthday? If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day. Month and year must be recorded.
AG2. How old is (name)?
Probe: How old was (name) at his / her last birthday? Record age in completed years. Record '0' if less than 1 year. Compare and correct AG1 and/or AG2 if inconsistent.
Birth Registration: BR

BR1. Does (name) have a birth certificate?
If yes, ask: may I see it?
BR2. Has (name)'s birth been registered/declared in a civil registry office?

BR3. Do you know how to register (name)'s birth?

BR3A. What is the main reason for not registering r not declaring your child at the civil registry office?

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.
Does he/she play with:
If the respondent says "yes" to the categories above, then probe to learn specifically what the child plays with to ascertain the response.




EC3. Sometimes adults taking care of children have to leave the house to go shopping, wash clothes, or for other reasons and have to leave young children.
On how many days in the past week was (name):
If 'none' enter '0'. If '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.
EC5. Does (name) attend any organized learning or early childhood education programme, such as a private or government facility, including nursery school or community child care?

EC7. In the past 3 days, did you or any household member age 15 or over engage in any of the following activities with (name):
If yes, ask: Who engaged in this activity with (name)?
Circle all that apply.







EC8. I would like to ask you some questions about the health and development of (name). 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 (name)'s development.
Can (name) identify or name at least ten letters of the alphabet?

EC9. Can (name) read at least four simple, common 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 directions on how to do something correctly?

EC14. When 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 and dietary intake: BD

BD1. Check AG2: Age of child.
BD2. Has (name) ever been breastfed?

BD3. Is (name) still being breastfed?

BD4. Yesterday, during the day or night, did (name) drink anything from a bottle with a nipple?

BD5. Did (name) drink ORS (oral rehydration solution) yesterday, during the day or night?

BD6. Did (name) drink or eat vitamin or mineral supplements or any medicines yesterday, during the day or night?

BD7. Now I would like to ask you about (other) liquids that (name) may have had yesterday during the day or the night. I am interested to know whether (name) had the item even if combined with other foods.
Please include all liquids consumed outside of your home.
Did (name) drink (name of item) yesterday during the day or the night:

[A] Plain water?

[B] Juice or juice drinks?

[C] Clear broth or soup?

[D] Milk such as tinned, powdered, or fresh animal milk?

[E] Infant formula sold in store?

[F] Any other liquids?
(Specify) ____

BD8. Now I would like to ask you about (other) foods that (name) may have had yesterday during the day or the night. Again, I am interested to know whether (name) had the item even if combined with other foods. Please include all foods consumed outside of your home.
Did (name) eat (name of food) yesterday during the day or the night:


[A] Yogurt?
If yes: How many times did (name) drink or eat yogurt? If 7 or more times, record '7'. If unknown, record '8'.

[B] Any milk cereal (Cerelac, Farinor, Bledine, ?)

[C] Bread, rice, noodles, porridge, or other foods made from grains?

[D] Pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside?

[E] White potatoes, white yams, manioc, white sweet potato, or any other foods made from roots?

[F] Any dark green, leafy vegetables?

[G] Ripe mangoes, papayas or [insert any other locally available vitamin A-rich fruits]?

[H] Any other fruits or vegetables?

[I] Liver, kidney, heart or other organ meats?

[J] Any meat, such as beef, pork, lamb, goat, chicken, or duck?

[K] Eggs?

[L] Fresh or dried fish or seafood?

[M] Any foods made from beans, peas, lentils, or nuts?

[N] Cheese or other food made from milk?

[P] Snails or caterpillars?

[Q] Any food made with palm oil?

[O] Any other solid, semi-solid, or soft food that I have not mentioned? (Specify) ____

BD9. Check BD8 (Categories "A" through "O").
BD10. Probe to determine whether the child ate any solid, semi-solid or soft foods yesterday during the day or night.
BD11. How many times did (name) eat any solid, semi-solid or soft foods yesterday during the day or night?
If 7 or more times, record '7'.
Immunization: IM

If an immunization (child health) card is available, copy the dates in IM3 for each type of immunization and Vitamin A recorded on the card. Questions IM6-IM17 will only be asked if a card is not available.

IM1. Do you have a card where (name)'s vaccinations are written down?
If yes: May I see it please?
IM2. Did you ever have a vaccination (child health) card for (name)?

IM3.

(a) Copy dates for each vaccination from the card.
(b) Write '44' in day column if card shows that vaccination was given but no date recorded.

BCG

Polio at birth

Polio 1

Polio 2

Polio 3

HepB at birth

Pentavalent 1
"Pentacime" 1
Diphtheria, tetanus, acellular Pertussis + Hep B + Hib 1

Pentavalent 2
"Pentacime" 2
Diphtheria, tetanus, acellular Pertussis + Hep B + Hib 2

Pentavalent 3
"Pentacime" 3
Diphtheria, tetanus, acellular Pertussis + Hep B + Hib 3

PCV-13 1
PPSV23

PCV-13 2
PPSV23

PCV-13 3
PPSV23

RotaTeq 1

RotaTeq 2

RotaTeq 3

Measles (or MMR or MR)

Yellow fever

Vitamin A (first dose)

Vitamin A (second dose)

IM4. Check IM3. Are all vaccines (BCG to Yellow Fever) recorded?
IM5. In addition to what is recorded on this card, did (name) receive any other vaccinations - including vaccinations received in campaigns or immunization days or child health days?

IM6. Has (name) ever received any vaccinations to prevent him/her from getting diseases, including vaccinations received in a campaign or immunization day or child health day?

IM7. Has (name) ever received a BCG vaccination against tuberculosis - that is, an injection in the arm or shoulder that usually causes a scar?

IM8. Has (name) ever received any vaccination drops in the mouth to protect him/her from polio?

IM9. Was the first polio vaccine received in the first two weeks after birth?

IM10. How many times was the polio vaccine received?

IM11A. Has (name) ever received a Penta vaccine (Diphtheria, Tetanus, Pertussis, Hep B and Hib) - that is, an injection in the left arm, to prevent him/her from contracting tetanus, whooping cough, diphtheria, Hepatitis B nd Haemophilus influenzae type B
Probe by indicating that the Penta vaccine is sometimes given at the same time as polio.
IM12A. How many times was the Penta vaccine (Diphtheria, Tetanus, Pertussis, Hep B and Hib) received?

IM14A. Was (name) given a dose of Hepatitis B, that is, an injection in the left thigh, in the 24 hours after birth?

IM14B. Has (name) ever received a PCV vaccine, that is, an injection in the right thigh to prevent him/her from getting pneumonia?
Probe by indicating that the PCV vaccine is sometimes given at the same time as the Penta vaccine.
IM14C. How many times was the PCV vaccine given?

IM14D. Has (name) ever received a RotaTeq vaccine--that is a dose of liquid to drink to prevent her/him from having diarrhoea?

IM14E. How many times has the RotaTeq vaccine been given?

IM16. Has (name) ever received a measles injection (or "var" varicella) - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

IM17. Has (name) ever received the yellow fever vaccination - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting yellow fever?
Probe by indicating that the Yellow Fever vaccine is sometimes given at the same time as the measles vaccine.
IM19. Please tell me if (name) has participated in any of the following campaigns, national immunization days and/or vitamin a or child health days:
[A] 2-5 Oct 2015/Polio

[B] 10-13 April 2015/Polio

[C] 31 Oct-3 Nov 2014/Polio

[D] 19-22 Sept 2014/Polio

[E] 13-16 June 2014/Polio

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?
If 'less', probe: Was he/she given much less than usual to drink, or somewhat less to drink than usual?
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 to eat than usual?
CA3A. Did you seek any advice or treatment for the diarrhoea from any source?

CA3B. 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) ____

CA3D. Check CA3B. Any of codes A-O selected?

CA3C. What is the name of the facility or community health worker where you sought care?
Probe to get the names of all the facilities/community health workers and record the codes. If several facilities are named, record in order of when sought for care, beginning with the first. If the facility/community health worker is not pre-coded, chose the code "999999996" and write the names in the space provided.
CA4. During the time (name) had diarrhoea, was (name) given to drink:

[A] A fluid made from a special packet called ORS (Orasel)?

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

CA4A. Check CA4: ORS.
CA4B. Where did you get the ORS?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CA4C. During the time (name) had diarrhoea, was (name) given:

[A] Zinc tablets?

[B] Zinc syrup?

CA4D. Check CA4C: Any zinc?
CA4E. Where did you get the zinc?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CA4F. During the time (name) had diarrhoea, was (name) given to drink any of the following:
Read each item aloud and record response before proceeding to the next item.
[A] Sugar salt water?

[B] Millet/rice porridge?

[C] Fresh coconut water?

[D] Carrot soup?

[E] Clean water?

[F] Guava leaves drink?

[G] Other? (specify)

CA5. Was anything (else) given to treat the diarrhoea

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

CA6A. In the last two weeks, has (name) been ill with a fever at any time?

CA6B. At any time during the illness, did (name) have blood taken from his/her finger or heel for testing?

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. Was the fast or difficult breathing due to a problem in the chest or a blocked or runny nose?

CA9A. Check CA6A: Had fever?
CA10. Did you seek any advice or treatment for the illness 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) ____

CA11B. Check CA11. Any codes A-O selected?

CA11A. What is the name of the facility or community health agent where you sought care?
Probe to get the names of all the facilities/community health workers and record the codes. If several structures are named, record in order of care, starting with the first. If the structure/community health agent is not pre-coded, use the code "999999996" and write the name(s) in the space provided.
CA12. At any time during the illness, was (name) given any medicine for the illness?

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

CA13A. Check CA13: Antibiotic mentioned (codes I or J)?
CA13B. Where did you get the (name of medicine from CA13)?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CA13C. Check CA13: Anti-malarial mentioned (codes A - H)?
CA13D. Where did you get the (name of medicine from CA13)?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CA13E. How long after the fever started did (name) first take (name of anti-malarial from CA13)?
If multiple anti-malarials mentioned in CA13, name all anti-malarial medicines mentioned.

CA14. Check AG2: Age of child.
CA15. The last time (name) passed stools, what was done to dispose of the stools?

UF13. Record the time
UF14. Check List of Household Members, columns HL7B and H15.
Is the respondent the mother or caretaker of another child age 0-4 living in this household?
Anthropometry: AN

After questionnaires for all children are complete, the measurer weighs and measures each child.
Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child's name and line number in the List of Household Members before recording measurements.

AN1. Measurer's name and number:
AN2. Result of height / length and weight measurement:
AN3. Child's weight:
AN3A. Was the child undressed to the minimum?
AN3B. Check age of child in AG2:
AN4. Child's length or height:
AN4A. How was the child actually measured? Lying down or standing up?
AN6. Is there another child in the household who is eligible for measurement?
Interviewer's observations ________

Field editor's observations ________

Measurer's observations ________