MICS: Questionnaire for Children Under Five

Under--five Child information Panel

This questionnaire is to be administered to all mothers or caretakers (see household listing, column HL8) who care for a child that lives with them and is under the age of 2 years (see household listing, column HL5). A separate questionnaire should be used for each eligible child.
Fill in the cluster and household number, and names and line numbers of the child and the mother/caretaker in the space below. Insert your own name and number, and the date.

UF1. Consulting room number: _ _ _

UF2. Household number: _ _ _

UF3. Child's name: ____

UF4. Child's line number: _ _

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

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

UF7. Interviewer name and number: ____ _ _

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

UF9. Result of Interview for children under 5
Codes refer to mother/caregiver

[] 1 Completed
[] 2 Not at home
[] 3 Refused
[] 4 Partially completed
[] 5 Incapacitated
[] 6 Other (specify) ____

Repeat greeting if not already read to this respondent:
We are from the Ministry of Public health. We are working on a project concerned with family health and education. I would like to talk to you about this. The interview will take about 15 minutes. All the information we obtain will remain strictly confidential and your answers will never be identified. Also, you are not obliged to answer any question you do not want to, and you may withdraw from the interview at any time. May I start now?
If permission is given, begin the interview. If the respondent does not agree to continue, thank him/her and go to the next interview. Discuss this result with you r supervisor for a future revisit.

UF10: Now I would like to ask you some questions about the health of each child under the age of 2 in your care, who lives with you now. Now I want to ask you about (name) in what 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.
Date of Birth:

Day: _ _

[] 98 DK day

Month: _ _
Year: _ _ _ _

UF11: How old was (name) at his/her last birthday?
Record age in completed years.

Age in completed years: _

Breastfeeding Module: BF

BF1. Has (name) ever been breastfeed?

[] 1 Yes
[] 2 No (go to BF3)
[] 8 DK (go to BF3)

MN13. How long after (name's) birth did you first breastfeed them?
If less than one hour, register "00" hours If less than 24 hours, register hours Other answers, register days

[] 000 Immediately
[] 1 Hours _ _
[] 2 Days _ _
[] 998 DK/Doesn't remember

BF2. Is he/she still being breast--fed?

[] 1 Yes
[] 2 No
[] 8 DK

BF3. Since this time yesterday, did he/she receive any of the following:
Read each item aloud and record response before proceeding to the next item

A. Vitamin, mineral supplements or medicine?

[] 1 Yes
[] 2 No
[] 8 DK

B. Plain water?

[] 1 Yes
[] 2 No
[] 8 DK

C. Sweetened, flavored water or fruit juice or tea or infusion?

[] 1 Yes
[] 2 No
[] 8 DK

D. Oral rehydration solution (ORS)?

[] 1 Yes
[] 2 No
[] 8 DK

E. Infant formula?

[] 1 Yes
[] 2 No
[] 8 DK

F. Tinned, powdered or fresh milk?

[] 1 Yes
[] 2 No
[] 8 DK

G. Any other liquids?

[] 1 Yes
[] 2 No
[] 8 DK

H. Solid or semi--solid (mushy) food?

[] 1 Yes
[] 2 No
[] 8 DK

BF4. Check BF3H: Child received solid or semi--sold (mushy) food?

[] Yes (continue with BF5)
[] No or DK (go to next module)

BF5. Since this time yesterday, how many times did (name) eat solid, semi--solid, or soft foods other than liquids? (if 7 or more times record 7)

Number of times: ____
[] 8 DK

Immunization Module: IM

[IPUMS note: Due to the resolution of the Cuban survey (it was already pixelated at a low resolution, so zooming in would not help either) this section was very difficult to read and took longer than expected to document/translate. The numbers and abbreviations on the vaccination chart are not legible at all so the information from the standard Spanish and English versions were used as a reference, still, the numbers might not be 100% accurate.]

If an immunization card is available, copy the dates in IM2--IM8D for each type of immunization or vitamin A dose recorded on the card. IM10--IM23 are for recording vaccinations that are not recorded on the card. IM10--IM23 will only be asked when a card is not available.

IM1. Is there a vaccination card for (name)?

[] 1. Yes, seen
[] 2. Yes, not seen (go to IM10)
[] 3. No (go to IM10)

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. When you finish writing, probe further regarding the difficulties for the vaccines' application.
Date of immunization (DD/MM/YYYY)

IM2. BCG, Tuberculosis (before mother is discharged from maternity) _ _/_ _/_ _ _ _