Egypt Sub-national MICS


Under-five child information panel: UF

This questionnaire is to be administered to all mothers or caretakers (see List of Household Members, column HL15) 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
Repeat greeting if not already read to this respondent:
My name is ____, and we are conducting a survey on behalf of the ministry of health and population and UNICEF the survey is about the situation of children and mothers, families and households, and is focusing on perinatal care, child health and nutrition. I would like to talk to you about (child?s name from UF3)?s health and well-being. The interview will take about 20 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 other topics. This interview will take about 20 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 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 with the civil authorities?

BR2A. How long after (name's) birth was the birth registered?

BR2B. Check BR2A number of days/months
BR2C. What are the reasons for late registration with (name)?
Probe: What else?
BR3. Do you know how to register (name)'s birth?

BR3A. Why was (name)'s birth not registered?
Probe: What else?
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. Yesterday, during the day or night, did (name) drink ORS (oral rehydration solution)?

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

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 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] Any clear broth or soup?

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

[E] Infant formula?

[F] Any other liquids?

BD7A. Check BD7 (Category "E")
BD7B. How old was (name) when he/she took the infant formula for the first time?

BD7C. Who advised you to give (name) this infant formula?

BD7D. Did you receive this infant formula from the health facility?

BD7E. How many packets did you receive from the health facility during your last visit?
Probe for the last visit the packets was taken
BD7F. Did anyone of the employees in the health facility explain to you how to use the infant formula and the problems that may happened with it?

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 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] Cerelac, RIRI?

[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, cassava, or any other foods made from roots?

[F] Any dark green, leafy vegetables (spinach, molokhia, parkley, the dill)?

[G] Mangoes, apricot, peach, cantaloupe?

[H] Any other fruits or vegetables?

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

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

[K] Eggs?

[L] Fresh or dried fish or shellfish?

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

[N] Cheese or other food made from milk?

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

[P] Any other oils, fats or butter or foods made with any of these?

[Q] Any sugary foods such as chocolates, sweets, pastries, or biscuits?

BD9. Check BD8 (Categories "A" through "Q").
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 recorded on the card.

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

IM3.

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

Polio 0

BCG

Polio 1

DPT 1

HepB 1

Polio 2

DPT 2

HepB 2

Polio 3

DPT 3

HepB 3

Polio 4

Measles, MMR 1

Polio 5

Polio Booster dose

DPT Booster dose

Measles, MMR Booster dose

IM4. Check IM3. Are all vaccines (Polio to MMR Booster dose) 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?

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, or later?

IM10. How many times was the polio vaccine received?

IM11. Has (name) ever received a DPT vaccination ? that is, an injection in the thigh to prevent him/her from getting tetanus, whooping cough, or diphtheria?
Probe by indicating that DPT vaccination is sometimes given at the same time as Polio.
IM12. How many times was a DPT vaccine received?

IM13. Has (name) ever been given a Hepatitis B vaccination ? that is, an injection in the thigh to prevent him/her from getting Hepatitis B?
Probe by indicating that the Hepatitis B vaccine is sometimes given at the same time as Polio and DPT vaccines.
IM14. Was the first Hepatitis B vaccine received within 2 months after birth?

IM15. How many times was the Hepatitis B received?

IM16. Has (name) ever received a measles injection (or an MMR or MR) ? that is, a shot in the arm at the age of 12 months or older - to prevent him/her from getting measles?

IM18. Has (name) received a vitamin a dose like this/any of these within the last 6 months?
Show common types of ampules / capsules / syrups
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] 21-23 Apr 2012 / National Polio campaign

[B] 17-20 Nov 2013 / National Polio campaign

Growth Monitoring: GM

Use the health card to obtain the date of the last scheduled growth monitoring visit.(regular check-up page 3 in the HC)

GM1. Check IM1?
GM2. From the child?s age, identify the last scheduled growth monitoring visit.
Record whether the child attended, and if height and weight and haemoglobin are completely recorded

GM2A. Attended (Y/N)

GM2B. Weight

GM2C. Height

GM2D. Haemoglobin recorded (Y/N)

GM2E. Check GM2A:
GM3. Why did you not attend the last growth monitoring visit?
Probe : any other reasons?
Care of illness: CA

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

CA2. I would like to know how much (name) was given to drink during the diarrhea (including breastmilk).
During the time (name) had diarrhea, 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?
CA3. During the time (name) had diarrhea, 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?
CA3A. Did you seek any advice or treatment for the diarrhea 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) ____

CA3C. Check CA3B:
CA3D. Where did you first seek advice for diarrea?
Probe to identify the type of source. If unable to determine whether public or private sector, write the name of the place.
(Name of place) ____

CA4. During the time (name) had diarrea, was (name) given to drink a fluid made from a special packet called "mahlol moalget el gafaf"?

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 diarrea, was (name) given: zinc syrup?

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) ____

CA5. Was anything (else) given to treat the diarrea?

CA6. What (else) was given to treat the diarrea?
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?

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?
CA9B. I would like to know how much (name) was given to drink (including breastmilk) during the illness with a (fever/cough).
During the time (name) had (fever/cough), 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?
CA9C. During the time (name) had (fever/cough), 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?
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) ____

CA11A. Check CA11:
CA11B. Where did you first seek advice or treatment?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CA12. At any time during the illness, did (name) take 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 and/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) ____

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 HL15.
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 on the household listing 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

Supervisor's observations

Measurer's observations