Ghana 2011

Under-five child 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 _ _ / _ _ / _ _ _ _

Repeat greeting if not already read to this respondent:
We are from Ghana Statistical Service. We are working on a project concerned with family health and education. I would like to talk to you about (name)'s health and well-being. The interview will take about 20 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.

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 your answers will never be shared with anyone other than our project team.

May I start now?

UF9. Result of interview for children under 5
Codes refer to mother/caretaker.
UF10. Field edited by (name and number)

UF11. Data entry clerk (name and number):

UF12. Record the time.

Age: AG

AG1. Now I would like to ask you some questions about the health of (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. 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 births and deaths registry?

BR2A. Was (name)'s birth registered within the first year of birth?

BR2B. What is the main reason why (name's) birth is not registered?

BR3. Do you know how to register your child's birth?

BR4. How much did it cost you, or how much do you think it would cost to register your child with the birth and death registry if the child is under 1 year old?

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.
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, 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 kindergarten or community child care?

EC6. Within the last seven days, about how many hours did (name) 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):
If yes, ask: Who engaged in this activity with (name)? Circle all that apply.

[A] Read 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 or enclosure?

[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 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: BF

BF1. Has (name) ever been breastfed?

BF2. Is he/she still being breastfed?

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?

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

Diet Diversity: DD

Now I would like to ask you about (other) liquids and foods that (name) may have had yesterday during the day or the night. I am interested to know whether your child had the item even if combined with other foods,

DD1: Did (name) drink/eat (name of food) during the day or the night before:

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

[DD2A] How many times did (name) drink ilk such as tinned, powdered or fresh animal milk?

[B] Infant formula (SMA, lactogen?)?

[DD2B] How many times did (name) drink infant formula (SMA, lactogen?)?

[C] Baby cereal (nestle cerelac, fresocrem?)?

[DD2C] How many times did (name) drink baby cereal (nestle cerelac, fresocrem?)?

[D] Tea or coffee?

[E] Any other liquid (juice, cocoa, coconut water?)?

[F] Bread, rice, noodles or other foods made from grain (kenkey, banku, koko, tuo zaafi, akple, weanimix?)?

[G] Pumpkin, red or yellow yams, carrots, and orange or yellow sweet potatoes??

[H] White potatoes, white yams, manioc, cassava, cocoyam, fufu or any other foods made from roots, tubers or plantain?

[I] Any dark green leafy vegetables (kontomire, aleefu, ayoyo, kale, cassava leaves)?

[J] Ripe mangoes, pawpaw?

[K] Any other fruits or vegetables (bananas, avocados, tomatoes, oranges, apples?)?

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

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

[N] Eggs?

[O] Fresh or dried fish or shellfish (prawns, lobsters? )?

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

[Q] Cheese, yogurt or other milk products?

[R] Any oil, fats or butter, or foods made with any of this?

[S] Any sugary foods as chocolate, sweet candles, pastries, cakes or biscuits?

[T] Any other solid or semi-solid foods?

Check DD1: food consumed during the day or night before
BF17. How many times did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night?

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?
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 item aloud and record response before proceeding to the next item.

[A] A fluid made from a special packet called (local name for ORS packet solution)?

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

[C] Coconut water?

[D] Rice water?

[E] Mashed Kenkey?

CA4F. Check CA4: ORS sachet or Pre-Packaged ORS given
CA4G. where did you get the (ORS sachet/pre-packaged ORS) from?
Probe: Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions.
CA4H. How much did you pay for the ORS?

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) ____

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?

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) ____

CA12. Was (name) given any medicine to treat this 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. From where did you get the antibiotic (pill/syrup or injection)?
Probe: Anywhere else?
CA14. Check AG2: Child aged under 3?
CA15. The last time (name) passed stools, what was done to dispose of the stools?

Malaria: ML

ML1. In the last two weeks, has (name) been ill with a fever at any time?

ML2. At any time during the illness, did (name) have blood taken from his/her finger or heel for testing?

ML3. Did you seek any advice or treatment for the illness from any source?

ML4. Was (name) taken to a health facility during this illness?

ML4A. Where was (name) taken during this illness?
Probe: Anywhere else?
ML5. Was (name) given any medicine for fever or malaria at the health facility?

ML6. What medicine was (name) given?
Probe: Any other medicine? Circle all medicines mentioned. Write brand name(s) of all medicines, if given.
(Name) ____

ML7. Was (name) given any medicine for the fever or malaria before being taken to the health facility?

ML8. Was (name) given any medicine for fever or malaria during this illness?

ML9. What medicine was (name) given?
Probe: Any other medicine? Circle all medicines mentioned. Write brand name(s) of all medicines, if given.
(Name) ____

ML10. Check ML6 and ML9: Anti-malarial mentioned (codes A-H)
ML11. How long after the fever started did (name) first take (name of anti-malarial from ML6 or ML9)?
If multiple anti-malarials mentioned in ML6 or ML9, name all anti-malarial medicines mentioned.
Immunization: IM

If an immunization card is available, copy the dates in IM3 for each type of immunization recorded on the card. IM6-IM17 are for registering vaccinations that are not recorded on the card. IM6-IM17 will only be asked when 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 card for (name)?

IM3. Date of Immunization

(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

Penta1(DPT/HepB/Infl1)

Penta2(DPT/HepB/Infl2)

Penta3(DPT/HepB/Infl3)

Measles (or MMR)

Yellow Fever

Vitamin A (1) (most recent)

Vitamin A (2) (most recent)

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?
Record 'Yes' only if respondent mentions vaccines shown in the table above.
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 getting diseases - that is, 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 or buttocks - 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?

IM16. Has (name) ever received a Measles injection or an MMR injection - 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
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] Polio immunization phase I (March 2011)

[B] Polio immunization phase II (May 2011)

[C] Polio immunization phase III (August 2011)

[D] Polio immunization phase IV (November 2011)

National Health Insurance: HI

HI1: Has (name) ever been registered with any health insurance scheme?

HI2. What type of health insurance does (name) have?
Probe: Any other?
HI3: Check HI2:
HI3A: In which year was (name) first registered with the national health insurance scheme (NHIS):

HI4: How was (name's) membership of the NHIS achieved:

HI5: Does (name) hold a valid national health insurance scheme (NHIS) card?
If child has valid insurance card, request to see it. Check to make sure it is valid for 2011.
HI6: Why does (name) not have a valid NHIS card?

HI7: Do you plan to renew (name's) NHIS registration?

HI8: Why do you not want to renew (name's) NHIS registration?
Probe: Any other reason?
HI9: In your opinion, does a child with the NHIS card get better/same/worse services when they visit health care facilities?

HI10: Why have you not registered or renewed registration for (name) with the NHIS
Probe: Any other reason
HI11: Is (name's) insurance currently valid for 2011?

UF14. Is the respondent the mother or caretaker of another child age 0-4 living in this household?
[] Yes [Indicate to the respondent that you will need to measure the weight and height of the child later. 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 and tell her/him that you will need to measure the weight and height of the child]
Check to see if there are other woman's, man's or under-5 questionnaires to be administered in this household.
Move to another woman's, man's or under-5 questionnaire, or start making arrangements for anthropometric measurements of all eligible children in the 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

AN4. Child's length or height
Check age of child in AG2:
[] Child under 2 years old. [Measure length (lying down).]
[] Child age 2 or more years. [Measure height (standing up).]
AN5. Oedema
Observe and record
AN6. Is there another child in the household who is eligible for measurement?

Anaemia and Malaria Testing for Children under Five: AM

After weighting and measuring the child, the health technician will request to do the anaemia and malaria testing.

AM1. Check AG1: Was child born in month of interview of five previous months?
AM2. Ask consent for anaemia test from mother or caretaker:
As part of this survey, we are asking that children all over the country take an anaemia test. Anaemia is a serious health problem that usually results from poor nutrition, infection, or disease. This survey will help the government to develop programs to prevent and treat anaemia.
We ask that all children age 6 months to 5 years participate in the anaemia testing part of this survey and give a few drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test. Your child will feel some pain that lasts a few seconds when his/her finger is pricked. There is also a slight risk of bleeding and infection where the finger is pricked, but we take precautions to reduce this risk.
The blood will be tested for anaemia immediately and the result will be made known to you right away. The result will be kept confidential and will not be shared with anyone than members of our survey team.
Do you have any question?
You can say yes to the test or you can say no. It is up to you to decide.
Will you allow (name of child) to participate in the anaemia test?

AM3.Anaemia testing consent outcome

AM4. Ask consent for malaria test from mother or caretaker:
As part of this survey, we are asking that children all over the country take an malaria test. malaria is a serious health problem that usually results from poor nutrition, infection, or disease. This survey will help the government to develop programs to prevent and treat malaria.
We ask that all children age 6 months to 5 years participate in the malaria testing part of this survey and give a few drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test. Your child will feel some pain that lasts a few seconds when his/her finger is pricked. There is also a slight risk of bleeding and infection where the finger is pricked, but we take precautions to reduce this risk.
The blood will be tested for malaria immediately and the result will be made known to you right away. The result will be kept confidential and will not be shared with anyone than members of our survey team.
Do you have any question?
You can say yes to the test or you can say no. It is up to you to decide.
Will you allow (name of child) to participate in the malaria test?

AM5. Malaria testing consent outcome

AM6.Prepare supplies for the tests for which consent was granted and proceed with the tests

AM7. Bar code label. Put the first bar code label here, the 2nd on the RDT, the 3rd on the slide and the 4th and 5th on the transmittal forms.

AM8. Haemoglobin level. Record the haemoglobin level here and in the anaemia and malaria brochure.

AM9. Malaria rapid test outcome

AM10. Malaria rapid test result. Record the result of the RDT here and in the anaemia and malaria brochure.

AM11.Check AM8: Haemoglobin result
AM12.Severe anaemia referral

AM13.Does (name) suffer from any of the following illnesses or symptoms:

AM14.Check AM13: Any code circled
AM15.Check AM8: Haemoglobin result
AM16.In the past 2 weeks has (name) taken any medicine given by a doctor or health center to treat the malaria?
Check if it is AL/AS-AQ by asking to see the medicine. Circle"1" only if it is AL or AS-AQ
AM17.Severe malaria referral
The malaria test shows that (name of child) has malaria. Your child also has symptoms of severe malaria. The malaria treatment I have will not help your child, and I cannot give you the medication. Your child is very ill and must be taken to a health facility right away. (End)

AM18.Referral for those who are already taking AL or AS-AQ
You have told me that (name of child) has already received medication for malaria. Therefore, I cannot give you additional medication. However, the test shows that he/she is positive for malaria. If your child has a fever for two days after the last dose of medication, you should take the child to the nearest health facility for further examination. (End)

AM19.Consent for malaria treatment
The malaria test shows that your child has malaria. We can give you free medicine. The medicine is called AS-AQ. It is very effective and in a few days it should get rid of the fever and other symptoms. You do not have to give the child the medicine. It is up to you to decide. Please tell me if you accept the medicine or not.

AM20. Accepted medicine?

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________