Republic of Guinea 2016


Under-five child information panel: UF

This questionnaire is to be administered to all mothers or guardians (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/guardian's name:
UF6. Mother's/guardian'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 National Institute of Statistics. We are working on a project about 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 respondent, 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/guardian.

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/guardian 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. Circle '2' if less than 1 year and record age in completed months on the second line. 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 with the civil authorities?

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

BR4. What is the main reason that you have not registered (name) with the civil authorities?

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 'never' 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 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, commonplace 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 pebble 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?

BD3A. How old (in months) was (name) when you stopped breastfeeding?
Record '98' if don't know.
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 drink) yesterday during the day or the night:

[A] Plain water?

[B] Juice or juice drinks?

[C] Clear soup or broth?

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

[E] Infant formula sold commercially?

[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 commercially fortified baby food like Cerelac or Melolac?

[C] Bread, rice, noodles, or other foods made from grains (corn, fonio, sorghum, millet) like "Kania Nema"?

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

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

[F] Any dark green, leafy vegetables?

[G] Ripe mangoes, papayas?

[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?

[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-IM18A 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 0

Polio 1

Penta 1 (DPT 1)

Polio 2

Penta 2 (DPT 2)

Polio 3

Penta 3 (DPT 3)

Inactivated polio vaccine (IPV)

Measles (VAR)

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?

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?

IM10A. How many times was the polio vaccine given orally (drops in the mouth)?

IM10B. The last time that (name) received the drops against polio, did he/she also receive an injection against polio?
Probe that this question concerns an injection and not drops administered orally. Probe to know if the 2 types of vaccinations against polio (drops and injection) were in fact given.
IM11. Has (name) ever received a "Penta" vaccination - that is, an injection in the thigh or buttock to prevent him/her from getting tetanus, whooping cough, or diphtheria, Hepatitis B and Haemophilus Influenzae type B?
Probe by indicating that Penta vaccination is sometimes given at the same time as Polio.
IM16. Has (name) ever received a measles 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.
IM18A. Over the last 6 months, did (name) ever receive a dose of Vitamin A like this one?
Show types of vials or gel caps/syrup.
IM18B. Over the last 6 months, was (name) given any iron tablets, granules with iron or syrup with iron like (this one)?
Show examples of vitals or gel caps/syrup.
IM18C. Over the last 6 months, was (name) given any Mebendazole, that is, a medicine to treat intestinal worms, for deworming?

IM19. Please tell me if (name) was vaccinated in any of the following campaigns, national immunization days and/or vitamin a or child health days:
[A] 28-31 January 2016/Polio Campaign

[B] 16-23 February 2016/Measles Campaign

[C] 03-06 March 2016/Polio Campaign

[D] 07-10 April 2016/Polio Campaign

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?

CA3B. From where did you seek advice or treatment?
Probe: Anywhere else? Circle all places mentioned, but do not prompt with any suggestions. Probe to identify each type of place. If unable to determine if public or private sector, write the name of the place.
(Name of place) ____

CA4. During the time (name) had diarrhoea, was (name) given a liquid to drink that was prepared from a special packet (like Orasel)?

CA4B. Where did you get the ORS?
Probe to identify the type of place. 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 place. 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] Sweet and salty water?

[B] Peanut milk?

[C] Carrot juice?

[D] Tea?

[E] Boiled rice water?

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 of medication) ____

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?
CA9B. I would like to know how much fluid was given to (name) (including breast milk) during his illness (with fever and cough).
When (name) had diarrhoea, did he/she receive less to drink than usual, about the same quantity or more than usual?
If less probe: Did he/she receive much less to drink than usual, or a little less to drink than usual?
CA9C. When (name) was sick with fever/cough, was he/she given less to eat than usual, about the same quantity, more than usual or did he/she not eat anything?
If less probe: Did he/she receive a lot less to eat than usual, or a little less to eat than usual?
CA10. Did you seek any advice or treatment for the illness from any source?

CA10A. How many days after the fever started did you seek advice or treatment?

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

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 place. 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?

Anemia and Malaria Test: TSB

TSB201. Check AG1 or AG2
Child is age 0-5 months, that is, born in month of the survey or the 5 preceding months.
TSB207. Ask consent for the anemia test from child's parent or caretaker.
In this survey, we are asking children all over the country to participate in anemia testing. Anemia is a serious health problem which usually results from a poor diet, infections, or chronic illnesses. The results of this survey will help the government develop programs to prevent and treat anemia.
We are asking all children born in 2011 or later to participate in the anemia testing included in this survey by giving a couple of drops of blood from a finger or heel. For this test, we use equipment that is clean and poses no risk. It has never been used before and will be thrown out after each test.
The blood will be tested immediately for anemia and the results will be communicated to you right away. The results are strictly confidential and will not be shared with anyone outside of the survey team.
Do you have any questions to ask me?
You can say 'yes' to the test or you can say 'no'. It's your decision.
Do you authorize (child's name) to take part in this anemia test?

TSB208. Circle the appropriate result code for consent to the anemia test.

TSB209. Ask parent or caretaker for permission to administer the malaria test.
As part of this survey, we are asking children all over the country to participate in a test to check if they have malaria or not. Malaria is a serious health problem caused by a parasite transmitted by a mosquito bite. This survey will help the government develop programs to prevent malaria.
We are asking all children born in 2011 or later to participate in the malaria test included in this survey by giving a few drops of blood from a finger or heel. For this test, we use equipment that is clean and poses no risk. It has never been used before and will be thrown out after each test. (We will use blood from the same sample and same finger for the anemia test).
A drop of blood will be tested immediately for malaria and the results will be shared with you right away. Some drops will be placed on one or more slides and sent to a laboratory for testing. The results of the laboratory test will not be shared with you. The results are strictly confidential and will not be shared with anyone outside the survey team.
Do you have any questions to ask me?
You can say 'yes' to the test or you can say 'no'. It's your decision.
Will you allow (child's name) to take part in the malaria test?

TSB210. Circle the appropriate result code for consent to malaria testing.

TSB211. Prepare only the equipment and supplies needed for test(s) for which consent has been obtained and continue with the test(s).

TSB212. Enter bar code for malaria test.

TSB213. Record the hemoglobin level here and in the Anemia and Malaria booklet.

TSB214. Record the result code of rapid test for malaria.

TSB215. Record the result of rapid test for malaria here and in Anemia and Malaria booklet.

TSB216. Check TSB213: Hemoglobin Level

TSB217. Reference statement for severe anemia.
The diagnostic test for anemia shows that (child's name) has severe anemia. Your child is seriously ill and must be taken to a health facility immediately. (Go to UF13)

TSB218. Does (name) suffer from any of the following illnesses or have any of the following symptoms:

TSB219. Check TSB218: Is any code A-H circled?
TSB220. Check TSB213: Hemoglobin level

TSB221. In the last two weeks, has (name) taken or is (name) taking ACT given by a doctor or a health centre to treat the malaria?
Check by asking to see the medicine.
TSB221A: Advice and reference statement for children already taking an ACT medication.
You have told me that (child's name) is showing these symptoms that you just cited and you also told me that he/she has already received ACT for the malaria. I can not give you any additional ACT. If your child has a fever or continues to have symptoms for 2 days after the last dose of ACT, you should take the child to the nearest health centre for further examination. (Go to TSB227)

TSB221B: Reference statement for severe anemia.
The diagnostic test for malaria shows that (name) has malaria. Your child also has symptoms of severe malaria. The medicine that I have for malaria will not help your child, and I can not give him/her any treatment. Your child is seriously ill and must be taken immediately to a health facility. (Go to TSB227)

TSB222: In the last two weeks, did (name) take or is (name) taking ACT given by a doctor or a health centre to treat the malaria?
Check by asking to see the medication.

TSB223. Reference statement for children already taking an ACT medication.
You told me that (child's name) has already received ACT for the malaria. I can not give you any additional ACT. However, the test shows that he/she has malaria. If your child has a fever for 2 days after the last dose of ACT, you must take the child to the nearest health centre for further examination. (Go to TSB227)

TSB224. Read the information for treatment of malaria and the consent statement to the child's parent or caretaker.
The test for malaria shows that your child has malaria. We can give you some free medication. The medication is called ACT. ACT is very effective and in a few days, he/she will no longer have a fever or any other symptoms. You do not have to give the medication to the child. It is your decision. Please tell me whether or not you accept the medication.

TSB225. Circle the appropriate code and sign your name.
TSB226A. Treatment for children with a positive malaria test, using Artesunate-amodiaquine (AS-AQ).

Also tell the child's parent/caretaker: If (name) has a high fever, difficult or rapid breathing, if he/she can not drink or suckle, if his/her condition gets worse or does not get better in two days, you must immediately take him/her to see a health professional for treatment.
TSB226B. Treatment for children who test positive for malaria, using Artesunate Amodiaquine (AL)

Also tell the child's parent/caretaker: If (name) has a high fever, difficult or rapid breathing, if he/she can not drink or suckle, if his/her condition gets worse or does not get better in two days, you must immediately take him/her to see a health professional for treatment.

TSB227. Record the result code for malaria treatment on reference form

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

UF1. Cluster number: _ _ _

UF2. Household number: _ _

UF3. Child's name: Name ____

UF4. Child's line number _ _

UF5. Mother's/guardian's name:
UF6. Mother's/guardian's line number: _ _

UF7. Interviewer's name and number:
UF8. Day/month/year of interview
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. Was the child measured lying down or standing up?
AN6. Is there another child in the household who is eligible for measurement?
Interviewer's observations ________

Measurer's observations ________