Multiple Indicator Cluster Survey


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:
We are from the Statistics Committee of the Ministry of National Economy of the Republic of Kazakhstan. We are conducting a survey about the situation of children, families and households. I would like to talk to you about (child's name from UF3)'s health and well-being. The interview will take about 25 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 25 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 with the civil authorities?

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

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 kindergarten 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, 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 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 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 soup or broth?

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

[E] Infant formula such as malyutka, nan, nestle, nutrilon, similac, malysh, humana?

[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 foods consumed outside of your home.
Did (name) eat/drink (name of food) yesterday during the day or the night:

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

[B] Baby food, such as gerber, frutonyanya, heinz, agusha, hipp, nestle or other grain containing and fortified baby food?
If yes, probe: Was there anything other than grain in that food?
If yes, probe: What other items? And circle other appropriate items on the list.

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

[D] Pumpkin or carrots?

[E] Any foods made from potatoes, or any other foods made from roots?

[F] Any dark green, leafy vegetables, such as sorrel or spinach?

[G] Fresh or dried apricots or ripe persimmon?

[H] Any other fruits or vegetables such as fresh or dried apples, pears, bananas, peaches, fresh or pickled tomatoes, cucumbers, cabbage, beetroot or onion?

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

[J] Meat, for example beef, horse meat, pork, lamb, goat, poultry, or processed meat such as sausage and canned meat products?

[K] Eggs?

[L] Fresh or dried fish or shellfish?

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

[N] Cheese, cottage cheese or other food made from milk?

[P] Any gary foods such as chocolates, sweets, candies, cookies, cakes or biscuits?

[Q] Any fried, salty snacks such as potato chips?

[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 passport or card is available at home, copy the dates in IM3 for each type of immunization recorded on the card. IM6-IM16B will only be asked if a passport or card is not available.

IM1. Do you have at home a passport or card where (name)'s vaccinations are written down?
If yes: May I see it please?
IM2. Did you ever have a vaccination from the passport / card for (name)?

IM3.

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

BCG

Polio 1

Polio 2

Polio 3

Polio 4

Polio 5

DPT 1

DPT 2

DPT 3

DPT 4

HepB1 at birth

HepB 2

HepB 3

Hib 1

Hib 2

Hib 3

Hib 4

Measles (measles, mumps and rubella)

Pneumococcal 1

Pneumococcal 2

Pneumococcal 3

IM4. Check IM3. Are all vaccines (BCG to PCV) 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?

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 combined with HIB, Hepatitis B and Polio (as Hexavalent vaccine) or combined with Polio and Hib (as Pentavalent vaccine).
IM12. How many times was the DPT vaccine received?

IM13. Has (name) ever received 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 combined with DPT, Polio and HIB (as Hexavalent vaccine).
IM14. Was the first Hepatitis B vaccine received within 24 hours after birth?

IM15. How many times was the Hepatitis B received?

IM15A. Has (name) ever received a Hib vaccination ? that is, an injection in the thigh to prevent him/her from getting haemophilus influenzae type B?
Probe by indicating that the Hib vaccine is sometimes given combined with DPT, Polio and Hepatitis B (as Hexavalent vaccine) or combined with DPT and Polio (as Pentavalent vaccine).
IM15B. How many times was the Hib vaccine 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?

IM16A. Has (name) ever received a pneumococcal vaccination ? that is, an injection in the thigh or shoulder to prevent him/her from getting pneumonia?

IM16B. How many times was the Pneumococcal vaccine received?

IM20. Issue a questionnaire form for vaccination records at health facility for this child. Complete the information panel on that questionnaire and go to next module.

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 measures both the weight and height/length of 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

Supervisor's observations

Measurer's observations