Mongolia, 2010

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.
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. Year / month / day of interview _ _ _ _ / _ _ / _ _

If greeting has not already been read to this mother/caretaker, then read the following:
We are from the National Statistical Office of Mongolia and working on a project concerned with family health, education, and living situation. I would like to talk to you about (name)'s health and well-being. The interview will take about 40 minutes. According to the article 5, paragraph 4 of the Mongolian state law on confidentiality of an individual and state law on statistics all the information we obtain will remain strictly confidential.

If greeting at the beginning of the household questionnaire has already been read to this mother/caretaker, 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 40 minutes. According to the article 5, paragraph 4 of the Mongolian state law on confidentiality of an individual and state law on statistics all the information we obtain will remain strictly confidential.

May I start now?

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

UF11. Data entry clerk name and number:

UF12. Interview started at

Age: AG

AG1. Now I would like to ask you some questions about (name).
In what month and year WAS (name) born?
Birth year and month of the child must be recorded. If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day.
AG2. How old is (name)?
Probe: how old was (name) at his / her last birthday?
Always check if AG1 and AG2 are consistent.
Birth registration: BR

BR1. Does (name) have a birth certificate?
If yes, ask: Please show it to me.

BR2. Has (name)'s birth been registered with the civil authorities?

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

Early childhood development: EC

EC1. In your household, 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.
Probe to learn specifically what the child plays with to ascertain the response
Does he/she play with:

[A] Handmade toys?

[B] Manufactured toys?

[D] Household objects such as cups, pots, etc.

[E] Objects found outside such as sticks, stones, etc.?

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 the children by themselves or have older children watch the younger ones.
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 to see if the child is aged 3-4 years
EC5. During the school year of 2010/2011, is (name) attending a pre-school or any other alternative forms for early childhood education?

EC6. Within the last seven days, about how many hours did (name) attend a pre-school or any other alternative forms for early childhood education?

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)? Record 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)?

EC7A. 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. The following questions are related to several aspects of your child?s development. Can (name) identify some colours?

EC7B. Can (name) identify simple shapes such as triangle, square, circle, etc.?

EC8. Can (name) identify or name at least ten letters of the alphabet?

EC9. Can (name) read at least four simple words?

EC9A. Can (name) count?

EC10. Can (name) name the numbers until 10?

EC11. Can (name) pick up a small object pinching two fingers from the ground?

EC11A. Can (name) hold a spoon, a fork or a pencil with the thumb, index finger, and middle finger?

EC12. Is (name) sometimes too weak 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. Compared with other children of the same age, does (name) get distracted easily?

Breastfeeding: BF

BF1. Has (name) ever been breastfed?

BF2. Is he/she still being breastfed?

BF3. I would like to ask you about liquid and foot items (name) had yesterday during the day or the night. I am interested in whether (name) had the item even if it was combined with other foods.
Did (name) drink plain water during the last day and night?

BF4. Did (name) drink infant formula during the last day and night?

BF5. How many times did (name) drink infant formula during the last day and night?

BF6. Did (name) drink milk, such as tinned, powdered or fresh animal milk during the last day and night?

BF7. How many times did (name) drink tinned, powdered or fresh animal milk during the last day and night?

BF7A. Did (name) drink tea during the last day and night?

BF8. Did (name) drink juice or juice drinks during the last day and night?

BF9. Did (name) drink meat soup during the last day and night?

BF10. Did (name) drink vitamin or mineral supplements or any medicines during the last day and night?

BF11. Did (name) drink oral rehydration solution during the last day and night?

BF12. Did (name) drink any other liquids during the last day and night?

BF12A. Did (name) eat fruit or vegetable puree yesterday during the last day and night?

BF12B. How many times did (name) eat fruit or vegetable puree during the last day and night?

BF13. Did (name) drink or eat yogurt during the last day and night

BF14. How many times did (name) drink or eat yogurt during the last day and night?

BF15. Did (name) eat thin porridge during the last day and night?

BF15A. How many times did (name) eat thin porridge during the last day and night?

BF16. Did (name) eat solid or semi-solid food such as soup thickened with flour, food for adults during the last day and night?

BF17. How many times did (name) eat solid or semi-solid (soft, mushy) food such as soup thickened with flour, food for adults during the last day and night?

BF18. Did (name) drink anything from a bottle with a nipple during the last day and 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 the following types of oral rehydration solutions to drink:
Read each item aloud and record response before proceeding to the next item.

[A] Fluid from ORS packet

[F] Home prepared oral rehydration solution

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.
(Name) ____

CA6A. Who recommended this treatment?

CA7. During the last 14 days, has (name) had an illness with a cough?

CA8. During the time (name) had an illness with a cough, did he/she breathe faster than usual with short or rapid breaths or have difficulty breathing?

CA9. What was the reason for 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 (name)?s illness from any source?

CA11. From where did you seek advice or treatment?
Probe: Anywhere else or anyone else?
Probe to identify each type of source. Do not prompt with any suggestions. Record all that apply.
(Name of place) ____

CA12. Was (name) given any medicine to treat this illness?

CA13. What medicine was (name) given?
Probe: Any other medicine? Record all that apply.
(Names of medicines) ____

CA14. Check AG2: Child aged under 3?
CA15. The last time (name) passed stools, what was done to dispose of the stools?

Immunization: IM

If an immunization card is available, copy the dates in IM3 for each type of immunization recorded on the card.

IM1. Does (name) have an immunization card?
(If yes) Please show it to me.

IM2. Did you ever have an immunization card?

IM3. Vaccination date

(a) Copy dates for each vaccination from the card.
(b) Record 4444 in the corresponding year column if card shows that vaccination was given but no date recorded.

BCG

Polio at birth

Polio 1

Polio 2

Polio 3

DPT or Pentavalent 1

DPT or Pentavalent 2

DPT or Pentavalent 3

Diphtheria-tetanus

HepB at birth

HepB1

HepB2

HepB3

MMR 1

MMR 2

Vitamin A

IM3A. Was the information in IM3 filled out from the immunization card that was available at the health facility?
IM4. Check IM3. Are all vaccines 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 1 only if the mother / caretaker mentions vaccinations shown in IM3.
IM6. Has (name) ever received any vaccinations?

IM7. Has (name) ever received a BCG vaccination against tuberculosis - that is, an injection in the arm or shoulder that usually causes a scar?

IM7A. Was the BCG vaccination received within 48 hours after birth?

IM8. Has (name) ever received any "vaccination drops in the mouth" to prevent polio?

IM9. Was the first polio vaccine received within 48 hours after birth?

IM10. How many times was the polio vaccine received?

IM11. Has (name) ever received a DPT or pentavalent vaccination - that is, an injection in the thigh or buttocks?
DPT is a vaccination against tetanus, whooping cough, and diphtheria.
Pentavalent is a vaccination against tetanus, whooping cough, diphtheria, hepatitis B, and hemophilic influenza B.
Probe by indicating that DPT or pentavalent vaccinations are 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 or buttocks?
Probe by indicating that the Hepatitis B vaccine is sometimes given at the same time as BCG and polio vaccines
IM14. Was the first Hepatitis B vaccine received within 48 hours after birth?

IM15. How many times was a hepatitis B vaccine received?

IM16. Has (name) ever received a MMR vaccination against measles - that is, an injection in the arm at the age of 8 months?

IM16A. How many times was the MMR vaccination received?

IM18. Has (name) received a vitamin a dose 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 national immunization days?

[A] Immunization days in May

[B] Immunization days in October

UF13. Interview completed at
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]

Anthropometry: AN

Weights and heights of all eligible children under age of 5 years in the household will be measured after all Questionnaire for Child under 5 are completed. Be careful to record the results of the measurements correctly on the respected questionnaires by checking the name and line number of each eligible child in the Module HL.

AN1. Measurer's name and number:

AN2. Result of 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).]
AN6. Is there another child in the household who is eligible for measurement?
Gather together all questionnaires for this household and check that all identifying information is entered on each page. Complete the total number of household members, number of eligible women, children, and men, who completed the individual questionnaires in the Household Questionnaire.
Interviewer's notes ________

Field editor's notes ________

Supervisor's notes ________