[Mongolia]

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. Day / month / year of interview _ _ / _ _ / _ _ _ _

If greeting has 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 nearly 40 minutes. According to the article 5 paragraph 4 of the Mongolian state law on confidentiality of an individual and Article 22, paragraph 3 of the Mongolian 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 person, then read the following:
Now I would like to talk to you more about (name)'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 article 22, paragraph 3 of the Mongolian state law on statistics all the information we obtain will remain strictly confidential.

Shall we start the interview?

UF9. Result of interview
Codes refer to mother/caretaker of the eligible child.
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).
Please tell me (name)'s date of birth?
Birth year and month of the child must be recorded. If the mother/caretaker knows the exact day of birth, 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 registration 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 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 (name) play with the following things:

[A] Homemade 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 young 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. During the last 7 days, how many hours did (name) attend a pre-school or any other alternative forms for early childhood education?

EC7. During the last 3 days, did you or any household member over 15 years of age engage in 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 with (name) or lullabies to (name)?

[D] Took (name) outside?

[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 (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 your child's development.
Can (name) identify some colours?

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

EC8. Can (name) name at least 10 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 with 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. Does (name) get 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 (name) still being breastfed?

BF3. I would like to ask you about liquids that (name) may have had yesterday during the day or the night.
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, 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 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 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 14 days, has (name) had diarrhoea?

CA2. I would like to know how much (name) was given to drink breast milk or any other liquids and to eat any food during the time he/she had diarrhoea.
During the time (name) had diarrhoea, was he/she given less than usual to drink or more than usual?
If less, probe: Much less than usual or somewhat less than usual?
CA3. During the time (name) had diarrhoea, was he/she given less than usual to eat or more than usual?
If "less", probe: Much less than usual or somewhat less than usual?
CA4. During the time (name) had diarrhoea, was he/she given the following types of oral rehydration solutions to drink?

[A] Fluid from ORS packet

[F] Home prepared oral rehydration solution

CA5. During the time (name) had diarrhoea, was he/she given any (other) treatment?

CA6. What (else) was given to treat the diarrhoea?
Probe: Any other treatment? Record all that apply.
(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, rapid breaths or have difficulty breathing?

CA9. What was the reason for the fast or difficult breathing? Was it 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 or whom 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 his/her illness?

CA13. What medicine was (name) given to treat his/her illness?
Probe: Any other medicine? Record all that apply
(Names of medicines) ____

CA14. Check AG2 to see if the child is aged 0-2 years.
CA15. When the last time (name) passed stools, what was done to dispose 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, ask): Please show it to me.

IM2. Did (name) 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

DPT1 or Pentavalent 1

DPT2 or Pentavalent 2

DPT3 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 to see if all vaccinations are recorded.
IM5. In addition to what is recorded on this immunization card, did (name) receive any other vaccinations - including vaccinations received in campaigns or immunization days?
Record '1' only if respondent mentions vaccines 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 influenze B.
Probe by indicating that DPT or pentavalent vaccination is sometimes given at the same time as Polio vaccination.
IM12. How many times was the DPT or Pentavalent vaccination 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

IM18A. What kind of vitamin A dose (color of package) has received within the last 6 months?

IM18B. Has (name) received a vitamin D dose within the last 6 months

IM18C. What kind of vitamin D dose has received within the last 6 months?

IM18D. Has received an iron supplement within the last six months?

IM18E. What kind of iron supplement has received within the last 6 months?

IM19. Has (name) participated in any of the following national immunization days?

[A] Immunization days in May

[B] Immunization days in October

IM20. Has received a micro-nutrient supplement within the last 6 months?

IM21. How many packages of multi-nutrient supplement are received within the last 6 months?

IM22. How are the multi-nutrient added to the meals?

IM23. Where the information about multi-nutrient supplements is received from?

UF13. Interview completed at
UF14. Check if the mother/caretaker is the mother/caretaker of another child under age of 5 years in this household.
[] Yes [Explain that you will need to measure the weight and height of the child when you complete all interviews. Go to next questionnaire for child under 5 to be administered to the same mother/caretaker]
[] No [End the interview with mother/caretaker 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 and prepare for the measurement]

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/height
Check age of child in AG2:
[] The child is under age of 2 years. [Measure length by having the child lie down.]
[] The child is aged 2 or more years. [Measure height by having the child stand up.]
AN6. Check if there is another child under age of 5 years 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 ________