Mexico 2015


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 Instituto Nacional De Salud Publica [National Institute Of Public Health]. 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.
AG3. Is (name) affiliated to the medical services of:
Read all the answers and mark the selected ones.
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 registry?

BR2A. Why hasn't (name) been registered or why doesn't he/she have a birth certificate?
Circle every mentioned answer.
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?

EC18. Check in AG2 (name's) birth date and calculate their age in months _ age in months.
EC19. Does (name) smile at you?

EC20. Can (name) lift their head when they are lying on their belly?

EC21. Does (name) turn around when being called?

EC22. Does (name) laugh when you play covering and uncovering your face with your hands?

EC23. Does (name) do things on purpose to bother you?

EC23A. Check age in months in EC18.
EC24. Can (name) sit by themselves?

EC25. Does (name) repeat sounds like baba, lala, gaga?

EC25A. Check age in months in EC18.
EC26. When (name) is having fun and you tell them "no", do they react?

EC26A. Check age in months in EC18.
EC27. Does (name) walk on its own?

EC28. Can (name) say at least four words besides mom and dad?

EC29. When you feed (name) can they hold their own plate or cup?

EC30. Does (name) hug and kiss you?

EC30A. Check age in months in EC18.
EC31. Can (name) kick a ball without falling down?

EC32. When you dress (name) can they help out by, for example, putting their arm through the sleeve?

EC32A. Check age in months in EC18.
EC33. Can (name) say at least eight words besides mom and dad?

EC34. Does (name) ask for more when they like something?

EC35. Does (name) ask "why" frequently?

EC36. Does (name) play with other children?

EC37. Can (name) say their own name?

EC38. Can (name) use the toilet by themselves?

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?

[B1] 100% Natural mango, carrot, papaya, or other orange colored fruits (not including orange juice) juice?

[B2] 100% Natural orange juice or other fruits (made only with fruits or vegetables)?

[B3] Pre-packaged sweet drinks such as Frutsi, Boing, or Naranjada [artificial local drinks]?

[B4] "Aguas Frescas" [lit. Fresh Waters are flavored beverages] made with sugar, water and fruit?

[B5] Any soda drinks or carbonated beverages that contain sugar?

[C] Broth (only the broth, no meat, rice or noodles or other things)?

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

[E] Infant formula?

[F] Tea or infusions?

[G] 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 (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 fortified baby foods such as Cerelac, Gerber, NUTRISANO, porrigde, or powder from the PROGRAMA OPORTUNIDADES [a social programme]?

[C] Tortilla, bread, rice, noodles, porridge, or other foods made from grains?

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

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

[F] Any dark green, leafy vegetables such as spinach, seachard, chard, or quelites?

[G] Ripe mangoes, papayas or yellow or orange cantaloupes?

[H] Any other fruits or vegetables such as Bananas, Apples, Prickly Pears, Zucchinis?

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

[J] Any meat, such as beef, pork, lamb, goat, rabbit, chicken, duck, sausages or ham?

[K] Eggs?

[L] Fresh or dried fish or shellfish?

[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) ____

[P] Any sugary foods such as candy, chocolate, bread, cake or cookies?

[Q] Any salty foods such as potato chips, corn chips or chicharrón de harina [lit. flour cracklings]?

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'.
BD11A. During your pregnancy or since (name) was born, have you heard or seen any ads or commercials about formula or powdered milk for babies or children?

BD11B. Do you know or have you heard or talk about the benefits that breastmilk provides to the child and to the mother?

BD11C. Could you name some of the benefits of breastfeeding (for the mother)?
Don't read the answers, just mark the ones that are mentioned.
BD11D. Could you name some of the benefits of breastfeeding (for the baby)?
Don't read the answers, just mark the ones that are mentioned.
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. IM6-IM17 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)?

IM2A. In addition to the card, did you get a card called "improving the development of my daughter or son"?
Probe: it is a card with drawings that comes folded next to the card. It serves to record the baby's development.
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. IM6-IM17 will only be asked if a card is not available.
IM3. Verify IM1

BCG (tuberculosis)

Polio 1 (Sabin)

Polio 2 (Sabin)

Polio 3 (Sabin)

Hepatitis B0 at birth

Hepatitis B1

Hepatitis B2

Pentavalent 1 (Acellular Pentavalent DPAT+CPI+HIB)

Pentavalent 2

Pentavalent 3

Pentavalent 4

Rotavirus 1 (Diarrhea due to rotavirus)

Rotavirus 2

Rotavirus 3

Pneumococcal 1

Pneumococcal 2

Pneumococcal 3

Influenza 1

Influenza 2

Influenza 3 (annual booster)

Influenza 4 (annual booster)

SPR [MMR] (sarampión, rubéola y parotiditis/ MMR)

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 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?

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 at the same time as Polio and DPT vaccines.
IM14. Was the first Hepatitis B vaccine received within 24 hours after birth?

IM15. How many times was the Hepatitis B received?

IM15C. Did (name) ever get a Pentavalent vaccine, an injection in the thigh to prevent diphteria, whooping cough, thetanus, polio, and type B influenza?

IM15D. How many times did (name) get the pentavalent vaccine?

IM15E. Did (name) ever get a Rotavirus vaccine (which protects against diarrhea due to rotavirus and is a liquid vial that is administered orally)?

IM15F. How many times did (name) get the rotavirus vaccine?

IM15G. Did (name) ever get a Pneumococcal vaccine, which protects against infections due to Pneumococcus?

IM15H. How many times did (name) get the Pneumococcal vaccine?

IM15I. Did (name) ever get an influenza vaccine?

IM15J. How many times did (name) get the Influenza vaccine?

IM16. Has (name) ever received a measles injection (or an MMR or MR) - that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles?

IM16A. How many times did (name) received Vitamin A, even during national vaccination week?

IM16B. Did (name) ever get any additional Polio vaccines during vaccination weeks?

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] First National Health Week 2015, February 21-27, Polio Vaccine

[B] Another National Health Week in 2015

[C] Another National Health Week prior to 2015

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?
CA3A. Did you seek any advice or treatment for the diarrhoea from any source?

CA3B. 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) ____

CA3C. In which institution did you seek advice or treatment for (name)?

CA4. During the time (name) had diarrhoea, was (name) given to drink:

[A] A powder that comes in a special packet called "Vida Suero Oral" [lit. Life ORS]?

[B] Any rehydrating solution for diarrhea such as Pedialyte?

CA4A. Check CA4: ORS.
CA4B. Where did you get the ORS?
Probe to identify the type of source. 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 source. 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] Homemade remedy?

[B] Rice water?

[C] Cornstarch drink?

[D] Herbal tea?

[E] Other liquids except for coffee or soda pops?

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) ____

CA6A. In the last two weeks, has (name) been ill with a fever at any time?

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?
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) ____

CA11AA. In which institution did you seek advice or treatment for (name)?

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. In which institution did you get the medication for (name)?

CA14. Check AG2: Age of child.
CA15. The last time (name) passed stools, what was done to dispose of the stools?

Child functioning and disability in children 2-4 years of age: CFD

CFD0. Check UB2: Age of child.
CFD1. I would like to ask you some questions about difficulties (name) may have. Does (name) wear glasses?

CFD2. Does (name) have a difficult time seeing things when wearing glasses?

CFD3. Does (name) have a difficult time seeing?

CFD4. Does (name) use a hearing aid?

CFD5. Does (name) have a difficult time hearing sounds like voices or music when wearing their hearing aid?

CFD6. Does (name) have a difficult time hearing sounds like voices or music?

CFD7. Does (name) use any equipment or receive assistance for walking?

CFD8. Does (name) have a difficult time walking without assistance or equipment?

CFD9. Does (name) have a difficult time walking with assistance or equipment?

CFD10. Compared with children of the same age, does (name) have difficulty walking?

CFD10A. What kind of difficulty does (name) have?

CFD10B. How worried are you about this disability?

CFD11. Compared with children of the same age, does (name) have difficulty picking up small objects with (his/her) hand?

CFD12. Does (name) have difficulty understanding you?

CFD13. When (name) speaks, do you have difficulty understanding (him/her)?

CFD14. Compared with children of the same age, does (name) have difficulty learning things?

CFD15. Compared with children of the same age, does (name) have difficulty playing?

CFD16. Compared with children of the same age, how much does (name) kick, bite or hit other children or adults? Would you say: not at all, less, the same, more or a lot more?

CFD17. Did (name) attend any special school or any special education group at a normal school, even during early childhood?

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 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:
AN3AA. Child's weight: (second measurement)
AN3AB. Child's weight: (third measurement)
AN3A. Was the child undressed to the minimum?
AN3B. Check age of child in AG2:
AN4. Child's length or height:
AN4AA. Child's length or height: (second measurement)
AN4AB. Child's length or height: (third measurement)
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?
Hemoglobin: HM

Once the anthropometric measurements of every child are completed,the technician will take a blood sample and measure each child's hemoglobin levels. Register the hemoglobin test result below, making sure to record it on the correct questionnaire for each child. Check the child's name and their line number on the HH members' list before registering the results..

HM1A. Check AG2
HM1. Measurer's name and number:
HM2. Result of hemoglobin test:
HM3. Results of the hemoglobin test:
HM4. In this household, are there any other children eligible for the hemoglobin test?
Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________

Measurer's observations ________