Republic of Serbia, 2010

Under-five child information panel: UF

This questionnaire is to be administered to all mothers or caretakers (see Household Questionnaire, Module HL ? Household Listing, column HL9) who care for a child under five that lives with them (see household questionnaire, module HL ? Household listing, column HL6).

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 _ _ / _ _ / _ _ _ _

Repeat greeting if not already read to mother/caretaker:

We are from Statistical Office of the Republic of Serbia. We are working on survey concerned with health and education of family members. I would like to talk to you about (name from UF3) health and welfare. The interview will take about 20 minutes. All the information we obtain will remain strictly confidential and your answers will never be identified.

If the greetings were read to the respondent when starting with Household Questionnaire, the following text should be read:

Now I would like to talk to you more about (child's name from UF3)'s health and other issues. This interview will take about 20 minutes, and I repeat that all the information obtained remains strictly confidential and your answers will never be identified.

May I start now?

UF9. Result of interview for children under 5
Codes refer to mother/caretaker.

UF10. Field edited by:

UF11. Data entry clerk:

UF12. Record the time.

Age: AG

AG1. Now I would like to ask you some questions about (name)'s health.

In 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 your child's birth?

BR3A. Does (name) have a health insurance card?

If yes, ask: May I see it?

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.

If the respondent says "yes" to the categories above, then probe to learn specifically what the child plays with to ascertain the response

Does he/she play with:

[A] Homemade toys (such as dolls, cars, or other toys made at home)?

[B] Toys from a shop or manufactured toys?

[C] Household objects (such as bowls or pots) or objects found outside (such as sticks, rocks, leaves, etc.)?

EC3. Adults who care for a child sometimes have to go out shopping, to visit doctor, or have to leave young children for any other reason.

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, i.e. someone less than 10 years old, for more than an hour?

EC4. Check AG2: Age of child

EC5. Does (name) attend kindergarten or any organized learning or early childhood education programme?

These can be private, government or NGO programmes

EC6. Within the last seven days, about how many hours did (name) attend that programme?

EC6A. What type of facility does the child attend?

EC6B. What are the main reasons that (name) does not go to a kindergarten or any other early learning facility?

Probe: anything else?

[] A The child will not learn much in the kindergarten
[] B The child is disabled
[] C Low level of services (poor conditions, inadequate personnel)
[] D Poor treatment (ethnicity reasons, does not speak the language)
[] E The child is taken care at home

[] F Not admitted in the facility as both parents are unemployed
[] G Overcrowded facility
[] H Costly services
[] I Other expenses (transport, clothes, food) too high
[] J The facility is too far/no organized transport for children
[] X Other (specify)

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):

Read each item aloud. If yes, ask: Who engaged in this activity with (name)? Circle 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)?

EC7. In the past 3 days, did anyone who is not a member of your household and is over 15 years of age engage in any of the following activities with (name):

Read each item aloud. If yes, ask: Who engaged in this activity with (name)? Circle 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)?

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 of them take their first steps before 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, 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 on his/her own?

EC15. Does (name) get along well with other children?

EC16. Does (name) kick, bite, or hit other children or adults?

EC17. Does (name) get lose attention easily?

Breastfeeding: BF

BF1. Has (name) ever been breastfed?

BF2. Is he/she still being breastfed?

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

BF4. Did (name) drink adapted baby milk (Bebelac, Aptamil, Impamil, etc.) yesterday, during the day or night?

BF5. How many times did (name) drink adapted baby milk?

BF6. Did (name) drink fresh or powdered animal milk yesterday, during the day or night?

BF7. How many times did (name) drink fresh or powdered animal milk?

BF8. Did (name) drink juice or juice drinks yesterday, during the day or night?

BF9. Did (name) eat clear soup yesterday, during the day or night?

BF10. Did (name) drink or eat vitamin or mineral supplements or any medicines yesterday, during the day or night?

BF11. Did (name) drink oral rehydration solution ? Orosal, Nelit, etc. - yesterday, during the day or night?

BF12. Did (name) drink any other liquids yesterday, during the day or night?

BF13. Did (name) drink or eat yogurt yesterday, during the day or night?

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

BF15. Did (name) eat soft cereal meal yesterday, during the day or night?

BF16. Did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night?

BF17. How many times did (name) eat solid or semi-solid (soft, mushy) food yesterday, during the day or night?

BF18. Yesterday, during the day or night, did (name) drink anything from a bottle with a nipple?

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 to drink any of the following:

Read each item aloud and record response before proceeding to the next item.

[A] A fluid made from a special packet called - orosal, nelit, etc.?

[B] A pre-packed ORS?

[C] Boiled rice water?

[D] Instant or stock cube soup

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) ____

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?

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) ____

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

CA14. Check AG2: Child aged under 3?

CA15. The last time (name) passed stools, what was done to dispose of the stools?

UF13. Record the time.

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]

Check to see if there are other eligible woman (age 15-49 years) or child under 5 questionnaires to be administered in this household.

Move to the questionnaire for another woman or child under 5 or start preparations for anthropometric measurements of all children under 5 residing in that 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 on the household listing before recording measurements.

AN1. Measurer's name and identification code:

AN2. Result of height / length and weight 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 identification numbers are inserted on information panel of each questionnaire. Record total number of completed questionnaires for woman, child and man into the Household Questionnaire, Module HH - household information panel, questions HH13, HH15 and HH15A.

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________