Republic of Serbia


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 ID code:
UF8. Day/month/year of interview
Repeat greeting if not already read to this respondent:
We are from Statistical Office of the Republic of Serbia. 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 20 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 20 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 ID code: Name ____ _ _

UF11. Main data entry clerk's name and ID code r: 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 birth register?

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

BR3A. Does (name) have a health insurance card?
If yes, ask: may I see it?
Birth Grant: BG

BG1. Did you apply for the birth grant for (name) No later than six month after he/she was born?
explain, if necessary
When I say the birth grant I mean financial subsidy parent is entitled to after a child is born and the first four children in the family are entitled to it. One can apply within the first six months of the child's birth.

BG2. Did you receive the birth grant?

BG3. What is the main reason you did not apply for the birth grant?

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?

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?
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.







EC7A. Check AG2: Age of child?

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?

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

[E] Infant formula (Bebelac, Aptamil, Impamil, Hipp, Nestle and Alike)?

[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 (name of food) yesterday during the day or the night:


[A] Yogurt/Sour milk?
If yes: How many times did (name) drink or eat yogurt? If 7 or more times, record '7'.

[B] Baby Cereals (Baby King, Milupa, Hipp, Nestle and Alike) ?

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

[D] Pumpkin, carrots?

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

[F] Spinach, Swiss Chard, Kale or any other dark green, leafy vegetables?

[G] Apricot or Cantaloupe?

[H] Any other fruits or vegetables?

[I] Liver, kidney, heart or other offal?

[J] Any meat, such as beef, pork, lamb, goat, chicken, or turkey?

[K] Eggs?

[L] Fish?

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

[N] Cheese or other food made from milk?

[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 (child health) card is available, copy the dates in IM3 for each type of immunization and Vitamin A recorded on the card. IM6-IM16 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)?

IM3.

(a) Copy dates for each vaccination from the card.
(b) Write '44' in day column if card shows that vaccination was given but no date recorded.
(c) Circle "1" in the Combined pentavalent vaccine (PENTAXIM or INFANRIX)" column if the card shows that monovalent vaccine was given as a part of pentavalent vaccine (PENTAXIM or INFANRIX),. Otherwise circle '2'.

BCG

Polio 1

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

Polio 2

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

Polio 3

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

DPT 1

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

DPT 2

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

DPT 3

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

HepB 1

HepB 2

HepB 3

Hib 1

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

Hib 2

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

Hib 3

Combined pentavalent vaccine (PENTAXIM or INFANRIX)

Measles (or MMR or MR)

IM4. Check IM3. Are all vaccines (BCG to MMR1) 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?

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. Has (name) ever received combined pentavalent vaccine (PENTAXIM or INFANRIX)?
Probe by indicating that pentavalent vaccine is usually given at the suggestion of pediatrician or parent's request and it prevents child from getting polio, diphteria, tetanus, whooping cough and diseases caused by bacteria Hib.

IM7B. How many times (name) received the combined pentavalent vaccine?

IM7C. Check IM7B, How many times is combined pentavalent vaccine received?
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 at the same time as Polio.
IM12. How many times was the DPT vaccine received?

IM12A. Has (name) ever received a HIB vaccination - that is, an injection in the thigh to prevent him/her from getting meningitis/pneumonia or any other disease caused by bacteria haemophilus influenzae type B?
Probe by indicating that Hib vaccine is almost always given at the same time as Polio and DTP vaccines.
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?

IM16. Has (name) ever received a MMR - that is, a shot in the arm at the age of 12 months or older - to prevent him/her from getting measles, mumps and rubella?

IM20. Issue a questionnaire form for vaccination records at health facility for this child. Complete the the Module HF- Under-Five child information panel and go to UF13.

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 ID code:
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 ________

Under-five child information panel: HF

This questionnaire form is to be used at health facilities to record information on the vaccinations and Vitamin A supplementation for children age 0-2 years. A separate questionnaire form should be used for each eligible child.
The questionnaire for children under five must be completed for the child prior to completing this form. This panel should be completed before visiting the health facility.
This questionnaire form must be appended to the questionnaire for children under five for each child.

HF0. Results of request for consent to collect vaccination records from the health facility

HF1. Cluster number: _ _ _

HF2. Household number: _ _

HF3. Child's name and surname:

HF4. Child's line number: _ _

HF5. Mother's / Caretaker's name:

HF6. Mother's / Caretaker's line number: _ _

HF7. Interviewer's name and ID code:

HF8. Day / Month / Year of facility visit: _ _ / _ _ / 2014

HF9. Day, month and year of birth
(From AG1 in Questionnaire for Children Under-5)
HF10. Name of health facility:

HF10A. Name and number of the fieldwork staff member that visited the health facility:

HF11. Result of health facility visit

HF11A. Field editor's name and ID code:

HF11B. Main data entry clerk's name and ID code:

HF12. Record day, month and year of birth as written on vaccination record

HF13.

BCG

Polio 1

Polio 2

Polio 3

DPT 1

DPT 2

DPT 3

HepB 1

HepB 2

HepB 3

Hib 1

Hib 2

Hib 3

MMR1