Somalia (Northeast Zone), 2011

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 (see Household Listing Form, 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 this respondent:

We are from MOPIC. We are working on a project concerned with family health and education. I would like to talk to you about (name)'s health and well-being. The interview will take about 20-30 minutes. All the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.

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 20-30 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone other than our project team.

May I start now?

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

UF10. Field edited by (name and number)

UF11. Data entry clerk (name and number):

UF12. Record the time.

Age: AG

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

In what month and year WAS (name) born?

Probe: what is his / her birthday? Do you have any documents that may have (name's date of birth (such as a child health day card, birth notification, or birth certificate)? If the mother/caretaker knows the exact birth date and/or it is printed in a document/card, also enter the day; otherwise, circle 98 for day. Month and year must be recorded. If unknown month or year, ask for documents or use the calendar of events

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. Note: For most children, the age indicated on the Routine Immunization Card is not current

AG3. Compare AG1 and AG2

AG4. Insicate how date of birth was obtained:

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, animal shells or leaves)?

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?

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

EC6A. Does (name) attend Koranic school?

EC6B. Within the last seven days, about how many hours did (name) attend Koranic school?

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)? 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 walk earlier than 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?
If no, probe: This can be in any language (Somali, Arabic, etc.)

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: 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 infant formula yesterday, during the day or night?

BF5. How many times did (name) drink infant formula?

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

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

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

BF9. Did (name) drink Maraqcad 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 ORS (oral rehydration solution) 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 thin porridge 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 a fluid made from a special packet called ORS such as this?
Show sample ORS packet

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?

Malaria: ML

ML1. In the last two weeks, has (name) been ill with a fever at any time?

ML2. At any time during the illness, did (name) have blood taken from his/her finger or heel for testing?

ML3. Did you seek any advice or treatment for the illness from any source?

ML4. Was (name) taken to a health facility during this illness?

ML5. Was (name) given any medicine for fever or malaria at the health facility?

ML6. What medicine was (name) given?

Probe: Any other medicine? Circle all medicines mentioned. Write brand name(s) of all medicines, if given.

(Name) ____

ML7. Was (name) given any medicine for the fever or malaria before being taken to the health facility?

ML8. Was (name) given any medicine for fever or malaria during this illness?

ML9. What medicine was (name) given?

Probe: Any other medicine? Circle all medicines mentioned. Write brand name(s) of all medicines, if given.

(Name) ____

ML10. Check ML6 and ML9: Anti-malarial mentioned (codes A-H)

ML11. How long after the fever started did (name) first take (name of anti-malarial from ML6 or ML9)?

If multiple anti-malarials mentioned in ML6 or ML9, name all anti-malarial medicines mentioned. Record how long after the fever started the first anti-malarial was given.

Immunization: IM

If an immunization card is available, copy the dates in IM3 for each type of immunization recorded on the card. IM6-IM16A are for registering vaccinations that are not recorded on the card. IM6-IM16A will only be asked when 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?

IM1A. Observe and record the type of card(s)

IM2. Did you ever have a vaccination or child health days card for (name)?

IM2A. Do or did you have one or more of the cards shown here where (name)'s vaccinations are or were written down?
Show the sample cards and record the response

IM3. Date of Immunization

BCG

Polio at birth

Polio 1

Polio 2

Polio 3

DPT1

DPT2

DPT3

Measles (or MMR)

Vitamin A (most recent)

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

IM5. In addition to what is recorded on this card, did (name) receive any other vaccinations - including national immunization days and child health days?

Record 'Yes' only if respondent mentions vaccines shown in the table above.

IM6. Has (name) ever received any vaccinations to prevent him/her from getting diseases, including national immunization days and child health days?

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. Did (name) (or the person with (name) at the time) receive free ORS packet(s) such as this at the time of this vaccination?

Show sample ORS packet

IM8. Has (name) ever received any "vaccination drops in the mouth" to protect him/her from getting diseases - that is, polio?

Show and probe: The vaccination is most commonly given in a vial such as this

IM8A. Did (name) (or the person with (name) at the time) receive free ORS packet(s) such as this at the time of this vaccination?

Show sample ORS packet

IM9. Was the first polio vaccine received in the first two weeks after birth or later?

IM10. How many times was the polio vaccine received?

IM11. Has (name) ever received a DPT vaccination - that is, an injection usually in the right 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

IM11A. Did (name) (or the person with (name) at the time) receive free ORS packet(s) such as this at the time of this vaccination?

Show sample ORS packet

IM12. How many times was a DPT vaccine received?

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

IM16A. Did (name) (or the person with (name) at the time) receive free ORS packet(s) such as this at the time of this vaccination?

Show sample ORS packet

IM18. Has (name) received a vitamin a dose like this within the last 6 months?
Show capsule(s)

IM19. Please tell me if (name) has participated in any of the following national immunization days and child health days:

[A] Jan/Fed 2009 CHDs (Vit A, measles and polio)

[B] June 2009 NIDs (Polio)

[C] July 2009 NIDs

[D] Jul/Aug 2009 CHDs (Vit A, Measles and Polio)

[E] June 2010 CHDs (Vit A, Measles and Polio)

[F] Sept 2010 NIDs (Polio)

[G] October 2010 NIDs (Polio)

[H] December 2010 CHDs (Vit A, Measles and Polio)

IM20. Check IM19: Did child participate in the December 2010 CHDS (IM19(H)=1)?

IM21. Did (name) (or the person with (name) at the time) receive free ORS packet(s) such as thin in the December 2010 child health days?
Show sample ORS packet

IM22. Check CA1: Did child have an episode of diarrhoea in the past 2 weeks (CA1=1)?

IM23. Since the receipt of the free ORS packet(s) in december, has (name) had any episode of diarrhoea?

IM24. Was/were the free ORS packet(s) received in December used to treat (name) for diarrhoea?

UF13. Record the time.

UF14. Is the respondent the mother or caretaker of another child age 0-4 living in this household?

[] Yes [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. Check to see if there are other woman's or under-5 questionnaires to be administered in this household. Move to another woman's or under-5 questionnaire.]