Thailand

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. EA number from the MICS sample: _ _ _
UF1A. Household cluster (from listing)

UF2. Household number: _ _

UF3. Child's name (copy from HL2 of the household listing form):
Name ____

UF4. Child's ordinal number (copy from HL1 of the household listing form): _ _

UF5. Mother's / caretaker's name (copy from HL2 of the household listing form):
Name ____

UF6. Mother's / caretaker's ordinal number (copy from HL8 of the household survey form): _ _

UF7. Interviewer name and number
First-last name ____ _ _

UF8. Day / month / year of interview _ _ / _ _ / 2012

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 20-25 minutes. Again, all the information we obtain will remain strictly confidential and your answers will never be shared with anyone

May I start now?

UF9. Result of interview for children under 5
Codes refer to mother/caretaker.
UF12. Starting time of the interview.

Age: AG

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

The birth certificate is issued by the registrar after a birth report is sent to the district or municipality. If the parent/guardian has only a "birth report" issued by the delivering hospital, the child's birth was not yet registered.

BR1. Does (name) have a birth certificate?
If yes, ask: May I see it?

BR2. Has (name)'s birth been issued by the registrar at the district or municipality?

BR2A. Do you know that you have to report the birth and obtain a birth certificate for (name)?

BR2B. What is the main reason for not reporting the birth and obtain a birth certificate for (name)?

Early childhood development: EC

EC1. How many children's books or picture books does this household 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:

[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, do household chores 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?

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?

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?
(By natural mother or other women)
BF2. Is he/she still being breastfed?
(By natural mother or other women, at least once a day)
BF2A. For how many months has he/she ever been breastfed continuously?
(If less than 1 month record "00". If don't know record "98".)
BF3. I would like to ask you about liquids that (name) may have had in the past 24 hours (day and night). I am interested in whether (name) had the item even if it was combined with other foods.
Did (name) drink plain water?

BF4. Did (name) drink infant formula?

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

BF6. Did (name) drink tinned, boxed, powdered or fresh animal milk?

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

BF7A. Did (name) drink sweetened condensed milk?

BF7B. How many times did (name) drink sweetened condensed milk?

BF8. Did (name) drink juice or juice drinks?

BF9. Did (name) drink clear soup/clear broth?

BF10. Did (name) drink or eat vitamin or mineral supplements or any medicines such as fish liver oil, iron?

BF11. Did (name) drink ORS (oral rehydration salts)?

BF11A. Did (name) drink soda/sweetened drinks?

BF12. Did (name) drink any other liquids?

BF13. Did (name) drink or eat yogurt?

BF14. How many times did (name) drink or eat yogurt?

BF15. Did (name) eat rice porridge?

BF16. Did (name) eat solid or semi-solid (soft, mushy) food?

BF17. How many times did (name) eat solid or semi-solid (soft, mushy) food such as mashed rice or mashed banana?

BF18. Within last 24 hours (day and 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 (loose stools at least three times a day, bloody mucous in the stools at least once a day, or watery stool more than once a day)?

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?
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] Fluid from ORS packet?

[C] Health personnel recommended homemade fluid?

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. 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 health outlet) ____

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?
(Name of health outlet) ____

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?

Immunization: IM

If an immunization card is available, copy the dates in IM3 for each type of immunization recorded on the booklet. IM6-IM1 are for registering vaccinations that are not recorded on the booklet. IM6-IM17 will only be asked when a card is not available.

IM1. Do you have a booklet where (name)'s vaccinations are written down?
(If yes) May I see it please?

IM2. Did you ever have a vaccination booklet for (name)?

IM3. Date of Immunization

(a) Copy dates for each vaccination from the booklet.
(b) Write '44' in day column if booklet shows that vaccination was given but no date recorded.

BCG

Polio 1

Polio 2

Polio 3

Polio 4

Polio 5

DPT1

DPT2

DPT3

DPT4

DPT5

HepB at birth

HepB1

HepB2

HepB3

Measles

JapE 1

JapE 2

JapE 3

IM4. Check IM3. Are all vaccines (BCG to JapE 3) recorded?
IM5. In addition to what is recorded on this booklet, did (name) receive any other vaccinations from elsewhere that are not recorded, including vaccinations received in campaigns or immunization 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 vaccinations received in a campaign or immunization 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?

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

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 in the thigh or buttocks - 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 a DPT vaccine received?

IM13. Has (name) ever been given a Hepatitis B vaccination - that is, an injection in the thigh or buttocks - 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, or later?

IM15. How many times was a hepatitis B 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. Has (name) ever received a JE vaccine - to prevent him/her from getting Japanese encephalitis?

IM16B. How many times was a JE vaccine received?

IM19. Has (name) ever participated in a polio prevention campaign?

UF13. Ending time of interview (hours and minutes).
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 woman's, man's or under-5 questionnaires to be administered in this household.
Move to another woman's or under-5 questionnaire, or start making arrangements for anthropometric measurements of all eligible children in the 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 number:

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?

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________