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Mics Questionnaire for Children Under Five


Survey of the situation of children and women in Thailand, B.E. 2562

Under-five child information panel: UF

UF1. Cluster number: _ _ _

UF2. Household number: _ _

UF3. Child's name and line number:
Name ____ _ _

UF4. Mother's/caretaker's name and line number:
Name ____ _ _

UF5. Interviewer's name and number:
Name ____ _ _ _

UF6. Supervisor's name and number:
Name ____ _ _ _

UF7. Day/month/year of interview
_ _ / _ _ / 2562

UF8. Record the time:
Hours : minutes
_ _ : _ _


Check respondent's age in HL6 in list of household members, household questionnaire:
If age 15-17, verify that adult consent for interview is obtained (HH33 or HH39) or not necessary (HL20=90). If consent is needed and not obtained, the interview must not commence and '06' should be recorded in UF17. The respondent must be at least 15 years old.


UF9. Check completed questionnaires in this household: Have you or another member of your team interviewed this respondent for another questionnaire?

[] 1 Yes, interviewed already (Go to UF10B)
[] 2 No, first interview (Go to UF10A)

UF10A. Hello, my name is (your name). We are from National Statistical Office. 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. This interview will take about 20 minutes. All the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?
UF10B. Now I would like to talk to you about (child's name from UF3)'s health and well-being in more detail. This interview will take about 20 minutes. Again, all the information we obtain will remain strictly confidential and anonymous. If you wish not to answer a question or wish to stop the interview, please let me know. May I start now?

[] 1 Yes (Go to under five's background module)
[] 2 No/not asked (Go to UF17)

UF17. Result of interview for children under 5
Codes refer to mother/caretaker. Discuss any result not completed with Supervisor.
[] 01 Completed
[] 02 Not at home
[] 03 Refused
[] 04 Partly completed
[] 05 Incapacitated (specify) ____
[] 06 No adult consent for mother/caretaker age 15-17
[] 96 Other (specify) ____

Under-five's background: UB

UB0. Before I begin the interview, could you please bring (name)'s Birth Certificate Maternal and Child Health Handbook, and any immunisation record from a private health provider? We will need to refer to those documents.

UB1. On what day, month and year was (name) born?

Probe: What is (his/her) birthday? If the mother/caretaker knows the exact date of birth, also record the day; otherwise, record '98' for day. Month and year must be recorded.
Date of birth
_ _ Day
[] 98 DK day
_ _ Month
201 _ Year

UB2. 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. If responses to UB1 and UB2 are inconsistent, probe further and correct.
Age (in completed years) _

UB3. Check UB2: Child's age?
[] 1 Age 0, 1, or 2 (Go to UB9)
[] 2 Age 3 or 4

UB4. Check the respondent's line number (UF4) and the respondent to the household questionnaire (HH47):
[] 1 Respondent is the same, UF4=HH47
[] 2 Respondent is not the same, UF4 does not equal HH47 (Go to UB6)

UB5. Check ED10 in the education module in the household questionnaire: Is the child attending ECE in the current school year?
[] 1 Yes, ED10=0 (Go to UB8B)
[] 2 No, ED10 does not equal 0 or blank (Go to UB9)

UB6. Has (name) ever attended any early childhood education programme, such as Children's Development Centre, early childhood skills and development promotion school, public and private nursery school, etc.?

[] 1 Yes
[] 2 No (Go to UB9)

UB7. At any time since May 2562, did (he/she) attend (programmes mentioned in UB6)?

[] 1 Yes (Go to UB8A)
[] 2 No (Go to UB9)

UB8A. Does (he/she) currently attend (programmes mentioned in UB6)?
UB8B. You have mentioned that (name) has attended an early childhood education programme this school year. Does (he/she) currently attend this programme?

[] 1 Yes
[] 2 No

UB9. Is (name) covered by any health insurance?

[] 1 Yes
[] 2 No (Go to next module)

UB10. What type of health insurance is (name) covered by?

Record all mentioned.
[] A Community health insurance
[] B Health insurance through employer
[] D Private Health Insurance
[] E Universal health-care coverage scheme
[] F Government officer
[] G Local administrative organization
[] H State enterprises or independent agencies
[] X Other (specify) ____

Birth registration: BR

BR1. Does (name) have a birth certificate?

If yes, ask: May I see it?
[] 1 Yes, seen (Go to next module)
[] 2 Yes, not seen (Go to next module)
[] 3 No
[] 8 DK

BR2. Has (name)'s birth been registered with the civil authorities?

[] 1 Yes (Go to end of module)
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No

Early childhood development: EC

EC1. How many children's books or picture books do you have for (name)?

[] 00 None
[] _ Number of children's book
[] 10 Ten or more books

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?

[] 1 Yes
[] 2 No
[] 8 DK

[B] Toys from a shop or manufactured toys?

[] 1 Yes
[] 2 No
[] 8 DK

[C] Household objects, such as bowls or pots, or objects found outside, such as sticks, rocks, animal shells or leaves?

[] 1 Yes
[] 2 No
[] 8 DK

EC2D. Does (child's name) play with electronic devices such as mobile phones, tablets, game consoles?

[] 1 Yes
[] 2 No (Go to EC3)
[] 8 Don't know (Go to EC3)

EC2E. Normally, how many hours does (child's name) play with these electronic devices in a day?
If less than one hour, record '00'. If 'Don't know', record '98'.
_ _ Number of hours
[] 98 Don't know

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):
[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?
If 'None' record '0'. If 'Don't know' record '8'.

_ Number of days left alone for more than an hour
_ Number of days left with another child for more than an hour

EC4. Check UB2: Child's age?
[] 1 Age 0 or 1 (Go to next module)
[] 2 Age 2, 3 or 4

EC5. 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)?
A foster/step mother or father living in the household who engaged with the child should be coded as mother or father. Record all that apply. 'No one' cannot be recorded if any household member age 15 and above engaged in activity with child.

[A] Read books or looked at picture books with (name)?

[] A Mother
[] B Father
[] X Other
[] Y No one

[B] Told stories to (name)?

[] A Mother
[] B Father
[] X Other
[] Y No one

[C] Sang songs to or with (name), including lullabies?

[] A Mother
[] B Father
[] X Other
[] Y No one

[D] Took (name) outside the home?

[] A Mother
[] B Father
[] X Other
[] Y No one

[E] Played with (name)?

[] A Mother
[] B Father
[] X Other
[] Y No one

[F] Named, counted, or drew things for or with (name)?

[] A Mother
[] B Father
[] X Other
[] Y No one

EC5G. Check UB2: Child's age?
[] 1 Age 2 (Go to next module)
[] 2 Age 3 or 4

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.

EC6. Can (name) identify or name at least ten letters of the alphabet?

[] 1 Yes
[] 2 No
[] 8 DK

EC7. Can (name) read at least four simple, popular words?

[] 1 Yes
[] 2 No
[] 8 DK

EC8. Does (name) know the name and recognize the symbol of all numbers from 1 to 10?

[] 1 Yes
[] 2 No
[] 8 DK

EC9. Can (name) pick up a small object with two fingers, like a stick or a rock from the ground?

[] 1 Yes
[] 2 No
[] 8 DK

EC10. Is (name) sometimes too sick to play?

[] 1 Yes
[] 2 No
[] 8 DK

EC11. Does (name) follow simple directions on how to do something correctly?

[] 1 Yes
[] 2 No
[] 8 DK

EC12. When given something to do, is (name) able to do it independently?

[] 1 Yes
[] 2 No
[] 8 DK

EC13. Does (name) get along well with other children?

[] 1 Yes
[] 2 No
[] 8 DK

EC14. Does (name) kick, bite, or hit other children or adults?

[] 1 Yes
[] 2 No
[] 8 DK

EC15. Does (name) get distracted easily?

[] 1 Yes
[] 2 No
[] 8 DK

Child discipline: UCD

UCD1. Check UB2: Child's age?
[] 1 Age 0 (Go to next module)
[] 2 Age 1, 2, 3, 4

UCD2. Adults use certain ways to teach children the right behavior or to address a behavior problem. I will read various methods that are used. Please tell me if you or any other adult in your household has used this method with (name) in the past month.

[A] Took away privileges, forbade something (name) liked or did not allow (him/her) to leave the house.

[] 1 Yes
[] 2 No

[B] Explained why (name)'s behavior was wrong.

[] 1 Yes
[] 2 No

[C] Shook (him/her).

[] 1 Yes
[] 2 No

[D] Shouted, yelled at or screamed at (him/her).

[] 1 Yes
[] 2 No

[E] Gave (him/her) something else to do.

[] 1 Yes
[] 2 No

[F] Spanked, hit or slapped (him/her) on the bottom with bare hand.

[] 1 Yes
[] 2 No

[G] Hit (him/her) on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.

[] 1 Yes
[] 2 No

[H] Called (him/her) dumb, lazy or another name like that.

[] 1 Yes
[] 2 No

[I] Hit or slapped (him/her) on the face, head or ears.

[] 1 Yes
[] 2 No

[J] Hit or slapped (him/her) on the hand, arm, or leg.

[] 1 Yes
[] 2 No

[K] Beat (him/her) up, that is hit (him/her) over and over as hard as one could.

[] 1 Yes
[] 2 No

UCD3. Check UF4: Is this respondent the mother or caretaker of any other children under age 5 or a child age 5-14 selected for the questionnaire for children age 5-17?
[] 1 Yes
[] 2 No (Go to UCD5)

UCD4. Check UF4: Has this respondent already responded to the following question (UCD5 or FCD5) for another child?
[] 1 Yes (Go to next module)
[] 2 No

UCD5. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?

[] 1 Yes
[] 2 No
[] 8 DK/no opinion

Breastfeeding and dietary intake: BD

BD1. Check UB2: Child's age?
[] 1 Age 0, 1, or 2
[] 2 Age 3 or 4 (Go to next module)

BD2. Has (name) ever been breastfed?

[] 1 Yes
[] 2 No (Go to BD3A)
[] 8 DK (Go to BD3A)

BD3. Is (name) still being breastfed?

[] 1 Yes
[] 2 No (Go to BD3A)
[] 8 DK (Go to BD3A)

BD3A1. Yesterday, both during the day and night, how many times did (child's name) receive breast milk?

Number of times received breast milk: _ _

BD3A. Check UB2: Child's age?
[] 1 Age 0 or 1
[] 2 Age 2 (Go to next module)

BD4. Yesterday, during the day or night, did (name) drink anything from a bottle with a nipple?

[] 1 Yes
[] 2 No
[] 8 DK

BD5. Did (name) drink Oral Rehydration Salt solution (ORS) yesterday, during the day or night?

[] 1 Yes
[] 2 No
[] 8 DK

BD6. Did (name) drink or eat vitamin or mineral supplements or any medicines yesterday, during the day or night?

[] 1 Yes
[] 2 No
[] 8 DK

BD7. Now I would like to ask you about all other liquids that (name) may have had yesterday during the day or the night.
Please include liquids consumed outside of your home.
Did (name) drink (name of item) yesterday during the day or the night:

[A] Plain water?

[] 1 Yes
[] 2 No
[] 8 DK

[B] Juice or juice drinks?

[] 1 Yes
[] 2 No
[] 8 DK

[C] Clear broth, clear soup?

[] 1 Yes
[] 2 No
[] 8 DK

[D] Infant formula, such as Enfelac, Dumex, Hi-Q, S026, etc.?

[] 1 Yes
[] 2 No (Go to BD7[E])
[] 8 DK (Go to BD7[E])

[D1] How many times did (name) drink infant formula?

If 7 or more times, record '7'. If unknown, record '8'.
Number of times drank infant formula _

[E] Milk from animals, such as fresh, tinned, or powdered milk?

[] 1 Yes
[] 2 No (Go to BD7[ F])
[] 8 DK (Go to BD7[F])

[E1] How many times did (name) drink milk?

If 7 or more times, record '7'. If unknown, record '8'.
Number of times drank milk _

[F] Sugary drinks, such as carbonated soft drink, sweetened drinks, sweetened soy milk, tea and coffee?

[] 1 Yes
[] 2 No
[] 8 DK

[X] Any other liquids?

[] 1 Yes
[] 2 No (Go to BD7[8])
[] 8 DK (Go to BD7[8])

[X1] Record all other liquids mentioned.

(Specify) ____

BD8. Now I would like to ask you about everything that (name) ate yesterday during the day or the night. Please include foods consumed outside of your home.
Think about when (name) woke up yesterday. Did (he/she) eat anything at that time?
If 'Yes' ask: Please tell me everything (name) ate at that time. Probe: Anything else?
Record answers using the food groups below.

What did (name) do after that? Did (he/she) eat anything at that time?
Repeat this string of questions, recording in the food groups, until the respondent tells you that the child went to sleep until the next morning. For each food group not mentioned after completing the above ask: Just to make sure, did (name) eat (food group items) yesterday during the day or the night.

[A] Yogurt made from animal milk?

Note that liquid/drinking yogurt should be captured in BD7[E] or BD7[X], depending on milk content.
[] 1 Yes
[] 2 No (Go to BD8[B])
[] 8 DK (Go to BD8[B])

[A1] How many times did (name) eat yogurt?

If 7 or more times, record '7'. If unknown, record '8'.
Number of times ate yogurt _

[B] Any baby food, such as Cerelac, Nestle, PediaSure, etc.?

[] 1 Yes
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No
[] 8 DK

[F] Any dark green, leafy vegetables, such as Chinese kale, broccoli, spinach, ivy gourd, water spinach?

[] 1 Yes
[] 2 No
[] 8 DK

[G] Ripe mangoes or ripe papayas or cantaloupes, melons or peach?

[] 1 Yes
[] 2 No
[] 8 DK

[H] Any other fruits or vegetables, such as bananas, apples, guavas, rambutans, lychees, water chestnuts, cabbage, etc.?

[] 1 Yes
[] 2 No
[] 8 DK

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

[] 1 Yes
[] 2 No
[] 8 DK

[J] Any other meat, such as beef, pork, lamb, goat, chicken, duck or sausages made from these meats?

[] 1 Yes
[] 2 No
[] 8 DK

[K] Eggs?

[] 1 Yes
[] 2 No
[] 8 DK

[L] Fish or shellfish, either fresh or dried?

[] 1 Yes
[] 2 No
[] 8 DK

[M] Beans, peas, lentils or nuts, including any foods made from these?

[] 1 Yes
[] 2 No
[] 8 DK

[N] Cheese or other food made from animal milk?

[] 1 Yes
[] 2 No
[] 8 DK

[O] Crunchy snacks or semi-processed foods that are salty such as instant noodles?

[] 1 Yes
[] 2 No
[] 8 DK

[P] Sweets such as cakes, cookies, candy, Thai desserts?

[] 1 Yes
[] 2 No
[] 8 DK

[X] Other solid, semi-solid, or soft food?

[] 1 Yes
[] 2 No (Go to BD9)
[] 8 DK (Go to BD9)

[X1] Record all other solid, semi-solid, or soft food that do not fit food groups above.

(Specify) ____

BD9. How many times did (name) eat any solid, semi-solid or soft foods yesterday during the day or night?

If BD8[A] is 'Yes', ensure that the response here includes the number of times recorded for yogurt in BD8[A1]. If 7 or more times, record '7'.
_ Number of times
[] 8 DK

Immunisation: IM

IM2. Do you have the Maternal and Child Health handbook (the Pink Book), immunisation records from a private health provider or any other document where (name)'s vaccinations are written down?

[] 1 Yes, has only card(s) (Go to IM5)
[] 2 Yes, has only other document
[] 3 Yes, has card(s) and other document (Go to IM5)
[] 4 No, has no cards and no other document

IM3. Did you ever have the Maternal and Child Health handbook (the Pink Book) or immunisation records from a private health provider for (name)?

[] 1 Yes
[] 2 No

IM4. Check IM2:
[] 1 Has only other document, IM2=2
[] 2 Has no cards and no other document available, IM2=4 (Go to IM11)

IM5. May I see the Health Handbook (and/or) other document?

[] 1 Yes, only card(s) seen
[] 2 Yes, only other document seen
[] 3 Yes, card(s) and other document seen
[] 4 No cards and no other document seen (Go to IM11)

IM6.
(a) Copy dates for each vaccination from the documents.
(b) Write '44' in day column if documents show that vaccination was given but no date recorded


BCG

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

HepB (at birth)

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Polio (OPV) 1

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Polio (OPV) 2

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Polio (OPV) 3

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Polio (OPV) 4

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Polio (OPV) 5

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Polio (IPV)

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

DTP 1

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

DTP 2

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

DTP 3

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

DTP 4

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

DTP 5

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

HepB1

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

HepB2

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

HepB3

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

MMR/MR 1

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

MMR/MR 2

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Encephalitis 1

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Encephalitis 2

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

Encephalitis 3

Date of immunisation Day/month/year _ _ / _ _ / 25_ _

IM7. Check IM6: Are all vaccines (BCG to JE) recorded?

[] 1 Yes (Go to next module)
[] 2 No

IM9. In addition to what is recorded on the document(s) you have shown me, did (name) receive any other vaccinations including vaccinations received during the campaigns, immunisation days or child health days just mentioned?

[] 1 Yes
[] 2 No (Go to next module)
[] 8 DK (Go to next module)

IM10. Go back to IM6 and probe for these vaccinations.
Record '66' in the corresponding day column for each vaccine received. For each vaccination not received record '00' in day column.
When finished, go to end of module.
(Go to next module)

IM11. Has (name) ever received any vaccinations to prevent (him/her) from getting diseases?

[] 1 Yes
[] 2 No
[] 8 DK

IM13. Check IM11:
[] 1 no or DK (Go to next module)
[] 2 yes

IM14. Has (name) ever received a BCG vaccination against tuberculosis - that is, an injection in the arm or shoulder that usually causes a scar?

[] 1 Yes
[] 2 No
[] 8 DK

IM15. Did (name) receive a Hepatitis B vaccination - that is an injection on the outside of the thigh to prevent Hepatitis B disease - within the first 24 hours after birth?

[] 1 Yes, within 24 hours
[] 2 Yes, but not within 24 hours
[] 3 No (Go to IM16)
[] 8 DK (Go to IM16)

IM15A. How many times was the Hepatitis B received?

_ Number of times
[] 8 DK

IM16. Has (name) ever received any vaccination drops in the mouth to protect (him/her) from polio?
Probe by indicating that the first drop is usually given at birth and later at the same time as injections to prevent other diseases.
[] 1 Yes
[] 2 No (Go to IM26)
[] 8 DK (Go to IM26)

IM17. Were the first polio drops received in the first two weeks after birth?

[] 1 Yes
[] 2 No
[] 8 DK

IM18. How many times were the polio drops received?

_ Number of times
[] 8 DK

IM19. The last time (name) received the polio drops, did (he/she) also get an injection to protect against polio?
Probe to ensure that both were given, drops and injection.
[] 1 Yes
[] 2 No
[] 8 DK

IM26. Has (name) ever received a MMR/MR vaccine - that is, a shot in the arm at the age of 9 months or older - to prevent (him/her) from getting measles, mumps and rubella?

[] 1 Yes
[] 2 No (Go to IM29)
[] 8 DK (Go to IM29)

IM26A. How many times was the MMR vaccine received?

_ Number of times
[] 8 DK

IM29. Has (child's name) ever received a DTP vaccine, to prevent diptheria, tetanus, whooping cough, shot in the thigh, hip or upper arm?
Probe by indicating that sometimes it is shot at the same time as the polio vaccine.
[] 1 Yes
[] 2 No (Go to IM31)
[] 8 DK (Go to IM31)

IM30. How many times did (child's name) receive DTP vaccine?

_ Number of times
[] 8 DK

IM31. Has (child's name) ever received a encephalitis JE vaccine shot in the thigh, hip or upper arm?

[] 1 Yes
[] 2 No (Go to UF11)
[] 8 DK (Go to UF11)

IM32. How many times did (child's name) receive a JE vaccine?

_ Number of times
[] 8 DK

UF11. Record the time.
_ _ : _ _ Hours and minutes

UF12. Language of the Questionnaire.
[] 1 Thai
[] 2 English

UF13. Language of the Interview.
[] 1 Thai
[] 2 English
[] 6 Other language (specify) ____

UF14. Native language of the Respondent.
[] 1 Thai
[] 2 English
[] 3 Chinese
[] 4 Burmese
[] 5 Khmer / Kuy
[] 6 Malay / Jawi
[] 7 Lao
[] 8 Karen
[] 9 Hmong
[] 10 Lahu
[] 11 Mon
[] 12 Lawa
[] 13 Akha
[] 14 Nyeu
[] 15 Shan
[] 6 Other language (specify) ____

UF15. Was a translator used for any parts of this questionnaire?
[] 1 Yes, the entire questionnaire
[] 2 Yes, parts of the questionnaire
[] 3 No, Not used

UF16. Tell the respondent that you will need to measure the weight and height of the child before you leave the household and a colleague will come to lead the measurement. Issue the anthropometry module form for this child and complete the Information Panel on that Form.
Check columns HL10 and HL20 in list of household members, household questionnaire: Is the respondent the mother or caretaker of another child age 0-4 living in this household?
[] Yes (Go to UF17 on the under-five information panel and record '01'. Then go to the next questionnaire for children under five to be administered to the same respondent.)
[] No (Check HL6 and column HL20 in list of household members, household questionnaire: Is the respondent the mother or caretaker of a child age 5-17 selected for Questionnaire for Children Age 5-17 in this household?)

Interviewer's observations ________

Supervisor's observations ________

Anthropometry module information panel: AN

AN1. Cluster number: _ _ _

AN2. Household number _ _

AN3. Child's name and line number:
Name ____ _ _

AN4. Child's age from UB2:
Age (in completed years) _

AN5. Mother's/caretaker's name and line number:
Name ____ _ _

AN6. Interviewer's name and number
Name ____ _ _ _

Anthropometry

AN7. Measurer's name and number:
Name ____ _ _ _

AN8. Record the result of weight measurement as read out by the Measurer:
Read the record back to the Measurer and also ensure that he/she verifies your record.
_ _ . _ Kilograms (KG)
[] 99.3 Child not present (Go to AN13)
[] 99.4 Child refused (Go to AN10)
[] 99.5 Respondent refused (Go to AN10)
[] 99.6 Other (specify) ____ (Go to AN10)

AN9. Was the child undressed to the minimum?
[] 1 Yes
[] 2 No, the child could not be undressed to the minimum

AN10. Check AN4: Child's age?
[] 1 Age 0 or 1 (Go to AN11A)
[] 2 Age 2, 3, or 4 (Go to AN11B)

AN11A. The child is less than 2 years old and should be measured lying down. Record the result of length measurement as read out by the Measurer:
Read the record back to the Measurer and also ensure that he/she verifies your record.
AN11B. The child is at least 2 years old and should be measured standing up. Record the result of height measurement as read out by the Measurer:
Read the record back to the Measurer and also ensure that he/she verifies your record.
_ _ _ . _ Length/height (CM)
[] 999.4 Child refused (Go to AN12A)
[] 999.5 Respondent refused (Go to AN12A)
[] 999.6 Other (specify) ____ (Go to AN12A)

AN12. How was the child actually measured? Lying down or standing up?
[] 1 Lying down
[] 2 Standing up

AN12A. Was (child's name) weighed at birth?

[] 1 Weighed
[] 2 Not weighed (Go to AN12C)
[] 8 Don't know (Go to AN12C)

AN12B. What was the birth weight of (child's name)?
If the Health Handbook is available, record the weight as stated in the Handbook.
[] 1 From Health Handbook: (KG) _ . _ _ _
[] 2 From inquiry: (KG) _ . _ _ _
[] 9.998 DK

AN12C. Was (child's name) measured the length at birth?

[] 1 Measured
[] 2 Not measured (Go to AN13)
[] 8 Don't know (Go to AN13)

AN12D. What was the birth length of (child's name)?
If the Health Handbook is available, record the length as stated in the Handbook.
[] 1 From Health Handbook: (CM) _ . _ _ _
[] 2 From inquiry: (CM) _ . _ _ _
[] 99.98 DK

AN13. Today's date: Day/month/year:
_ _ / _ _ / 2562

AN14. Is there another child under age 5 in the household who has not yet been measured?

[] 1 Yes (Go to next child)
[] 2 No

AN15. Thank the respondent for his/her cooperation and inform your supervisor that the measurer and you have completed all the measurements in this household.

Interviewer's observations for anthropometry module ________

Measurer's observations for anthropometry module ________

Supervisor's observations for anthropometry module ________