Under--five Child information Panel

This questionnaire is to be administered to all mothers or caretakers (see household listing, column HL8) who care for a child that lives with them and is under the age of 5 years (see household listing, column HL5). A separate questionnaire should be used for each eligible child.
Fill in the cluster and household number, and names and line numbers of the child and the mother/caretaker in the space below. Insert your own name and number, and the date.

UF1. Cluster number: _ _ _

UF2. Household number: _ _ _

UF3. Child's name: ____

UF4. Child's line number: _ _

UF5. Mother's / caretaker's name: ____

UF6. Mother's/ caretaker's line number: _ _

UF7. Interviewer name and number: ____ _ _

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

UF9. Result of Interview for children under 5
Codes refer to mother/caregiver
Repeat greeting if not already read to this respondent:
We are the representatives of the State Statistics Committee of Ukraine. The state statistics committee and the United Nations children's fund (UNICEF) are currently undertaking a survey concerned with family health and education. We would like to pose you several questions. The interview will take about 45 minutes. Your experience in building your family life and bringing up your children will have big importance for the improvement of activities by the healthcare facilities and the social services in Ukraine. All the information we obtain will remain strictly confidential and your answers will never be identified. The information will be used only in the generalised form and only together with the responses of other Ukrainian families. You may abstain from responding to the questions that you do not like and are free to interrupt the interview any time you want. May I start now?
If permission is given, begin the interview. If the respondent does not agree to continue, thank him/her and go to the next interview. Discuss this result with your supervisor for a future revisit.

UF10: Now I would like to ask you some questions about the health of each child under the age of 5 in your care, who lives with you now. Now I want to ask you about (name). In what 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.
Date of Birth:

UF11: How old was (name) at his/her last birthday?
Record age in completed years.
Birth Registration and Early Learning Module: BR

BR1. Does (name) have a birth certificate? May I see it?

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

BR3. Why is (name's) birth not registered?

BR4. Do you know how to register your child's birth?

BR5. Check age of child in UF11: Child is 3 or 4 years old?
BR6. Does (name) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community child care?

BR7. Within the last seven days, about how many hours did (name) attend?

Child development: CE

Some questions in this module are to be administered only once for each household visited. Others require responses for each child in the household under the age of 5 years. Record only one response for each question, unless otherwise indicated.

CE1. How many children's books or picture books do you have for (name)?
If 'none' enter 00
CE2. How many other books are there in the household? (including schoolbooks, but not other books meant for children, such as picture books)
If 'none' enter 00
CE3. I am interested in learning about the things that (name) plays with when he/she is at home.
What does (name) play with? Does he/she play with

Code Y if child does not play with any of the items mentioned.

CE4. the past week, since last (day of the week) how many times was (name) left in the care of another child (that is, someone less than 10 years old)?
If 'none' enter 00

CE5. In the past week, how many times was (name) left alone?
If 'none' enter 00
CE6. Does the child visit kindergarten, day care centre, or participating in any kind of organized developmental activities (dancing, painting, sport, music lessons) for young children?

If no
CE6a. what is the reason?

Breastfeeding Module: BF

BF1. Has (name) ever been breastfeed?

BF2. Is he/she still being breast--fed?

BF2A. For how long (name) being breastfeed?

BF2B. When did you start to add other food to child diet?

BF2C. Have you ever received any support or counseling regarding breastfeeding?

BF2D. Who provided counselling on breastfeeding to you?

BF2E. Have you ever used breastmilk substitutes?

BF2F. Why did you start to use breastmilk substitutes?

BF3. Since this time yesterday, did he/she receive any of the following:
Read each item aloud and record response before proceeding to the next item









BF4. Check BF3H: Child received solid or semi--sold (mushy) food?
BF5. Since this time yesterday, how many times did (name) eat solid, semi--solid, or soft foods other than liquids? (if 7 or more times record 7)
Care of illness module: CA

CA14. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away?
Ask the following question (CA14) only once for each caretaker.
Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions