Part 3, Section A: Birth Registration and Early Learning BR

The information of each under 5 child is to be filled in each following column. This part is to be administered to all mothers or caretakers for the child. Fill in the names and line numbers of the child and the respective mother/caretaker as indicated in the household listing.

Child no.: ____
Child name: ____
Mother/PCT No.: ____
Mother/PCT name: ____

UF10: What is the birthday of (name)? _ _ / _ _ / _ _
Record 98 if day is not known. Month and year of birth need to be entered.

UF11: How old was (name) at his/her last birthday?
Record age in completed years.
Child no.: ____
Child name: ____
Mother/PCT No.: ____
Mother/PCT name: ____

BR1. Does (name) have a birth certificate? May I see it?
If birth certificate is given, check the birthdate. If birth certificate is not given, refer to other documents (e.g. health card, etc.) Correct the given birthdate, if necessary.
BR2. Has (name's) birth been registered with the concerned authorities?

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

BR4. Do you know how to register (name's) birth?

BR5. Interviewer check the age recorded in UF11, if the child is under 3 years old? (go to BR8)

BR6. Does (name) attend any private or public kindergarten or community child care?

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

BR8. In the past 3 days, did you or any member of your household 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 answers given







Part 3, Section B: Child development CE

Child no.: ____
Child name: ____

CE1. How many books are there in the household? Please include school textbooks, but exclude other children books such as picture books
If 'none' enter 00. If 10 or more books, enter '10'
CE2. How many children's books or picture books do you have for (name)?
If 'none' enter 00
CE3. I am interested in learning about the things that (name) plays with when he/she is at home?

If the respondent says "YES" to any of the prompted categories, then probe to learn specifically what the child plays with to ascertain the response

CE4. Within the last 7 days, how many times was (name) left in the care of another child who is less than 10 years old?
If 'none' enter 00
CE5. Within the last 7 days, how many times was (name) left alone?
If 'none' enter 00
Part 3, Section C: Vitamin A VA

Child no.: ____
Child name: ____

VA1 . Has (name) ever received a vitamin A capsule (supplement) like this one?

VA2. How many months ago did (name) take the last Vitamin A dose?
Record completed months.
VA3. Where did (name) get this last vitamin A dose?

Part 3, Section D: Breastfeeding BF

Child no.: ____
Child name: ____

BF1. Has (name) ever been breastfeed?

BF2. Is (name) still being breastfed?

BF3. Since this time yesterday, did (name) receive any of the following:
Read each item from 3A to 3H and record response before proceeding to the next item









BF4. Check BF3H: Child received solid or semi--sold (mushy) food? If "no" or "don't know" (go to section 3E)

BF5. Since this time yesterday, how many times did (name) eat solid, semisolid foods? If 7 or more times enter 7. If do not know, enter 8.
Part 3, Section E: Care of illness CA

Child no.: ____
Child name: ____

CA1. Has (name) had diarrhea in the last two weeks?
Three or more loose or watery stools per day, or blood in stool.
CA2. During this last episode of diarrhea, did (name) drink any of the following: Read aloud each item and record response before proceeding to the next item.










CA3. During (name's) illness did (name) drink less, about the same, or more than usual?

CA4. During (name's) illness, did (name) eat less, about the same, or more food than usual?
If "less", probe by asking: much less or a little less?
CA5. In the last two weeks, has (name) had an illness with a cough at any time?

CA6. When (name) had an illness with a cough, did he/she breathe faster than usual with short, quick breaths or have difficulty breathing?

CA7. Were the symptoms due to a problem in the chest or a blocked nose?

CA8. Did you seek advice or treatment for the illness outside the home?

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CA9. From where did you seek advice or treatment for the illness (no suggestion by interviewer is allowed)?
Circle all items given.
CA10. Was (name) given medicine to treat this illness?

CA11. What medicine was (name) given?
Circle all items given
CA12. Check UF11: (name) aged under 3?
CA13. The last time (name) passed stools, what was done to dispose of the stools?

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 only once to each mother/primary caretaker.
Keep asking for more signs or symptoms until the mother/primary caretaker cannot recall any additional symptoms. Circle all items given. Do not prompt with any suggestions
Part 3, Section F: Malaria of children under 5 ML

Child no.: ____
Child name: ____

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

ML2. Was (name) seen at a health facility during this illness?

ML3. Did (name) take a medicine for treatment of fever or malaria that was provided or prescribed at the health facility?

ML4. What medicine did (name) take that was provided or prescribed at the health facility?
Circle all medicines mentioned.
ML5. Was (name) given medicine for treatment of fever or malaria before being taken to the health facility?

ML6. Was (name) given medicine for treatment of fever or malaria during this illness?

ML7. What medicine was (name) given?
Circle all medicines given.
ML8. Check ML4 and ML7: Anti-malaria mentioned (item A to H)?
ML9. How long after the fever started did (name) first take (name of anti-malarial from ML4 or ML7)?
If multiple anti-malarials mentioned in ML4 or ML7, name all anti-malarial medicines mentioned. Record the code for the day on which the first anti--malarial was given.
ML10. Last night, did (name) sleep under a mosquito net?

Part 3, Section G: Immunization IM

If vaccination card is available and the interviewer can see it, copy the dates in IM2-IM8 for each type of immunization or vitamin A dose recorded on the card. IM10-IM18 are for recording vaccinations that are not recorded on the card. IM10-IM18 will only be asked when a card is not available.

Child no.: ____
Child name: ____

IM1. Is there a vaccination card recording vaccination injected and medicine received for (name)?

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.














IM9. In addition to the vaccinations and vitamin A shown on this card, did (name) receive any other vaccinations?

IM10. Has (name) ever received any vaccinations, including vaccinations received in a campaign or immunization day?

IM11. Has (name) ever been given a BCG vaccination against tuberculosis -- that is, an injection often in the left shoulder that caused a scar?

IM12. Has (name) ever been given any "vaccination drops in the mouth" to protect him/her from getting polio disease?

IM14. How many times was (name) given this vaccination?

IM15. Has (name) ever been given DPT vaccination? (Sometimes given at the same time of anti-polio vaccination)

IM16. How many times was (name) given vaccination?

IM17. Has (name) ever been given Measles vaccination? (This vaccination injection is a shot in the arm at the age of 9 months or older -- to prevent him/her from getting measles?

IM19. Please tell me if (name) has participated in any of the following campaigns, immunization day of vitamin A day?




Interviewer check and interview the next mother/primary caretaker for the next U5 children (if any). If information of all U5 children have been collected, interviewer fill in the question 1A.