Viet Nam MICS 2014


Under-five child information panel: UF

This questionnaire is to be administered to all mothers or caretakers (see List of Household Members, column HL15) who care for a child that lives with them and is under the age of 5 years (see List of Household Members, column HL7B).
A separate questionnaire should be used for each eligible child.

UF0A. Province/city?s name and number: Name____ _ _

UF0B. District?s name and number: Name ____ _ _ _

UF0C. Commune/ward name and number ____ _ _ _ _ _

UF1. Cluster?s name and number: ____ _ _ _

UF2. Household number: _ _

UF3. Child's name: Name ____

UF4. Child's line number _ _

UF5. Mother's/caretaker's name:
UF6. Mother's/caretaker's line number: _ _

UF7. Interviewer's name and number:
UF8. Day/month/year of interview
Repeat greeting if not already read to this respondent:
My name is ____. We are from the General statistics 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. The interview will take about 40 minutes. All the information we obtain will remain strictly confidential and anonymous.

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 40 minutes. Again, all the information we obtain will remain strictly confidential and anonymous.

May I start now?

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

UF10. Field editor's name and number: Name ____ _ _

UF11. Main data entry clerk's name and number: Name ____ _

UF12. Record the time.
Age: AG

AG1. Now I would like to ask you some questions about the development and health of (name).
On what day, month and year according to western calendar 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

BR1. Does (name) have a birth certificate?
If yes, ask: may I see it?
BR2. Has (name)'s birth been registered with the people community?

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

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.
Does he/she play with:
If the respondent says "yes" to the categories above, then probe to learn specifically what the child plays with to ascertain the response.




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?

EC7. 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)?
Circle all that apply.







EC8. 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.
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 and dietary intake: BD

BD1. Check AG2: Age of child.
BD2. Has (name) ever been breastfed?

BD3. Is (name) still being breastfed?

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

BD5. Did (name) drink ORS (oral rehydration solution) yesterday, during the day or night?

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

BD7. Now I would like to ask you about (other) liquids that (name) may have had yesterday during the day or the night. I am interested to know whether (name) had the item even if combined with other foods.
Please include liquids consumed outside of your home.
Did (name) drink (name of item) yesterday during the day or the night:

[A] Plain water?

[B1] Juice from ripening fruits with yellow/orange inside, such as: mango, papaya. Strawberry, water mellon?
[B2] Other fruit juice?

[C] Rice soup/boiled water or clear broth from vegetables or meat without pieces and grains fibers?

[D] Milk such as tinned, powdered, or fresh animal milk?

[E] Infant formula?

[F] Any other liquids?
(Specify) ____

BD8. Now I would like to ask you about (other) foods that (name) may have had yesterday during the day or the night. Again, I am interested to know whether (name) had the item even if combined with other foods. Please include foods consumed outside of your home.
Did (name) eat (name of food) yesterday during the day or the night:


[A] Yogurt?
If yes: How many times did (name) drink or eat yogurt? If 7 or more times, record '7'. If unknown, record '8'.

[B] Any kind of powder, cake, supplementation food such as cerelac, dielac, hipp, nin, alpha, nesle?

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

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

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

[F] Any dark green, leafy vegetables?

[G] Ripe mangoes or papayas?

[H] Any other fruits or vegetables?

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

[J] Any meat, such as beef, pork, lamb, goat, chicken, or duck?

[K] Eggs?

[L] Fresh or dried fish or shellfish?

[M] Any foods made from beans, peas, lentils, or nuts?

[N] Cheese or other food made from milk?

[O] Any other solid, semi-solid, or soft food that I have not mentioned? (Specify) ____

BD9. Check BD8 (Categories "A" through "O").
BD10. Probe to determine whether the child ate any solid, semi-solid or soft foods yesterday during the day or night.
BD11. How many times did (name) eat any solid, semi-solid or soft foods yesterday during the day or night?
If 7 or more times, record '7'.
Immunization: IM

If an immunization (child health) card is available, copy the dates in IM3 for each type of immunization and Vitamin A recorded on the card. IM6-IM17 will only be asked if 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. If no, whether vaccination card is kept at health center?

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

IM3.

(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.

BCG

Polio 1

Polio 2

Polio 3

Pentavalent 1

Pentavalent 2

Pentavalent 3

DPT 1

DPT 2

DPT 3

HepB at birth

HepB 1

HepB 2

HepB 3

Hib 1

Hib 2

Hib 3

Measles (or MMR or MR)

Vitamin A (first dose)

Vitamin A (second dose)

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 vaccinations received in campaigns or immunization days or child health days?

IM6. Has (name) ever received any vaccinations to prevent him/her from getting diseases, including vaccinations received in a campaign or immunization day or child health 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 polio?

IM10. How many times was the polio vaccine received?

IM10A. Has (name) ever received a pentavalent vaccination, that is an injection in the thigh, to prevent him/her from getting DPT, Hep B and Hib B?
Probs by indicating that this vaccination is sometimes called as 5 in 1.
IM10B. How many times was the pentavalent vaccine received?

IM11. Has (name) ever received a DPT vaccination - that is, an injection in the 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.
IM12. How many times was the DPT vaccine received?

IM13. Has (name) ever received a Hepatitis B vaccination - that is, an injection in the thigh 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?

IM15. How many times was the Hepatitis B received?

IM15A. Has (name) ever received a Hib vaccination - that is, an injection in the thigh to prevent him/her from getting haemophilus influenzae type B?
Probe by indicating that the Hib vaccine is sometimes given at the same time as Polio and DPT vaccines.
IM15B. How many times was the Hib vaccine received?

IM16. Has (name) ever received a measles injection (or an MMR or MR) - that 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, national immunization days and/or vitamin a or child health days:
[A] June 2013 Vitamin A campaign

[B] December 2012/2013 Vitamin A campaign

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?
CA3A. Did you seek any advice or treatment for the diarrhoea from any source?

CA3B. 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) ____

CA4. During the time (name) had diarrhoea, was (name) given to drink:
Read each item aloud and record response before proceeding to the next item.

[A] A fluid made from a special packet oral rehydration solution (ORS)?

[B] A pre-packaged ORS fluid for diarrhoea?

CA4A. Check CA4: ORS.
CA4B. Where did you get the ORS?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CA4C. During the time (name) had diarrhoea, was (name) given:

[A] Zinc tablets?

[B] Zinc syrup?

CA4D. Check CA4C: Any zinc?
CA4E. Where did you get the zinc?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CA4F. During the time (name) had diarrhoea, was (name) given to drink any of the following:
Read each item aloud and record response before proceeding to the next item.
[A] Water from rice porridge/rice soup (with salt)?

[B] Lemon orange/coconut drink?

[C] Soup water from boiled vegetables/meat?

[D] Water from fried and boiled rice?

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. At any time during the illness, was (name) given any medicine for the 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) ____

CA13A. Check CA13: Antibiotic mentioned (codes I or J)?
CA13B. Where did you get the antibiotics?
Probe to identify the type of source. If unable to determine whether public or private, write the name of the place.
(Name of place) ____

CA14. Check AG2: Age of child.
CA15. The last time (name) passed stools, what was done to dispose of the stools?

UF13. Record the time
UF14. Check List of Household Members, columns HL7B and HL15.
Is the respondent the mother or caretaker of another child age 0-4 living in this household?
Thank you for answering the questions. Could you please give us your telephone number in case we might need some more information? We do not use or share your number for any other purposes.
Telephone number: ____

Interviewer's observations ________

Field editor's observations ________

Supervisor's observations ________




Viet Nam MICS 2014


Under-five child information panel: HF

This questionnaire form is to be used at commune health centers to record information on the vaccinations and Vitamin A supplementation for children age 0-2 years. A separate questionnaire form should be used for each eligible child. The questionnaire for children under five must be completed for the child prior to completing this form. This panel should be completed before visiting the health facility. This questionnaire form must be appended to the questionnaire for children under five for each child.

HF0A. Province/city?s name and number: Name____ _ _

HF0B. District?s name and number: Name ____ _ _ _

HF0C. Commune/ward name and number ____ _ _ _ _ _

HF1. EA?s name and number: ____ _ _ _

HF2. Household number: _ _

HF3. Child's name: Name ____

HF4. Child's line number: _ _

HF5. Mother?s/caretaker?s name: Name ____

HF6. Mother?s/caretaker?s line number: _ _

HF7. Interviewer?s name and number: ____ _ _ _

HF8. Day/month/year of facility visit:
HF9. Day, month and year of birth (from AG1 in questionnaire for children under 5):
HF10. Tel. no. of com. health center: ____

HF10A. Name of health staff: ____

HF10B. Tel. no. of health staff: ____

HF11. Result of health facility visit

HF11A. Field editor?s name and number: ____ _ _ _

HF11B. Main data entry clerk?s name and number: ____ _ _ _

Immunization: HI

HF12. Record day, month and year of birth as written on vaccination record
HF13.
(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.


BCG

Polio at birth

Polio 1

Polio 2

Polio 3

Pentavalent 1

Pentavalent 2

Pentavalent 3

DPT 1

DPT 2

DPT 3

HepB at birth

HepB 1

HepB 2

HepB 3

Hib 1

Hib 2

Hib 3

Measles (or MMR or MR)

Vitamin A (first dose)

Vitamin A (second dose)

Observations: ____




Viet Nam MICS 2014


15 Years old and over household members information panel: HF

This questionnaire form must be completed after the completion of the household characteristic module. This questionnaire form must be appended to the household questionnaire.

MP0A. Province/city?s name and number: Name____ _ _

MP0B. District?s name and number: Name ____ _ _

MP0C. Commune/ward name and number ____ _ _ _ _ _

MP1. Cluster?s name and number ____ _ _ _

MP2. Household number _ _

List of provinces

MDCP: MP

In MP3 copy each line number (HL1) of persons 15 years old and older (refer to HL6). Next in MP4 copy names from HL2 corresponding to these line numbers. Ask questions starting with MP5 for each person at a time.

MP3. Line number _ _

MP4. Name (copy from HL2) ____

MP5. In which province has (name) registered for residency?

MP6. In the last 12 months has (name) worked for income?
Probe: Worked for wage/salary, household production or service in planting, breeding, forestry, or aquaculture, or trading/business for household?
MP7. What is the main reason (name) has not worked in the last 12 months?