child code from board
respondent code from board
Date of visit
Interviewer
Start time of module, hour
Start time of module, minute
Child's YEAR of birth
Child's MONTH of birth
Child's DAY of birth
Childs age, NUMBER
Childs age, UNITS
Where was this child born?
Where was this child born? OTHER, SPECIFY
Who helped with delivery of child? GOV'T_DOCTOR
Who helped with delivery of child? PRIVATE_DOCTOR
Who helped with delivery of child? ANM
Who helped with delivery of child? NURSE/COMPOUNDER
Who helped with delivery of child? DAIMA,_UNTRAINED
Who helped with delivery of child? TBA_(SEVA_MANDIR/OTHER_NGO)
Who helped with delivery of child? VHW/CHW_(SEVA_MANDIR/OTHER_NGO)
Who helped with delivery of child? HRW/BHOPA/TRADITIONAL_HEALER
Who helped with delivery of child? FAMILY_MEMBER
Who helped with delivery of child? OTHER
Who helped with the delivery of this child? OTHER, SPECIFY
Do you have an immunization card for this child? May I see it?
Has this child received the BCG immunization?
Where did this child receive the BCG immunization?
Has this child received the DPT immunization?
Where did this child receive the DPT immunization?
Has this child received the OPV immunization?
Where did this child receive the OPV immunization?
Has this child received the measles vaccine?
Where did this child receive the measles vaccine?
Has this child received the pulse polio immunization?
Where did this child receive the pulse polio immunization?
Was this child ever breast-fed?
Is this child still being breast-fed?
For how many months was this child breast-fed?
Does the child take any other drink or food in addition to being breast-fed?
For how many months was the child breast-fed with no other drink and food?
Is he/she studying this year or going to an angawadi/balwadi?
yesno
Why is he/she not in school this year? TOO_YOUNG
Why is he/she not in school this year? TOO_OLD/FINISHED
Why is he/she not in school this year? ILL/DISABLED
Why is he/she not in school this year? PREGNANT/HAS_CHILD
Why is he/she not in school this year? SCHOOL_TOO_HARD
Why is he/she not in school this year? NO_MONEY_FOR_FEES
Why is he/she not in school this year? NEEDED_TO_EARN_MONEY
Why is he/she not in school this year? NO_SCHOOL_LOCALLY
Why is he/she not in school this year? NO_ACCOMMODATION
Why is he/she not in school this year? LOST_INTEREST
Why is he/she not in school this year? TEACHER_BEATS
Why is he/she not in school this year? LACK_OF_TEACHING
Why is he/she not in school this year? HOUSEWORK
Why is he/she not in school this year? PARENTS_NOT_INTERESTED
Why is he/she not in school this year? OTHER
Why is he/she not in school this year? OTHER, SPECIFY
Which type of school is he/she attending?
Which type of school is he/she attending? OTHER, SPECIFY
In which class is he/she studying?
In which activities in anganwadi does child participate? NUTRITION
In which activities in anganwadi does child participate? PRE-SCHOOL_ACTIVITES
In which activities in anganwadi does child participate? HEALTH_CHECK_UP
In which activities in anganwadi does child participate? IMMUNIZATION
In which activities in anganwadi does child participate? OTHER,_SPECIFY
Is this child retarded?
Is this child handicapped?
How would you classify your child's health these days? (LADDER: 10-high, 1-low)
Has this child experienced COLD_SYMPTOMS in the last 30 days?
Was COLD_SYMPTOMS serious?
Has this child experienced COUGH in the last 30 days?
Was COUGH serious?
Has this child experienced HOT_FEVER in the last 30 days?
Was HOT_FEVER serious?
Has this child experienced DIARRHEA in the last 30 days?
Was DIARRHEA serious?
Has this child experienced WEAKNESS in the last 30 days?
Was WEAKNESS serious?
Has this child experienced VOMITING in the last 30 days?
Was VOMITING serious?
Has this child experienced WORMS_IN_STOOL in the last 30 days?
Was WORMS_IN_STOOL serious?
Has this child experienced TROUBLE_BREATHING in the last 30 days?
Was TROUBLE_BREATHING serious?
Has this child experienced PAIN_IN_ABDOMEN in the last 30 days?
Was PAIN_IN_ABDOMEN serious?
Has this child experienced SKIN_PROBLEMS in the last 30 days?
Was SKIN_PROBLEMS serious?
Has this child experienced OTHER_SYMPTOMS in the last 30 days?
Was OTHER_SYMPTOMS serious?
Has this child experienced OTHER SYMPTOMS in the last 30 days? SPECIFY
CP: Was there any condition checked in I5.0?
Did you consult anyone about conditions child experienced in the last 30 days?
How many times did you consult someone about these conditions this child experie
Who did you consult?
Who did you consult? OTHER, SPECIFY
Was this facility/health provider public or private?
What is the name of the facility or health provider?
Where is this facility located? VILLAGE/TOWN
Where is this facility located? TEHSIL
Where is this facility located? DISTRICT
Where is this facility located? STATE
How may days ago was this consultation?
CP: Was it more than 30 days ago?
Was anyone from this household with the child during this consultation?
Who was with you? (CODE NUMBER FROM BOARD)
which condition(s) was the visit for?
CP: Was it a consultation with a bhopa?
Did you get CONSULTATION at this visit?
Did you pay for CONSULTATION at this visit?
How much did you pay for CONSULTATION?
Did you get MEDICATION_GIVEN_IN_FACILITY at this visit?
Did you pay for MEDICATION_GIVEN_IN_FACILITY at this visit?
How much did you pay for MEDICATION_GIVEN_IN_FACILITY?
Did you get MEDICATION_BOUGHT_OUTSIDE_THE_FACILITY at this visit?
Did you pay for MEDICATION_BOUGHT_OUTSIDE_THE_FACILITY at this visit?
How much did you pay for MEDICATION_BOUGHT_OUTSIDE_THE_FACILITY?
Did you get INJECTION at this visit?
Did you pay for INJECTION at this visit?
How much did you pay for INJECTION?
Did you get DRIP at this visit?
Did you pay for DRIP at this visit?
How much did you pay for DRIP?
Did you get OPERATION at this visit?
Did you pay for OPERATION at this visit?
How much did you pay for OPERATION?
Did you get LAB_TEST at this visit?
Did you pay for LAB_TEST at this visit?
How much did you pay for LAB_TEST?
Did you get OTHER_TREATMENT at this visit?
Did you pay for OTHER_TREATMENT at this visit?
How much did you pay for OTHER_TREATMENT?
Did you get ROUND_TRIP_TRANSPORTATION at this visit?
Did you pay for ROUND_TRIP_TRANSPORTATION at this visit?
How much did you pay for ROUND_TRIP_TRANSPORTATION?
How much in TOTAL did you pay for the visit?
Did the child get any jalibuti or any other treatment?
How much did this visit to the bhopa cost you in total?
After this consultation did the child feel better?
CP: Was any medication/treatment received/prescribed at this consultation?
Did this child finish the medicine/treatment?
Why did this child interrupt the medicine/treatment?
CP: Did child have any other consultation in the last 30 days?
Facility code
CP: Are there any conditions in E5.0 for which you did not seek consultation?
Why did you not seek consultation for those conditions?
Did you/anyone else give child treatment w/out consulting health provider first?
For which conditions did you/anyone else treat child w/out consultation first?
Did you give TABLETS/BOTTLED_MEDICINE to child w/out consultation first?
Did you give HOME_REMEDY to child w/out consultation first?
Did you give JALI_BUTI to child w/out consultation first?
Did you give OTHER_TREATMENT to child w/out consultation first?
Did you give OTHER TREATMENT to child w/out consultation first? SPECIFY
Why treat child w/out consultation first? ADVISED_BY_FAMILY_MEMBER
Why treat child w/out consultation first? ADVISED_BY_NEIGHBOR/FRIEND
Why treat child w/out consultation first? PAST_EXPERIENCE
Why treat child w/out consultation first? OTHER
Why treat child w/out consultation first? OTHER, SPECIFY
How much did you pay for treatment undertaken w/out consultation first?
Has this child  ever been tested for Tuberculosis (TB)?
Has this child you ever been diagnosed with Tuberculosis (TB)?
When was the first time that you were told your child  had TB?
In last 12 months, has child received any medication/treatment for TB from...?
CP: Has the child suffered from cough in last 30 days?
Is your child still suffering from cough?
Has the cough been continuing for more than past two weeks?
End time of module, hour
End time of module, minute
Did you have to go back a second time?
When did you go back? DAY
When did you go back? MONTH
When did you go back? YEAR
Start time of module, hour (day two)
Start time of module, minute (day two)
End time of module, hour (day two)
End time of module, minute (day two)
Comprehension level of respondent
Cooperation level of respondent
How much did others assist the respondent with his/her answers?
Who was helping respondent with his/her answers? (CODE NUMBER IF IN HH)
Who was helping respondent with his/her answers? name
DAY of health measurements
MONTH of health measurements
YEAR of health measurements
Height of respondent (cm)
Weight of the respondent (Kg)
Is the child wearing any heavy item?
Is the child wearing ANKLETS?
Is the child wearing NECKLACE?
Is the child wearing HEAVY_BRACELETS?
Is the child wearing OTHER_HEAVY_ITEM?
Hb (g/dl)
Body temperature (Celsius)
How much time does it take the respondent to squat and stand up 5 times? (sec)
Pick flow meter reading 1 (L/min)
Pick flow meter reading 2 (L/min)
Pick flow meter reading 3 (L/min)
Total number of hh members
Village/Hamlet ID number
Household/person weight: strata pop / strata sample pop