WOMAN’S INFORMATION PANEL.................................WM This questionnaire is to be administered to all women age 15 through 49 (see list of household members, HH survey HL1-HL6). One questionnaire should be used for each eligible woman. Province ............................. District ................................. Village ............................. Code: __ __ Code: __ __ Code: __ __ ___ Cluster Code: __ __ __ __ WM1. Household Listing Number: WM2. Household number (within cluster): __________________________ ___ ___ ___ ___ ___ WM3. Woman’s name (HL2): WM4. Woman’s line number (HL1): Name ___ ___ WM5. Interviewer’s name and number: WM6. Day / Month / Year of interview: Name......................................................... ___ ___ /___ ___ / 2 0 1 ___ Repeat greeting if not already read to this woman: WE ARE FROM THE NATIONALSTATISTICS CENTREAND MINISTRY OF HEALTH. WE ARE CONDUCTING A SURVEY ABOUT THE SITUATION OF CHILDREN, FAMILIES AND HOUSEHOLDS. I WOULD LIKE TO TALK TO YOU ABOUT THESE SUBJECTS. THE INTERVIEW WILL TAKE ABOUT 50 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 woman, then read the following: NOW I WOULD LIKE TO TALK TO YOU MORE ABOUT YOUR HEALTH AND OTHER TOPICS. THIS INTERVIEW WILL TAKE ABOUT 50 MINUTES. AGAIN, ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND ANONYMOUS. MAY I START NOW? Yes, permission is given Go to WM10 to record the time and then begin the interview. No, permission is not given Circle “03” in WM7. Discuss this result with your supervisor. WM7. Result of woman’s interview Completed...........................01 Not at home.........................02 Refused.............................03 Partly completed....................04 Incapacitated.......................05 Other (specify).....................96
Transcript
WOMAN’S INFORMATION PANEL..................................................................WMThis questionnaire is to be administered to all women age 15 through 49 (see list of household members, HH survey HL1-HL6). One questionnaire should be used for each eligible woman.
Province ............................. District ................................. Village .............................Code: __ __ Code: __ __ Code: __ __ ___
Repeat greeting if not already read to this woman:
WE ARE FROM THE NATIONALSTATISTICS CENTREAND MINISTRY OF HEALTH. WE ARE CONDUCTING A SURVEY ABOUT THE SITUATION OF CHILDREN, FAMILIES AND HOUSEHOLDS. I WOULD LIKE TO TALK TO YOU ABOUT THESE SUBJECTS. THE INTERVIEW WILL TAKE ABOUT 50 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 woman, then read the following:
NOW I WOULD LIKE TO TALK TO YOU MORE ABOUT YOUR HEALTH AND OTHER TOPICS. THIS INTERVIEW WILL TAKE ABOUT 50 MINUTES. AGAIN, ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND ANONYMOUS.
MAY I START NOW?Yes, permission is given Go to WM10 to record the time and then begin the interview.
No, permission is not given Circle “03” in WM7. Discuss this result with your supervisor.
WM7. Result of woman’s interview Completed.............................................................01Not at home...........................................................02Refused.................................................................03Partly completed...................................................04Incapacitated.........................................................05
Other (specify).......................................................96
WM8. Field Editor name and number:
Name___________________________ __ __
WM9. Main data entry clerk’s name and number:
Name__________________________________ __ __
WM10. Record the time. Hour and minutes __ __ : __ __
WB6. WHAT IS THE HIGHEST GRADE YOU COMPLETED AT THAT LEVEL?Primary………………………….. 11-15lower sec………………………... 21-24upper sec……………………….. 31-33post sec, vocational/ diploma …. 41-43tertiary edu or higher……………..51-57DK…………...………………………...98
Grade:
If less than 1 grade at this level, enter “00”
Grade __ __
WB7. Check WB5:
...................................................... Secondary or higher (WB5=2, 3, 4, 5) Go to Next Module.
..................................................................................... Primary (WB5=1) Continue with WB8.
WB8. NOW I WOULD LIKE YOU TO READ THIS SENTENCE TO ME.
Show sentence on the card to the respondent.If respondent cannot read whole sentence, probe:
CAN YOU READ PART OF THE SENTENCE TO ME?
SIMPLE SENTENCES FOR LITERACY TEST:THE CHILD IS READING A BOOK.THE RAIN CAME LATE THIS YEAR.PARENTS MUST CARE FOR THEIR CHILDREN.FARMING IS HARD WORK.
Cannot read at all……………………..….1Able to read only parts of sentence…….2Able to read whole sentence……………3
No sentence in required language……...4(specify language)
_____________________
Blind / mute, visually/speech impaired….5
ACCESS AND USE OF INFORMATION TECHNOLOGY AND KNOWLEDGE .........................(IK)
IK1. Check WB8:
....... If no answer (If respondent has secondary or higher education) Continue with IK2.
......... Able to read or no sentence in required language (WB8 = 2, 3 or 4) Continue with IK2.
................................... Cannot read at all or blind/visually impaired (WB8 = 1 or 5) Go to IK3.
IK2. HOW OFTEN DO YOU READ A NEWSPAPER OR MAGAZINE: ALMOST EVERY DAY, AT LEAST ONCE A WEEK, LESS THAN ONCE A WEEK OR NOT AT ALL?
Almost every day (4-7 days/wk)................1At least once a week (1-3 days/wk)...........2Less than once a week..............................3Not at all....................................................4
IK3. DO YOU LISTEN TO THE RADIO ALMOST EVERY DAY, AT LEAST ONCE A WEEK, LESS THAN ONCE A WEEK OR NOT AT ALL?
Almost every day (4-7 days/wk)................1At least once a week (1-3 days/wk)...........2Less than once a week..............................3Not at all....................................................4
IK4. HOW OFTEN DO YOU WATCH TELEVISION: WOULD YOU SAY THAT YOU WATCH ALMOST EVERY DAY, AT LEAST ONCE A WEEK, LESS THAN ONCE A WEEK OR NOT AT ALL?
Almost every day (4-7 days/wk)................1At least once a week (1-3 days/wk)...........2Less than once a week..............................3Not at all....................................................4
IK5. HAVE YOU EVER SEEN, HEARD, OR READ ANYTHING ABOUT BREASTFEEDING IN THE MEDIA OR ANYWHERE ELSE, NOT INCLUDING ‘WORD OF MOUTH’?
IK6. WHEN DID YOU SEE, HEAR, OR READ ANYTHING ABOUT BREASTFEEDING IN THE MEDIA OR ANYWHERE ELSE, NOT INCLUDING WORD OF MOUTH?
In the past month.......................................1One to six months ago...............................2Six months to one year ago.......................3More than one year ago............................4
IK7. PLEASE NAME ALL OF THE SOURCES OF INFORMATION WHERE YOU SAW OR HEARD A MESSAGE ON BREASTFEEDING, NOT INCLUDING ‘WORD OF MOUTH’
First, ask without probing and circle spontaneous responses. For all sources not mentioned, probe and circle aided or no.
Spontaneous
Aided No
[A] On the radio
1 4 2
[B] On the television
1 4 2
[C] On the internet
1 4 2
[D] Newspaper
1 4 2
[E] In a magazine
1 4 2
[F] On a poster
1 4 2
[G] On a billboard / sign
1 4 2
[H] In a pamphlet / brochure
1 4 2
[I] Village voice announce
1 4 2
If TV is mentioned, go to IK8, if no TV is mentioned, go to IK9.
IK8. PLEASE NAME ALL OF THE TELEVISION STATIONS WHERE YOU SAW A MESSAGE ON BREASTFEEDING
Lao Star.....................................................1Lao National TV.........................................2Both Lao Star and Lao National TV...........3Other.........................................................7Specify _________________
IK9. IN THE PAST HAVE YOU HEARD ANYTHING ABOUT BREASTFEEDING FROM ANOTHER PERSON?
IK10. PLEASE NAME ALL OF THE SOURCES OF PEOPLE YOU HEARD ABOUT BREASTFEEDING FROM
Probe for the type of person seen and circle all answers given.
Yes No[A] Mother / Relative 1 2[B] Friend 1 2
Health professional:[C] Doctor 1 2[D] Nurse / Midwife 1 2[E] Medical Assistant 1 2
Other worker/volunteer:
[F] Traditional birth attendant
1 2
[G] Community health worker
1 2
[H] Lao Women’s Union Volunteer
1 2
[I] Other worker/volunteer
1 2
[J] Other (specify)………….6
If mother/ relative or friend or ‘other’ IK12
IK11. WHEN DID YOU HEAR ANYTHING ABOUT BREASTFEEDING FROM (title of health professional(s) or other worker/volunteer(s) circled in IK10)?
In the past month...................................1One to six months ago...........................2Six months to one year ago....................3More than one year ago.........................4
IK12. IN THE PAST HAVE YOU HEARD ANYTHING ABOUT COMPLEMENTARY FEEDING FROM ANOTHER PERSON?
Define complementary feeding as food given to young children in addition to breastmilk
IK13. PLEASE NAME ALL OF THE SOURCES OF PEOPLE YOU HEARD ABOUT COMPLEMENTARY FEEDING FROM
Probe for the type of person seen and circle all answers given.
Yes No[A] Mother / Relative 1 2[B] Friend 1 2
Health professional:[C] Doctor 1 2[D] Nurse / Midwife 1 2[E] Medical Assistant 1 2
Other worker/volunteer:
[F] Traditional birth attendant
1 2
[G] Community health worker
1 2
[H] Lao Women’s Union Volunteer
1 2
[I] Other worker/volunteer
1 2
[J] Other (specify)………….6
If ‘mother/ relative or friend or ‘other’ IK15
IK14. WHEN DID YOU HEAR ANYTHING ABOUT COMPLEMENTARY FEEDING FROM (title of health professional(s) or other worker/volunteer(s) circled in IK10)?
Circle all that apply
In the past month...................................1One to six months ago...........................2Six months to one year ago....................3More than one year ago.........................4
IK15. HOW SOON AFTER BIRTH SHOULD YOU GIVE A CHILD ANYTHING TO DRINK OTHER THAN BREASTMILK?
BY DRINK WE MEAN ANY LIQUID INCLUDING WATER, CLEAR BROTH, JUICE, ETC.
Fill in one line only. Circle the appropriate time frame (days, weeks or months) and write in the answer
Days after birth.............................1 __ __Weeks after birth..........................2 __ __Months after birth.........................3 __ __
IK16. HOW SOON AFTER BIRTH SHOULD YOU GIVE A CHILD THEIR FIRST FOODS TO EAT?
BY FOODS WE MEAN ANY SOLID, SEMI-SOLID OR SOFT FOOD LIKE PORRIDGE, STICKY RICE, RICE, ETC
Fill in one line only. Circle the appropriate time frame (days, weeks or months) and write in the answer
Days after birth.............................1 __ __Weeks after birth..........................2 __ __Months after birth.........................3 __ __
IK24B What is the main reason why you don’t think it is not good to wash hands regularly with soap?
Lazy, takes time/effort……………..1Not important………………………2I’ve never used/seen soap………….3Soap is expensive/can’t afford……..4I don’t know where to get soap…….5I don’t think soap is useful…………6Don’t Know………………………..8
IK25. AT WHAT TIMES DO YOU NORMALLY WASH YOUR HANDS WITH SOAP?
(CIRCLE THE RESPONSES SPOKEN)
(DO NOT PROMPT)
Mentioned
Not mentioned
[A] Before eating 1 2[B] After using the toilet
1 2
[C] Every time / regularly
1 2
[D] Before cooking food
1 2
[E] When I have diarrhea
1 2
[F] After working 1 2[G] When my hands look dirty
1 2
[H] After handling animals
1 2
[I] Don’t know 98[J] None mentioned 99[K] Other (specify) ………………………6
CM1. HAVE YOU EVER GIVEN BIRTH? Yes………………………………..1No…………………………………2 2Go to MD
CM2. WHAT WAS THE DATE OF YOUR FIRST BIRTH?
I MEAN THE VERY FIRST TIME YOU GAVE BIRTH, EVEN IF THE CHILD IS NO LONGER LIVING, OR THE FATHER IS NOT YOUR CURRENT PARTNER.
If don’t know year of birth, go to CM3If know year of birth, go to CM4
Date of first birth
Month ……………….. ___ ___DK month……………………….98
Year ……………___ ___ ___ __DK Year………………………...9998
KnowCM4
CM3. HOW MANY YEARS AGO DID YOU HAVE YOUR FIRST BIRTH? Completed years since first birth
__ __
CM4. DO YOU HAVE ANY SONS OR DAUGHTERS TO WHOM YOU HAVE GIVEN BIRTH WHO ARE NOW LIVING WITH YOU?
Yes………………………..1No………………………….2 2CM6
CM5. HOW MANY CHILDREN LIVE WITH YOU?
If none, record “00”.
Sons at home __ __
Daughters at home __ __
CM6. DO YOU HAVE ANY SONS OR DAUGHTERS TO WHOM YOU HAVE GIVEN BIRTH WHO ARE ALIVE BUT DO NOT LIVE WITH YOU?
Yes………………………..1No………………………….2 2CM8
CM7. HOW MANY SONS ARE ALIVE BUT DO NOT LIVE WITH YOU?
HOW MANY DAUGHTERS ARE ALIVE BUT DO NOT LIVE WITH YOU?
If none, record “00”.
Sons elsewhere __ __
Daughters elsewhere __ __
CM8. HAVE YOU EVER GIVEN BIRTH TO A BOY OR GIRL WHO WAS BORN ALIVE BUT LATER DIED?
If “No” probe by asking:I MEAN; TO A CHILD WHO EVER BREATHED OR CRIED OR SHOWED OTHER SIGNS OF LIFE – EVEN IF HE OR SHE LIVED ONLY A FEW MINUTES OR HOURS?
Yes………………………..1No………………………….2 2CM10
CM9. HOW MANY BOYS HAVE DIED?
HOW MANY GIRLS HAVE DIED?
If none, record “00”.
Boys dead __ __
Girls dead ___ __
CM10. Sum answers to CM5, CM7, and CM9. Sum __ __
CM11. JUST TO MAKE SURE THAT I HAVE THIS RIGHT, YOU HAVE HAD IN TOTAL (TOTAL NUMBER IN CM10) LIVE BIRTHS DURING YOUR LIFE. IS THIS CORRECT?
Yes. Check below:
No Live Births Go to IS. One or more live births Continue with CM12.
No. Check responses to CM1-CM10 and make corrections as necessary before proceeding to CM12.
CM12. WHEN DID YOU DELIVER THE LAST ONE (EVEN IF HE OR SHE HAS DIED)?
Month and year must be recorded.
Date of last birth
Month __ __
Year __ __ __ __
CM13. Check CM12: Last birth occurred within the last 2 years, that is, since (month of interview) 2013(if the month of interview and the month of birth are the same, and the year of birth is 2013, consider this as a birth within the last 2 years).
................................................................................... No live birth in last 2 years. Go to MD1.
....................... One or more live births in last 2 years. Ask for the name of the last-born child.
.......................................................................Name of last-born child_______________________
...If child has died, take special care when referring to this child by name in the following modules.
..............................................................................................................Continue with Next Module.
MATERNAL AND NEWBORN HEALTH.................................................................................... [MN]
This module is to be administered to all women with a live birth in the 2 years preceding the date of interview.Record name of last-born child from CM13 here _____________________.Use this child’s name in the following questions, where indicated.MN1. DID YOU SEE ANYONE FOR ANTENATAL CARE DURING YOUR PREGNANCY WITH (NAME)?
MN4A. CHECK MN3. If <4 continue with MN5If 4 or more go to MN6AMN5. WHAT WERE THE MAIN REASONS YOU DID NOT SEE ANYONE FOR ANTENATAL CARE or YOU DID NOT HAVE AT LEAST 4 ANTENATAL CARE VISITS DURING YOUR PREGNANCY WITH (NAME)?
If more than one reason, list the 3 top reasons (A, B, C), with A. being the top choice.
Did not want/not important………….1No money for transport/services……2Travel not possible because of roads/lack of transport……………….3Needed to take care of other children and/or work……………………………4Not allowed by family member………5Does not like/trust closest ANC provider…………………………………6Found out about pregnancy too late..7
Other……………………………………9Specify______________
DK/refuse……………………………….8
RANK
A. __
B. __
C. __
MN6A AS BEST AS YOU CAN REMEMBER, WHAT WAS YOUR WEIGHT JUST BEFORE YOU BECAME PREGNANT?
If respondent does not know ask for an estimate.
[A]Known __ __ __ kg
[B]Estimated __ __ __ kg
DK………………………8
MN6B AS BEST AS YOU CAN REMEMBER, WHAT WAS YOUR WEIGHT JUST BEFORE YOU GAVE BIRTH?
If respondent does not know ask for an estimate.
[A]Known __ __ __ kg
[B]Estimated __ __ __ kg
DK ………………………….8
MN7 DURING THIS PREGNANCY, WERE YOU GIVEN OR DID YOU BUY ANY IRON/IRON FOLIC
Yes ………….1No……………2 2MN8
ACID TABLETS OR IRON SYRUP? DK……………8 8MN8
MN7B. DURING THE WHOLE PREGNANCY, FOR HOW MANY DAYS DID YOU TAKE THE TABLETS OR SYRUP?
If answer is not numeric, probe for approximate number of days
Days __ __ __
DK…………..998
MN8 DURING THIS PREGNANCY, WERE YOU GIVEN OR DID YOU BUY ANY DRUG FOR INTESTINAL WORMS/PARASITES?
Show tablet
Yes ………….1No……………2DK……………8
2MN9 8MN9
MN8B HOW MANY MONTHS PREGNANT WERE YOU WHEN YOU FIRST TOOK ANY DRUG FOR INTESTINAL WORMS/PARASITES
Record the answer as stated by respondent.
Months …….__ _
DK…………….98
MN9. DURING THIS PREGNANCY WERE YOU GIVEN OR DID YOU BUY ANY MULTIVITAMINS?
Yes ………….1No……………2DK……………8
MN10. WHO ASSISTED WITH THE DELIVERY OF (NAME)?
Probe:ANYONE ELSE?
Probe for the type of person assisting and circle all answers given.
If respondent says no one assisted, probe to determine whether any adults were present at the delivery.
Yes NoHealth professional:[A] Doctor 1 2[B] Nurse / Midwife 1 2[C] Medical Assistant
1 2
Other person
[D] Traditional birth attendant
1 2
[E] Community health worker
1 2
[F] Relative / Friend 1 2[G] Other (specify)……………..6[H] No one 1 2
MN11. WHERE DID YOU GIVE BIRTH TO (NAME)?
Probe to identify the type of source.
If unable to determine whether public or private, write the name of the place.
(Name of place)__ _______________________________________
Home:
Respondent’s home 11
Other’s home 12
Public sector:Government hospital
21
Government Clinic/ Health centre
22
Government Health Service Place
23
Other public (specify)………..26Private medical sectorPrivate hospital 31Private clinic 32Private maternity home
33
Other (specify)……………….96
11MN13A12MN13A
Other specified MN13A
MN12. WAS (NAME) DELIVERED BY CAESAREAN SECTION? THAT IS, DID THEY CUT YOUR BELLY OPEN TO TAKE THE BABY OUT?
Yes………………1No……………….2
1MN13B2MN13B
MN13A. WHAT WAS THE MAIN REASON YOU GAVE BIRTH TO (NAME) OUTSIDE A HEALTH CENTER OR HOSPITAL?
If more than one reason, list the 3 top reasons (A, B, C), with A. being the top choice.
Prefer to deliver at home / did not want to deliver in facility
1
No money for transport/services
2
Travel not possible because of roads/lack of transport
3
Needed to take care of other children and/or work
4
Not allowed by family member
5
Does not like/trust health facility
6
Other Specify………..9Refuse/ Don’t know…8
RANK
A. __
B. __
C. __
MN13B. WHEN (NAME) WAS BORN, WAS HE/SHE VERY LARGE, LARGER THAN AVERAGE, AVERAGE, SMALLER THAN AVERAGE, OR VERY SMALL?
Very large……………………..1Larger than average………….2Average………………………..3Smaller than average…………4Very small………………………5
DK………………………………8
MN14. WAS (NAME) WEIGHED AT BIRTH? Yes ………….1No……………2DK……………8
2MN168MN16
MN15. HOW MUCH DID (NAME) WEIGH?
If a card is available, record weight from card.From card 1 (kg) __ . __ __ __
From recall 2 (kg) __ . __ __ __
DK …………..9998
MN16. Hours ................. 1 __ __
NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT WHAT HAPPENED IN THE HOURS AND DAYS AFTER THE BIRTH OF (name).YOU HAVE SAID THAT YOU GAVE BIRTH IN (name or type of facility in MN18). HOW LONG DID YOU STAY THERE AFTER THE DELIVERY?If less than one day, record hours.If less than one week, record days.Otherwise, record weeks.
Days .................. 2 __ __
Weeks................ 3 __ __
DK/remember........... 98
MN17.WHO CHECKED ON YOUR HEALTH AT THAT TIME?
Yes NoHealth professional:[A] Doctor 1 2[B] Nurse / Midwife 1 2[C] Medical Assistant
1 2
Other person:
[D] Traditional birth attendant
1 2
[E] Community health worker
1 2
[F] Other person (Specify) ………6
MN18.WHERE DID THIS CHECK FOR YOU TAKE PLACE?Probe to identify the type of source.If unable to determine whether public or private, write the name of the place.(Name of place)
Home:
Respondent’s home 11
Other’s home 12
Public sector:Government hospital
21
Government Clinic/ Health centre
22
Other public (specify)………..26Private medical sectorPrivate hospital 31Private clinic 32Private maternity home
33
Other (specify)……………….96
MN19A. AFTER THIS PREGNANCY, WERE YOU GIVEN OR DID YOU BUY ANY IRON/IRON FOLIC ACID TABLETS OR IRON SYRUP?
Yes ………….1No……………2DK……………8
2MN20 8MN20
MN19B. AFTER THIS PREGNANCY, FOR HOW MANY DAYS DID YOU TAKE THE TABLETS OR SYRUP?
If answer is not numeric, probe for approximate number of days
Days __ __ __
DK 998
MN20. AFTER THIS PREGNANCY, WERE YOU GIVEN OR DID YOU BUY ANY DRUG FOR INTESTINAL WORMS/PARASITES?
Yes ………….1No……………2DK……………8
MN21. HAS YOUR MENSTRUAL PERIOD RETURNED SINCE THE BIRTH OF (NAME)?
Yes ………….1No…………….2
MN22. DID YOU EVER BREASTFEED (NAME)? Yes……………1
No……………..2 2[MN27]
MN23. HOW LONG AFTER BIRTH DID YOU FIRST PUT (NAME) TO THE BREAST?
If less than 1 hour, record “00” hours.If less than 24 hours, record hours.Otherwise, record days.
Immediately……………000
Hours 1……………… __ __
Days 2 ………………..__ __
DK / Don’t remember 998
MN24. IN THE FIRST THREE DAYS AFTER DELIVERY, WAS (NAME) GIVEN ANYTHING TO DRINK OTHER THAN BREAST MILK?
Yes…………………1No………………….2 2[MN27]
MN25. WHAT WAS (NAME) GIVEN TO DRINK?
Probe:ANYTHING ELSE?
Yes No[A] Milk (not breastmilk)
1 2
[B] Infant formula
1 2
[C] Plain water
1 2
[D] Sugar or glucose water
1 2
[E] Gripe water
1 2
[F] Sugar-salt-water solution
1 2
[G] Fruit juice
1 2
[H] Tea / Infusions
1 2
[I] Honey 1 2[J] Other (specify)……..6
MN26. WAS (NAME) GIVEN (NAME OF TRADITIONAL PRELACTEAL FEED) IN THE FIRST THREE DAYS AFTER DELIVERY?
Yes ………….1No……………2DK……………8
MN27.
WHO ARE YOU MOST LIKELY TO LISTEN TO WHEN MAKING DECISIONS ABOUT FEEDING YOUR CHILD?
EXCLUDING MEDIA SUCH AS NEWSPAPERS, TELEVISION, AND RADIO; AND WORD OF MOUTH FROM PEOPLE YOU KNOW OR WORKERS,
If more than one person, list the 3 top choices (A, B, C), with #1 being the top choice.
Medical Assistant 5Other personTraditional birth attendant
6
Community health worker
7
Lao Women’s Union Volunteer
8
Other (specify)……..9
RANK
A. __
B. __
C. __
MATERNAL DIET AND IYCF ATTITUDES.............................................................................. [MD]
MD1. ARE YOU PREGNANT NOW?
Yes, currently pregnant…………………1
No…………………………………………2
Unsure or DK…………………………….8
1=MD3
2=MD2
8=MD2MD2. Check CM13: Last birth occurred within the last 2 years, that is, since (month of interview) in 2013(if the month of interview and the month of birth are the same, and the year of birth is 2013, consider this as a birth within the last 2 years).
................................................................................ No live birth in last 2 years. Next Module.
........................................................................... One or more live births in last 2 years. MD3.
Explain that the statement can be right or wrong. Then, read each statement and ask respondent to agree or disagree
MD3. DO YOU AGREE OR DISAGREE WITH THE FOLLOWING STATEMENTS?
[A] A child needs to drink a liquid other than breastmilk, such as water, tea, or juice, immediately after birth or in the first 3 days after birth.
[B] For the first six months breastmilk alone is enough food for a child.
[C] Infant formula is better or the same as breastmilk for a child.
[D] For the first six months a child who is not sick needs to drink a liquid other than breastmilk, such as water, tea, or juice.
Agree Disagree[A] A child needs to drink a liquid other than breastmilk, such as water, tea, or juice, immediately after birth or in the first 3 days after birth.
1 2
[B] For the first six months breastmilk alone is enough food for a child.
1 2
[C] Infant formula is better or the same as breastmilk for a child.
1 2
[D] For the first six months a child who is not sick needs to drink a liquid other than breastmilk, such as water, tea, or juice.
1 2
MD4. DOES ANYONE IN YOUR SOCIAL NETWORK (SPOUSE, RELATIVES, FRIENDS, BOSS, OTHER PEOPLE YOU ARE CLOSE TO) DISAPPROVE OF YOU BREASTFEEDING?
Yes…………………………………..1No……………………………………2
MD5. I WOULD LIKE TO ASK YOU ABOUT FOODS THAT YOU MAY HAVE HAD YESTERDAY DURING THE DAY OR THE NIGHT. AGAIN, I AM INTERESTED TO KNOW WHETHER YOU HAD THE ITEM EVEN IF COMBINED WITH OTHER FOODS.
Please include foods consumed outside of your home.
YESTERDAY DURING THE DAY OR NIGHT, DID YOU DRINK/EAT (FOOD GROUP ITEMS)?Questions and filters (Circle the corresponding code and you can underline more than one answer)
Always start with: ‘YESTERDAY DID YOU EAT….’[A] ANY OFFAL ITEMS (excluding intestines)?
Probe: SUCH AS LIVER, BRAIN, LUNG, HEART, GIZZARD, KIDNEY, OF ANY ANIMAL
Yes ………….1No……………2DK……………8
[B] THE INTESTINE OF ANY ANIMAL? Yes ………….1No……………2DK……………8
[C] ANY KIND OF MEAT?
Probe: SUCH AS ANY MEAT, SUCH AS BEEF (FRESH OR DRY), BUFFALO, PORK, GOAT, CHICKEN, GOOSE, DUCK, SAUSAGE, BLOOD SAUSAGE, SOUR SAUSAGE
Yes ………….1No……………2DK……………8
[D] ANY KIND OF EGGS?
Probe: ‘SUCH AS?’ EGGS FROM CHICKEN, DUCK, TURTLE OR OTHER ANIMALS
Yes ………….1No……………2DK……………8
[E] ANY KIND OF FISH OR AQUATIC ANIMALS?
Probe: ‘SUCH AS?’ FRESH, FERMENTED OR DRIED FISH, SWAMP EEL, SQUID, SHRIMP (FRESH OR DRY), CRAB, GRANULATED ARK, CLAM, SNAIL, FROG, WATER INSECTS
Yes ………….1No……………2DK……………8
[F] ANY KIND OF WILD ANIMALS?
Probe: ‘Such As?’ Lizard, Rat, Rabbit, Wild Bird, Small Birds
[H] ANY KIND OF DAIRY PRODUCTS (not including Coffee Creamer)?
Probe: ‘SUCH AS?’ CHEESE (BUTTER), YOGURT, OR OTHER MILK PRODUCTS
Yes ………….1No……………2DK……………8
[I] OTHER FOODS THAT CAME FROM AN ANIMAL.
(Write down other foods the respondent names that come from an animal.)______________________________________
Yes ………….1No……………2DK……………8
J. Rice (sticky rice, white rice), Maize / Corn, Cassava, Other roots of tubers (potatoes, yam)
Yes ………….1No……………2DK……………8
K. Pulses/Lentils/Tofu/Bean Curd Yes ………….1No……………2DK……………8
L. Nuts or seeds (e.g. sesame seeds, mung bean, ground bean, sun flower seed, cashew nuts etc.)
Yes ………….1No……………2DK……………8
M. ANY DARK GREEN LEAFY VEGETABLES SUCH AS PAK CHOI, SWAMP CABBAGE, MORNING GLORY, SWEET POTATO LEAVES, CHINESE KALE
Yes ………….1No……………2DK……………8
N. RIPE ORANGE FLESHED MANGOES, RIPE ORANGE FLESHED PAPAYAS, Pumpkin, carrots,sweet potatoes that are yellow or orange inside?
Yes ………….1No……………2DK……………8
O. Other vegetables Yes ………….1No……………2DK……………8
P. Other fruit Yes ………….1No……………2DK……………8
Q. Other
Specify: ___________________________________
Yes ………….1No……………2DK……………8
MD6, HOW MANY TIMES DID YOU EAT YESTERDAY DURING THE DAY AND NIGHT?
Circle the corresponding answer.
1 meal……………12 meals…………..23 meals…………..34 meals…………..45 meals…………..56 or more meals…6DK…………………8
MD7. YESTERDAY, DID YOU EAT MORE FOR YOUR CHILD. THAT IS, DID YOU EAT MORE THAN YOU DID BEFORE BECOMING PREGNANT / HAVING A BABY?
Yes ………….1No……………2DK……………8
MD8. YESTERDAY, DID YOU EAT AN EXTRA MEAL(S) FOR YOUR CHILD. THAT IS, DID YOU EAT MORE MEALS THAN YOU DID BEFORE BECOMING PREGNANT / HAVING A BABY?
Yes ………….1No……………2DK……………8
MD9. YESTERDAY, DID YOU EAT EXTRA SNACKS FOR YOUR CHILD. THAT IS, DID YOU EAT MORE SNACKS THAN YOU DID BEFORE BECOMING PREGNANT / HAVING A BABY?
Yes ………….1No……………2DK……………8
MD10. DID YOU RECEIVE ANY RICE SOYA BLEND, CORN SOYA BLEND, NUTRIBUTTER SINCE YOU BECAME PREGNANT OR DURING YOUR MOST RECENT PREGNANCY IN LAST 2 YEARS?
Show pictures of products. Nutributter is given in supplementary feeding programmes for pregnant women.
Yes ………….1No……………2DK……………8
MD11. DID YOU RECEIVE ANY RICE SINCE YOU BECAME PREGNANT OR DURING MOST RECENT PREGNANCY IN LAST 2 YEARS?
Yes ………….1No……………2DK……………8
ILLNESS SYMPTOMS.................................................................................................................. IS
IS1. Check List of Household Members, columns HL8 and HL11:
Is the respondent the mother or caretaker of any child under age 5?
............................................................................................................. Yes Continue with IS2.
............................................................................................................. No Go to Next Module.
IS2. SOMETIMES CHILDREN HAVE SEVERE ILLNESSES AND SHOULD BE TAKEN IMMEDIATELY TO A HEALTH FACILITY.
WHAT TYPES OF SYMPTOMS WOULD CAUSE YOU TO TAKE A CHILD UNDER THE AGE OF 5 TO A HEALTH FACILITY RIGHT AWAY?
WM11. Record the time. Hour and minutes.........__ __ : __ __
WM12. Check List of Household Members, columns HL8 and HL11:Is the respondent the mother or caretaker of any child aged under 59 months living in this household?
