dry zone nutrition and food security survey questionnaire 3.pdf · dry zone nutrition and food...

VILLAGE PROFILE 1

Dry Zone nutrition and food security survey questionnaire

Date|___||___|/|___||___|/|_1_||_3_| (DD/MM/YY)

Team number / team leader’s name: |___|/ __________________________ Agroecological zone ID: |___|

Township name: ___________________________ Village ID: |___||___| Village name: ___________________

UNIQUE IDENTIFIER: Agroecological zone ID/village ID:|___|/|___||___|

Number of the 40 households absent (but not abandoned) |___|

Village profile

Enumerator’s instructions: Team leader to complete with a mixed sex group, including village leaders.

No Demography

1 How many households are there in this village (including all those inside the administrative boundaries) (nb. Record households as reported by the village leader and not as survey definition)

|___||___||___||___|

2. How many households are female headed? |___||___||___|

3. What is the village population (total number of people; check the figure is up to date and includes all inside administrative boundaries)

|___||___||___||___||___||___|

No Crop Production. What are the main crops cultivated in this village?

4. Main Crop 1 ____________

5. How many acres are cultivated in this village?

|___||___|

6. What is the normal yield (baskets acre)?

|___||___|

7. How many pyi are in one

basket?

|___||___|

8. Main Crop 2 ____________


|___||___|

10. What is the normal yield (baskets/acre)?

|___||___|

11. How many pyi are in one basket?

|___||___|

12. Main Crop 3 ____________


|___||___|

14. What is the normal yield (baskets/acre)?

|___||___|

15. How many pyi are in one basket?

|___||___|

16. What type of market does the village have? None…………….0

Daily……………..1

Periodic………..2

If 1 or 2 skip to 20.

17. In the rainy season

What is the round trip travel time to

the nearest market

|___|days; |___||___|hours; |___||___|minutes

18. In the summer season |___|days; |___||___|hours; |___||___|minutes

19. In the winter |___|days; |___||___|hours; |___||___|minutes

No Public Health Environment

20. Is there a sub-health centre/formal health facility in the village?

No…………….0

Yes…………..1 If 1 skip to 24.

VILLAGE PROFILE 2

21. If no, in the rainy season

What is the round trip travel time to the nearest

sub health centre

|___|days; |___||___|hours; |___||___|minutes

22. If no, in the summer season |___|days; |___||___|hours; |___||___|minutes

23. If no, in the winter season |___|days; |___||___|hours; |___||___|minutes

24. What proportion of households have drinking water on the premises? (round the estimate up if needed)

|___||___|%

For those households without drinking water on the premise, what is the main water source (circle one)

25. In the rainy season

Ponds…………………………………….....1

Rainwater……………..……………….….2

Protected spring………………..........3

Unprotected spring……………….…..4

Protected hand dug well….………..5

Tubewell/bore hole……………….....6

Streams/rivers……………….………….7

26. In the summer season

Ponds…………………………………….....1

Rainwater……………..……………….….2






27. In the winter season

Ponds…………………………………….....1

Rainwater……………..……………….….2






What is the round trip travel time? (not including the time to collect the water)

28. |___||___|minutes 29. |___||___|minutes 30. |___||___|minutes

What are the 3 most common illnesses affecting children under 5 years old?

31. In the rainy season : 1st: 32. In the rainy season: 2nd 33. In the rainy season 3rd:

Diarrhoea…………………………….…..1

Fever…………….…………………….……2

Cough/difficulty breathing due to illness…………………….……….……….3

Other………………………………...…...4

Specify ______________

Diarrhoea…………………….….……...1

Fever…………….…………………...……2

Cough/difficulty breathing due to illness…………………….……………..…3

Other……………………………………....4

Specify ______________

None………………………………………………………....0

Diarrhoea…………………….…….……...................1

Fever…………….……………………………………………2

Cough/difficulty breathing due to illness ……3

Other………………………………………...………….......4

Specify ______________

34. In the summer season : 1st: 35. In the summer season: 2nd 36. In the summer season 3rd:

Diarrhoea…………………………….…..1

Fever…………….…………………….……2


Other………………………………...…...4

Specify ______________

Diarrhoea…………………….….……...1

Fever…………….…………………...……2


Other……………………………………....4

Specify ______________

None………………………………………………………....0

Diarrhoea…………………….…….……...................1

Fever…………….……………………………………………2


Other………………………………………...………….......4

Specify ______________

37. In the winter season : 1st: 38. In the winter season: 2nd 39. In the winter season 3rd:

Diarrhoea…………………………….…..1

Fever…………….…………………….……2


Other………………………………...…...4

Specify ______________

Diarrhoea…………………….….……...1

Fever…………….…………………...……2


Other……………………………………....4

Specify ______________

None………………………………………………………....0

Diarrhoea…………………….…….……...................1

Fever…………….……………………………………………2


Other………………………………………...………….......4

Specify ______________

COVER SHEET AND MODULE 1: HOUSEHOLD COMPOSITION 1

Dry Zone nutrition and food security survey questionnaire

Read this statement to the head of the household or, if they are absent, another adult member of the house before the

interview

My name is ___________________ and I am working on behalf of WFP.

We would like to invite your household to participate in a survey that is looking at the nutrition status and food security

situation of people living in the Dry Zone. WFP is funding this nutrition survey. Taking part in this survey is totally your choice.

You can decide to not participate, or if you do participate you can stop taking part in this survey at any time for any reason. If

you stop being in this survey, it will not have any negative effects on how you or your household is treated or what assistance

you receive. If you agree to participate, we will ask you some questions about your family and we will also take measurements

including weight and height of the children under 5 in the household and their mothers. Before we start to ask you any

questions or take any measurements, we will ask you to state your consent on this form. Be assured that any information that

you will provide will be kept strictly confidential. You can ask me any questions that you have about this survey before you

decide to participate or not. If you do not understand the information or if your questions were not answered to your

satisfaction, do not declare your consent on this form. Thank you.

Signed: _____________________ Name of head of household (or adult representative of the household):__________________

Date|___||___|/|___||___|/|_1_||_3_| (DD/MM/YY)

Agroecological zone ID: |___| Township name: __________________

Village ID: |___||___| Village name: ___________________

Team number / team leader’s name: |___|/ ____________

Household ID: |___||___|

UNIQUE IDENTIFIER: Agroecological zone ID/village ID/ household ID:|___|/|___||___|/|___||___|

Module 1: Household composition:

Enumerator’s instructions: Complete in any household where you measure a child and in any household where you ask the

FSL/HH module 3 (see more instructions below)

No Household demography Coding categories Skip

1.1 What is the sex of the household head Male…………….1

Female…………2

If 1 skip to 1.3

1.2 If female, why Never married………………………………….………….1

Husband died………………………………….……………2

Divorced………………………………………………….…..3

Husband migrated ……………………………….………4

Other……………………………………………………………5

COVER SHEET AND MODULE 1: HOUSEHOLD COMPOSITION 2

1.3 How many people live in your household (A household is a person or a group of persons who eat from the same pot and share resources, and are normally living together at least 4 nights weekly – do not include those who have migrated)

|___| |___|

1.4 Are any household members away, having migrated for work?

No…………….0 Yes…………….1

If ‘no’ skip to 1.6

1.5 If yes, how many household members have migrated?

|___| |___|

1.6 Starting with the youngest child, what is the age and sex of each household member? (not including those who have migrated)

Male = 1 Female = 2 (Age in completed years - at last birthday. If < 1 year old enter 00) (verify with 1.3 by checking the total number of household members)

Sex Age

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

|___| |___| |___|

Enumerator’s instructions:

Complete Module 2 (Mother’s questionnaire) with the mother of the children under 5 in any of the 40 households

Complete Module 3 (Household Food Security questionnaire) with the head of household and the spouse, in every 3rd

household from 3 to 39 (minimum 10 households)

Complete Module 4 (Child questionnaire) for each child under 5, with the mother until module complete (minimum 12

households have been surveyed and 12 children measured)

Complete Module 5 (IYCF questionnaire) for each child under 2, with the mother, until module 4 is complete

MOTHER’S QUESTIONNAIRE 1

Module 2: Mother’s questionnaire


Enumerator’s name: _________________

Enumerator’s instructions: Complete in any household with a child under 5 until module 4 is complete (minimum 12

households have been surveyed and 12 children measured)

Part A No Questions Coding categories Skip

2.1 Mother’s name

___________________________

2.2 Mother’s age (Age in completed years - at last birthday)

|___|___|

2.3 [Record MUAC] |___|___|___|.|___| cm

2.4 How many children have you given birth to? (including those who have died)

|___|___|

2.5 What is the sex and age of each of your (living) children (even adults), starting with the youngest (verify 1.6) Male = 1 Female = 2 (Age in completed years - at last birthday. If < 1 year old enter 00)

Sex Age |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___| |___|

2.6 [Count the number of living children, check the number is correct with mother, then enter total]

|___| |___|

2.7 What age were you when you had your first child? (age in completed years)

|___|___| years

2.8 Are you breastfeeding now? No……………….0 Yes………………1

2.9 Are you pregnant now? No……………….0 Yes………………1

If “Yes” skip to 2.12

2. 10

[Record weight]

|___|___| . |___|kg

2. 11

[Record height]

|___|___|___| . |___|cm

2. 12

In the first six weeks after you last delivered, did you receive a vitamin A dose like this? (show red 200,00 IU capsule)

No…………………………………………… 0

Yes………………………………………….. 1

Don’t know……………………………… 8

N/A (Not completed 6 weeks).. 9

2. 13

Did you see anyone during your last pregnancy? If yes, whom did you see (probe – anyone else? – and circle ALL answers given)

No Doctor………………………………………. 0 Nurse………………………...……………… 0 Midwife ……………………..……………… 0 Auxiliary midwife…………………. 0 Traditional birth attendant….. 0 Other…………………………………… 0 Specify __________________ 0

Yes 1 1 1 1 1 1


2. 14

During your last pregnancy, did you take any vitamin B1? (show an example; include OBMIN and other pregnancy micronutrient supplements)

No…………………………………………… 0

Yes………………………………………….. 1

Don’t know……………………………… 8

2. 15

During your last pregnancy, did you take any iron capsules, tablets or syrups? If yes, how often? (show examples)

Not taken………………………………… 0

Rarely (1-2 times a month)………. 1

Sometimes (1-2 times a week)…. 2

Often (3-4 times a week)………….. 3

Mostly (More than 5days/ week ) 4

Don’t know………………………………. 8

Continue to Module 2, Part B.


Module 2: Mother’s questionnaire


Enumerator’s name: _________________

Part B 2. 17

Yesterday during the day or night (last 24 hours) what did YOU eat at home OR outside home?

A. Rice, rice noodles, corn, bread or other foods made from cereals including thick grain based porridge

B. White potatoes, white yams, taro or any other foods made from roots

C. Pumpkin, carrots, sweet potatoes and any other vegetables that are yellow/orange inside (including wild vegetables)

D. Any dark green leafy vegetables e.g. watercress, gourd leaves, spinach, tamarind leaves

E. Orange or yellow fruits e.g. ripe mangoes, ripe papayas, ripe jackfruits

F. Any other fruits or vegetables G. Liver, kidney, heart, other organs H. Any meat (beef, sheep, pork, chicken, goat,

duck, rats, frog etc.) I. Eggs (e.g. chicken, quail, duck, ngone) J. Fish/ dried fish/prawn, seafood K. Any foods made of beans/nuts/lentils/seeds L. Cheese, yoghurt or milk product M. Any oil (sesame, sunflower, peanut, palm (not

red), fats/ butter or foods made with any of these

N. Any sugary foods such as honey, chocolates, candies, pastries, cakes or biscuits

O. Condiments for flavour (chillies, spices, herbs or fish paste/powder)

P. Salty snacks such as chanachur, biscuits, potato chips

Q. Others (Specify)

No Yes DK

A……………..

0

1

8

B……………..

0

1

8

C……………..

0

1

8

D……………..

0

1

8

E……………..

0

1

8

F……………… 0 1 8

G…………….. 0 1 8

H……………..

0

1

8

I……………… 0 1 8

J……………… 0 1 8

K…………….. 0 1 8

L……………… 0 1 8

M…………….

0

1

8

N…………….

0

1

8

O…………….. P…………… Q …………… Specify_____________

0 0 0 0

1 1 1

8 8 8

1

Food Security Modules for Dry Zone Household Questionnaire

Household Dietary Diversity/Food Consumption (Please USE training manual for food groups)

How many times did you and your family members eat yesterday?

Adults |____| times

Children (6 mths-15 yrs) |____| times

No children in the household (circle if appropriate) 9

In the past 7 days, state the number of days the following food items consumed by household members? (this does not include foods purchased and eaten outside of the home by individual members)

Food Items (refer to manual for more complete examples)

a) Number of days in the past

7days

b) Was the Food Eaten in the last 24hrs? (Yes/No)

c) Main Source of the food (see list below the table)

Rice |_____| 0=No…………………….1=Yes |_____|

Maize (millet, corn, etc.) |_____| 0=No…………………….1=Yes |_____|

Other cereals (wheat, noodles) |_____| 0=No…………………….1=Yes |_____|

Potatoes/Tubers (sweet potato, taro, Yam, etc.) |_____| 0=No…………………….1=Yes |_____|

Beans (lablab bean, lima bean, butter bean, etc.), lentils, peas (check pea, gram, etc.),

|_____| 0=No…………………….1=Yes

|_____|

Nuts (peanut etc.) |_____| 0=No…………………….1=Yes |_____|

Vegetables (gourd, brinjal, cucumber, tomato, leafy vegetables etc...)

|_____| 0=No…………………….1=Yes

|_____|

Fruits (banana, orange, apple, pineapple etc.) |_____| 0=No…………………….1=Yes |_____|

Beef (cows, buffalo) |_____| 0=No…………………….1=Yes |_____|

Pork |_____| 0=No…………………….1=Yes |_____|

Mutton (goat, sheep) |_____| 0=No…………………….1=Yes |_____|

Poultry (chicken, duck) |_____| 0=No…………………….1=Yes |_____|

Eggs (hen, duck, ngone) |_____| 0=No…………………….1=Yes |_____|

Fish (fish, prawn, dried fish, etc.)/ seafood |_____| 0=No…………………….1=Yes |_____|

Milk/ Milk products (e.g. cheese, dried milk and infant formulas)

|_____| 0=No…………………….1=Yes

|_____|

Oil (e.g. groundnut, sesame, palm)/ Fat (e.g. butter, animal fat)

|_____| 0=No…………………….1=Yes

|_____|

Sugar |_____| 0=No…………………….1=Yes |_____|

Condiments (including fish paste where it is a small amount in food)

|_____| 0=No…………………….1=Yes

|_____|

Source of food: 1 = Own Production (includes fishing with nets) 2 = Purchase

3 = Borrow, credit or advance 4 = Exchange items for food 5 = Exchange work for food 6 = Gift from friends/ relatives

7 = Foraging (incl. improvised line fishing) 8 = Food assistance 9 = Other

Does your household typically maintain stocks of rice or other staple foods (i.e. maize, wheat, sorghum, etc)? (If No, skip to question ###)

No……………..………….0

Yes.…………………………1

If yes, how many days will these stocks last the household? |_____|days

Test of Iodine presence in salt

Negative…………..…….0

Positive……………………1 No salt…………...……….9

Household Hunger Scale

In the past [4 weeks/30 days], was there ever no food to eat of any kind in your house because of lack of resources to get food?

No………………………………………………………………………………..0 Rarely (1–2 times)………………………………………………………..1 Sometimes (3–10 times)………………………………………………2 Often (more than 10 times)………………….…..…………………3

In the past [4 weeks/30 days], did you or any household member go to sleep at night hungry because there was not enough food?


In the past [4 weeks/30 days], did you or any household member go a whole day and night without eating anything at all because there was not enough food?


2

Months of Adequate Household Food Provisioning

In the last 12 months, were there any months when your household did not have enough food to meet the household’s food needs? (circle the appropriate)

No……….…….…..………….0

Yes.……..…….………………1

If yes, please indicate during which months your household did not have enough food to meet the households’ needs

May 2013 No…………………………..0 Yes………………..…….1 April 2013 No…………………………..0 Yes………………..…….1 March 2013 No…………………………..0 Yes………………..…….1 February 2013 No…………………………..0 Yes………………..…….1 January 2013 No…………………………..0 Yes………………..…….1 December 2012 No…………………………..0 Yes………………..…….1 November 2012 No…………………………..0 Yes………………..…….1 October 2012 No…………………………..0 Yes………………..…….1 September 2012 No…………………………..0 Yes………………..…….1 August 2012 No…………………………..0 Yes………………..…….1 July 2012 No…………………………..0 Yes………………..…….1 June 2012 No…………………………..0 Yes………………..…….1

Coping Mechanisms

In the past 7 days, have there been times when your household did not have enough food or money to buy food? (circle the appropriate)

No…………..….………………..0 Yes….…………….……………..1

If yes, how often in the past week has the household had to utilize the following coping mechanisms? (Enter the number of days (0-7) when the mechanisms was used in the last 7-days)

Eating rice porridge |_____| days Borrowing food from neighbours / relatives |_____| days

Prioritizing children and elderly for food |_____| days Eating rice seed stocks |_____| days

Reducing the number of daily meals |_____| days Eating immature crops |_____| days

Reducing rice portion size |_____| days Eating wild animals or plants |_____| days

Consuming only rice at meal times |_____| days Purchasing food on credit |_____| days

Consuming less preferred staples |_____| days Reducing health expenditures |_____| days

Changing curry ingredients / variety / rice quality |_____| days Sending children/elderly away to eat |_____| days

Begging for food |_____| days

Income

Have the following activities contributed to your household’s income over the last 12 months? (check one by one—No………….0, Yes……………..……1)

1. Sale of paddy |_____| 2. Service provider (milling, taxi/bus/trishaw driver….) |_____| 3. Sale of rice |_____| 4. Petty trading |_____| 5. Sale of other cereals (maize, wheat…) |_____| 6. Remittances from inside Myanmar |_____| 7. Sale of vegetables |_____| 8. Remittances from abroad |_____| 9. Sale of fruits |_____| 10. Collection and sale of firewood |_____|

11. Sale of pulses/ beans |_____| 12. Sale of other wooden products (timber, rattan, bamboo, palm

leaves…) |_____|

13. Sale of sesame |_____| 14. Sale of non -timber forest products (orchids….) and wild food

products (plants/animals) |_____|

15. Sale of nuts |_____| 16. Government job |_____|

17. Sale of livestock or animal products |_____| 18. Salaried job in private sector (companies, hotels, restaurants,

workshops…) |_____|

19. Caretaker of livestock/ shepherd |_____| 20. Mining and/ or quarrying |_____| 21. Sale of toddy products (sap, jaggery,

alcoholic products…) |_____|

22. Begging |_____|

23. Sale of fish (river fishing / fish farming) |_____| 24. Pensions |_____| 25. Agriculture wage labour |_____| 26. Other 1 (specify)___________________________ |_____| 27. Non agriculture wage labour |_____| 28. Other 2 (specify)___________________________ |_____| 29. Sale of handicraft (carving, baskets, mats,

pottery…) |_____|

30. Other 3 (specify)___________________________ |_____|

31. Skilled labour / artisan (carpentry, masonry…)

|_____| 32. No income in last 12 months

|_____|

33. Trade, commerce, shop keeper |_____|

Among the activities above, which ones have been the 2 most important activities sustaining your income (in term of amount of money generated) in the last 30 days? (take the code from the list above)

Main activity

|____| How many family members participated in this activity?

6.1 Men (>15yrs) |____| 6.2 Women (>15yrs) |___|

6.3 Children ≤15yrs |___|

Second activity

|____| How many family members participated in this activity?

6.1 Men (>15yrs) |____| 6.2 Women (>15yrs) |___|

6.3 Children ≤15yrs |___|

What has been your household total income in the last 30 days? |______________| mmk

3

Is this amount for the last 30 days typical of an average month or does your household usually earn more or less?

Less…………………………………………..………………………0 The same…………………………………………………………..1 More…………………………………………..…………………….3 Doesn’t know/not available………………………….…..9

Expenditures

How much did your household spend on the following items in the last 30 days? (includes cash & purchase on credit)

How much did your household spend on the following items in the last 6 months? (includes cash & purchase on credit)

Expenditures in last 30days

Amount from cash purchase

Amount from credit purchase

Expenditures in the last 6 months Amount from cash purchase

Amount purchase on

credit

Paddy / Rice ________mmk ________mmk Education (school fees, books, uniforms) _________mmk ________mmk

Other cereals & staples ________mmk ________mmk Health for adults and child. > 5years _________mmk ________mmk

Pulses/beans/nuts ________mmk ________mmk Health for children < 5 years ols _________mmk ________mmk

Vegetables ________mmk ________mmk Transportation

Fruits ________mmk ________mmk Debt repayment _________mmk ________mmk

Meat, fish, eggs ________mmk ________mmk Sending remittances House construction/maintenance including electricity & water

_________mmk _________mmk

________mmk ________mmk Cooking oil ________mmk ________mmk

Other food items ________mmk ________mmk Shop/trade/commerce

Firewood /cooking fuel ________mmk ________mmk Farming (seeds, fertilizers, labor costs…), Livestock breeding (vaccines, fodder…), fish breeding

_________mmk _________mmk Betel nut/Cigarettes/Alcohol

________mmk ________mmk

Drinking water ________mmk ________mmk Celebrations/social events _________mmk _________mmk

If you had to buy rice now, how much would you pay per pyi? Price __________________ mmk/pyi

Doesn’t know/not available 9

Credits/Debts

Has your household taken money loans/credits in the last 12 months? No………………………………………….0 Yes………………………………………...1

If No, why? No need……………………………..….0 No access to credit………………...1

If Yes, please indicate below whom you borrowed the money from? (multiple answers possible) No……………………0, Yes…………………….1

1. Family or friend |___| 4. Micro credit institution |___| 7. Employer 10. Private company |___| 2. Shop-keeper/ trader |___| 5. Village saving group |___| 8. Private bank 11. Other (specify)

____________ |___|

3. Money lender |___| 6. Pre-sale of products to trader(s) |___| 9. Government bank

What was the main use of the loans (select the appropriate)?

1. Food purchases |___| 6. Education |___| 11. Business investment |___| 2. Health expenditures |___| 7. Purchase agri. Inputs/ rent land |___| 12. Livestock breeding inputs/costs |___| 3. Water purchase |___| 8. Pay agri. Labour charges |___| 13. Other debts reimbursement |___| 4. House maintenance/improvement |___| 9. Purchase of new productive assets |___| 14. Payment of taxes |___| 5. House purchase |___| 10. Funeral / wedding |___| 15. Migration costs (travel abroad…) |___| 16. Other (specify) ___________ |___|

What is the value of your current debts/loans from all sources of credits/loans?

Less than 25,000mmk……………………………………….0 >25,000 – 50,000mmk………………………………………1 >50,000 – 75,000mmk………………………………………2 >75,000 – 100,000mmk…………………………………….3 > 100,000 – 150,000mmk………………………………….4 >150,000 – 200,000mmk…………………………………..5 >200,000 – 250,000mmk…………………………………..6 >250,000 – 300,000mmk……………………………………7 >300,000mmk…………………………………………………….8 Don’t know/no response/not available……………..9

Compared to last year, at the same period, is this debt….?

Less…………………………………………..………….……………0 The same…………………………………………………….……..1 More…………………………………………..…………….……….3 Doesn’t know/not available…………………….…….…..9

Livestock and other HH assets

How many of the following livestock do the household own? – multiple answers possible

Nb owned

Nb shared How many of the following assets does the household own and/or have access to?

Nb owned

Nb shared

A. Adult male cattle (draught) |__| |__| A. Plough/ tiller (drawn by animal) |__| |__|

4

B. Adult male cattle/bull (for breeding) |__| |__| B. Power tiller |__| |__|

C. Adult female cattle (draught/ breeding/ milking) |__| |__| C. Tractor |__| |__|

D. Young calves (cattle) |__| |__| D. Trawlerjee |__| |__|

E. Adult male buffalo (for breeding) |__| |__| E. Power thresher |__| |__|

F. Adult female buffalo (draught/ breeding/ milking) |__| |__| F. Backpack sprayer |__| |__|

G. Young calves (buffalo) |__| |__| G. Improved crop storage bin or silo |__| |__|

H. Pigs (Gilts) |__| |__| H. Tarpaulin or seed drying net |__| |__|

I. Pigs (Sow) |__| |__| I. Irrigation pump |__| |__|

J. Pigs (Boar) |__| |__| J. Animal drawn cart |__| |__|

K. Pigs (grower pigs/ suckling pigs) |__| |__| K. Trailer (drawn by vehicle) |__| |__|

L. Chicken |__| |__| L. Seeder |__| |__|

M. Ducks |__| |__| M. Fish or aquaculture pond |__| |__|

N. Horses |__| |__| N. Rice mill |__| |__|

O. Donkeys/ Mules |__| |__| O. Bicycle |__| |__|

P. Sheep |__| |__| P. Trishaw |__| |__|

Q. Goats |__| |__| Q. Black and white/ color television |__| |__|

R. Motorized vehicle (three or four wheeled) |__| |__|

S. Boats with motor |__| |__|

T. Boats without motors (rowing boats) |__| |__|

U. Fishing nets |__| |__|

V. Motorcycle |__| |__|

W. Bed (wooden or steel) |__| |__|

X. Stove (gas or electric) |__| |__|

Y. Cell phone |__| |__|

Z. Solar Panel |__| |__|

Education

What is the highest standard/diploma/degree that the female head/spouse has passed?

No female head/spouse………………………………………………………………..…….……………………………….0 None, kinder garden or first standard, 7=Second standard………………..……..………………………….1 Third to fifth standard, 9=Sixth standard or higher………………………………..……………………………..8

10. Housing

10.1. How many rooms does the household occupy, including bedrooms, living rooms, and rooms used for household businesses (do not count toilets, kitchens, balconies, nor corridors)?

None or one……………………………………………………..…………..0 2rooms…………………..…………………………………………..…………2 3rooms………………..…………………………………………………………3 4rooms………………..…………………………………………………………4 5rooms or more………………..……………………………………………9

Observation (observe, do not ask) 10.2. What is the major construction material of the floor?

Earth/sand, palm/bamboo, combination of earth and wood/palm/bamboo, or other…………………….0 Wood planks, parquet or polished wood, cement, wood or cement with covering, or a combination of cement/finished wood and something else………………………………………………………………………………...5

Observation (observe, do not ask) 10.3 What is the major construction material of the external (outer) walls?

Thatch/large leaves/palm/dhani, or tarpaulin……………………………….………………………………..…………..0 Bamboo, or rudimentary wood……………………………………………………………..………………………..…………..2 Mud, finished wood………………………………………………….………………………………………………………………...3 Baked brick and any type of cement………………………………………………….…………..………………………..…9

10.4 What is the major source of lighting in your household?

Electricity (government/public)…………………………………………………………………………………..……….…0 Private generator……………………………………………..………………………………………..………………………….1 Solar panels…………………………………………………..……………………………………………..………………………..2 Kerosene lamps/candles……………………………………………..……………………………..………………………….3 Not available/no electricity………………………………………….…………………………………………………………9

11. Cooking and food storage

11.1 What type of stove is used most often used in the household?

Open fire, open stove, rice-husk stove, or traditional closed stove……………………………..0 Improved stove, electric stove, gas, kerosene/diesel, or other……………………….………..…4

11.2 Does any member of your household members own or have access to a cupboard or a food-storage cabinet (including one rented to others or pawned)?

Neither………………………………..………………………………………..……………………………….………….0 One, but not both………………..………………………………………….…………..……………………………1 Both…………………………………………………………………………………………………..………………………5

WASH

What is the major source of drinking water for the household in the different seasons?

Rainy season Winter season Summer season

A. Ponds Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

B. Rainwater Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

C. Protected springs Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

D. Unprotected springs Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

E. Protected hand dug well Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

F. Unprotected hand dug well Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

G. Tube well/ borehole Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

H. Stream/ Rivers Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

5

I. Other Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1 Not use……….…..0 Use……..………1

How do you treat the water before drinking? No………………………….0 Yes………………………….1

Leave to settle |_____|

Cloth filtration |_____|

Other filtration system (sand filter, ceramic filter…) |_____|

Boiling |_____|

No filtration |_____|

What type of latrine does your household use?

Flush/ pour flush (flush to piped sewer system/ flush to septic/ Flush to somewhere else)…………………….0 Ventilated improve pit latrine (VIP)………………………………………………………………………………………………………….1 Pit latrine with slab…………………………………………………………………………………………………………………………………..2 Pit latrine without slab/ open pit……………………………………………………………………………………………………………..3 No facilities/ open defecation…………………………………………………………………………………………………………..……..9

6

Agricultural Production Does your household engage in crop production (including home gardens) either for sale or own

production? No........0 Yes………….1 (If no, please skip to section ##)

If yes, please indicate the acreage of land owned or rented. Owned |__________| Rented |__________|

Non irrigated crops

(see crop codes list)

Months of cultivation with no irrigation (tick all months during which each crop was cultivated—beginning with the month that

planting occurred and continuing to the month of harvest)

Flatland surface

cultivated (list # of acres)

Upland surface


Did you use organic

fertilizers? Yes=1 No=0

Did you use chemical


Did you use pesticides?

Yes=1 No=0

What were the 2 main constraints

faced in cultivation of each crop?

(see codes below) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Crop 1 |__| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_|

Crop 2 |__| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_|

Crop 3 |__| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_|

Crop 4 |__| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_|

Irrigated crops

(see crop codes list)

Months of cultivation with irrigation (tick all months during which each crop was cultivated—beginning with the month that

planting occurred and continuing to the month of harvest)

Flatland surface


Upland surface


Did you use organic


Did you use chemical


Did you use pesticides?

Yes=1 No=0

What were the 2 main constraints

faced in cultivation of each crop?

(see codes below) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Crop 5 |__| |_|

|_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_|

Crop 6 |__| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_|

Crop 7 |__| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_|

Crop 8 |__| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_| |_|

Codes for the crops

Cereal crop/Roots/Tubers 1. Paddy 2. Wheat 3. Corn/Maize 4. Millet/Sorghum 5. Potato 6. Sweet potato 7. Other cereal crop Industrial crop 8. Tobacco

9. Sugar cane 10. Cotton 11. Other ind. crop Oil seed crop 12. Peanut 13. Sesame 14. Mustard (for seed) 15. Sunflower 16. Other oil seed crop

Pulses 17. Green gram 18. Black gram 19. Chick pea 20. Pigeon pea 21. Butter bean 22. Cow pea 23. Sultapya

24. Sultani 25. Soya bean 26. Pelun 27. Rice bean 28. Duffin bean 29. Lablab bean 30. Long bean / lima bean 31. Mung bean 32. Other pulse crop

Vegetable / Aromatic crop 33. Onion 34. Garlic 35. Ginger 36. Chili 37. Tomato 38. Aubergine 39. Cucumber 40. Watermelon

41. Mustard 42. Cabbage 43. Cauliflower 44. Kailan 45. Other vegetable /aromatic crop

Other crops 46. Other crop1__________________ 47. Other crop2__________________ 48. Other crop3__________________

Codes for the crops constraints 1. Insufficient or erratic rains 2. Floods/too much rain 3. Lanslides/water erosion 4. Wind erosion 5. Low soil fertility 6. Pest infestation 7. Low seed quality

12. Limited/inappropriate access to or availability of farming equip. 13. Lack of draught animals 14. Problem with irrigation infrastructure 15. Limited access to land (cost, availability) 16. Market instability, low demand 17. Limited market information 18. Limited transportation infrastructure to closest market

7

8. Incapacity to cover labor costs 9. Low labor availability 10. Lack of credit to cover agric. Costs 11. Limited/inappropriate access to or availability of agic. Inputs

19. Lack of experience/need for additional technical knowledge 20. Other 1_________ 21. Other 2_________ 22. Other3_________

For each crop mentioned above, indicate how the last harvest was used (% of quantities harvested)

Non irrigated crops Irrigated crops Crop1 Crop2 Crop3 Crop4 Crop5 Crop6 Crop7 Crop8

% kept for home consumption _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

% sold _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

% kept for seeds _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

% used to feed animals _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

% used to pay back debts _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

% used to pay labor costs _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

% used to rent land _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

% used for donations _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

% for other uses _______ % _______ % _______ % _______ % _______ % _______ % _______ % _______ %

Total 100% 100% 100% 100% 100% 100% 100% 100%

Crop Marketing

Please indicate how you sold your last harvests (If crops are not sold, please check “Don’t sell”)

Crop1 Crop2 Crop3 Crop4 Crop5 Crop6 Crop7 Crop8

Directly to consumers in your own village |___| |___| |___| |___| |___| |___| |___| |___|

To trader(s) in your own village |___| |___| |___| |___| |___| |___| |___| |___|

Directly to consumers in another village market |___| |___| |___| |___| |___| |___| |___| |___|

To traders in another village |___| |___| |___| |___| |___| |___| |___| |___|

Directly to consumers in town market |___| |___| |___| |___| |___| |___| |___| |___|

To traders in town market |___| |___| |___| |___| |___| |___| |___| |___|

Through a contract with a company |___| |___| |___| |___| |___| |___| |___| |___|

Other, specify_____________________ |___| |___| |___| |___| |___| |___| |___| |___|

Don’t sell |___| |___| |___| |___| |___| |___| |___| |___|

When did you sell your last harvests? Crop1 Crop2 Crop3 Crop4 Crop5 Crop6 Crop7 Crop8

In small quantities during several weeks after harvest |___| |___| |___| |___| |___| |___| |___| |___|

Once just after the harvest |___| |___| |___| |___| |___| |___| |___| |___|

1 month after the harvest |___| |___| |___| |___| |___| |___| |___| |___|

2months after the harvest |___| |___| |___| |___| |___| |___| |___| |___|

3months after the harvest |___| |___| |___| |___| |___| |___| |___| |___|

4months or more after the harvest |___| |___| |___| |___| |___| |___| |___| |___|

How do you generally sell your main cash crops?

Sell alone only………………………………………………..……………1

Sell with a group only …………………………………………………2

8

Sell with a group and alone…………………………………………………3

No cash crop………………………………………………………………………..9

Do you normally access information on market prices prior to selling crops?

Yes |____|

If yes, from where do you get information?

From radio/tv/newspapers……………………………………………….1

From agriculture department/extension services…………….2

From market exchange centres (phone message)…………..3

From brokers/traders……………………………………………………….4

No |_____|

From friends or other farmers in the village…………………….5

By visiting the market………………………………………………………..6

From NGO / association…………………………………………………….7

Other, specify_________________________......................9

MODULE 4: CHILD QUESTIONNAIRE 1

Module 4: Child questionnaire: for children 0 – 59 months of age

Date|___||___|/|___||___|/|_1_||_3_| (DD/MM/YY) Agroecological zone ID: |___|

Village ID (Cluster): |___||___| Team number: |___| Child ID : |___||___| Household ID: |___||___|

UNIQUE IDENTIFIER: Agroecological zone ID/village ID/ household ID/child ID:|___|/|___||___|/|___||___|/|___||___|

Enumerator’s name: _________________ Enumerator’s instructions: Complete for all children under 5 in any household with a child under 5 until this module is complete = A minimum 12 households have been surveyed and 12 children measured

No Age and birth weight Coding categories Skip

4.1 Child’s name ____________________

4.2 What sex is (NAME)? Male…………….1 Female…………2

4.3 In what month and year was (NAME) born? Probe: what was his/her birthday (If the mother/carer knows the exact date of birth, also enter the date, otherwise circle 15 for the date)

Date of birth: Date |___|___| DK date……… 15 Month……… |___|___| Year………… |___|___|___|___|

No Anthropometric measurements Coding categories Skip

4.4 [record child’s weight] (measure mother and child if necessary – see 4.9)

|___|___| . |___|kg

4.5 [record height / length] (measure children >=2 years standing, measure children <2 years lying down) (record whether standing or lying – see 4.11)

|___|___|___| . |___|cm

4.6 [record bilateral pitting oedema] Refer acutely malnourished children as appropriate

0 ………….N 1……………Y

4.7 [record child’s MUAC]

|___|___| . |___|cm

4.8 [look up WFH Z-score] Refer acutely malnourished children as appropriate

≥ -2 …………………….. 1 <- 2 - ≥ -3 …………… 2 < -3 …………………….. 3

4.9 If the mother wants to hold the child: Mother and child’s weight

|___|___| . |___|kg

4. 10

Mother’s weight |___|___| . |___|kg

4. 11

[record height measurement posture] standing = 1; lying = 2

|___|

4. 12

Was (NAME) weighed within three days of birth? No………………………………………… 0 Yes……………………………………….. 1 Don’t know………………………….. 8

If “No”

skip to

4.14

4. 13

[If yes, record birth weight from card, if available. Do not record recalled birthweight– only weight verifiable with a card]

|___|___|.|___| ounces


No Supplementation, vaccination and sickness Coding categories Skip

4. 14

Has (NAME) received a Vitamin A supplement (like this one) in the last 6 months? (show blue 100,000 IU for 6-11 month olds Show red 200,000 IU for 12-59 month olds)

No………………………………………… 0 Yes……………………………………….. 1 Don’t know………………………….. 8

4. 15

Has (NAME) received de-worming medicine in the last 6 months? (Circle ONE answer)

No………………………………………… 0 Yes……………….………………………. 1 Don’t know………………………….. 8

4. 16

Has (NAME) been vaccinated for measles? (only choose option 1 if you have seen the card) (Circle ONE answer)

No………………………………………… 0 Yes, with card………………………. 1 Yes, no card…………………………. 2 Don’t know………………………….. 8

4. 17

[record BCG scar] (look for the scar on the arm)

No………………………………… 0 Yes………………………………. 1

4. 18

Did (NAME) sleep under a bed net last night? No………………………………… 0 Yes………………………………. 1

4. 19

Was (NAME) sick in the last 2 weeks (since state day of the week the week before last)

No………………………………… 0 Yes………………………………. 1

If “No”

skip to

4.24

4. 20

If yes, what sickness/es did (NAME) have? (Circle ANY answer/s that apply) Case definition for diarrhoea in children > 6 months = 3 or more loose stools in 24 hours Verify measles by seeing the child

No Diarrhoea………………………………… 0 Fever………………………….………………. 0 Cough/difficulty breathing caused by sickness ………………………………… 0 Measles…………….…………………. 0 Other…………………………………… 0 Specify __________________ 0

Yes 1 1

1 1 1

If no diarrhoea skip to 4.24

4. 21

If (NAME) had diarrhoea, during the diarrhoea, how much did (NAME) drink? (Circle ONE answer)

None/less/same.......

More………………………

Don’t know…………….

Not applicable…………

0

1

8

9

4. 22

If (NAME) had diarrhoea, during the diarrhoea, how much did (NAME) eat? (Circle ONE answer)

None/less/same…… More……………………. Don’t know………….. Not applicable………

0 1 8 9

4. 23

If (NAME) had diarrhoea, during the diarrhoea, did (NAME) drink any of the following liquids/drinks? (Read list and circle ANY that are appropriate)

Fluid made with ORS Homemade sugar-salt-water Zinc syrup……………… Zinc tablet…………………

No Yes NA 0 1 9 0 1 9 0 1 9 0 1 9

Enumerator’s instructions: if questions 4.24 – 4.28 have already been asked for another child, finish this questionnaire

No Hygiene practices Coding categories Skip

4. 24

The last time you cleaned [NAME] after he/she passed stool, did you wash your hands?

No……………..

Yes……………

0 1

If “No” skip to 4.26

4. 25

How did you wash your hands after cleaning [NAME]? (Circle ONE answer)

Water — only……………………… Water with soap…………………. Water with ash…………………… Water with other detergent.. Water with soil…………… Other………………………………….. Don’t know………………………….

1 2 3 4 5 6

8


4. 26

The last time [NAME] passed stools, where were the faeces disposed of? (Circle ONE answer)

Child used toilet facility or thrown/dropped in toilet…… Disposed into waste/trash…. Discarded outside yard………. Covered with soil/ash…………. Left where child defaecated.. Other………………………………….. Don’t know………………………….

1 2 3 4 5 6 8

4. 27

The last time you prepared/cooked food for [NAME], did you (mother/carer) wash your hands before you did so?

No……………………………………… Yes…………………………………….. Not applicable (child exclusively breastfed)…………………….

0 1

9

4. 28

How did you wash your hands before preparing/cooking [NAME’S] food? (Circle ONE answer)

Water — only……………………… Water with soap…………………. Water with ash…………………… Water with other detergent.. Water with soil…………………… Other………………………………….. Don’t know…………………………. Not applicable……………………

1 2 3 4 5 6 8 9

MODULE 5: INFANT AND YOUNG CHILD FEEDING QUESTIONNAIRE 1

Module 5: Infant and Young Child Feeding Practices questionnaire: for children 0-23 months old

Date|___||___|/|___||___|/|_1_||_3_| (DD/MM/YY) Agroecological zone ID: |___|

Village ID : |___||___| Team number: |___| Child ID : |___||___| Household ID: |___||___|

UNIQUE IDENTIFIER: Agroecological zone ID/village ID/ household ID/child ID:|___|/|___||___|/|___||___|/|___||___|

Enumerator’s name: _________________ Enumerator’s instructions: Complete for all children under 2 in any household until module 4 is complete = a minimum 12

households have been surveyed and 12 children measured

5.1 Child’s name

__________________________

5.2 Has (NAME) ever been breastfed or consumed any breastmilk?

No……………….……………… 0 Yes………………………..……. 1 DK ……………………………… 8

If ”no” or “DK” skip to 5.7

5.3 How long after giving birth did you first put (NAME) to your breast?

If respondent reports she put the infant to the breast immediately after birth, circle 0 for immediately. If less than 1 hour, write ‘00’ for hours (and ‘00’ for days). If 1-<24 hours, record number of completed hours from 1 to 23 (and ‘00’ for days). If >=24 hours (01 day), record completed days (and ‘00’ for hours).

IMMEDIATELY.......... 0

HOURS........................ |___|___|

DAYS........................... |___|___|

Don’t know ………………. 88 Not applicable…………… 99

5.4 Did you give (NAME) your colostrum?

Read this to the mother: Colostrum is the first breast milk produced soon after birth, it is more yellow and more liquid and less thick than mature breastmilk.

No……………….…………… 0 Yes………………………..…. 1 DK …………………………… 8

5.5 In the first 3 days after birth was (NAME) given anything to drink other than or in addition to breastmilk? If yes, what? If yes circle ALL items that are reported. Do not read the list

Plain water………………………. Sugar water/honey water... Milk (cow, goat)…………….…. Milk powder……………………… Infant formula…………………… Rice water………………………… Vitamins/minerals/medicine /ORS………………………….. Traditional Myanmar medicine Other ..…………………………….. Specify ________________

No Yes DK 0 1 8 0 1 8 0 1 8 0 1 8 0 1 8 0 1 8 0 1 8 0 1 8 0 1 8 0

5.6 Yesterday, during the day or night, was (NAME) breastfed?

No……………….. 0 Yes………………. 1 DK ……………… 8

If “Yes”, skip to 5.9


5.7 Read this to the mother: Sometimes babies are fed breast milk in different ways, for example, by spoon, cup or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman, or given breast milk from another woman by spoon, cup or bottle or some other way. This can happen if a mother cannot breastfeed her own baby.

Yesterday, during the day or night, did (NAME) drink any breastmilk in any of these ways?

No……………….. 0 Yes………………. 1 DK ……………… 8

If “Yes”, skip to 5.8

5.8 Have you stopped breastfeeding (NAME)? No……………….……………… 0 Yes………………………..……. 1

5.9 Did (NAME) have had any of the following liquids yesterday during the day or night? (Enter number of times milk was eaten, or 00 if not eaten)

A. Plain water B. Sweetened/flavoured/sugar water C. Juice / juice drinks, green coconut D. Infant formula (local brand names)

E. Fresh animal milk

F. Powdered milk

G. Tinned/condensed milk

H. Rice water

I. Vitamins/minerals/supplements/medicine

/ORS

J. Traditional Myanmar medicine

K. Any other liquids (include watery soup) Specify

No

Yes

DK / how many times

A…………………………..

0

1

8

B………………………….. 0 1 8

C…………………………… 0 1 8

D………………………….. 0 1 8 |___|___|

E………………………… 0 1 8 |___|___|

F………………………… G……………………….. H……………………….. I ……………………….. J……………………….. K………………………… __________________

0 0 0 0 0 0 0

1

1

1

1

1

1

8 |___|___|

8 |___|___|

8 8 8 8

5. 10

Yesterday during the day or night did (NAME) drink anything from a bottle with a nipple?

No……………………………………. 0 Yes………………………………….. 1 Don’t know……………………... 8


5. 11

Yesterday during the day or night, what did (NAME) eat at home OR outside home?

A. Rice, rice noodles, corn, bread or other foods made from cereals including thick grain based porridge

B. White potatoes, white yams, taro or any other foods made from roots

C. Pumpkin, carrots, sweet potatoes and any other vegetables that are yellow/orange inside (including wild vegetables)

D. Any dark green leafy vegetables e.g. watercress, gourd leaves, spinach, tamarind leaves

E. Orange or yellow fruits e.g. ripe mangoes, ripe papayas, ripe jackfruits

F. Any other fruits or vegetables G. Liver, kidney, heart, other organs H. Any meat (beef, sheep, pork, chicken, goat,

duck, rats, frog etc.) I. Eggs (e.g. chicken, quail, duck) J. Fish/ dried fish/prawn, seafood K. Any foods made of beans/nuts/lentils/seeds L. Cheese, yoghurt or milk product M. Any oil (sesame, sunflower, peanut, palm

(not red), fats/ butter or foods made with any of these

N. Any sugary foods such as honey, chocolates, candies, pastries, cakes or biscuits

O. Condiments for flavour (chillies, spices, herbs or fish paste/powder and salt)

P. Salty snacks such as chanachur, biscuits, potato chips

Q. Others (Specify)

No Yes DK

A……………..

0

1

8

B……………..

0

1

8

C……………..

0

1

8

D……………..

0

1

8

E……………..

0

1

8

F……………… 0 1 8

G…………….. 0 1 8

H……………..

0

1

8

I……………… 0 1 8

J……………… 0 1 8

K…………….. 0 1 8

L……………… 0 1 8

M…………….

0

1

8

N……………..

0

1

8

O……………. 0 1 8

P…………….. Q…………… Specify_____________

0 0 0

1 1

8 8

If all NO go to 5.12. If at least one YES or DK go to 5.13

5. 12

Yesterday during the day or at night did [NAME] eat any solid, semi-solid or soft foods? If YES, PROBE: What kind of solid, semi-solid or soft foods did [NAME] eat?

No……………………………………. 0 Yes………………………………….. 1 Don’t know……………………... 8

If YES go back to 5.11 and record foods eaten. If no skip to 5.15

5. 13

Yesterday during the day or night, how many times did (NAME) eat solid, semi-solid, or soft foods, other than liquids, at home or outside home? Small snacks and small feeds such as one or two bites of mother’s or sibling’s food should not be counted

Number of times…… |___|___| Don’t know………………. 88

5. 14

Yesterday during the day or night, did (NAME) consume any food to which you added a micronutrient powder? (e.g. Sprinkles)? (Show this to mother)

No…………………………… 0 Yes…………………………. 1 Don’t know………………. 8

5. 15

Yesterday during the day or night, did (NAME) consume drops, tablets or fortified infant formulas or baby foods containing iron? (If yes, ask to see the product to verify)

No………………………….. 0 Yes…………………………. 1 Don’t know………………. 8

dry zone nutrition and food security survey questionnaire 3.pdf · dry zone nutrition and food...

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