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Household Template 43 -Form Fill

Village Information
Q01

District Name
Q02

District Code
Q03

Block Name
Q04

Block Code
Q05

Village Name
Q06

Village Code
Q07

Village Organization Name
Q08

Village Organization Code
Q09

Type of Area
Q10

GPS coordinates
Survey Information
A01

Name of the respondent
A02

Respondent identification code

A03

FIRST VISIT

A03_1

Interviewer name
A03_2

Interviewed code
A03_3

Date of the interview
A03_4

Result of the interview
A04

SECOND VISIT

A04_1

Interviewer name
A04_2

Interviewed code
A04_3

Date of the interview
A04_4

Result of the interview
A05

THIRD VISIT

A05_1

Interviewer name
A05_2

Interviewed code
A05_3

Date of the interview
A05_4

Result of the interview
A06

Record time when you start the interview
Respondent Information
B01

Name of the head of the household
B02

Address
B03

Phone number
B04

Name of the respondent

B05

Line number of the respondent in the list
B06

Age of the respondent in completed years
B07

Type of household
B08

SHG membership
B09

Household code

Household Roster
C01

Line Number
C02

Please tell me the names of all the persons who usually live in your household, starting with the head of the household

C03

What is the relationship of [NAME] to the head of household?
C04

What is the sex of [NAME]?
C05

How old is [NAME]?
C06

Whether the member is currently a part of SHG?
C07

Code of the SHG
C08

Date of joining SHG
Socio-demographic Details
D01

What was your age, in completed years, at the time of your marriage?
D02

What is your religion?
D03

Do you belong to a scheduled caste, scheduled tribe, other backward class, or general class?
D04

Can you read and write?
D05

What is the highest standard or class you have completed?
D06

Can your husband read and write?
D07

What is the highest standard your husband has completed?
D08

Apart from housework, what kinds of work did/do you do for which you are paid in cash or kind in the last 12 months?
D09

What is your monthly income?
D09A

How did the lockdown affect your monthly income?
D10

How much do you contribute to the household’s income per month?
D11

How has the lockdown affected the amount of work done by you?
D11A

Some people try to save money for emergencies or to buy something special in the future.
D12

How long ago did you start saving?
D13

How much have you personally saved in cash?
D14

How has the lockdown affected the amount of money you saved?
D15

During the last 12 months, where did you deposit your savings usually?
D16

Apart from housework, what kinds of work did/does your husband do for which he was paid in cash or kind in the last 12 months?
D17

In your opinion, if a girl pursues an income-generation activity outside the house within or near the village/town, would that
D18

Would you allow your daughter to engage in an income generating activity?
D19

Would you allow your daughter-in-law to engage in an income generating activity?
D20

What is your husband’s monthly income?
D21

How did the lockdown affect your husband’s monthly income?
D22

Is your husband currently residing with you in this house or does he live elsewhere?
D23

How many times did your husband migrate for work in the past 12 months?
D24

What is the reason for migration?
D25

Did your husband had to return from the town/city during lockdown?
D26

What is the reason for returning?
D27

Does your household own a ration card?
D28

What is the type of the ration card?
D29

Does anyone in your household own an MGNREGA card?
D30

Does anyone in your household have a bank account?
D31

Does anyone in your household have a voter card?
D32

Has any member of the household applied for registration under the AYUSHMAN BHARAT or/and PRADHAN MANTRI JAN AROGYA YOJANA?
D33

Where did the household member apply for registration under AYUSHMAN BHARAT?
D34

What is the status of the application?
D35

Are you worried about the healthcare system’s ability to help those with corona in your community for any the following reasons?
D36

Are you worried about the healthcare system’s ability to help those with healthcare issues other than corona in your community for any the following reasons?
Household Asset Ownership
E01

Does your household own this house or any other house?
E02

LOOK AT THE FLOOR AND CODE THE MAIN MATERIAL OF THE FLOOR
E03

LOOK AT THE ROOF AND CODE THE MAIN MATERIAL OF THE ROOF
E04

LOOK AT THE EXTERIOR WALLS AND CODE THE MAIN MATERIAL OF THE WALLS
E05

Type of windows

E05_1

Any windows
E05_2

Windows with glass
E05_3

Windows with screens
E05_4

Windows with curtains or shutters
E06

How may rooms in this house are used for sleeping?
E07

Do you have a separate room which is used as kitchen?
E08

What type of fuel does your household use for cooking?
E09

What is the main source of lighting in this household?
E10

What is the main source of drinking water for members of your household?
E11

What do you usually do to the water to make it safer to drink?
E12

Does this household use mosquito nets (treated/ untreated) for sleeping children aged 0-5 years?
E13

What kind of toilet facility do members of your household usually use?
E14

Does the individual defecate in the open or used a latrine?
E15

Where do you generally defecate: use toilets or go out in open?
E16

On what occasions did you wash your hands with soap since this time yesterday?
E17

Is there soap and water available near the place where food is prepared?
E18

Does your household have

E18_1

Electricity
E18_2

A mattress
E18_3

A pressure cooker
E18_4

A chair
E18_5

A cot or bed
E18_6

A table

E18_7

An electric fan
E18_8

A radio or transistor
E18_9

A black and white television
E18_10

A color television
E18_11

A sewing machine
E18_12

A mobile phone
E18_13

Any other type of telephone
E18_14

A computer/laptop
E18_15

A refrigerator
E18_16

A watch or clock
E18_17

A bicycle
E18_18

A motorcycle or scooter
E18_19

An animal-drawn cart
E18_20

A car
E18_21

A water pump
E18_22

A thresher
E18_23

A tractor
E18_24

Internet
E18_25

Air Conditioner or Cooler
E18_26

Washing Machine
Birth history and pregnancy
F01

How many times have you been pregnant till date? Please include all pregnancy that resulted in live birth, whether still alive or not, whether had an abortion or miscarriage, or whether currently pregnant.
F02

What was the outcome of your ……pregnancy?
F03

What was the year of pregnancy outcome?
F04

How many months did this pregnancy last?
F05

What name was given to your (first/next) baby?
F06

CHECK BOX IF FOCAL CHILD ONLY
F07

Was this a single/multiple birth?
F08

What is/was the sex of [NAME]?
F09

Is [NAME] still alive?
F10

How old was (NAME) when he/she died?
F11

Did you use any birth spacing method before this ...pregnancy?
F12

Was this …... pregnancy planned?
F13

How old were you when you had your first pregnancy?
F14

Are you pregnant now?
F15

Are you registered for this pregnancy with ANM, ASHA, or AWW?
F16

After the child you are expecting now, would you or your husband like to have another child, or would you prefer not to have any more children?
F17

Would you or your husband like to have a/another child, or would you prefer not to have any more children?
F18

When would you like to have your next child?
F19

At the time you became pregnant (current or last), did you want to become pregnant then, did you want to wait until later, or did you not want to have any/any more children at all?
Dietary diversity
G01

Was yesterday a special day (celebration, feast day, or fasting) where you ate special foods or more or less than usual?
G01A

Please describe all the food items that you have consumed yesterday after waking up in the morning till the night before sleeping

G01A_1

From morning till 8 o'clock
G01A_2

Between 8 am to 12pm
G01A_3

Between 12pm to 4pm
G01A_4

Until 4 o'clock till morning
G02

I would like to ask you about food that you may have had yesterday during day or night (or the day before if yesterday was unusual)

G02_1

Food made from grains
G02_2

Roots and tubers and plaintains
G02_3

Food made from white roots and tubers and plaintains
G02_4

Any dark green leafy vegetables such as spinach etc.
G02_5

Ripe mangoes, ripe papayas, or other fruits rich in Vitamin A
G02_6

Any other fruits or vegetables
G02_7

Liver, kidney, heart or other organ meats
G02_8

Any meat such as pork, lamb, goat, chicken or duck
G02_9

Eggs
G02_10

Fresh or dried fish, shellfish or seafood
G02_11

Any foods made from beans, peas, lentils, nuts or seeds
G02_12

Cheese, yogurt, or other milk products
G02_13

Any oil, fats, or butter or foods made with any of these
G02_14

Any sugary foods such as chocolates, sweets, candies, pastries, cakes or biscuits
G02_15

Condiments for flavor, such as chilies, spices, herbs, or fish powder
G02_16

Grubs, snails, or insects
G02_17

Foods made with red palm oil, red palm nut, or red palm nut pulp sauce
G02_18

Other food or food items (Specify)
G02_19

Has there been a change in the consumption of food during the lockdown?
G03

Please tell me whether you have heard of these messages, and its source

G03_1

It is important to understand the relationship between health, nutrition and cleanliness to increase income and savings and to prevent unnecessary expenses on illness.
G03_2

Only by paying attention to health, nutrition and hygiene can we reduce diseases and increase the livelihood of the family as well as maintain the earning potential.
G03_3

Be sure to feed mother's milk to the baby immediately after birth (within 1 hour).
G03_4

Mother's first yellow thick milk is nectar for the child, make sure to feed it to the child.
G03_5

From birth till 6 months, the child should be given only mother's milk, not even a drop of water.
G03_6

Giving only mother's milk for 6 months has many benefits for the child, healthy and healthy life is one of them.
G03_7

A lactating mother should take special care of her eating habits. The mother should consume extra amounts of food and water.
G03_8

After 6 months, the child should be given complementary food, and breastfeeding should also continue for at least 23 months.
G03_9

For supplementary feeding, it is important to pay attention to the right age, right time, right variety, right consistency and right method.
G03_10

Women must include 5 food groups out of 10 in their daily diet.
G03_11

Pregnant and lactating women should take 1 to 2 extra meals a day more than usual.
G03_12

Women should also keep motivating the adolescent girls around them to eat nutritious food.
G03A

Sources

G03A_1

It is important to understand the relationship between health, nutrition and cleanliness to increase income and savings and to prevent unnecessary expenses on illness.
G03A_2

Only by paying attention to health, nutrition and hygiene can we reduce diseases and increase the livelihood of the family as well as maintain the earning potential.
G03A_3

Be sure to feed mother's milk to the baby immediately after birth (within 1 hour).
G03A_4

Mother's first yellow thick milk is nectar for the child, make sure to feed it to the child.
G03A_5

From birth till 6 months, the child should be given only mother's milk, not even a drop of water.
G03A_6

Giving only mother's milk for 6 months has many benefits for the child, healthy and healthy life is one of them.
G03A_7

A lactating mother should take special care of her eating habits. The mother should consume extra amounts of food and water.
G03A_8

After 6 months, the child should be given complementary food, and breastfeeding should also continue for at least 23 months.
G03A_9

For supplementary feeding, it is important to pay attention to the right age, right time, right variety, right consistency and right method.
G03A_10

Women must include 5 food groups out of 10 in their daily diet.
G03A_11

Pregnant and lactating women should take 1 to 2 extra meals a day more than usual.
G03A_12

Women should also keep motivating the adolescent girls around them to eat nutritious food.
Pregnancy
H01

How many months pregnant are you?
H02

Have you registered the current pregnancy?
H03

Whom did you register your current pregnancy with for the first time?
H04

Where was the current pregnancy registered?
H05

Did you get any card (Mother and Child Protection Card) after registering the current pregnancy?
H06

Can I please see the Mother and Child Protection Card?
H07

In which month of your current pregnancy, was your pregnancy registered?
H08

During your current pregnancy, did you go to see anyone for antenatal checkup?
H09

During your current pregnancy, did anyone come to you for antenatal checkup?
H10

Did any woman from your SHG/VO SAC or family accompany you during (any of) your antenatal visits for your current pregnancy?
H11

Who accompanied you?
H12

During your current pregnancy, how many months pregnant were you when you received antenatal checkup for the first time?
H13

During your current pregnancy, how many times did you receive antenatal checkup during lockdown?
H14

During your current pregnancy, as part of your antenatal check-ups, during lockdown, were any of the following done at least once.

H14_1

Were you weighed?
H14_2

Was your blood pressure measured?
H14_3

Did you give a urine sample?
H14_4

Was your blood checked for hemoglobin level?
H14_5

Was your abdomen checked?
H14_6

Was your ultrasound done?
H15

Who all did your antenatal checkups during your current pregnancy during the lockdown?
H15A

Where all did you receive antenatal checkups during your current pregnancy during the lockdown?
H16

Why did you not receive antenatal care during lockdown?
H17

During your current pregnancy, how many times did you receive antenatal checkup after the lockdown?
H18

During your current pregnancy, as part of your antenatal check-ups, after lockdown, were any of the following done at least once.

H18_1

Were you weighed?
H18_2

Was your blood pressure measured?
H18_3

Did you give a urine sample?
H18_4

Was your blood checked for hemoglobin level?
H18_5

Was your abdomen checked?
H18_6

Was your ultrasound done?
H19

Who all did your antenatal checkups during your current pregnancy after the lockdown?
H20

Where all did you receive antenatal checkups during your current pregnancy after the lockdown?
H21

During your current pregnancy, were you given a TT injection?
H22

During your current pregnancy, how many times did you receive a tetanus injection?
H23

At any time before this pregnancy,did you receive any tetanus injections?
H24

How many years ago did you receive the last tetanus injection before this pregnancy?
H25

During your current pregnancy, was your blood checked for Hemoglobin during the first three months?
H26

Have you been identified as anemic?
H27

During your current pregnancy, did you buy or receive any Iron Folic Acid (IFA) tablets?
H28

In which months of your current pregnancy did you buy or receive IFA tablets for the first time?
H29

How many tablets did you buy in total during your whole pregnancy?
H30

How many tablets did you buy in total during your whole pregnancy?
H31

Did you face any challenges in buying IFA tablets during the lockdown?
H32

During the whole pregnancy, how many I.F.A tablets did you consume?
H33

How many I.F.A tablets did you consume in the last 24 hours?
H34

During this pregnancy, were you given, or did you buy any iron folic syrup?
H35

In which month of this pregnancy did you receive IFA syrup bottles for the first time?
H36

How many IFA syrup bottles did you receive in total, during your whole pregnancy?
H37

During the whole pregnancy with [CHILD NAME], how many bottles did you consume?
H38

Did you consume IFA syrup in the last 24 hours?
H39

Did you face any challenges in buying IFA syrup during the lockdown?
H40

During this pregnancy with [CHILD NAME], were you given, or did you buy any calcium tablets?
H41

During this pregnancy with [CHILD NAME], how many calcium tablets were you given, or did you buy?
H42

During the whole pregnancy with [CHILD NAME], how many tablets did you consume?
H43

How many calcium tablets did you consume in the last 24 hours?
H44

Did you face any challenges in buying calcium tablets during the lockdown?
H45

During your current pregnancy, did you take any drug for intestinal worms?
H46

During this pregnancy, did you receive any dose of Sp/Fansidar, which is used for preventing malaria?
H47

How many doses did you get?
H48

During this pregnancy, did you have malaria?
H49

Did you seek treatment for malaria?
H50

During this pregnancy, were you tested for syphillis?
H51

Were you given a Penicillin injection/ tablet as treatment for syphilis?
H52

During this pregnancy, were you tested for HIV?
H53

Did you seek treatment for HIV?
H54

Were you screened for diabetes during this pregnancy?
H55

Were you tested positive for diabetes during this pregnancy?
H56

Did you seek treatment for diabetes?
H57

During this pregnancy, did you ever receive any Take Home Ration (THR) from the Anganwadi Centre (AWC)?
H58

During this pregnancy, how many packets of THR did you receive from the AWC/VHND?
H59

Why did you not receive THR?
H60

During this pregnancy, how many packets of THR have you consumed?
H61

During this pregnancy what kind of problems did you experience?

H61_1

Excessive vaginal bleeding

H61_2

Difficulty in breathing
H61_3

Severe headache
H61_4

Blurred vision
H61_5

Swelling of the hands, feet, body or face

H61_6

High fever
H61_7

Loss of consciousness
H61_8

Severe abdominal pain
H61_9

Convulsions

H61_10

High Blood Pressure
H62

Did you seek treatment for this problem?
H63

From where did you seek treatment?
H64

Have you got tested for Covid 19?
H65

Did you receive any support from the SHG members on the problems that occurred during this pregnancy/delivery?
H66

What type of support did you receive?
H67

How many times did the ASHA come to meet you at your home during this pregnancy?

H67_1

Before lockdown
H67_2

During lockdown
H67_3

After lockdown
H68

How many times did the AWW come to meet you at your home during this pregnancy?

H68_1

Before lockdown
H68_2

During lockdown
H68_3

After lockdown
H69

How many times did the ANM come to meet you at your home?

H69_1

Before lockdown
H69_2

During lockdown
H69_3

After lockdown
H70

How many times did the LHV/Government Doctor come to meet you at your home?

H70_1

Before lockdown
H70_2

During lockdown
H70_3

After lockdown
H71

Did you attend any Village Health Sanitation Nutrition Days in your current pregnancy?
H72

When was the last time that you attended VHSND?
H73

Have you heard of Filariasis?
H74

Have you heard of “Haathi Paon”?
H75

How is Filariasis transmitted?
H76

Can infection with Filaria be prevented?
H77

How can Filaria be prevented?
H78

Has the planning for delivery of your child changed due to the lockdown/corona?
H79

How has the planning changed?
H80

Please tell me whether you have heard of these messages, and its source.

H80_1

As soon as pregnancy is detected, ensure registration at Anganwadi center and four antenatal check-ups.
H80_2

Keep the mother-child card safe and ensure that the necessary information is filled in the card after every check-up.
H80_3

For safe delivery, keep the identity of the hospital, name of the person donating blood, ambulance number, Asha number and save money for delivery expenses.
H80_4

In case of emergency, keep the number of a trained nurse ready for home delivery and a clean cloth, new blade, new thread and new soap in a bag.
H80_5

Recognize the dangers occurring during pregnancy and after delivery and immediately go to the nurse didi or the nearest hospital.
H80_6

Identify the danger signs in a newborn baby and immediately go to the nurse or the nearest hospital.
H80_7

Be sure to feed mother's milk to the baby immediately after birth (within 1 hour).
H80_8

From birth till 6 months, the child should be given only mother's milk, not even a drop of water.
H80_9

It is necessary to keep the newborn baby warm, hence keep the baby's head and body covered.
H80_10

The newborn baby should take proper care especially of the navel to avoid infection.
H80_11

Children can be protected from many deadly diseases by regular vaccination.
H80_12

As soon as you see symptoms of diarrhea in the child, prepare ORS solution and start feeding it to the child.
H80A

Sources

H80A_1

As soon as pregnancy is detected, ensure registration at Anganwadi center and four antenatal check-ups.
H80A_2

Keep the mother-child card safe and ensure that the necessary information is filled in the card after every check-up.
H80A_3

For safe delivery, keep the identity of the hospital, name of the person donating blood, ambulance number, Asha number and save money for delivery expenses.
H80A_4

In case of emergency, keep the number of a trained nurse ready for home delivery and a clean cloth, new blade, new thread and new soap in a bag.
H80A_5

Recognize the dangers occurring during pregnancy and after delivery and immediately go to the nurse didi or the nearest hospital.
H80A_6

Identify the danger signs in a newborn baby and immediately go to the nurse or the nearest hospital.
H80A_7

Be sure to feed mother's milk to the baby immediately after birth (within 1 hour).
H80A_8

From birth till 6 months, the child should be given only mother's milk, not even a drop of water.
H80A_9

It is necessary to keep the newborn baby warm, hence keep the baby's head and body covered.
H80A_10

The newborn baby should take proper care especially of the navel to avoid infection.
H80A_11

Children can be protected from many deadly diseases by regular vaccination.
H80A_12

As soon as you see symptoms of diarrhea in the child, prepare ORS solution and start feeding it to the child.
Ante-natal care
I01

Was the last pregnancy a singleton or twins/multiple birth?
I02

Line number of the child
I03

Was the child delivered during lockdown or after 25 March 2020?
I04

If twins/multiple birth, has this woman been interviewed before?
I05

During your last pregnancy with [CHILD NAME], did you register the pregnancy?
I06

During your last pregnancy with [CHILD NAME], who did you register the pregnancy with?
I07

Where was the last pregnancy registered?
I08

Did you get any card (Mother and Child Protection Card) after registering the last pregnancy?
I09

Can I please see the Mother and Child Protection Card?
I10

In which month of the last pregnancy, was your pregnancy registered?
I11

During the last pregnancy with [CHILD NAME], did you go to see anyone for antenatal checkup?
I12

During the last pregnancy with [CHILD NAME], did anyone come to you for antenatal checkup?
I13

Did any woman from your SHG or family accompany you during (any of) your antenatal visits?
I14

Why did you not seek antenatal check-up for the last pregnancy?
I15

Why did you seek antenatal checkup for the last pregnancy?
I16

When you were pregnant with [CHILD NAME], how many times did you receive antenatal checkup?
I17

ANC visit no.
I18

In which month of the last pregnancy did you receive this check-up?
I19

Who did your antenatal checkups during your last pregnancy with [CHILD NAME]?
I20

Where did you receive this ANC check-up?
I21

Is the information on this ANC available in MCP card?
I22

Blood Test
I23

Weight measured
I24

Blood pressure measured
I25

Urine testing
I26

Abdominal check up
I27

During your last pregnancy child [CHILD NAME], as part of your antenatal checkups were any of the following done at least once?

I28

Were you weighed?
I29

Was your blood pressure measured?
I30

Did you give a urine sample?
I31

Was your blood checked for hemoglobin level?
I32

Was your abdomen checked?
I33

During the last 3 months of your last pregnancy with [CHILD NAME], was your blood pressure checked?
I34

During the last 3 months of your last pregnancy with [CHILD NAME], was your blood checked for hemoglobin level?
I35

When you were last pregnant with [CHILD NAME], did you get an ultrasound?
I36

In which month of your last pregnancy with [CHILD NAME], did you get an ultrasound for the first time?
I37

Why didn’t you go for more ANC check-ups?
I38

During your last pregnancy, did health Social Action Committee (SAC) members of your Village Organization (VO) come to meet you?
I39

During your last pregnancy with [CHILD NAME], were you given a TT injection?
I40

During your last pregnancy with [CHILD NAME], how many times did you receive a tetanus injection?
I41

In which month of the last pregnancy did you receive your 2nd tetanus injection?
I42

Was the tetanus injection given as a part of an antenatal visit?
I43

At any time before your last pregnancy, did you receive any tetanus injections?
I44

How many years ago did you receive the last tetanus injection?
I45

During your last pregnancy with [CHILD NAME], did you take any drug for intestinal worms?
I46

What are the reasons for not consuming the drug?
I47

Did you ever buy/receive IFA tablets during your last pregnancy with [CHILD NAME]?
I48

In which month of your last pregnancy with [CHILD NAME] did you first buy/receive IFA tablets?
I49

How many times during your last pregnancy with [CHILD NAME] did you first buy/receive IFA tablets?
I50

How many IFA tablets did you buy over the entire duration of your last pregnancy with [CHILD NAME]?
I51

How many IFA tablets did you receive over the entire duration of your last pregnancy with [CHILD NAME]?
I52

During the whole pregnancy with [CHILD NAME], how many tablets did you consume?

I53

What are the reasons for not consuming I.F.A tablets?
I54

During your last pregnancy with [CHILD NAME], were you given, or did you buy any iron folic syrup?
I55

In which month of last pregnancy did you receive IFA syrup for the first time?
I56

How many IFA syrup bottles did you receive in total during your whole pregnancy with [CHILD NAME]?
I57

During the whole pregnancy with [CHILD NAME], how many IFA syrup bottles did you consume?
I58

During your last pregnancy with [CHILD NAME], were you given, or did you buy any calcium tablets?
I59

During your last pregnancy with [CHILD NAME], how many calcium tablets were you given or did you buy?
I60

During the whole pregnancy with [CHILD NAME], how many tablets did you consume?
I61

What are the reasons for not consuming calcium tablets?
I62

During your last pregnancy what kind of problems did you experience?

I62_1

Excessive vaginal bleeding

I62_2

Smelly vaginal discharge
I62_3

Swelling of the hands, feet, body or face

I62_4

Headache
I62_5

Blurred vision
I62_6

Convulsions
I62_7

Febrile illness
I62_8

Severe abdominal pain that is not labor pain
I62_9

Pallor

I62_10

Difficulty in breathing
I62_11

High fever
I62_12

Loss of consciousness
I62_13

High Blood Pressure
I62_14

Heart palpitations

I62_15

Diabetes (sugar problem)
I62_16

Other medically diagnosed disease

I62_17

Diagnosed with syphilis

I62_18

Diagnosed with HIV
I62_19

Malaria
I63

Did you seek treatment for this problem?
I64

From where did you seek treatment?
I65

Did you discuss the complications during the last pregnancy or delivery during the SHG meetings?
I66

Did you receive any support from the SHG on the problems that occurred during your last pregnancy or delivery?
I67

What type of support did you receive?
I68

Did you attend any Village Health Sanitation Nutrition Days during your last pregnancy?
I69

When was the last time that you attended VHSND?
I70

Have you heard of Filariasis?
I71

Have you heard of “Haathi Paon”?
I72

How is Filariasis transmitted?
I73

Can infection with Filaria be prevented?
I74

How can Filaria be prevented?
I75

Please tell me whether you have heard of these messages, and its source.

I75_1

As soon as pregnancy is detected, ensure registration at Anganwadi center and four antenatal check-ups.
I75_2

Keep the mother-child card safe and ensure that the necessary information is filled in the card after every check-up.
I75_3

For safe delivery, keep the identity of the hospital, name of the person donating blood, ambulance number, Asha number and save money for delivery expenses.
I75_4

In case of emergency, keep the number of a trained nurse ready for home delivery and a clean cloth, new blade, new thread and new soap in a bag.
I75_5

Recognize the dangers occurring during pregnancy and after delivery and immediately go to the nurse didi or the nearest hospital.
I75_6

Identify the danger signs in a newborn baby and immediately go to the nurse or the nearest hospital.
I75_7

Be sure to feed mother's milk to the baby immediately after birth (within 1 hour).
I75_8

From birth till 6 months, the child should be given only mother's milk, not even a drop of water.
I75_9

It is necessary to keep the newborn baby warm, hence keep the baby's head and body covered.
I75_10

A newborn baby should especially take proper care of the navel to avoid infection.
I75_11

Children can be protected from many deadly diseases by regular vaccination.
I75_12

As soon as you see symptoms of diarrhea in the child, prepare ORS solution and start feeding it to the child.
I75A

Sources

I75A_1

As soon as pregnancy is detected, ensure registration at Anganwadi center and four antenatal check-ups.
I75A_2

Keep the mother-child card safe and ensure that the necessary information is filled in the card after every check-up.
I75A_3

For safe delivery, keep the identity of the hospital, name of the person donating blood, ambulance number, Asha number and save money for delivery expenses.
I75A_4

In case of emergency, keep the number of a trained nurse ready for home delivery and a clean cloth, new blade, new thread and new soap in a bag.
I75A_5

Recognize the dangers occurring during pregnancy and after delivery and immediately go to the nurse didi or the nearest hospital.
I75A_6

Identify the danger signs in a newborn baby and immediately go to the nurse or the nearest hospital.
I75A_7

Be sure to feed mother's milk to the baby immediately after birth (within 1 hour).
I75A_8

From birth till 6 months, the child should be given only mother's milk, not even a drop of water.
I75A_9

It is necessary to keep the newborn baby warm, hence keep the baby's head and body covered.
I75A_10

A newborn baby should especially take proper care of the navel to avoid infection.
I75A_11

Children can be protected from many deadly diseases by regular vaccination.
I75A_12

As soon as you see symptoms of diarrhea in the child, prepare ORS solution and start feeding it to the child.
Birth preparedness
J01

Prior to the delivery, did you plan or intend to deliver [CHILD NAME] at home or in a health facility?
J02

Did you discuss plans for your last delivery with any family member?
J03

Who did you discuss your plans for the last delivery?
J04

Did you discuss plans for your last delivery in any of the SHG meetings?
J05

Now I would like to ask you about anything specific that you did to prepare for the last delivery. Did you do anything specific to prepare for last delivery?

J05_1

Identify and arrange for a skilled birth attendant to be present during childbirth

J05_2

Identify and arrange for a birth companion to be present during childbirth

J05_3

Obtain a new blade to cut the cord
J05_4

Obtain a new/clean thread to tie the cord
J05_5

Obtain clean cloth for drying the baby
J05_6

Obtain clean cloth for wrapping the baby
J05_7

Save money for the delivery
J05_8

Identify a health facility to go to in case of an emergency

J05_9

Identify in advance a vehicle you would use to reach health facility for delivery or in case of emergency

J05_10

Kept important phone numbers handy, like the phone numbers of the ASHA, hospital, and ambulance
J05_11

Identify a person to accompany you to the healthcare facility
J05_12

Identifying a person with the similar blood group as the woman
J05_13

Ensure soap is available for the person conducting the delivery
J06

Did the planning for delivery of your child change due to the lockdown/corona?
J07

How did the planning change?
Delivery and child care
K01

How many months pregnant were you when [CHILD’s NAME] was born?
K02

Was the baby born early, on time, or after it was due?
K03

Where did you deliver [CHILD NAME]?
K04

How long did you stay at the healthcare facility after delivery?
K05

Why did you not deliver at a health facility?
K06

Who conducted the delivery of [CHILD NAME]?
K07

Who accompanied you to the hospital during the last delivery?
K08

Did you make arrangements for money in case of emergency?
K09

Did you make arrangements for transportation in case of emergency?
K10

Was the baby weighted after birth?
K11

How much did [Child Name] weigh at birth?
K12

Immediately after the birth, was [Child Name] put on your chest/abdomen?
K13

After delivery, did anyone (doctor/family member/health worker / community member) place your child unclothed in skin-to-skin contact to your chest or abdomen?
K14

After the day of delivery, did you put your child on your bare chest and covered properly and practice skin to skin care?
K15

For how many days after birth did you practice skin-to-skin care?
K16

For how long each day did you practice skin to skin care?
K17

After delivery, was the baby wiped dry, wiped with a wet cloth, or bathed?
K18

How soon after the delivery was [Child Name] given (his/her) first bath?
K19

To keep child warm, skin to skin contact method is done. Do you know about this method?
K20

Could you explain how to practice skin to skin contact method?
K21

Who explained you how to practice skin to skin contact method?
K22

After the delivery, who cut the umbical cord?
K23

What instrument was used to cut the umbilical cord?
K24

What was used to tie the cord?
K25

Was anything applied to the cord after cutting and tying?
K26

What was applied to the cord after cutting and tying?
K27

Was anything applied to the umbilicus after the cord dropped off?
K28

What was applied to the umbilicus after the cord dropped off?
K29

How to prevent cord infection to a newborn after birth?
K30

Who told you about the ways to prevent cord infection?
K31

Did a health worker such as an ANM, ASHA, or Aanganwadi Worker come to your home to see you and your baby after the delivery?
K32

Who came to visit you and the baby?
K33

How many days or weeks after the delivery did the first home visit take place?
K34

How many times did an ASHA, AWW, ANM visit you at home during the first week after you gave birth to your child?
K35

How many times did an ASHA, AWW, ANM visit you at home during the first month after you gave birth to your child?
K36

How many times did an ASHA, AWW, ANM visit you at home during the first TWO months after you gave birth to your child?
K37

How many times did an ASHA, AWW, ANM visit you at home during the first THREE months after you gave birth to your child?
K38

What specific questions did the health worker ask you during any of the home visits?

K38_1

Number of times mother takes full meals in the last 24 hours
K38_2

Number of pads changed in a day
K38_3

Baby being kept warm (near mother, clothed and wrapped properly)
K38_4

Baby being fed properly

K38_5

Baby crying incessantly or passing urine less than 6 times a day
K39

What are the examinations that the health worker conducted upon you during the home visits?

K39_1

Measure and record temperature
K39_2

Enquired about foul smelling discharge
K39_3

Enquired about fits or other abnormalities
K39_4

Enquired about breast milk
K39_5

Enquired about pain in breast
K40

Did you receive any financial assistance for delivery care (JSY)?
K41

How much was the payment received?
K42

How long after the delivery did you receive the financial payment/assistance?
K43

Now I am going to ask you about some messages delivery and child care practices. Please tell me whether you have heard of these messages, and its source.

K43_1

How to recognize danger signs of pregnancy
K43_2

How to recognize the danger signs at the time of delivery (for e.g. prolonged labor, excessive bleeding, etc.)
K43_3

Must undergo PNC
K43_4

Keeping the new born baby warm
K43_5

Placing the infant unclothed on the mother’s chest with skin to skin contact under a blanket or some clothing
K43_6

Keep soft clean cloth for drying the baby and a separate clean cloth for wrapping the new-born baby
K43_7

Delay first bathing of the newborn by at least 2 days
K43_8

Use a clean blade to cut the cord
K44

Source

K44_1

How to recognize danger signs of pregnancy
K44_2

How to recognize the danger signs at the time of delivery (for e.g. prolonged labor, excessive bleeding, etc.)
K44_3

Must undergo PNC
K44_4

Keeping the new born baby warm
K44_5

Placing the infant unclothed on the mother’s chest with skin to skin contact under a blanket or some clothing
K44_6

Keep soft clean cloth for drying the baby and a separate clean cloth for wrapping the new-born baby
K44_7

Delay first bathing of the newborn by at least 2 days
K44_8

Use a clean blade to cut the cord
New born care and child feeding practices
L01

Did [CHILD NAME] ever suffer from any of these problems within the first month after birth?

L01_1

Diarrhea
L01_2

Fever
L01_3

Cough
L01_4

Breathing faster than usual with short rapid breaths
L01_5

Chest indrawing
L01_6

Blocked or runny nose
L01_7

Less movement
L01_8

Unconsciousness
L01_9

Convulsion
L01_10

Poor sucking
L01_11

Baby not gaining weight
L01_12

Drowsy/lethargic/difficult to awaken
L01_13

Cold to touch
L01_14

Weak cry of the baby
L01_15

Yellowing of the skin
L01_16

Loss of interest in breastfeeding
L01_17

Tetanus
L01_18

Pertusis
L01_19

Measles
L01_20

Malaria
L01_21

Meningitis
L01_22

Congenital diseases
L02

Did you seek treatment for [CHILD NAME] for these problems?
L03

Where did you seek treatment?

L04

Was [CHILD NAME] hospitalized for this problem?
L05

How many hours/days was [CHILD NAME] in the hospital?
L06

Did you ever breastfeed [CHILD NAME]?
L07

Why did you never breastfeed [CHILD NAME]?
L08

How long after birth did you first put [CHILD NAME] to the breast?
L09

Did you discuss plans to place the newborn child on your breast immediately after delivery?
L10

Did you feed [CHILD NAME] your first yellow thick milk/colostrum (Khees)?
L11

Did you receive any support to breastfeed [CHILD NAME] immediately after delivery?
L12

Who supported you to breastfeed [CHILD NAME] immediately after delivery?
L13

Did you or anyone else give [CHILD NAME] anything such as honey, water, tea, jaggary, ghutti before giving breast milk for the first time?
L14

Did you or anyone else give [CHILD NAME] anything such as honey, water, tea, jaggary, ghutti other than breast milk within the first three days after birth?
L15

What was [CHILD NAME] given?
L16

Did you discuss plans to avoid giving any honey, janam gutti, water, other milk or anything except breastmilk to the newborn child after delivery in the first 3 days?
L17

Are you still breastfeeding [CHILD NAME]?
L18

For how many months did you breastfeed [CHILD NAME]?
L19

Why did you stop breastfeeding [CHILD NAME]?
L20

How long did you exclusively breastfeed [CHILD NAME]?
L21

During the time you exclusively breastfeed [CHILD NAME] did you occasionally give him/her a little water from time to time?
L22

Have you breastfed [CHILD NAME] in the past 24 hours – either day time or night time?
L23

How long do you intend to breastfeed the child?
L24

How long do you intend to exclusively breastfeed the child (with no water, other milk, fluids or foods)?
L25

In past 30 days, were you ever advised by the ASHA, ANM or AWW that you should not give anything other than breast milk (not even water) to [CHILD NAME] for 6 months?
L26

Did the ASHA/AWW/ANM tell you to breast feed [CHILD NAME] till 2 years?
L27

Please describe all the food items that you have fed your child yesterday after waking up early in the morning till the night before sleeping?

L27_1

From morning till 8 o'clock
L27_2

Between 8 am to 12pm
L27_3

Between 12pm to 4pm
L27_4

Until 4 o'clock till morning
L28

Now I would like to ask you about the liquids and/or solids [CHILD NAME] was given in the last 24 hours.

L28_1

Breast milk
L28_2

Plain Water
L28_3

Infant Formula
L28_4

Commercially Fortified Baby Food (Cerelac etc.)
L28_5

Milk such as tinned, powdered, or fresh animal milk
L28_6

Juice or juice drinks
L28_7

Clear Broth
L28_8

Thin Porridge (dalia)
L28_9

Sattu Mixed in water
L28_10

Roti mixed in milk

L28_11

Thin Suji/Halwa
L28_12

Thin Khichdi

L28_13

Tea or Coffee

L28_14

Sugar/Glucose Water

L28_15

Sodas like pepsi, coke, Orange drink
L28_16

Honey

L28_17

Bread, roti, chapati, rice, noodles, biscuits, idli, or other foods made from grains

L28_18

Pumpkin, carrots, squash, or sweet potatoes that are yellow or orange inside

L28_19

Any dark green leafy vegetables
L28_20

Ripe mangoes, papayas, cantaloupe, or jack fruit

L28_21

Any other vegetables/fruits (Bottle guard, brinjal, capsicum, cauliflower, ladyfinger, tinda, drum stick, snake gourd, cabbage, tomato, apple, banana, grape)

L28_22

White potatoes, white yams, manioc, cassava or any other foods made from roots
L28_23

Liver, Kidney, heart, or other organ meats

L28_24

Any meat, such as lamb, goat, chicken, or duck
L28_25

Any other meat including fish, pork, etc.
L28_26

Eggs
L28_27

Foods made from beans, peas, lentils, seeds or nuts
L28_28

Milk/Dairy Products (Cheese, yogurt, Ice cream kadhi and buttermilk, or any other milk products)

L28_29

Fats/Oils (Any oil, fats, or butter, or foods made with any of these)
L28_30

Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or biscuits

L28_31

Condiments (Such as herbs, chilies and spices)
L28_32

Salty purchased snacks foods (chips, mmuniz, namkeen,)

L29

Did [CHILD NAME] drink anything from a bottle with a nipple in the last 24 hours?
L30

Do you give [CHILD NAME] any solid, semi-solid, mashed or soft foods to eat?
L31

From what age did you start feeding [CHILD NAME] solid, semi-solid, mashed or soft foods?
L32

Excluding oil for cooking, did you add oil/ghee/butter to the food you gave [CHILD NAME] in the last 24 hours?

L33

How many times did [CHILD NAME] eat solid, semi-solid, mashed or soft foods other than liquids yesterday during the last 24 hours?

L34

Has there been a change in the consumption of the food of [CHILD NAME] during the lockdown?
L35

During the period 5-8 months after delivery, did any ASHA visit you at home to talk to you about [CHILD NAME]?
L36

Have you ever received counselling/advice on age appropriate complementary feeding?
L37

How old was [CHILD NAME] when you first received counselling/advice on age appropriate complementary feeding?
L38

Who gave you counselling/advice on age appropriate complementary feeding?
L39

What counselling/advice on age appropriate feeding did ASHA give you?
L40

Did the AWW ever talk/discuss topics related to complementary feeding with you?
L41

During the last month, did the AWW ever talk/discuss topics related to complementary feeding with you?
L42

During any of the visits, did the AWW tell you when to start feeding [CHILD NAME] solid, semi-solid, mashed or soft foods?
L43

From which month did the AWW tell you to start feeding [CHILD NAME] solid, semi-solid, mashed or soft foods?
L44

Did the AWW tell you what types of food you should feed [CHILD NAME]?
L45

What foods did the AWW tell you to feed [CHILD NAME]?
L46

Did the AWW tell you how many times to feed [CHILD NAME] each day?
L47

How many times did the AWW tell you to feed [CHILD NAME] per day?
L48

Did the AWW advise you to feed [CHILD NAME] from your plate or to feed [CHILD NAME] out of a separate plate or bowl?

L49

After your delivery, how many packets of THR did you receive from the Anganwadi center/VHND?
L50

Why did you not receive THR?
L51

After your delivery, how many packets of THR did you consume?

L52

How many packets of THR did the child receive from the Anganwadi center/VHND?
L53

Why did the child not receive THR?
L54

How many packets of THR did the child consume?
L55

During the lockdown, how often has the child received food from the Anganwadi centre?
L56

After the lockdown, how often has the child received food from the Anganwadi centre?
L57

Did the ASHA/AWW/ANM tell you about installation of a handwashing facility?
L58

Did the ASHA/AWW/ANM tell you about correct disposal of child’s feces?
L59

Did the ASHA/AWW/ANM tell you about how to feed [CHILD NAME] during illness?
L60

Has [CHILD NAME] ever been weighed at the AWC/VHND?
L61

Has [CHILD NAME] been weighed at the AWC/VHND IN THE LAST MONTH?
L62

Did AWW identify [CHILD NAME] in the severe underweight (RED) category?
Prevalence of diarrhea and pneumonia
M01

In the last two weeks, did [CHILD NAME] have diarrhoea (loose watery stools)?
M02

Was there any blood in [CHILD NAME’s] stools?
M03

Did you seek any advice/treatment for diarrhoea when [CHILD NAME] had diarrhoea the last time?
M04

Where did you seek advice/treatment from first, when [CHILD NAME] had diarrhoea the last time?
M05

What all was given to [CHILD NAME] when s/he had diarrhoea the last time?

M05_1

Zinc tablet
M05_2

Zinc syrup
M05_3

IV-line
M05_4

Injections
M05_5

Pill or syrup antibiotic
M05_6

Home remedy/herbal medicine
M05_7

Non-antibiotic syrup
M05_8

Pills crushed to powder and wrapped in paper
M05_9

ORT/ORS
M06

What was the child fed when he/she had diarrhoea?
M07

During the time [CHILD NAME] had diarrhoea, was he/she offered the same amount of breastfeeding as earlier?
M08

During the time [CHILD NAME] had diarrhoea, was he/she offered the same amount of food as earlier?
M09

Does [CHILD NAME] still have diarrhoea?
M10

Have you received any information on diarrhea and its management?
M11

From where you received the information on diarrhea and its management?
M12

Has [CHILD NAME] been ill with a fever at any time in the last 2 weeks?
M13

Has [CHILD NAME] been ill with a cough or other breathing difficulty at any time in the last 2 weeks?
M14

When [CHILD NAME] had an illness, did he/she breathe faster than usual with short, rapid breaths, have difficulty breathing or chest in drawings?
M15

When [CHILD NAME] had this illness, did he/she have a problem in the chest or a blocked or running nose?
M16

Did you seek any advice/treatment for this illness when [CHILD NAME] had the illness the last time?
M17

Where did you seek advice/treatment from first, when [CHILD NAME] had this illness the last time?
M18

At any time during the illness, did [CHILD NAME] take any drugs for the illness?
M19

What drugs did [CHILD NAME] take?

M19_1

Antibiotic Pill
M19_2

Antibiotic Syrup
M19_3

Injection
M19_4

Dispersible Tablets
M19_5

IV Fluid
M19_6

Nebulizer
M19_7

Oxygen
M20

Was it Amoxicillin antibiotic?
M21

During the time [CHILD NAME] was ill, was he/she offered the same amount of breastfeeding as earlier?
M22

During the time [CHILD NAME] was ill, was he/she offered the same amount of food as earlier?
M23

Does [CHILD NAME] still have fever or cough or difficulty in breathing or chest in drawing?
M24

Whether [CHILD NAME] has been tested for Covid 19?

M25

Was [CHILD NAME] screened by a medical doctor for any of the following

M25_1

Birth defects
M25_2

Development delays
M25_3

Deficiency
M26

Has the child been identified as anaemic by any ASHA/AWW/NURSE/DOCTOR?
Immunization
N01

Was [CHILD’S NAME] supposed to receive any vaccination in the lockdown?
N02

Does [CHILD’S NAME] receive any vaccinations during the lockdown?
N03

Where did [CHILD’S NAME] receive the vaccine during lockdown?
N04

Why did [CHILD’S NAME] not receive vaccination?
N05

Did [CHILD NAME] ever receive any vaccinations to prevent (him/her) from getting diseases?
N06

What is the main reason that [CHILD NAME] has not received any vaccinations?
N07

Do you have an immunization card or MCP card where [CHILD NAME]’s vaccinations are written down?
N08

COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD.

N08_1

BCG
N08_2

POLIO 0 (POLIO GIVEN AT BIRTH)
N08_3

HEPATITIS B 0 (HEPATITIS B GIVEN AT BIRTH)
N08_4

POLIO 1
N08_5

DPT 1
N08_6

PENTAVALENT 1
N08_7

ROTAVIRUS 1
N08_8

HIB 1
N08_9

HEPATITIS B 1

N08_10

IPV 1
N08_11

POLIO 2
N08_12

DPT 2
N08_13

PENTAVALENT 2
N08_14

ROTAVIRUS 2
N08_15

HIB 2
N08_16

HEPATITIS B 2
N08_17

POLIO 3
N08_18

DPT 3
N08_19

PENTAVALENT 3
N08_20

ROTAVIRUS 3
N08_21

HIB 3
N08_22

HEPATITIS B 3
N08_23

IPV 2
N08_24

MEASLES 1
N08_25

VITAMIN A (FIRST DOSE)

N08_26

JE 1
N08_27

DPT (16-24 MONTHS)
N08_28

POLIO (16-24 MONTHS)
N08_29

VITAMIN A (SECOND DOSE)
N08_30

JE 2
N08_31

MEASLES 2
N08_32

VITAMIN A (THIRD DOSE)
N09

Please tell me if [CHILD NAME] received any of the following vaccinations:

N09_1

A BCG vaccination against tuberculosis that is, an injection in the arm or shoulder that usually causes a scar?
N09_2

How old was the child when BCG was given?
N09_3

A Polio vaccine that is drop given in the mouth?
N09_4

How many times?
N09_5

Was the first polio vaccine received in the first two weeks after birth?
N09_6

Was drops in the mouth as part of the Pulse Polio campaign given to the child?
N09_7

An IPV (inactivated Polio Vaccine), that is an injection given in the right thigh?
N09_8

How many times
N09_9

How old was the child when last IPV was given?
N09_10

A Pentavalent vaccination, that is, an injection given in the thigh, sometimes at the same time as polio drops?
N09_11

How many times?
N09_12

How old was the child when this drop/vaccination was last given?
N09_13

An injection against measles at right arm/shoulder?
N09_14

How old was the child when this injection was last given?
N09_15

Vitamin A that is given by a spoon?
N09_16

How many times?
N09_17

How old was the child when this drop was last given?
N10

Before [CHILD NAME] received vaccination the last time, did an ASHA/AWW/ANM visit your home to remind you that [CHILD NAME] was due for a vaccination?
N11

Has [CHILD NAME] received a vitamin A dose in the last 6 months?
N12

Has [CHILD NAME] received iron pills or iron syrup (like this/ any of these) in the last 6 months?
N13

Has [CHILD NAME] received any iron pills or iron syrup in the last 7 days?
N14

Has [CHILD NAME] consumed any iron pills or iron syrup in the last 6 months?
N15

Has [CHILD NAME] taken any drug to get rid of intestinal worms in the past 6 months?
N16

Have you received any information on the importance of age appropriate complete immunization of the child?
N17

From where you received the information on the importance of age appropriate complete immunization of the child?
N18

Have you heard of Filariasis?
N19

Have you heard of “Haathi Paon”?
N20

How is Filariasis transmitted?
N21

Can infection with Filaria be prevented?
N22

How can Filaria be prevented?
N23

Now I am going to ask you about some messages around health, and nutrition. Please tell me whether you have heard of these messages, and its source.

N23_1

Children can be protected from many deadly diseases by regular vaccination.
N23_2

As soon as you see symptoms of diarrhea in the child, prepare ORS solution and start feeding it to the child.
N23A

source

N23A_1

Children can be protected from many deadly diseases by regular vaccination.
N23A_2

As soon as you see symptoms of diarrhea in the child, prepare ORS solution and start feeding it to the child.
Family planning
O01

After the delivery of [CHILD NAME], did you or your husband receive any counseling/advice on family planning by a health provider?
O02

After delivery, did you receive any counselling / advice on family planning from ASHA/AWW/ANM?

O02_1

ASHA
O02_2

ANM
O02_3

AWW
O03

What family planning methods were you/your husband informed about?
O04

Are you/your husband currently using any method to delay or avoid getting pregnant?
O05

Which method are you using?
O06

When after the birth of [CHILD NAME], did you accept this method of family planning?
O07

Did you and your husband discuss which method to adopt prior to accepting the method?

O08

Was this the family planning method of your choice or you were forced to accept this method?
O09

Would you have chosen a different family planning method?
O10

Which family planning method would you have chosen?
O10A

Did the lockdown affect your ability to get your preferred method to avoid pregnancy?
O11

Before your sterilization operation, were you or your husband told that you would not be able to have any (more) children because of the operation?
O12

Were you told what to do if you experienced side effects or problems with the method?
O13

Did you receive any follow-up care after accepting this method?
O14

Did you receive any follow-up care within a month after you started using this method?
O15

Who provided that care?
O16

Did you experience any difficulties due to using this method?
O17

What were the difficulties that you experienced?
O18

Did you receive any advice or treatment for this complication?
O19

You said that you do not want to have more children/ want to have a space between children, why are you not using any family planning methods currently?
O20

Do you think you will use a contraceptive method to delay or avoid pregnancy sometime during the next 6 months?
O21

Do you think you will use a contraceptive method to delay or avoid pregnancy in the next 12 months?
O22

Which contraceptive method would you prefer to use?

O23

What is the main reason that you think you will not use a contraceptive method at any time to delay or avoid in the future?
O24

In the past year, has your husband done any of the following?
O25

Did this happen more, less, or did not change during the lockdown period?
Knowledge on antenatal care, infant feeding practices, and immunization
P01

What are the 5 main ways to ensure a healthy life?
P02

What do you understand by antenatal care (ANC)?
P03

Why is ANC necessary?
P04

When should the first ANC checkup be done?
P05

How many ANCs checkups should a pregnant woman throughout her pregnancy?
P06

How many TT injections should be given to pregnant woman?
P07

What tests should the pregnant woman go through in their ANC?
P08

What are the danger signs during pregnancy?
P09

What should a mother do with the “first milk” or colostrum?
P09A

When should a mother initiate breastfeeding for her baby?
P10

How often should a baby breastfeed?
P11

If a mother thinks her baby is not getting enough breastmilk, what should she do?
P12

Do you think infants under 6 months of age should be given water sometimes?
P13

Do you think that a breastfeeding mother of an infant under 6 months of age should stop feeding if she becomes pregnant?
P14

If a mother has a young baby (less than 6 months) and needs to be away from her baby and the baby gets hungry, what should the baby be fed?
P15

What are some reasons why a young baby should be exclusively breastfed?
P16

What are the ways to protect a child from getting worms?
P17

Why is proper nutrition of pregnant woman important?

P18

How should a pregnant/lactating woman eat in comparison to a non-pregnant woman to provide good nutrition to her baby and help baby grow?
P19

Have you heard about iron-deficiency anaemia?
P20

Can you tell me how you can recognize someone who has anaemia?
P21

What are the health risks that pregnant woman can face from lack of iron in her diet?
P22

What causes anaemia?
P23

At what age (in completed months) is it recommended that a baby begin to drink other liquids, aside from breast milk?
P24

How long after birth is it recommended that a baby begin to eat foods, aside from breast milk?
P25

How does a mother know when to introduce solid foods to the infant?
P26

At that time, what are the first foods that are recommended for a baby to eat?
P27

When feeding a meal to a child who is 7-12 months old, what types of foods would you include in a single meal?
P28

When an infant begins to eat foods in addition to breast milk, what are the recommended ways that his/her food be prepared?
P29

In general, is it recommended that infants under 6 months of age be given water if the weather is very hot?
P30

Imagine there is a mother who is having trouble beginning to introduce foods to her infant. What are the recommended ways a mother can try to feed her infant foods, aside from breast milk?
P31

What is recommended for a mother to do when her child has diarrhea?
P32

What is recommended for a mother to do when her child had diarrhea/another illness?
P33

What should a mother do (in relation to feeding) AFTER her child has recovered from diarrhea or another illness?
P34

At what age (in completed months) should a child start be receiving vaccines?
P35

For an infant less than 5 years, at what times should they receive vaccines?
P36

Are the vaccines necessary?
P37

Do you think vaccine-preventable diseases are potentially severe?
P38

Will you vaccinate your child in summer?
P39

Will you vaccinate your child in the winter?
P40

Will you vaccinate your child if the child has a fever?
P41

Are vaccines harmful?
P42

What are the key symptoms of the corona (Covid-19)?
P43

Where did you get the information about symptoms of corona?
P44

According to you, can someone who shows no symptoms of corona still be infected?
P45

What according to you are the methods of protection against corona?
P46

What methods are you using to protect yourself against the virus?
Household food security
R01

Usually, does your household have food available for the whole year?
R02

In a year how many months/days does the household lack availability of food?
R03

In the past four weeks, did you worry that your household would not have enough food?
R04

How often did this happen?
R05

In the past four weeks, did you or any household member have to eat a limited variety of foods due to a lack of resources?
R06

How often did this happen?
R07

In the past four weeks, did you or any household member go to sleep at night hungry because there was not enough food?
R08

How often did this happen?
R09

Has there been a change in the type of food consumed by your household due to the lockdown?
R10

Has there been a change in the quantity of food consumed by your household due to the lockdown?
R11

Why did the consumption of food change during the lockdown?
R12

Did you receive any in-kind provision/supply for any of the food item above from the government during the lockdown?
R13

Did you receive any cash transfers/ coupons from the government during the lockdown?
R14

Prior to the lockdown, were any of the following issues a concern, and if this issue became worse, better or remained the same during the lockdown?

R14A

Did this occur in the last 30 days before lockdown?

R14A_1

Worried you would not have enough food to eat
R14A_2

Unable to eat healthy and nutritious food
R14A_3

Ate only a few kinds of food
R14A_4

Had to skip a meal
R14A_5

Ate less than you thought you should
R14A_6

Household ran out of food
R14A_7

Hungry but did not eat
R14A_8

Went without eating for a whole day
R14A_9

Ate less to make sure children in the family had enough to eat
R14A_10

Ate less to make sure men in the family had enough to eat
R14B

Did it increase, decrease, or stayed same during lockdown?

R14B_1

Worried you would not have enough food to eat
R14B_2

Unable to eat healthy and nutritious food
R14B_3

Ate only a few kinds of food
R14B_4

Had to skip a meal
R14B_5

Ate less than you thought you should
R14B_6

Household ran out of food
R14B_7

Hungry but did not eat
R14B_8

Went without eating for a whole day
R14B_9

Ate less to make sure children in the family had enough to eat
R14B_10

Ate less to make sure men in the family had enough to eat
Possession of bank account
S01

Do you have a bank/post office savings account?
S02

Did you get this account opened under PM Jan Dhan Yojna?
S03

Since how many years do you have this bank account?
S04

Do you have the bank passbook?

S05

What were the reasons for opening this bank account?
S06

Who operates your bank account?
S07

Approximately, how many deposits were made in the account in the last three and six months?
S08

Approximately, how many withdrawals were made in the account in the last three and six months?
S09

Were you able to go to a bank to deposit or withdrawn money during the lockdown?
S10

What are the reasons for not having a bank/post office account?
Political and social engagement
T01

As an SHG, have you ever brought up issues with the Gram Panchayat?
T02

If yes, can you tell me what issues you as a group addressed?
T03A

In your household, who normally makes most of the decisions about the following activities?

T03A_1

Can you personally travel to visit relatives outside the community?
T03A_2

Can you personally participate in community groups, activities or meetings taking place in your community?
T03B

To what extent do you think you could influence the person who makes the decision to change their decision?

T03B_1

Can you personally travel to visit relatives outside the community?
T03B_2

Can you personally participate in community groups, activities or meetings taking place in your community?
T04

Do you own a mobile phone, which you carry with yourself?
T05

Is it your personal phone or one for the household?
T06

Is it a smartphone?
T07

Total time in a day when you have access to the phone?
T08

How much did you spend on mobile phone in the last 30 days (recharge and others)?
Household decision making
U01

In your household, who normally makes most of the decisions about the activities listed below?

U01_1

How much of the crops harvested should be kept for consumption in the household
U01_2

How to spend the money made from the sale of crops or main household income generating activity
U01_3

How much to spend on food in each week/month etc.
U01_4

What food to buy and consume
U01_5

How much to spend on kitchen items such as pots/pans/ plates etc
U01_6

Purchase and sale of cattle, oxen and other large livestock
U01_7

Purchase and sale of sheep and goats
U01_8

Decision regarding type of fuel used in household
U01_9

More expensive items such as TV, mobiles
U01_10

Purchase clothing for you (sarees etc.)
U01_11

Decisions regarding whether children should be put in private or government schools
U01_12

Decisions regarding type of healthcare provider (government or private) if you fall ill
U01_13

Decisions regarding family planning (preventing or planning pregnancy)
U01_14

Decision on construction of toilets
U01_15

Purchase of furniture for the house
U01_16

Sale or purchase of agricultural land/plot of land
U01_17

Expenditure on wedding of a son or daughter
U01_18

Expenditure on festivals and other ceremonies, e.g. Diwali
U01_19

Whether the household should take out a loan from SHG, and how much to borrow
U01_20

Making a loan to any relatives/ friends of yours
U01_21

Whether to sell/mortgage any gold/ jewelry owned by you
U02

To what extent do you think you can influence the person who makes the decisions to change their decision?

U02_1

How much of the crops harvested should be kept for consumption in the household
U02_2

How to spend the money made from the sale of crops or main household income generating activity
U02_3

How much to spend on food in each week/month etc.
U02_4

What food to buy and consume
U02_5

How much to spend on kitchen items such as pots/pans/ plates etc
U02_6

Purchase and sale of cattle, oxen and other large livestock
U02_7

Purchase and sale of sheep and goats
U02_8

Decision regarding type of fuel used in household
U02_9

More expensive items such as TV, mobiles
U02_10

Purchase clothing for you (sarees etc.)
U02_11

Decisions regarding whether children should be put in private or government schools
U02_12

Decisions regarding type of healthcare provider (government or private) if you fall ill
U02_13

Decisions regarding family planning (preventing or planning pregnancy)
U02_14

Decision on construction of toilets
U02_15

Purchase of furniture for the house
U02_16

Sale or purchase of agricultural land/plot of land
U02_17

Expenditure on wedding of a son or daughter
U02_18

Expenditure on festivals and other ceremonies, e.g. Diwali
U02_19

Whether the household should take out a loan from SHG, and how much to borrow
U02_20

Making a loan to any relatives/ friends of yours
U02_21

Whether to sell/mortgage any gold/ jewelry owned by you
U03

How confident do you feel speaking your opinion in any training or SHG meetings?
U04

How confident do you feel when you have to talk to ASHA/ANM/AWW about your own health issues?
U05

How confident are you in recognizing the danger signs of ill health in children under 2 years of age?
U06

How confident are you that you can go to the government health centers to get reproductive health service?
Village Health Nutrition and Sanitation Day
V01

Have you heard about VHSND?
V02

How many times was VHSND conducted in your village during the lockdown?
V03

How many times was VHSND conducted in your village after the lockdown?
V04

After the lockdown, did you or your child participate in the VHSND?
V05

Did you receive the following when you visited VHSND?

V05_1

Got take home ration
V05_2

Antenatal care services
V05_3

Newborn care
V05_4

Immunization/vaccination
V05_5

Growth monitoring (weighing)/screening for Severe Acute Malnutrition (SAM)/ Mid Upper Arm Circumference (MUAC)
V05_6

Breastfeeding counseling
V05_7

Complementary feeding counseling
V05_8

Counsel on hygienic handling of complementary food
V05_9

Give IFA syrup to 6-month-old to 6 years old children
V05_10

Give iron tablets to adolescent girls
V05_11

Counsel on malaria management and prevention
V05_12

Family planning counseling/service provision
V05_13

Advice about sending children to school/Anganwadi
V05_14

Referral to Nutrition Rehabilitation Center/PHC
V05_15

Information on Janani Evam Bal Suraksha Yojna and Janani Shishu Suraksha Karyakram
SHG participation
W01

Are you currently a member of any SHG?
W02

Do you hold any of these positions in an SHG?
W03

Does any member of your household hold any of these positions in an SHG?
W04

Is any member of your household a part of community cadre?
W05

How many meetings of your SHG were held during the lockdown?
W06

How many SHG meetings did you attend during the lockdown?
W07

How many meetings of your SHG were held after the lockdown?
W08

How many SHG meetings did you attend after the lockdown?
W09

How much do you currently have saved with the SHG?
W10

What do you plan to do with your SHG savings?
W11

What do you do when you could not contribute to savings?
W12

Does the group help you or your household get access to any of the following services?

W12_1

Education in the village
W12_2

Health services
W12_3

Water supply or sanitation
W12_4

Credit or savings
W12_5

Agricultural input or technology
W12_6

Irrigation
W12_7

Wage employment schemes such as MGNREGA
W12_8

Self-employment schemes
W13

SHG helped?

W13_1

Education in the village
W13_2

Health services
W13_3

Water supply or sanitation
W13_4

Credit or savings
W13_5

Agricultural input or technology
W13_6

Irrigation
W13_7

Wage employment schemes such as MGNREGA
W13_8

Self-employment schemes
W14

How did the SHG help?

W14_1

Education in the village
W14_2

Health services
W14_3

Water supply or sanitation
W14_4

Credit or savings
W14_5

Agricultural input or technology
W14_6

Irrigation
W14_7

Wage employment schemes such as MGNREGA
W14_8

Self-employment schemes
W15

In the past month, were health and nutrition issues discussed during SHG meetings?
W16

On an average, how much time (in minutes) was spent on discussing health related issues?
W17

What were the topics discussed?
W18

Did you participate in any trainings organized by the SHG in the last 12 months?
W19

What trainings did you participate in?
W20

When you have a problem or worry, how often do you let someone else in the SHG know?
W21

If there was a problem that affected all or some of the group members, how many women would work together to deal with the problem from the SHG?
W22

If there was a problem that affected all or some of the group members, how many women would work together to deal with the problem from the village?
W23

Which of the following statements do you agree with vis-à-vis HN?

W23_1

As a SHG we are generally able to make our ASHA/ANM/Health worker listen to our problems
W23_2

As a SHG we are generally able to make our ASHA/ANM/Health workers help us in addressing our concerns
Opinion on women’s economic role
X01

Now I am going to read out some statements. Please respond to which of the TWO statements do you agree the most

X02_1

A woman can be a leader, just like a man

X02_2

Men are better leaders than women

X02A

which of the TWO statements do you agree the most
X03_1

It is a waste of time to train a woman to keep financial records when you could train a man and he will do the job better

X03_2

It is good to train a woman to keep financial records because she can do the job as well as a man

X03A

which of the TWO statements do you agree the most
X04_1

A good marriage is more important for a girl than a good education

X04_2

A good education is more important for a girl than a good marriage

X04A

which of the TWO statements do you agree the most
X05

If I gave you INR 15,000 today, what would you do with it? Please put monetary value on each of the options

X05_1

Education
X05_2

Medical
X05_3

Own business
X05_4

Husband business
X05_5

Give to parents/siblings
X05_6

Give it to in-laws
X05_7

Save in bank
X05_8

Chit fund
X05_9

Buy jewelry
Opinion on reproductive health
Y01

In your opinion, what is the suitable age for a woman to have a first baby?
Y02

In your opinion, what is the suitable age for a man to have a first baby?
Y03

How many children would you like to have (including the ones you already have)?
Y04

Does this decision depend on how many male children you already have?
Y05

Who decides on how many children to have?
Y06

Has your husband told you how many children he would like to have?
Y07

How many children do you think your husband wants to have with you in total? If he has not mentioned it explicitly, tell me your best guess
Y08

Does this decision depend on how many male children you already have?
Y09

To what extent do you agree with these statements?

Y09_1

It is only a woman’s responsibility to avoid getting pregnant
Y09_2

If a husband and wife get into an argument about family planning, the woman should have the final say, because she bears the child
Y10

Who decides on whether to use family planning methods or not?
Y11

Record time when you end the interview