Surveypoint

Q01

Do you receive a midday meal with fortified rice at school

Yes

No

Q02

Is your age between 9 and 10 years

Yes

No

Q03

Do you plan to attend this school for the entire school year

Yes

No

A01

NAME AND CODE OF DISTRICT WHERE SCHOOL IS LOCATED…………….

A02

NAME AND CODE OF TALUKA WHERE SCHOOL IS LOCATED ……..….……………

A03

NAME AND CODE OF VILLAGE WHERE SCHOOL IS LOCATED ………………………….…

A04

NAME AND CODE OF SCHOOL

A05

CHILD ID

A06

CHILD DATE OF BIRTH

A07

CHILD’S EDUCATION GARDE

A08

GENDER OF THE CHILD

A09

QUESTIONNAIRE NUMBER………………………….

A10

NAME AND CODE OF INTERVIEWER……………….

A11

DATE OF VISIT

A12

TIME OF VISIT

A13

RESULT CODE

COMPLETE

PARTIALLY COMPLETE

NOT AVAILABLE RESPONDENT

REFUSAL

OTHER (SPECIFY) :___________

A14

DATE

A15

CODE AND FIRST NAME

B01

Did you have mid-day meal at school yesterday?

Yes

No

Don’t Know

B02

How many days did you have mid-day meals at school in the last week?

B03

Apart from school meal, how many times did you eat at home yesterday?

Breakfast

Dinner

Others (Specify)

B04

Did you have any of the following yesterday?

Any foods made from maize, rice, wheat, or tapioca?

Any foods made from jowar, bajra, ragi, legumes and dhals? (chapati, rotti, ragi ball etc.)

Any foods made from Bengal gram, Black gram, green gram, dal-red lentil togari bele) and red gram, ground nut, cashew nut and almond?

Any food made out of cheese, khoa, skimmed milk powder, whole milk powder, milk?

Any foods made from carrot, pumpkin, green chillies, ripe mango and papaya?

Any green leafy vegetables (coriander leaves, spinach leaves, mint, radish leaves, amaranth, curry leaves, fenugreek leaves, ?

Any other vegetables?

Any other fruits?

Any fish, meat or egg?

Any foods made from beans, peas, or lentils?

Any butter, ghee (cow) and hydrogenated oil?

Any sugar or honey?

Any other foods, such as condiments, coffee, tea?

Other specify

B04A

Breakfast

Any foods made from maize, rice, wheat, or tapioca?

Any foods made from jowar, bajra, ragi, legumes and dhals? (chapati, rotti, ragi ball etc.)

Any foods made from Bengal gram, Black gram, green gram, dal-red lentil togari bele) and red gram, ground nut, cashew nut and almond?

Any food made out of cheese, khoa, skimmed milk powder, whole milk powder, milk?

Any foods made from carrot, pumpkin, green chillies, ripe mango and papaya?

Any green leafy vegetables (coriander leaves, spinach leaves, mint, radish leaves, amaranth, curry leaves, fenugreek leaves, ?

Any other vegetables?

Any other fruits?

Any fish, meat or egg?

Any foods made from beans, peas, or lentils?

Any butter, ghee (cow) and hydrogenated oil?

Any sugar or honey?

Any other foods, such as condiments, coffee, tea?

Other specify

B04B

Lunch

Any foods made from maize, rice, wheat, or tapioca?

Any foods made from jowar, bajra, ragi, legumes and dhals? (chapati, rotti, ragi ball etc.)

Any foods made from Bengal gram, Black gram, green gram, dal-red lentil togari bele) and red gram, ground nut, cashew nut and almond?

Any food made out of cheese, khoa, skimmed milk powder, whole milk powder, milk?

Any foods made from carrot, pumpkin, green chillies, ripe mango and papaya?

Any green leafy vegetables (coriander leaves, spinach leaves, mint, radish leaves, amaranth, curry leaves, fenugreek leaves, ?

Any other vegetables?

Any other fruits?

Any fish, meat or egg?

Any foods made from beans, peas, or lentils?

Any butter, ghee (cow) and hydrogenated oil?

Any sugar or honey?

Any other foods, such as condiments, coffee, tea?

Other specify

B04C

Dinner

Any foods made from maize, rice, wheat, or tapioca?

Any foods made from jowar, bajra, ragi, legumes and dhals? (chapati, rotti, ragi ball etc.)

Any foods made from Bengal gram, Black gram, green gram, dal-red lentil togari bele) and red gram, ground nut, cashew nut and almond?

Any food made out of cheese, khoa, skimmed milk powder, whole milk powder, milk?

Any foods made from carrot, pumpkin, green chillies, ripe mango and papaya?

Any green leafy vegetables (coriander leaves, spinach leaves, mint, radish leaves, amaranth, curry leaves, fenugreek leaves, ?

Any other vegetables?

Any other fruits?

Any fish, meat or egg?

Any foods made from beans, peas, or lentils?

Any butter, ghee (cow) and hydrogenated oil?

Any sugar or honey?

Any other foods, such as condiments, coffee, tea?

Other specify

B04D

Others

Any foods made from maize, rice, wheat, or tapioca?

Any foods made from jowar, bajra, ragi, legumes and dhals? (chapati, rotti, ragi ball etc.)

Any foods made from Bengal gram, Black gram, green gram, dal-red lentil togari bele) and red gram, ground nut, cashew nut and almond?

Any food made out of cheese, khoa, skimmed milk powder, whole milk powder, milk?

Any foods made from carrot, pumpkin, green chillies, ripe mango and papaya?

Any green leafy vegetables (coriander leaves, spinach leaves, mint, radish leaves, amaranth, curry leaves, fenugreek leaves, ?

Any other vegetables?

Any other fruits?

Any fish, meat or egg?

Any foods made from beans, peas, or lentils?

Any butter, ghee (cow) and hydrogenated oil?

Any sugar or honey?

Any other foods, such as condiments, coffee, tea?

Other specify

C01

How frequently do you fall sick

once in a fortnight

once in a month

once in 3 months

Watery diarrhoea

Bloody diarrhoea

Others (specify)

Does not know

C09

What is the maximum times you defecate in a day while you are having diarrhoea?

C10

How many days did you miss the school due to diarrhoea?

C11

Did you have/were you given ORS during diarrhoea?

Give ORS

Give less food than usual

Give same quantity of food as usual

Give more food than usual

Give less liquids than usual

Give the same amount of liquid as usual

Give more liquid than usual

Give syrup

Give traditional medication

Give treated water

Give carrot juice or rice water

Other (SPECIFY)

Does not know

C12

Compared to regular day, how much food did you have, when you had diarrhoea?

More than usual

Less than usual

Others (Specify)

Does not know

C13

Compared to regular day, how much liquid food did you have, when you had diarrhoea?

More than usual

Less than usual

Others (Specify)

Does not know

C14

What are the foods rich in vitamin A?

Fruits/vegetables/oranges

Green leaves

Eggs

Liver

Maternal milk

Cow milk

Other (SPECIFY)

Does not know

D01

In the last nine months, did you take (like this/any of these)?

iron pills

sprinkles with iron

Washing hands

Bathing

After defecation

Before eating

Other (SPECIFY

E06

Do you) brush your teeth every day?

Yes

No

E07

Yes

No

Don’t Know

Child'S Interview -Form Fill

Do you receive a midday meal with fortified rice at school

Is your age between 9 and 10 years

Do you plan to attend this school for the entire school year

NAME AND CODE OF DISTRICT WHERE SCHOOL IS LOCATED…………….

NAME AND CODE OF TALUKA WHERE SCHOOL IS LOCATED ……..….……………

NAME AND CODE OF VILLAGE WHERE SCHOOL IS LOCATED ………………………….…

NAME AND CODE OF SCHOOL

CHILD ID

CHILD DATE OF BIRTH

CHILD’S EDUCATION GARDE

GENDER OF THE CHILD

QUESTIONNAIRE NUMBER………………………….

NAME AND CODE OF INTERVIEWER……………….

DATE OF VISIT

TIME OF VISIT

RESULT CODE

DATE

CODE AND FIRST NAME

Did you have mid-day meal at school yesterday?

How many days did you have mid-day meals at school in the last week?

Apart from school meal, how many times did you eat at home yesterday?

Did you have any of the following yesterday?

Breakfast

Lunch

Dinner

Others

How frequently do you fall sick

Have you been ill with fever in the last two weeks?

Did go to doctor for treatment for fever?

Did you have medicine for your fever?

Do you have any bednets in your house?

In the last 2 weeks, have you missed school due to an illness?

In the last 2 weeks, have you had any episodes of diarrhoea?

What type of diarrhoea?

What is the maximum times you defecate in a day while you are having diarrhoea?

How many days did you miss the school due to diarrhoea?

Did you have/were you given ORS during diarrhoea?

Compared to regular day, how much food did you have, when you had diarrhoea?

Compared to regular day, how much liquid food did you have, when you had diarrhoea?

What are the foods rich in vitamin A?

In the last nine months, did you take (like this/any of these)?

In the last nine months, did you take deworming tablets?

Do you wash your hands before eating?

Do you wash your hands after defecation?

Do you wash your hands after returning home (from school/playing/etc.)?

Do you use soap?

When Do you use the soap?

Do you) brush your teeth every day?

Do you take bath every day?

Do you cut your nails or ask your parents to help cut your fingernails?

Do you comb hair?

Do you wear clean clothes?

Do you always wear shoes when you go out?

Do you use toilet at home?

Do you take drinking water from home to school

Do you receive health/ hygiene education at school?

Did you undergo any health check up at school in the past 6 months?