Surveypoint

Q01

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

Q02

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

Q03

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

Q04

NAME AND CODE OF SCHOOL

Q05

GENDER OF THE RESPONDENT

Q06

AGE OF THE RESPONDENT

Q07

RELATION WITH THE CHILD

Q08

CHILD ID

Q09

CHILD DATE OF BIRTH

Q10

CHILD’S EDUCATION GARDE

Q11

GENDER OF THE CHILD

Q12

QUESTIONNAIRE NUMBER………………………….

Q13

NAME AND CODE OF INTERVIEWER……………….

Q14

DATE OF VISIT

Q15

TIME OF VISIT

Q16

RESULT CODE

COMPLETE

PARTIALLY COMPLETE

NOT AVAILABLE RESPONDENT

REFUSAL

OTHER (SPECIFY)

Q17

DATE

Q18

CODE AND FIRST NAME

A01

Did your child had mid-day meal at school yesterday?

Yes

No

Don’t Know

A02

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

A03

Apart from school meal, did your child eat at home yesterday?

Breakfast

Dinner

Others (Specify)

A04

Did your child 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 lentils (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, cabbage, 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

A04A

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 lentils (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, cabbage, 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

A04B

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 lentils (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, cabbage, 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

A04C

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 lentils (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, cabbage, 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

A04D

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 lentils (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, cabbage, 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

B01

How frequently does your child (NAME) fall sick?

once in a fortnight

once in a month

once in 3 months

once in 6 months

once in a year

Others specify

B02

Has (NAME) been ill with fever in the last two weeks?"

Yes

No

Don’t Know

B03

Did you seek advice or treatment for (NAME’S) fever?

Yes

No

Don’t Know

B04

From where did you seek the treatment?

Government doctors or hospital

Private doctors/hospitals/nursing homes

Traditional doctor

What is the maximum times of defecation in a day while having diarrhoea?

B13

How many days did (NAME) miss the school due to diarrhoea?

B14

What are the signs/symptoms of the child that would make you take him/her to a medical facility right away (health centre, hospital)?

The child cannot drink or eat

The child is getting sicker

The child is running a fever

The child is breathing fast

The child has trouble breathing

The child has bloody stools

The child has trouble swallowing

Other (SPECIFY)

B15

What do you feel should be done when the child has 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

iron pills

sprinkles with iron

Washing hands

Bathing

After defecation

Before eating

Other (SPECIFY)

D06

Do you check your child’s (NAME’s) cleanliness and personal hygiene () at home?

Yes

No

D07

Does your child (NAME) brush his/her teeth every day?

Yes

No

D08

Yes

No

Don’t Know

Parents Interview -Form Fill

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

GENDER OF THE RESPONDENT

AGE OF THE RESPONDENT

RELATION WITH THE CHILD

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 your child had mid-day meal at school yesterday?

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

Apart from school meal, did your child eat at home yesterday?

Did your child have any of the following yesterday?

Breakfast

Lunch

Dinner

Others

How frequently does your child (NAME) fall sick?

Has (NAME) been ill with fever in the last two weeks?"

Did you seek advice or treatment for (NAME’S) fever?

From where did you seek the treatment?

Did you receive medicine for (NAME’S) fever?

Do you have any bed nets in your house?

Was the bed net ever soaked or dipped in a liquid to repel mosquitoes or bugs?

In the last 2 weeks, has (NAME) missed school due to an illness?

Did any member of the household had diarrhoeal episodes in the last 2 weeks

In the last 2 weeks, has (NAME) had any episodes of diarrhoea?

What type of diarrhoea?

What is the maximum times of defecation in a day while having diarrhoea?

How many days did (NAME) miss the school due to diarrhoea?

What are the signs/symptoms of the child that would make you take him/her to a medical facility right away (health centre, hospital)?

What do you feel should be done when the child has diarrhoea?

How should a sick child be fed?

What do you feel can happen to children who are iron-deficient?

What are the foods rich in vitamin A?

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

In the last nine months, did (NAME) take deworming tablets?

Does your child (NAME) wash his/her hands before eating?

Does your child (NAME) wash his/her hands after defecation?

Does your child (NAME) wash his/her hands after returning home (from school/playing/etc.)?

Does your child (NAME) use soap?

When does your child use the soap?

Do you check your child’s (NAME’s) cleanliness and personal hygiene () at home?

Does your child (NAME) brush his/her teeth every day?

Does your child (NAME) take bath every day?

Does your child (NAME) cut his/her finger nails or ask you to cut his/her fingernails?

Does your child (NAME) comb hair?

Does your child (NAME) wear clean clothes?

Does your child (NAME) always wear shoes when he/she goes out?

Does your child (NAME) use toilet at home?

Does your child (NAME) take drinking water to school

Does your child (NAME) receive health/ hygiene education at school?

Did your child (NAME) undergo any health check-up at school in the past 6 months?

Do you receive any complaints from the school about your child’s (NAME’s) irregularity in attending the school?