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Asha Aww Template -Form Fill
Questions
Q01
How much food should be given to the child while he/she was suffering from diarrhea?
Much Less the usual
Somewhere less than usual
About the same
More than usual
Completely stopped
Don’t Know
Q02
How many times food should be given to a child suffering from diarrhoea
Much Less than Usual
Somewhere Less than usual
About the Same
More than usual
Completely Stopped
Don’t Know
Q03
How much liquid should be given to a child suffering from diarrhea (please ask for both cases child less than 6 months and greater)
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Q03A
Exclusive Breast Milk for child less than 6 months
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Q03B
Any Liquids/Fluids
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Q04
How many times liquid/fluid should be given to a child suffering from diarrhoea (please ask for both cases child less than 6 months and greater)
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Q04A
Exclusive Breast Milk for child less than 6 months
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Q04B
Any Liquids/Fluids
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Q05
How much liquid was given to a child suffering from diarrhea (please ask for both cases child less than 6 months and greater, whichever is applicable)
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Not Applicable
Q05A
Exclusive Breast Milk for child less than 6 months
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Not Applicable
Q05B
Any Liquids/Fluids
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Not Applicable
Q06
How many times liquid was given to a child suffering from diarrhea (please ask for both cases child less than 6 months and greater, whichever is applicable)
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Not Applicable
Q06A
Exclusive Breast Milk for child less than 6 months
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Not Applicable
Q06B
Any Liquids/Fluids
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Not Applicable
Q07
How much food was given to a child suffering from diarrhea?
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Not Applicable
Q08
How many times food was given to a child suffering from diarrhea?
Much less than usual
Somewhat less than usual
About the same
More than usual
Completely stopped
Don’t Know
Not Applicable
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