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[record_id] |
Record ID |
text |
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[namaste_we_are_here_to_und] |
Namaste. We are here to understand the health, nutrition, and care practices of mothers and their young children under two years of age in your village. This information will help us improve counselling and health programs for mothers and children. If you agree to participate, we will ask you questions about your health, your child's feeding and care practices, and your household environment and measure your child's height and weight. Each survey will take about 15-20 minutes. Participation is completely voluntary, and you may choose not to participate or withdraw at any time without giving a reason. This will not affect any services or benefits you receive. Some questions may feel personal, and you may skip any question you do not wish to answer. All the information you share will be kept confidential, securely stored, and used only for research purposes. Your name and personal details will remain anonymous.
āĻ¨āĻŽāĻ¸ā§āĻāĻžāĻ°āĨ¤ āĻāĻŽāĻ°āĻž āĻāĻĒāĻ¨āĻžāĻ° āĻā§āĻ°āĻžāĻŽā§ āĻĻā§āĻ āĻŦāĻāĻ°ā§āĻ° āĻāĻŽ āĻŦā§āĻ¸ā§ āĻļāĻŋāĻļā§ āĻ āĻ¤āĻžāĻĻā§āĻ° āĻŽāĻžā§ā§āĻĻā§āĻ° āĻ¸ā§āĻŦāĻžāĻ¸ā§āĻĨā§āĻ¯, āĻĒā§āĻˇā§āĻāĻŋ āĻāĻŦāĻ āĻ¯āĻ¤ā§āĻ¨ā§āĻ° āĻŦāĻŋāĻˇā§ā§ āĻāĻžāĻ¨āĻ¤ā§ āĻāĻ¸ā§āĻāĻŋāĨ¤ āĻāĻĒāĻ¨āĻŋ āĻ¯āĻž āĻ¤āĻĨā§āĻ¯ āĻĻā§āĻŦā§āĻ¨, āĻ¤āĻž āĻŽāĻžā§ā§āĻĻā§āĻ° āĻ āĻļāĻŋāĻļā§āĻĻā§āĻ° āĻāĻ¨ā§āĻ¯ āĻĒāĻ°āĻžāĻŽāĻ°ā§āĻļ āĻāĻŦāĻ āĻ¸ā§āĻŦāĻžāĻ¸ā§āĻĨā§āĻ¯ āĻ¸ā§āĻŦāĻž āĻāĻ°āĻ āĻāĻžāĻ˛ā§ āĻāĻ°āĻ¤ā§ āĻāĻŽāĻžāĻĻā§āĻ° āĻ¸āĻžāĻšāĻžāĻ¯ā§āĻ¯ āĻāĻ°āĻŦā§āĨ¤
āĻāĻĒāĻ¨āĻŋ āĻ
āĻāĻļ āĻ¨āĻŋāĻ¤ā§ āĻ°āĻžāĻāĻŋ āĻšāĻ˛ā§, āĻāĻŽāĻ°āĻž āĻāĻĒāĻ¨āĻžāĻ° āĻ¸ā§āĻŦāĻžāĻ¸ā§āĻĨā§āĻ¯, āĻāĻĒāĻ¨āĻžāĻ° āĻļāĻŋāĻļā§āĻ° āĻāĻžāĻā§āĻžāĻ¨ā§ āĻ āĻ¯āĻ¤ā§āĻ¨ā§āĻ° āĻ
āĻā§āĻ¯āĻžāĻ¸, āĻāĻŦāĻ āĻāĻĒāĻ¨āĻžāĻ° āĻĒāĻ°āĻŋāĻŦāĻžāĻ°ā§āĻ° āĻĒāĻ°āĻŋāĻŦā§āĻļ āĻ¸āĻŽā§āĻĒāĻ°ā§āĻā§ āĻāĻŋāĻā§ āĻĒā§āĻ°āĻļā§āĻ¨ āĻāĻ°āĻŦāĨ¤ āĻāĻāĻžāĻĄāĻŧāĻž āĻāĻĒāĻ¨āĻžāĻ° āĻļāĻŋāĻļā§āĻ° āĻāĻā§āĻāĻ¤āĻž āĻ āĻāĻāĻ¨ āĻŽāĻžāĻĒāĻž āĻšāĻŦā§āĨ¤ āĻĒā§āĻ°ā§ āĻ¸āĻžāĻ°ā§āĻā§ āĻāĻ°āĻ¤ā§ āĻĒā§āĻ°āĻžā§ ā§§ā§Ģ-ā§¨ā§Ļ āĻŽāĻŋāĻ¨āĻŋāĻ āĻ¸āĻŽā§ āĻ˛āĻžāĻāĻŦā§āĨ¤
āĻāĻ āĻ¸āĻžāĻ°ā§āĻā§āĻ¤ā§ āĻ
āĻāĻļ āĻ¨ā§āĻā§āĻž āĻ¸āĻŽā§āĻĒā§āĻ°ā§āĻŖāĻ āĻāĻĒāĻ¨āĻžāĻ° āĻāĻā§āĻāĻžāĨ¤ āĻāĻĒāĻ¨āĻŋ āĻ¨āĻž āĻāĻžāĻāĻ˛ā§ āĻ
āĻāĻļ āĻ¨āĻžāĻ āĻ¨āĻŋāĻ¤ā§ āĻĒāĻžāĻ°ā§āĻ¨, āĻāĻŦāĻ āĻ¯ā§ āĻā§āĻ¨ā§ āĻ¸āĻŽā§ āĻā§āĻ¨ā§ āĻāĻžāĻ°āĻŖ āĻāĻžā§āĻžāĻ āĻ¸āĻžāĻ°ā§āĻā§ āĻĨā§āĻā§ āĻŦā§āĻ° āĻšā§ā§ āĻ¯ā§āĻ¤ā§ āĻĒāĻžāĻ°ā§āĻ¨āĨ¤ āĻāĻ¤ā§ āĻāĻĒāĻ¨āĻžāĻ° āĻā§āĻ¨ā§ āĻĒāĻ°āĻŋāĻˇā§āĻŦāĻž āĻŦāĻž āĻ¸ā§āĻŦāĻŋāĻ§āĻžāĻ° āĻāĻĒāĻ° āĻā§āĻ¨ā§ āĻĒā§āĻ°āĻāĻžāĻŦ āĻĒā§āĻŦā§ āĻ¨āĻžāĨ¤
āĻāĻŋāĻā§ āĻĒā§āĻ°āĻļā§āĻ¨ āĻŦā§āĻ¯āĻā§āĻ¤āĻŋāĻāĻ¤ āĻŽāĻ¨ā§ āĻšāĻ¤ā§ āĻĒāĻžāĻ°ā§āĨ¤ āĻāĻĒāĻ¨āĻŋ āĻāĻžāĻāĻ˛ā§ āĻ¸ā§āĻā§āĻ˛ā§ āĻā§āĻŋā§ā§ āĻ¯ā§āĻ¤ā§ āĻĒāĻžāĻ°ā§āĻ¨āĨ¤ āĻāĻĒāĻ¨āĻŋ āĻ¯ā§ āĻ¤āĻĨā§āĻ¯ āĻĻā§āĻŦā§āĻ¨ āĻ¤āĻž āĻ¸āĻŽā§āĻĒā§āĻ°ā§āĻŖ āĻā§āĻĒāĻ¨ āĻ°āĻžāĻāĻž āĻšāĻŦā§, āĻ¨āĻŋāĻ°āĻžāĻĒāĻĻā§ āĻ¸āĻāĻ°āĻā§āĻˇāĻŖ āĻāĻ°āĻž āĻšāĻŦā§, āĻāĻŦāĻ āĻļā§āĻ§ā§āĻŽāĻžāĻ¤ā§āĻ° āĻāĻŦā§āĻˇāĻŖāĻžāĻ° āĻāĻ¨ā§āĻ¯ āĻŦā§āĻ¯āĻŦāĻšāĻžāĻ° āĻāĻ°āĻž āĻšāĻŦā§āĨ¤ āĻāĻĒāĻ¨āĻžāĻ° āĻ¨āĻžāĻŽ āĻ āĻŦā§āĻ¯āĻā§āĻ¤āĻŋāĻāĻ¤ āĻ¤āĻĨā§āĻ¯ āĻā§āĻĨāĻžāĻ āĻĒā§āĻ°āĻāĻžāĻļ āĻāĻ°āĻž āĻšāĻŦā§ āĻ¨āĻžāĨ¤
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descriptive |
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3 |
[do_you_give_your_verbal_co] |
Do you give your verbal consent to participate in this interview?
āĻāĻĒāĻ¨āĻŋ āĻāĻŋ āĻāĻ āĻ¸āĻžāĻā§āĻˇāĻžā§āĻāĻžāĻ°ā§ āĻ
āĻāĻļāĻā§āĻ°āĻšāĻŖā§āĻ° āĻāĻ¨ā§āĻ¯ āĻāĻĒāĻ¨āĻžāĻ° āĻŽā§āĻāĻŋāĻ āĻ¸āĻŽā§āĻŽāĻ¤āĻŋ āĻĻāĻŋāĻā§āĻā§āĻ¨?
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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4 |
[interviewer_visits_details] |
Interviewer Visits Details āĻ¸āĻžāĻā§āĻˇāĻžā§āĻāĻžāĻ° āĻā§āĻ°āĻšāĻŖāĻāĻžāĻ°ā§āĻ° āĻāĻŋāĻāĻŋāĻā§āĻ° āĻŦāĻŋāĻŦāĻ°āĻŖ |
descriptive |
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5 |
[dd_mm_yyyy] |
DD/MM/YYYY
āĻĻāĻŋāĻ¨/āĻŽāĻžāĻ¸/āĻŦāĻāĻ°
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text (date_dmy), Required
Field Annotation: @TODAY |
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6 |
[interviewer_s_name] |
Name of Data Collector
āĻ¤āĻĨā§āĻ¯ āĻ¸āĻāĻā§āĻ°āĻžāĻšāĻā§āĻ° āĻ¨āĻžāĻŽ
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text, Required
Field Annotation: @APPUSERNAME-APP |
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7 |
[total_number_of_visits] |
Total Number of Visits
āĻŽā§āĻ āĻ¸āĻžāĻā§āĻˇāĻžā§āĻāĻžāĻ° āĻ¸āĻāĻā§āĻ¯āĻž
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text (number), Required |
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8 |
[section_a_household_identi] |
Section A: Household Identification & Background |
descriptive |
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9 |
[a2_village_block_district] |
A2. Village
āĻā§āĻ°āĻžāĻŽ
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text, Required |
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10 |
[block] |
Block
āĻŦā§āĻ˛āĻ
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dropdown, Required| 1 | Murhu | | 2 | Gopikandar | | 3 | Boipariguda | | 4 | Hirband | | 5 | Bagmundi | | 6 | Gosaba | | 7 | Kalimpong I | | 8 | Karra | | 9 | Jama | | 10 | Lakshmipur | | 11 | Raipur | | 12 | Barabazar | | 13 | Kultali | | 14 | Gorubathan |
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[district] |
District
āĻā§āĻ˛āĻž
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dropdown, Required| 1 | Khunti | | 2 | Dumka | | 3 | Koraput | | 4 | Bankura | | 5 | Puruliya | | 6 | South 24 Pgs | | 7 | Kalimpong |
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12 |
[a3_name_of_respondent] |
A3. Name of Respondent
āĻāĻ¤ā§āĻ¤āĻ°āĻĻāĻžāĻ¤āĻžāĻ° āĻ¨āĻžāĻŽ
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text, Required |
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13 |
[a4_phone_number] |
A4. Phone Number
āĻĢā§āĻ¨ āĻ¨āĻŽā§āĻŦāĻ°
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text (number, Min: 222222222, Max: 9999999999), Required
Field Annotation: @PLACEHOLDER='10 digits' @FORCE-MINMAX |
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14 |
[section_b_institutional_de] |
Section B: Institutional Delivery and PNC |
descriptive |
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15 |
[b1_where_did_you_deliver] |
B1. Where did you deliver?
āĻāĻĒāĻ¨āĻŋ āĻā§āĻĨāĻžā§ āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨ āĻĒā§āĻ°āĻ¸āĻŦ āĻāĻ°ā§āĻā§āĻ¨?
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radio, Required| 1 | Govt facility/ āĻ¸āĻ°āĻāĻžāĻ°āĻŋ āĻĒā§āĻ°āĻ¤āĻŋāĻˇā§āĻ āĻžāĻ¨ | | 2 | Private facility/ āĻŦā§āĻ¸āĻ°āĻāĻžāĻ°āĻŋ āĻĒā§āĻ°āĻ¤āĻŋāĻˇā§āĻ āĻžāĻ¨ | | 3 | Home delivery/ āĻŦāĻžā§āĻŋāĻ¤ā§ āĻĒā§āĻ°āĻ¸āĻŦ | | 4 | Other/ āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ |
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16 |
[other_please_specify]
Show the field ONLY if:
[b1_where_did_you_deliver] = '4'
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Other please specify |
text |
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17 |
[b2_you_delivered_at_home_w]
Show the field ONLY if:
[b1_where_did_you_deliver] = '3'
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B2.If you delivered at home, what was the reason?
āĻāĻĒāĻ¨āĻŋ āĻ¯āĻĻāĻŋ āĻŦāĻžāĻĄāĻŧāĻŋāĻ¤ā§ āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨ āĻĒā§āĻ°āĻ¸āĻŦ āĻāĻ°ā§ āĻĨāĻžāĻā§āĻ¨, āĻ¤āĻžāĻ° āĻāĻžāĻ°āĻŖ āĻā§ āĻāĻŋāĻ˛?
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radio, Required| 1 | Facility far / āĻĒā§āĻ°āĻ¤āĻŋāĻˇā§āĻ āĻžāĻ¨ āĻĻā§āĻ°ā§ | | 2 | Cost / āĻāĻ°āĻ | | 3 | Family preference / āĻĒāĻ°āĻŋāĻŦāĻžāĻ°ā§āĻ° āĻāĻā§āĻāĻž | | 4 | Others (specify) / āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ (āĻāĻ˛ā§āĻ˛ā§āĻ āĻāĻ°ā§āĻ¨) |
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18 |
[b_2_other_please_specify]
Show the field ONLY if:
[b2_you_delivered_at_home_w] = '4'
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Other please specify |
text, Required |
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19 |
[b3_was_your_delivery_c_sec] |
B3. Was your delivery C-section?
āĻāĻĒāĻ¨āĻžāĻ° āĻĒā§āĻ°āĻ¸āĻŦ āĻāĻŋ āĻ¸āĻŋāĻāĻžāĻ°āĻŋā§āĻžāĻ¨ āĻšā§ā§āĻāĻŋāĻ˛?
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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20 |
[b4_how_soon_after_delivery] |
B4. How soon after delivery was the baby first put to breast?
āĻĒā§āĻ°āĻ¸āĻŦā§āĻ° āĻāĻ¤ āĻ¸āĻŽā§ āĻĒāĻ° āĻļāĻŋāĻļā§āĻā§ āĻĒā§āĻ°āĻĨāĻŽāĻŦāĻžāĻ° āĻ¸ā§āĻ¤āĻ¨ā§āĻ¯āĻĒāĻžāĻ¨ āĻāĻ°āĻžāĻ¨ā§ āĻšā§ā§āĻāĻŋāĻ˛?
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radio, Required| 1 | Within 1 hr / ā§§ āĻāĻ¨ā§āĻāĻžāĻ° āĻŽāĻ§ā§āĻ¯ā§ | | 2 | 1-3 hrs / ā§§-ā§Š āĻāĻ¨ā§āĻāĻžāĻ° āĻŽāĻ§ā§āĻ¯ā§ | | 3 | >3 hrs/ā§Š āĻāĻ¨ā§āĻāĻžāĻ° āĻŦā§āĻļāĻŋ āĻĒāĻ°ā§ |
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21 |
[section_c_birth_outcomes_c] |
Section C: Birth Outcomes (Check MCP Card)āĻ
āĻ§ā§āĻ¯āĻžā§ C: āĻāĻ¨ā§āĻŽ āĻ¸āĻāĻā§āĻ°āĻžāĻ¨ā§āĻ¤ āĻĢāĻ˛āĻžāĻĢāĻ˛ (MCP āĻāĻžāĻ°ā§āĻĄ āĻĒāĻ°ā§āĻā§āĻˇāĻž āĻāĻ°ā§āĻ¨) |
descriptive |
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22 |
[c1_what_was_your_child_s_b] |
C1. What was your child's birth weight? (in grams)
āĻāĻĒāĻ¨āĻžāĻ° āĻļāĻŋāĻļā§āĻ° āĻāĻ¨ā§āĻŽā§āĻ° āĻ¸āĻŽā§ āĻāĻāĻ¨ āĻāĻ¤ āĻāĻŋāĻ˛? (in grams)
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text (number, Min: 1500, Max: 4000), Required
Field Annotation: @FORCE-MINMAX @PLACEHOLDER = "Numeric entry" |
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23 |
[c2_was_the_child_premature] |
C2. Was the child premature (< 37 weeks)?
āĻļāĻŋāĻļā§āĻāĻŋ āĻāĻŋ ā§Šā§ āĻ¸āĻĒā§āĻ¤āĻžāĻšā§āĻ° āĻāĻā§ āĻāĻ¨ā§āĻŽā§āĻāĻŋāĻ˛?
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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24 |
[c3_what_was_the_gestationa] |
C3. What was the date of Last Mensural Period (LMP)?
āĻāĻĒāĻ¨āĻžāĻ° āĻļā§āĻˇ āĻŽāĻžāĻ¸āĻŋāĻā§āĻ° āĻĒā§āĻ°āĻĨāĻŽ āĻĻāĻŋāĻ¨ā§āĻ° āĻ¤āĻžāĻ°āĻŋāĻāĻāĻž āĻāĻŦā§ āĻāĻŋāĻ˛?
(Cross-check from MCP Card)
MCP āĻāĻžāĻ°ā§āĻĄ āĻĨā§āĻā§ āĻŽāĻŋāĻ˛āĻŋāĻ¯āĻŧā§ āĻĻā§āĻā§āĻ¨āĨ¤
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text (date_dmy), Required |
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25 |
[date_of_birth_of_the_child] |
Date of birth of the child
āĻļāĻŋāĻļā§āĻ° āĻāĻ¨ā§āĻŽāĻ¤āĻžāĻ°āĻŋāĻ
Note from MCP card
MCP āĻāĻžāĻ°ā§āĻĄ āĻĨā§āĻā§ āĻ¨ā§āĻ āĻāĻ°ā§āĻ¨āĨ¤
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text (date_dmy), Required |
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26 |
[c4_have_you_had_any_compli] |
C4. Have you had any complications in the pregnancy?
āĻāĻĒāĻ¨āĻžāĻ° āĻāĻ°ā§āĻāĻžāĻŦāĻ¸ā§āĻĨāĻžā§ āĻā§āĻ¨ā§ āĻāĻāĻŋāĻ˛āĻ¤āĻž āĻšā§ā§āĻāĻŋāĻ˛ āĻāĻŋ? (MCP āĻāĻžāĻ°ā§āĻĄ āĻĨā§āĻā§ āĻ¯āĻžāĻāĻžāĻ āĻāĻ°ā§āĻ¨)
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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27 |
[if_yes_what_were_the_compl]
Show the field ONLY if:
[c4_have_you_had_any_compli] = '1'
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C5. If yes, what were the complications? (multiple options)
āĻ¯āĻĻāĻŋ āĻšā§āĻ¯āĻžāĻ, āĻ¤āĻŦā§ āĻāĻāĻŋāĻ˛āĻ¤āĻžāĻā§āĻ˛āĻŋ āĻā§ āĻāĻŋāĻ˛? (āĻāĻāĻžāĻ§āĻŋāĻ āĻŦāĻŋāĻāĻ˛ā§āĻĒ)
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checkbox, Required| 1 | if_yes_what_were_the_compl___1 | APH/ āĻ.āĻĒāĻŋ.āĻāĻāĻ. | | 2 | if_yes_what_were_the_compl___2 | Eclampsia/ āĻāĻā§āĻ˛āĻžāĻŽā§āĻĒāĻ¸āĻŋā§āĻž | | 3 | if_yes_what_were_the_compl___3 | PIH/ āĻĒāĻŋ.āĻāĻ.āĻāĻāĻ. | | 4 | if_yes_what_were_the_compl___4 | Anaemia/ āĻ
ā§āĻ¯āĻžāĻ¨āĻŋāĻŽāĻŋā§āĻž | | 5 | if_yes_what_were_the_compl___5 | Obstructed labor/ āĻŦāĻžāĻ§āĻžāĻā§āĻ°āĻ¸ā§āĻ¤ āĻĒā§āĻ°āĻ¸āĻŦ | | 6 | if_yes_what_were_the_compl___6 | PPH/ āĻĒāĻŋ.āĻĒāĻŋ.āĻāĻāĻ | | 7 | if_yes_what_were_the_compl___7 | LSCS/ āĻ¸āĻŋāĻāĻžāĻ°āĻŋāĻ¯āĻŧāĻžāĻ¨ āĻĄā§āĻ˛āĻŋāĻāĻžāĻ°āĻŋ | | 8 | if_yes_what_were_the_compl___8 | Other specify/ āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ (āĻāĻ˛ā§āĻ˛ā§āĻ āĻāĻ°ā§āĻ¨) |
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28 |
[c5_other_specify]
Show the field ONLY if:
[if_yes_what_were_the_compl(8)] = '1'
|
Other Specify |
text |
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29 |
[c6_past_history_multiple_o] |
C6. Past history (multiple options)
āĻĒā§āĻ°ā§āĻŦāĻŦāĻ°ā§āĻ¤ā§ āĻ°ā§āĻā§āĻ° āĻāĻ¤āĻŋāĻšāĻžāĻ¸ (āĻāĻāĻžāĻ§āĻŋāĻ āĻŦāĻŋāĻāĻ˛ā§āĻĒ)
|
checkbox, Required| 1 | c6_past_history_multiple_o___1 | Tuberculosis / āĻ¯āĻā§āĻˇā§āĻŽāĻž | | 2 | c6_past_history_multiple_o___2 | Hypertension / āĻāĻā§āĻ āĻ°āĻā§āĻ¤āĻāĻžāĻĒ | | 3 | c6_past_history_multiple_o___3 | Heart Disease / āĻšā§āĻĻāĻ°ā§āĻ | | 4 | c6_past_history_multiple_o___4 | Diabetes / āĻĄāĻžā§āĻžāĻŦā§āĻāĻŋāĻ¸ | | 5 | c6_past_history_multiple_o___5 | Asthma / āĻšāĻžāĻāĻĒāĻžāĻ¨āĻŋ | | 6 | c6_past_history_multiple_o___6 | Other specify / āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯, āĻāĻ˛ā§āĻ˛ā§āĻ āĻāĻ°ā§āĻ¨ | | 7 | c6_past_history_multiple_o___7 | None/ āĻāĻŋāĻā§āĻ āĻ¨āĻ¯āĻŧ |
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30 |
[c6_other_specify]
Show the field ONLY if:
[c6_past_history_multiple_o(6)] = '1'
|
Other Specify |
text, Required |
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31 |
[c7_have_you_ever_had_a_mis] |
C7. Have you ever had a miscarriage/ abortion?
āĻāĻĒāĻ¨āĻžāĻ° āĻāĻŋ āĻāĻāĻ¨ā§ āĻ¸ā§āĻŦāĻžāĻāĻžāĻŦāĻŋāĻ āĻ
āĻĨāĻŦāĻž āĻāĻŋāĻāĻŋā§āĻ¸āĻžāĻāĻ¨āĻŋāĻ¤ āĻāĻ°ā§āĻāĻĒāĻžāĻ¤/āĻ
āĻŦā§āĻā§āĻāĻŋāĻ āĻāĻ°ā§āĻāĻĒāĻžāĻ¤ āĻšā§ā§āĻā§?
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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32 |
[c8_how_many_times]
Show the field ONLY if:
[c7_have_you_ever_had_a_mis] = '1'
|
C8. how many times?
āĻ¯āĻĻāĻŋ āĻšā§āĻ¯āĻžāĻ, āĻ¤āĻŦā§ āĻā§āĻŦāĻžāĻ°?
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text (number), Required |
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33 |
[c9_have_you_ever_had_a_his] |
C9. Have you ever had a history of stillbirth?
āĻāĻĒāĻ¨āĻžāĻ° āĻāĻŋ āĻāĻāĻ¨ā§ āĻŽā§āĻ¤āĻļāĻŋāĻļā§ āĻāĻ¨ā§āĻŽā§āĻ° āĻāĻ¤āĻŋāĻšāĻžāĻ¸ āĻāĻā§?
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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34 |
[c10_if_yes_how_many_times]
Show the field ONLY if:
[c9_have_you_ever_had_a_his] = "1"
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C10. If yes, how many times?
āĻ¯āĻĻāĻŋ āĻšā§āĻ¯āĻžāĻ, āĻ¤āĻŦā§ āĻā§āĻŦāĻžāĻ°?
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text (number), Required |
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35 |
[section_d_breastfeeding_co] |
Section D: Breastfeeding & Complementary FeedingāĻ
āĻ§ā§āĻ¯āĻžā§ D: āĻ¸ā§āĻ¤āĻ¨ā§āĻ¯āĻĒāĻžāĻ¨ āĻ āĻĒāĻ°āĻŋāĻĒā§āĻ°āĻ āĻāĻžāĻā§āĻžāĻ¨ā§ |
descriptive |
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36 |
[d1_was_water_honey_janam_g] |
D1.Was water/ honey/ janam ghutti given at birth?
āĻāĻ¨ā§āĻŽā§āĻ° āĻ¸āĻŽā§ āĻāĻŋ āĻāĻ˛/āĻŽāĻ§ā§/āĻāĻ¨ā§āĻŽ āĻā§āĻāĻŋ āĻĻā§āĻā§āĻž āĻšā§ā§āĻāĻŋāĻ˛?
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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37 |
[d2_did_you_breastfeed_excl] |
D2. Did you breastfeed exclusively for the first 6 months?
āĻĒā§āĻ°āĻĨāĻŽ ā§Ŧ āĻŽāĻžāĻ¸ āĻāĻŋ āĻāĻāĻŽāĻžāĻ¤ā§āĻ° āĻ¸ā§āĻ¤āĻ¨ā§āĻ¯āĻĒāĻžāĻ¨ āĻāĻ°āĻŋā§ā§āĻā§āĻ¨?
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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38 |
[d3_if_no_at_what_month_did]
Show the field ONLY if:
[d2_did_you_breastfeed_excl] = '2'
|
D3. If no, at what month did you start other feeds?
āĻ¯āĻĻāĻŋ āĻ¨āĻž, āĻ¤āĻŦā§ āĻāĻ¤ āĻŽāĻžāĻ¸ āĻŦā§āĻ¸ā§ āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ āĻāĻžāĻŦāĻžāĻ° āĻĻā§āĻā§āĻž āĻļā§āĻ°ā§ āĻāĻ°ā§āĻāĻŋāĻ˛ā§āĻ¨?
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text (number), Required
Field Annotation: @PLACEHOLDER ="Numeric Entery" |
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39 |
[d4_age_at_which_complement] |
D4. Age at which complementary foods started (age in months)
āĻāĻ¤ āĻŽāĻžāĻ¸ āĻŦā§āĻ¸ā§ āĻĒāĻ°āĻŋāĻĒā§āĻ°āĻ āĻāĻžāĻŦāĻžāĻ° āĻĻā§āĻā§āĻž āĻļā§āĻ°ā§ āĻšā§ā§āĻāĻŋāĻ˛ (age in months)
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text (number), Required
Field Annotation: @PLACEHOLDER = "Numeric entery" |
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40 |
[d5_who_advised_you_to_star] |
D5. Who advised you to start complementary feeding?
āĻā§ āĻāĻĒāĻ¨āĻžāĻā§ āĻĒāĻ°āĻŋāĻĒā§āĻ°āĻ āĻāĻžāĻŦāĻžāĻ° āĻļā§āĻ°ā§ āĻāĻ°āĻ¤ā§ āĻŦāĻ˛ā§āĻāĻŋāĻ˛ā§āĻ¨?
|
checkbox, Required| 1 | d5_who_advised_you_to_star___1 | Doctor / āĻĄāĻžāĻā§āĻ¤āĻžāĻ° | | 2 | d5_who_advised_you_to_star___2 | ANM / āĻ.āĻāĻ¨.āĻāĻŽ. | | 3 | d5_who_advised_you_to_star___3 | ASHA / āĻāĻļāĻž āĻāĻ°ā§āĻŽā§ | | 4 | d5_who_advised_you_to_star___4 | Family / āĻĒāĻ°āĻŋāĻŦāĻžāĻ° | | 5 | d5_who_advised_you_to_star___5 | Other / āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ |
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41 |
[d5_other_specify]
Show the field ONLY if:
[d5_who_advised_you_to_star(5)] = '1'
|
Other Specify |
text |
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42 |
[d6_what_main_foods_were_in] |
D6. What main foods were introduced first?
āĻĒā§āĻ°āĻĨāĻŽā§ āĻā§āĻ¨ āĻĒā§āĻ°āĻ§āĻžāĻ¨ āĻāĻžāĻŦāĻžāĻ°āĻā§āĻ˛ā§ āĻĻā§āĻā§āĻž āĻšā§ā§āĻāĻŋāĻ˛?
|
checkbox, Required| 1 | d6_what_main_foods_were_in___1 | Rice/porridge / āĻāĻžāĻ¤/āĻĒāĻžā§ā§āĻ¸ | | 2 | d6_what_main_foods_were_in___2 | Dal / āĻĄāĻžāĻ˛ | | 3 | d6_what_main_foods_were_in___3 | Vegetables / āĻļāĻžāĻāĻ¸āĻŦāĻāĻŋ | | 4 | d6_what_main_foods_were_in___4 | Other (Specify) / āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ (āĻāĻ˛ā§āĻ˛ā§āĻ āĻāĻ°ā§āĻ¨) ......... |
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43 |
[other_specify]
Show the field ONLY if:
[d6_what_main_foods_were_in(4)] = '1'
|
Other Specify |
text |
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44 |
[d7_frequency_of_feeding_pe] |
D7. How many times a day do you feed your child?
āĻāĻ āĻĻāĻŋāĻ¨ā§ āĻāĻĒāĻ¨āĻŋ āĻŽā§āĻ āĻāĻ¤āĻŦāĻžāĻ° āĻāĻĒāĻ¨āĻžāĻ° āĻļāĻŋāĻļā§āĻā§ āĻāĻžāĻŦāĻžāĻ° āĻŦāĻž āĻŦā§āĻā§āĻ° āĻĻā§āĻ§ āĻāĻžāĻāĻ¯āĻŧāĻžāĻ¨?
|
text (number), Required
Field Annotation: @PLACEHOLDER ="Numeric entery" |
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45 |
[d8_did_you_continue_breast] |
D8. Did you continue breastfeeding after 1 year?
ā§§ āĻŦāĻāĻ°ā§āĻ° āĻĒāĻ°āĻ āĻāĻŋ āĻ¸ā§āĻ¤āĻ¨ā§āĻ¯āĻĒāĻžāĻ¨ āĻāĻžāĻ˛āĻŋā§ā§ āĻāĻŋā§ā§āĻāĻŋāĻ˛ā§āĻ¨?
|
radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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46 |
[d9_was_your_child_ever_bot] |
D9. Was your child ever bottle fed or given Infant formula?
āĻāĻĒāĻ¨āĻžāĻ° āĻļāĻŋāĻļā§āĻā§ āĻāĻŋ āĻāĻāĻ¨ā§ āĻŦā§āĻ¤āĻ˛ā§āĻ° āĻĻā§āĻ§ āĻ
āĻĨāĻŦāĻž āĻāĻ¨āĻĢā§āĻ¯āĻžāĻ¨ā§āĻ āĻĢāĻ°ā§āĻŽā§āĻ˛āĻž āĻāĻžāĻā§āĻžāĻ¨ā§ āĻšā§ā§āĻāĻŋāĻ˛?
|
radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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47 |
[section_e_child_growth_and] |
Section E: Child Growth and Nutritional Status (Check MCP Card)āĻ
āĻ§ā§āĻ¯āĻžā§ E: āĻļāĻŋāĻļā§āĻ° āĻŦā§āĻĻā§āĻ§āĻŋ āĻ āĻĒā§āĻˇā§āĻāĻŋāĻāĻ¤ āĻ
āĻŦāĻ¸ā§āĻĨāĻž (MCP āĻāĻžāĻ°ā§āĻĄ āĻ¯āĻžāĻāĻžāĻ āĻāĻ°ā§āĻ¨) |
descriptive |
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48 |
[e1_child_s_age_in_complete] |
E1. Child's age in completed months
āĻļāĻŋāĻļā§āĻ° āĻŦā§āĻ¸ (āĻ¸āĻŽā§āĻĒā§āĻ°ā§āĻŖ āĻŽāĻžāĻ¸ā§)
|
text (number), Required
Field Annotation: @PLACEHOLDER ="Numeric entery" |
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49 |
[e2_child_s_sex] |
E2. Child's sex
āĻļāĻŋāĻļā§āĻ° āĻ˛āĻŋāĻā§āĻ
|
radio, Required| 1 | Male / āĻā§āĻ˛ā§ | | 2 | Female / āĻŽā§ā§ā§ | | 3 | Other / āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ |
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50 |
[specify_other_e2]
Show the field ONLY if:
[e2_child_s_sex] = '3'
|
Specify Other |
text |
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51 |
[e3_child_s_current_weight] |
E3. Child's current weight (kg)
āĻļāĻŋāĻļā§āĻ° āĻŦāĻ°ā§āĻ¤āĻŽāĻžāĻ¨ āĻāĻāĻ¨ (āĻā§āĻāĻŋ)
|
text (number, Min: 1, Max: 15), Required
Field Annotation: @FORCE-MINMAX @PLACEHOLDER ="Numeric entery" |
|
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52 |
[e4_child_s_current_height] |
E4. Child's current height (cm)
āĻļāĻŋāĻļā§āĻ° āĻŦāĻ°ā§āĻ¤āĻŽāĻžāĻ¨ āĻāĻā§āĻāĻ¤āĻž (āĻ¸ā§āĻŽāĻŋ)
|
text (number), Required
Field Annotation: @PLACEHOLDER ="Numeric entery" |
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53 |
[e5_mid_arm_circumference] |
E5. Child's mid upper arm circumference
āĻļāĻŋāĻļā§āĻ° āĻŽāĻ§ā§āĻ¯ āĻŦāĻžāĻšā§āĻ° āĻĒāĻ°āĻŋāĻ§āĻŋ
|
text (number), Required
Field Annotation: @PLACEHOLDER ="Numeric entery" |
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54 |
[e7_do_you_have_a_recent_gr] |
E7. Do you have a recent growth card/record for your child?
āĻāĻĒāĻ¨āĻžāĻ° āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨ā§āĻ° āĻ¸āĻžāĻŽā§āĻĒā§āĻ°āĻ¤āĻŋāĻ āĻā§āĻ°ā§āĻĨ āĻāĻžāĻ°ā§āĻĄ/āĻ°ā§āĻāĻ°ā§āĻĄ āĻāĻŋ āĻāĻā§?
|
radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
|
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55 |
[e8_did_any_health_worker_i] |
E8. Did any health worker inform you about nutritional status?
āĻā§āĻ¨ā§ āĻ¸ā§āĻŦāĻžāĻ¸ā§āĻĨā§āĻ¯āĻāĻ°ā§āĻŽā§ āĻāĻŋ āĻāĻĒāĻ¨āĻžāĻā§ āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨ā§āĻ° āĻĒā§āĻˇā§āĻāĻŋāĻ° āĻ
āĻŦāĻ¸ā§āĻĨāĻž āĻ¸āĻŽā§āĻĒāĻ°ā§āĻā§ āĻāĻžāĻ¨āĻŋā§ā§āĻāĻŋāĻ˛ā§āĻ¨?
|
radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
|
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56 |
[e9_was_your_child_ever_dia] |
E9. Was your child ever diagnosed as underweight, stunted, or wasted?
āĻāĻĒāĻ¨āĻžāĻ° āĻļāĻŋāĻļā§āĻā§ āĻāĻŋ āĻāĻāĻ¨āĻ āĻāĻŽ āĻāĻāĻ¨ āĻŦāĻž āĻāĻŽ āĻāĻā§āĻāĻ¤āĻž / āĻĻā§āĻ°ā§āĻŦāĻ˛/āĻ¸ā§āĻŦāĻžāĻ¸ā§āĻĨā§āĻ¯āĻšā§āĻ¨ āĻŦāĻ˛ā§ āĻŦāĻ˛āĻž āĻšāĻ¯āĻŧā§āĻā§?"?
[Cross- Check MCP card]
|
radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
|
|
|
57 |
[e10_did_you_receive_treatm] |
E10. Did you receive treatment/support if child undernourished?
āĻ¯āĻĻāĻŋ āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨ āĻ
āĻĒā§āĻˇā§āĻ āĻāĻŋāĻ˛, āĻ¤āĻŦā§ āĻāĻĒāĻ¨āĻŋ āĻāĻŋ āĻāĻŋāĻāĻŋā§āĻ¸āĻž/āĻ¸āĻšāĻžā§āĻ¤āĻž āĻĒā§ā§ā§āĻāĻŋāĻ˛ā§āĻ¨?
|
radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž | | 3 | Not applicable / āĻĒā§āĻ°āĻ¯ā§āĻā§āĻ¯ āĻ¨āĻ¯āĻŧ |
|
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58 |
[e11_did_your_child_fall_si] |
E11. Did your child fall sick in last one month?
āĻāĻ¤ āĻāĻ āĻŽāĻžāĻ¸ā§ āĻāĻŋ āĻāĻĒāĻ¨āĻžāĻ° āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨ āĻ
āĻ¸ā§āĻ¸ā§āĻĨ āĻšā§ā§āĻāĻŋāĻ˛?
|
radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
|
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59 |
[e12_if_yes_reason_of_sickn]
Show the field ONLY if:
[e11_did_your_child_fall_si] = '1'
|
E12.If yes, reason of sickness? (multiple options)
āĻ¯āĻĻāĻŋ āĻšā§āĻ¯āĻžāĻ, āĻ
āĻ¸ā§āĻ¸ā§āĻĨ āĻšāĻā§āĻžāĻ° āĻāĻžāĻ°āĻŖ āĻā§ āĻāĻŋāĻ˛? (āĻāĻāĻžāĻ§āĻŋāĻ āĻŦāĻŋāĻāĻ˛ā§āĻĒ)
|
checkbox, Required| 1 | e12_if_yes_reason_of_sickn___1 | Pneumonia / āĻ¨āĻŋāĻāĻŽā§āĻ¨āĻŋāĻ¯āĻŧāĻž | | 2 | e12_if_yes_reason_of_sickn___2 | Diarrhea / āĻĄāĻžāĻ¯āĻŧāĻ°āĻŋāĻ¯āĻŧāĻž | | 3 | e12_if_yes_reason_of_sickn___3 | Sepsis / āĻ¸ā§āĻĒāĻ¸āĻŋāĻ¸ | | 4 | e12_if_yes_reason_of_sickn___4 | Neonatal Jaundice / āĻ¨āĻŦāĻāĻžāĻ¤āĻ āĻāĻ¨ā§āĻĄāĻŋāĻ¸ | | 5 | e12_if_yes_reason_of_sickn___5 | Malnutrition / āĻ
āĻĒā§āĻˇā§āĻāĻŋ | | 6 | e12_if_yes_reason_of_sickn___6 | Any Other (Specify) / āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ (āĻāĻ˛ā§āĻ˛ā§āĻ āĻāĻ°ā§āĻ¨) ......... |
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60 |
[specify_other_e12]
Show the field ONLY if:
[e12_if_yes_reason_of_sickn(6)] = '1'
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Specify other |
text |
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61 |
[e13_was_your_child_admitte] |
E13. Was your child admitted to hospital in last two months?
āĻāĻ¤ āĻĻā§āĻ āĻŽāĻžāĻ¸ā§ āĻāĻŋ āĻāĻĒāĻ¨āĻžāĻ° āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨āĻā§ āĻšāĻžāĻ¸āĻĒāĻžāĻ¤āĻžāĻ˛ā§ āĻāĻ°ā§āĻ¤āĻŋ āĻāĻ°āĻ¤ā§ āĻšā§ā§āĻāĻŋāĻ˛?
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radio, Required| 1 | Yes/ āĻšā§āĻ¯āĻžāĻ | | 2 | No/ āĻ¨āĻž |
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62 |
[e14_duration_of_hospital_s]
Show the field ONLY if:
[e13_was_your_child_admitte] = '1'
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E14. Duration of hospital stay
āĻšāĻžāĻ¸āĻĒāĻžāĻ¤āĻžāĻ˛ā§ āĻĨāĻžāĻāĻžāĻ° āĻ¸āĻŽā§āĻāĻžāĻ˛ (āĻā§āĻ¨āĻ āĻāĻ¤āĻŋāĻšāĻžāĻ¸ āĻ¨āĻž āĻĨāĻžāĻāĻ˛ā§ āĻļā§āĻ¨ā§āĻ¯ āĻ˛āĻŋāĻā§āĻ¨)
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text (number), Required
Field Annotation: @PLACEHOLDER = " In Days " |
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63 |
[section_f_immunization_sta] |
Section H: Immunization status (verify with MCP card)āĻ
āĻ§ā§āĻ¯āĻžā§ H: āĻāĻŋāĻāĻžāĻĻāĻžāĻ¨ āĻ
āĻŦāĻ¸ā§āĻĨāĻž (MCP āĻāĻžāĻ°ā§āĻĄ āĻĻāĻŋāĻ¯āĻŧā§ āĻ¯āĻžāĻāĻžāĻ āĻāĻ°ā§āĻ¨) |
descriptive |
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64 |
[h1_is_your_child_s_vaccina] |
H1.Is your child's vaccination up to date?
āĻāĻĒāĻ¨āĻžāĻ° āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨ā§āĻ° āĻāĻŋāĻāĻž āĻāĻŋ āĻ¸āĻŽā§āĻŽāĻ¤ā§ āĻ¸āĻŽā§āĻĒā§āĻ°ā§āĻŖ āĻšā§ā§āĻā§?
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radio, Required| 1 | Yes / āĻšā§āĻ¯āĻžāĻ | | 2 | No / āĻ¨āĻž | | 3 | Don't know / āĻāĻžāĻ¨āĻŋ āĻ¨āĻž |
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65 |
[h2_has_your_child_missed_a] |
H2. Has your child missed any scheduled immunization?
āĻāĻĒāĻ¨āĻžāĻ° āĻ¸āĻ¨ā§āĻ¤āĻžāĻ¨ā§āĻ° āĻāĻŋ āĻā§āĻ¨ā§ āĻ¨āĻŋāĻ°ā§āĻ§āĻžāĻ°āĻŋāĻ¤ āĻāĻŋāĻāĻž āĻŦāĻžāĻĻ āĻĒā§ā§āĻā§?
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radio, Required| 1 | Yes / āĻšā§āĻ¯āĻžāĻ | | 2 | No / āĻ¨āĻž | | 3 | Don't know / āĻāĻžāĻ¨āĻŋ āĻ¨āĻž |
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66 |
[h3_if_yes_which_vaccine_wa]
Show the field ONLY if:
[h2_has_your_child_missed_a] = '1'
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H3 If yes, which vaccine was missed? (multiple options)
āĻ¯āĻĻāĻŋ āĻšā§āĻ¯āĻžāĻ, āĻā§āĻ¨ āĻāĻŋāĻāĻž āĻŦāĻžāĻĻ āĻĒā§ā§āĻā§? (āĻāĻāĻžāĻ§āĻŋāĻ āĻŦāĻŋāĻāĻ˛ā§āĻĒ)
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checkbox, Required| 1 | h3_if_yes_which_vaccine_wa___1 | BCG (Tuberculosis) / āĻŦāĻŋāĻ¸āĻŋāĻāĻŋ (āĻ¯āĻā§āĻˇā§āĻŽāĻž) | | 2 | h3_if_yes_which_vaccine_wa___2 | OPV-0 (Oral Polio Vaccine - Zero dose) / āĻāĻĒāĻŋāĻāĻŋ-ā§Ļ (āĻāĻ°āĻžāĻ˛ āĻĒā§āĻ˛āĻŋāĻ āĻā§āĻ¯āĻžāĻāĻ¸āĻŋāĻ¨ - āĻļā§āĻ¨ā§āĻ¯ āĻĄā§āĻ) | | 3 | h3_if_yes_which_vaccine_wa___3 | Hepatitis B-0 (within 24 hours of birth) / āĻšā§āĻĒāĻžāĻāĻžāĻāĻāĻŋāĻ¸ āĻŦāĻŋ-ā§Ļ (āĻāĻ¨ā§āĻŽā§āĻ° ā§¨ā§Ē āĻāĻ¨ā§āĻāĻžāĻ° āĻŽāĻ§ā§āĻ¯ā§) | | 4 | h3_if_yes_which_vaccine_wa___4 | OPV-1 / āĻāĻĒāĻŋāĻāĻŋ-ā§§ | | 5 | h3_if_yes_which_vaccine_wa___5 | Pentavalent-1 (DPT + Hep B + HiB) / āĻĒā§āĻ¨ā§āĻāĻžāĻā§āĻ¯āĻžāĻ˛ā§āĻ¨ā§āĻ-ā§§ (āĻĄāĻŋāĻĒāĻŋāĻāĻŋ + āĻšā§āĻĒ āĻŦāĻŋ + āĻšāĻžāĻāĻŦāĻŋ) | | 6 | h3_if_yes_which_vaccine_wa___6 | fIPV-1 (Fractional Inactivated Polio Vaccine, intradermal) / āĻāĻĢāĻāĻāĻĒāĻŋāĻāĻŋ-ā§§ (āĻāĻāĻļāĻŋāĻ āĻ¨āĻŋāĻˇā§āĻā§āĻ°āĻŋāĻ¯āĻŧ āĻĒā§āĻ˛āĻŋāĻ āĻā§āĻ¯āĻžāĻāĻ¸āĻŋāĻ¨, āĻ
āĻ¨ā§āĻ¤āĻāĻ¤ā§āĻŦāĻā§āĻ¯āĻŧ) | | 7 | h3_if_yes_which_vaccine_wa___7 | Rotavirus-1 / āĻ°ā§āĻāĻžāĻāĻžāĻāĻ°āĻžāĻ¸-ā§§ | | 8 | h3_if_yes_which_vaccine_wa___8 | PCV-1 (Pneumococcal Conjugate Vaccine) / āĻĒāĻŋāĻ¸āĻŋāĻāĻŋ-ā§§ (āĻ¨āĻŋāĻāĻŽā§āĻāĻā§āĻāĻžāĻ˛ āĻāĻ¨āĻā§āĻā§āĻ āĻā§āĻ¯āĻžāĻāĻ¸āĻŋāĻ¨) | | 9 | h3_if_yes_which_vaccine_wa___9 | OPV-2 / āĻāĻĒāĻŋāĻāĻŋ-ā§¨ | | 10 | h3_if_yes_which_vaccine_wa___10 | Pentavalent-2 / āĻĒā§āĻ¨ā§āĻāĻžāĻā§āĻ¯āĻžāĻ˛ā§āĻ¨ā§āĻ-ā§¨ | | 11 | h3_if_yes_which_vaccine_wa___11 | Rotavirus-2 / āĻ°ā§āĻāĻžāĻāĻžāĻāĻ°āĻžāĻ¸-ā§¨ | | 12 | h3_if_yes_which_vaccine_wa___12 | PCV-2 / āĻĒāĻŋāĻ¸āĻŋāĻāĻŋ-ā§¨ | | 13 | h3_if_yes_which_vaccine_wa___13 | OPV-3 / āĻāĻĒāĻŋāĻāĻŋ-ā§Š | | 14 | h3_if_yes_which_vaccine_wa___14 | Pentavalent-3 / āĻĒā§āĻ¨ā§āĻāĻžāĻā§āĻ¯āĻžāĻ˛ā§āĻ¨ā§āĻ-ā§Š | | 15 | h3_if_yes_which_vaccine_wa___15 | fIPV-2 / āĻāĻĢāĻāĻāĻĒāĻŋāĻāĻŋ-ā§¨ | | 16 | h3_if_yes_which_vaccine_wa___16 | Rotavirus-3 (if 3-dose schedule) / āĻ°ā§āĻāĻžāĻāĻžāĻāĻ°āĻžāĻ¸-ā§Š (āĻ¯āĻĻāĻŋ ā§Š āĻĄā§āĻ āĻ¨āĻŋāĻ°ā§āĻ§āĻžāĻ°āĻŋāĻ¤ āĻĨāĻžāĻā§) | | 17 | h3_if_yes_which_vaccine_wa___17 | Measles-Rubella (MR-1) / āĻšāĻžāĻŽ-āĻ°ā§āĻŦā§āĻ˛āĻž (āĻāĻŽāĻāĻ°-ā§§) | | 18 | h3_if_yes_which_vaccine_wa___18 | JE-1 (Japanese Encephalitis, in endemic districts) / āĻā§āĻ-ā§§ (āĻāĻžāĻĒāĻžāĻ¨āĻŋāĻ āĻāĻ¨āĻ¸ā§āĻĢāĻžāĻ˛āĻžāĻāĻāĻŋāĻ¸, āĻ¸ā§āĻĨāĻžāĻ¨ā§āĻ¯āĻŧ āĻā§āĻ˛āĻžāĻ¯āĻŧ) | | 19 | h3_if_yes_which_vaccine_wa___19 | PCV-Booster / āĻĒāĻŋāĻ¸āĻŋāĻāĻŋ-āĻŦā§āĻ¸ā§āĻāĻžāĻ° | | 20 | h3_if_yes_which_vaccine_wa___20 | MR-2 / āĻāĻŽāĻāĻ°-ā§¨ | | 21 | h3_if_yes_which_vaccine_wa___21 | DPT 1st Booster / āĻĄāĻŋāĻĒāĻŋāĻāĻŋ āĻĒā§āĻ°āĻĨāĻŽ āĻŦā§āĻ¸ā§āĻāĻžāĻ° | | 22 | h3_if_yes_which_vaccine_wa___22 | OPV-Booster / āĻāĻĒāĻŋāĻāĻŋ-āĻŦā§āĻ¸ā§āĻāĻžāĻ° | | 23 | h3_if_yes_which_vaccine_wa___23 | JE-2 (in endemic districts) / āĻā§āĻ-ā§¨ (āĻ¸ā§āĻĨāĻžāĻ¨ā§āĻ¯āĻŧ āĻā§āĻ˛āĻžāĻ¯āĻŧ) |
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67 |
[h4_reason_for_missed_immun]
Show the field ONLY if:
[h2_has_your_child_missed_a] = '1'
|
H4. Reason for missed immunization?
āĻāĻŋāĻāĻž āĻŦāĻžāĻĻ āĻĒāĻĄāĻŧāĻžāĻ° āĻāĻžāĻ°āĻŖ āĻā§?
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checkbox, Required| 1 | h4_reason_for_missed_immun___1 | Child sick / āĻļāĻŋāĻļā§ āĻ
āĻ¸ā§āĻ¸ā§āĻĨ | | 2 | h4_reason_for_missed_immun___2 | Vaccine not available / āĻāĻŋāĻāĻž āĻĒāĻžāĻāĻ¯āĻŧāĻž āĻ¯āĻžāĻ¯āĻŧāĻ¨āĻŋ | | 3 | h4_reason_for_missed_immun___3 | Transport / āĻĒāĻ°āĻŋāĻŦāĻšāĻ¨ āĻ¸āĻŽāĻ¸ā§āĻ¯āĻž | | 4 | h4_reason_for_missed_immun___4 | Other specify / āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ (āĻāĻ˛ā§āĻ˛ā§āĻ āĻāĻ°ā§āĻ¨) ......... |
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68 |
[specify_other_h4]
Show the field ONLY if:
[h4_reason_for_missed_immun(4)] = '1'
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Specify other |
text |
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69 |
[h5_where_was_your_child_im] |
H5. Where was your child immunized?
āĻāĻĒāĻ¨āĻžāĻ° āĻļāĻŋāĻļā§āĻā§ āĻā§āĻ¨ āĻā§āĻ¨ā§āĻĻā§āĻ° āĻŦāĻž āĻšāĻžāĻ¸āĻĒāĻžāĻ¤āĻžāĻ˛/āĻā§āĻ˛āĻŋāĻ¨āĻŋāĻā§ āĻāĻŋāĻāĻž āĻĻā§āĻāĻ¯āĻŧāĻž āĻšāĻ¯āĻŧā§āĻā§?
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radio, Required| 1 | Anganwadi / āĻāĻā§āĻāĻ¨āĻāĻ¯āĻŧāĻžāĻĄāĻŧāĻŋ | | 2 | PHC / āĻĒā§āĻ°āĻžāĻĨāĻŽāĻŋāĻ āĻ¸ā§āĻŦāĻžāĻ¸ā§āĻĨā§āĻ¯ āĻā§āĻ¨ā§āĻĻā§āĻ° | | 3 | CHC / āĻāĻŽāĻŋāĻāĻ¨āĻŋāĻāĻŋ āĻ¸ā§āĻŦāĻžāĻ¸ā§āĻĨā§āĻ¯ āĻā§āĻ¨ā§āĻĻā§āĻ° | | 4 | Other specify / āĻ
āĻ¨ā§āĻ¯āĻžāĻ¨ā§āĻ¯ (āĻāĻ˛ā§āĻ˛ā§āĻ āĻāĻ°ā§āĻ¨) ......... |
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70 |
[specify_other_h_5]
Show the field ONLY if:
[h5_where_was_your_child_im] = 'Other'
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Specify other |
text |
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71 |
[result_code] |
Result Code:
āĻĢāĻ˛āĻžāĻĢāĻ˛ āĻā§āĻĄ
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dropdown, Required| 1 | Completed / āĻ¸āĻŽā§āĻĒā§āĻ°ā§āĻŖ āĻšāĻ¯āĻŧā§āĻā§ | | 2 | Refused / āĻ
āĻ¸ā§āĻŦā§āĻāĻžāĻ° āĻāĻ°ā§āĻā§ | | 3 | Partly completed / āĻāĻāĻļāĻŋāĻāĻāĻžāĻŦā§ āĻ¸āĻŽā§āĻĒā§āĻ°ā§āĻŖ āĻšāĻ¯āĻŧā§āĻā§ | | 4 | Not at home / āĻŦāĻžāĻĄāĻŧāĻŋāĻ¤ā§ āĻ¨ā§āĻ | | 5 | Postponed / āĻ¸ā§āĻĨāĻāĻŋāĻ¤ āĻšāĻ¯āĻŧā§āĻā§ |
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72 |
[form_1_complete] |
Section Header: Form Status
Complete?
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dropdown| 0 | Incomplete | | 1 | Unverified | | 2 | Complete |
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