RURAL BANGLADESH - PreventionWeb

Socio-Economic Profiles of WFP Operational Areas and Beneficiaries
Section C: Health, Maternal & Child Care
Member ID No.
01
02
03
04
05
06
07
08
09
Name
Health Status
C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12 C13 C14 C15
Ask the following questions to all members age 15 years and above Ask the following questions to women age between 15 and 49 years
Code
1
During the past 2 weeks
have you suffered from
an illness or injury?
What was the illness or
injury?
YES .1
NO .2 C6 Code
2
During past 2 weeks did
you have to stop your
normal activities because
of this or these illnesses?
YES .1
NO .2 C6
For how many days in
the past two weeks did
you stop normal
activities?
Who do you visit when
household members are sick
Code 3
137
Are you physically or
mentally handicapped in
any way?
YES .1
NO .2
C8
In what way are you
handicapped?
Code
4
If woman age between 15
and 49 years and
currently married
YES.1
NO .2
(»NEXT
PERSON)
Are you currently breastfeeding
a child?
YES.1
NO ..2
Are you currently
pregnant?
YES.1
NO ..2
In past 12 months did
you give birth to a child,
even if born dead?
YES .1
NO .2
(»NEXT
PERSON)
Did you regularly go to a
health clinic when you
were pregnant with this
child?
Who delivered this child?
YES.1
NO .2
(Code
-5)
Have your children been
immunized?
YES.1
NO. .2