Final Report (PDF, 2132K) - Measure DHS
Final Report (PDF, 2132K) - Measure DHS
Final Report (PDF, 2132K) - Measure DHS
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TABLE 3.5CF. TABLE 2.1:ENTER NAME AND SURVIVAL STATUS FOR ALL CHILDREN BORN SINCE JANUARY 1981.RECORD TNINS IN SEPARATE COLUMNS.USE (AN) EXTRA SHEET(S) IF MORE THAN 4 BIRTHS SINCE JANUARY 1981.ASK QUESTIONS STARTING NITH THE MOST RECENT (LAST) BIRTH.ASK QUESTIONS ONLY FOR SURVIVING CHILDREN.LAST BIRTH I 121 NEXT-TO-LAST I 131 SECOND FeO. I L~ THIRD FROMW I, , BIRTH I ' ' LAST BIRTH LAST HIRT.. . . . . ~n;;;~.. . . . I.. . . . ~;;;~.. . . . I.. . . . ~;;;;.. . . . . . . . .I ~;;;~ .ALIVE { ] ALIVE [ } ALIVE [ ] ALIVE [ )DEAD [ } --~ DEAD [ ] --~ DEAD [ ] --~DEAD [ )391 Do YES, SEEN .... I YES, SEEN .... IIIYES, SEEN .... I YES, SEEN ....you have a YES, BUTYES, HUTYES, BUTYES, BUTlamunizatio NOT SEEN .... 2 NOT SEEN .... 2 NOT SEEN .... 2 NOT SEEN ....Record Car~ | NO CARD ...... 3 NO CARD ...... 3 NO CARD ...... 3 i NO CARD ......for (NAME)IIF YES:May I leeit please? SKIP TO 393SKIP TO 393SKIP TO 393 ISKIP TO 393BCGPOLIO1DPTIPOLIO2DPT2POLIO3DPT3MEASLES392 RECORD DATES OF IMMUNIZATIONS FROM CARD (CIRCLE CODE I IF NO DATE):day month yeariIIIIII ;IiIIiIII I;iIelIIday month year¢ + ¢, II III ;J II;I III II II, Jl JlI ;I I;i ;I III II IIday month yeari Jl Jli Jl IIi II Jl, II ;Ii I] JIi J} III JJ Jill, II IIIIl. . .23day month yearIll1 ;;I, JtJ, flJJIJiIIISKIP TO SECTION 4SKIP TO SECTION 4SKIP TO SECTION 4SKIP TO SECTION 4393 Has (NAME) ever had • vaccination to prevent him/her tro• getting disease•?NO ........... 2 NO ........... 2 NO ........... 2 NO ........... 2iYES,i,Es 11, 1 I_ 1DK ........... 8 DK ........... 8 DK ........... $ DK ........... 812422