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Malawi 2015-16

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CHILD FUNCTIONING AND DISABILITY (AGE 2-9)<br />

CHILD 3 CHILD 4<br />

203 LINE NUMBER FROM COLUMN 1. LINE LINE<br />

NUMBER ..................... NUMBER .....................<br />

NAME FROM COLUMN 2. NAME NAME<br />

204 CHILD SEX FROM COLUMN 4.<br />

MALE . . . . . . . . . . . . . . . . . . . . . . 1 MALE . . . . . . . . . . . . . . . . . . . . . . 1<br />

FEMALE . . . . . . . . . . . . . . . . . . . 2 FEMALE . . . . . . . . . . . . . . . . . . . 2<br />

205 CHILD AGE FROM COLUMN 7.<br />

AGE AGE<br />

206 Compared with other children, does or YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

did (NAME) have any serious delay in NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

sitting standing, or walking?<br />

207 Compared with other children, does YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

(NAME) have difficulty seeing, either in NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

the daytime or at night?<br />

208 Does (NAME) appear to have any<br />

YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

difficulty hearing (uses hearing aid, hears NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

with difficulty or completely deaf)?<br />

209 When you tell (NAME) to do something, YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

does he/she seem to understand what NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

you are saying?<br />

210 Does (NAME) have difficulty in walking YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

or moving his/her arms or does he/she NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

have weakness and/or stiffness in the<br />

arms or legs?<br />

211 Does (NAME) sometimes have fits,<br />

YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

become rigid, or lose consciousness? NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

212 Does (NAME) learn to do things like YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

other children his/her age?<br />

NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

213 Does (NAME) speak at all (can he/she YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

make him or herself understood in<br />

NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

words; can he/she say any recognizable<br />

words)?<br />

214 CHECK 205: CHILD AGE<br />

3-9 YEARS 2 YEARS 3-9 YEARS 2 YEARS<br />

(GO TO 2<strong>16</strong>) (GO TO 2<strong>16</strong>)<br />

215 Is (NAME)’s speech in any way different YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

from normal (not clear enough to be<br />

(SKIP TO 217) (SKIP TO 217)<br />

understood by people other than the NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

immediate family)?<br />

2<strong>16</strong> Can (NAME) name at least one object YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

(for example, an animal, a toy, a cup, a NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

spoon)?<br />

217 Compared with other children of the YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1<br />

same age, does (NAME) appear in any NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2<br />

way mentally backward, dull or slow?<br />

218 GO BACK TO 206 IN NEXT<br />

COLUMN OF THIS<br />

QUESTIONNAIRE; IF NO MORE<br />

CHILDREN, GO TO 300.<br />

GO BACK TO 206 IN THE FIRST<br />

COLUMN OF A NEW<br />

QUESTIONNAIRE; IF NO MORE<br />

CHILDREN, GO TO 300.<br />

526 • Appendix F

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