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ChildDate of birth | _ || _ || . | _ || _ | . | _ || _ || _ || _ | (1)Date of birth| _ || _ || . | _ || _ | . | _ || _ || _ || _ | (2, if twins, and fill a second form)5. Clinical data and treatment5.1. AnthropometricsWeight| _ | _ || | _ | _ | kgHeight| _ | _ |,| _ | cmCranial Perimeter| _ | _ |,| _ | cmBrachial perimeter| _ | _ |,| _ | cm5.2. Has the child been hospitalised since birth/ last visit? □ yes □ no5.3. If yes, specify reason and dates: ……………………………………………………………………….…..……………………………………………………………………………………………………………………….5.4. Is the child receiving cotrimoxazole treatment? □ yes □ noIf yes since when? | _ || _ || . | _ || _ | . | _ || _ || _ || _ |6. Follow up on cotrimoxazole6.1. Are there obvious clinical manifestations of adverse drug effects? □ yes □ noIf yes, which effects ……………………………………………………………………………….………………6.2. Were there any difficulties in adherence/acceptability? □ yes □ noIf yes, which difficulties…………………………………………………………………………...……………….7. Feeding practice7.1. Current feeding practice □ exclusive breastmilk □ exclusive artificial milk□ breastmilk and other feeds □ artificial milk and otherfeeds7.2. Is the child weaned? □ yes □ no7.2.1. Date of complete weaning | _ || _ || . | _ || _ | . | _ || _ || _ || _ | □ on-going7.2.2. Reasons for weaning …………………………………………………………………………………..………………………………………………………………………………………………………………………8. HIV test8.1. Date of HIV testing | _ || _ || . | _ || _ | . | _ || _ || _ || _ |8.2. What are the test results? □ sero+ □ sero-Date of the next visit | _ || _ || . | _ || _ | . | _ || _ || _ || _ |Bus warrant given? □ yes □ no394