Télécharger le texte intégral - ISPED-Enseignement à distance

Annexe 3. Questionnaire de l’enquête sur les pratiques de nutrition infantile.Section 1. Caregiver socio-demographicsSurvey N° |___|___|___|Date|___|___| / |___|___| / |___|___|___|___|Questionnaire completed by ………………………… |___| Clinic ………………………… |___|Visit number □ first □ second □ third or above…………. |___|This form presents all the baseline information from the mother/caregiver and infant.Say “I’m going to ask you a few questions concerning the baby and the person responsible for looking afterthe baby, and also see if the baby is in good health”.1. Identification of caregiverFor all this section, do not read responses initially, then read and prompt if necessary1.1. What is your relationship to the baby? (respondent a first clinic visit)- mother □ - grandmother □- aunt/sister □ - elder sister/brother □- friend □ - other (specify) …………………. □ |___|1.2. Who is responsible for the baby?- mother □ - grandmother of the baby □- aunt/sister □ - elder sister/brother of the baby □- friend □ - other (specify) …………………. □ |___|1.3. Who usually prepares fluids/foods for the baby?- mother □ - grandmother of the baby □- aunt/sister □ - elder sister/brother of the baby □- friend □ - other (specify) …………………. □ |___|1.4. Who usually feeds the infant?- mother □ - grandmother of the baby □- aunt/sister □ - elder sister/brother of the baby □- friend □ - other (specify) …………………. □ |___|1.5. Interviewer conclusion: the caregiver of the infant is:- mother □ - grandmother of the baby □- aunt/sister □ - elder sister/brother of the baby □- friend □ - other (specify) …………………. □ |___|If the respondent is not the usual caregiver, make an appointment for a next clinic visit with the usualcaregiver2. Vital statistics2.1. If mother is not the usual caregiver, specify vital status of mother□ mother reported alive by family □ mother reported alive by health worker□ mother reported dead by family □ mother reported dead by health worker□ vital status unknown |___|397