P ERSPECTIVES DE SANTE PUBLIQUE
Annexe 3. Questionnaire de l’enquête sur les pratiques de nutrition infantile
Section 1. Caregiver socio-demographics
Survey 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 after the baby, and also see if the baby is in good health”.
1. Identification of caregiver
For all this section, do not read responses initially, then read and prompt if necessary 1.1. 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 usual caregiver
2. Vital statistics
2.1. 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 |___|
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2.2. If mother alive but not the usual caregiver, specify reasons
□ mother working in town □ mother living away □ mother too ill
□ mother abandoned baby □ other (specify)……… |___|
2.3. Vital status of the baby
□ alive seen by interviewer □ baby reported alive by family
□ baby reported alive by health worker □ baby reported dead by family
□ baby reported dead by health worker □ vital status unknown |___|
3. Usual caregiver demographics
3.1. Marital status □ married □ living with partner
□ single □ separated
□ divorced □ widowed |___|
3.2. N° children alive |___|___| pregnancies |___|___| live births |___|___|
3.3. Level of education □ none □ primary
□ secondary □ post-secondary |___|
3.4. Employment □ formally employed □ self-employed
□ homemaker □ volunteer
□ other (specify) ……… |___|
3.5. Religion □ Apostolic □ Protestant □ Zion
□ Muslim □ Roman Catholic
□ No religion □ other (specify) ……… |___|
3.6. Number of people living in the household |___|___|
4. Infant anthropometrics on day of survey
4.1 Date of birth |___|___| / |___|___| / |___|___|___|___
4.2 Weight |___|___|___|___| g
4.3 Height |___|___|___| cm
4.4 Head circumference |___|___|___| cm
4.5 Middle Upper Arm Circumference |___|___|___| cm
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Section 2. Infant feeding practices.
1. Breastfeeding practices
1.1. Have you ever breastfed the baby? □ yes □ no |___|
If no, go to 1.3
1.2. Are you currently breastfeeding the baby? □ yes □ no |___|
1.3. Has anyone else ever breastfed the baby? □ yes □ no |___|
If no, go to 1.7. If yes, ask whom, don’t read the responses initially, then read and prompt if necessary - sister □ yes □ no |___| - aunt □ yes □ no |___|
- baby’s grand-mother □ yes □ no |___| - other female (specify)…….. □ yes □ no |___|
1.4. For how long did this other person breastfeed the baby?
□ |___|___|___| days □ |___|___|___| weeks □ |___|___| months |___|
1.5. Is anyone else currently breastfeeding the baby?
If no, go to 1.7. If yes, ask whom, don’t read the responses initially, then read and prompt if necessary - sister □ yes □ no |___| - aunt □ yes □ no |___|
- baby’s grand-mother □ yes □ no |___| - another female (specify)…… □ yes □ no |___|
1.6. For how long has this other person been breastfeeding the baby?
□ |___|___|___| days □ |___|___|___| weeks □ |___|___| months |___|
If the usual caregiver is currently breastfeeding (answer yes at 1.2):
1.7. Up to what age do you intend to breastfeed the child? |___|___| months 1.8. How many times did you breastfeed the child yesterday? Tick according to the answers given
Frequency of feeding During daylight During night Less than 5
5 to 10 More than 10 Doesn’t know
daylight |___| night |___|
2. Foods other than breastmilk
2.1. Has the baby ever received fluids/foods other than breast milk? □ yes □ no |___|
If the usual caregiver answers “no”, go to 4.
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2.2. Here is a list of fluids/foods, have you been feeding the baby any of these “ever”, “yesterday”, “in the past 7 days”? Prompt line by line and tick according to the answers given
Ever Yesterday In the past 7 days
2.3. So yesterday you’ve been feeding your baby with …….…..… (recap her answers). Is this the usual
2.5. Does anyone else apart from you prepare these fluids/foods for the baby?
- grand-mother of the baby □ yes □ no |___|
- aunt/sister □ yes □ no |___|
- elder sister/brother of the baby □ yes □ no |___|
- friend □ yes □ no |___|
- other (specify) ………. □ yes □ no |___|
2.6. Does anyone else apart from you feed the baby?
- grand-mother of the baby □ yes □ no |___|
If usual caregiver answered “no” to 2.1, do not complete this section and go to section 4
3.1. How old was the child when you started feeding him other fluids/foods than breast milk?
□ |___|___|___| days □ |___|___| weeks □ months |___|___| |___|
3.2. Do you still put your baby to the breast at any time? □ yes □ no |___|
If “yes”, go to 3.9
3.3. How old was your baby when you completely stopped breastfeeding?
□ |___|___|___| days □ |___|___| weeks □ months |___|___| |___|
3.4. How long did it take you to completely stop breastfeeding your child from the day you decided to stop to the day your baby no longer suckled from your breasts?
□ |___|___|___| days □ |___|___| weeks □ months |___|___| |___|
For questions 3.5 to 3.12, do not read responses initially, then read and prompt if necessary 3.5. For what reasons did you stop breastfeeding your baby?
- mother illness/weakness □ yes □ no |___|
- new pregnancy □ yes □ no |___|
- baby old enough □ yes □ no |___|
- doesn’t remember □ yes □ no |___|
- other (specify) ……… □ yes □ no |___|
3.6. How did you stop breastfeeding your infant?
- put something on breast □ yes □ no |___|
3.9. Did you encounter problems when you introduced complementary fluids/foods?
□ yes □ no |___|
3.11. Who decided when to introduce complementary foods?
- personal decision □ yes □ no |___|
- husband decision □ yes □ no |___|
- other family member decision □ yes □ no |___|
- doesn’t remember □ yes □ no |___|
- other (specify)………. □ yes □ no |___|
3.12. Have you ever received food support from district organisations for you or your baby?
□ yes □ no |___|
3.14. If yes, which type of support?
If usual caregiver responded “yes” to 1.1, start with 4.1 else go strait to 4.3 4.1. Who decided on breastfeeding the baby?
Do not read responses, tick yes as many as applies - usual caregiver choice □ yes □ no |___|
4.2. What were the main reasons for you to breastfeed?
Do not read responses initially, then read and prompt if necessary - best for infant health □ yes □ no |___|
If mother/caregiver responded “yes” to 1.1, skip 4.3 and go to 4.4 4.3. What were the main reasons for you not to ever breastfeed?
Do not read responses initially, then read and prompt if necessary - mother illness/weakness □ yes □ no |___|
4.4. Today, which family member or members decides about how to feed your baby?
Tick yes as many as applies
4.5. Do you think you should feed something else to your child than what he/she currently receives?
□ yes □ no |___|
If no, go to 4.9
4.6. What would this other fluid/food be?
Do not read responses initially, then read and prompt if necessary
- breast milk □ yes □ no |___| - plain water □ yes □ no |___|
4.7. Why do you want to feed something else to your child?
Do not read responses initially, then read and prompt if necessary
- current practice too expensive □ yes □ no |___|
- current practice feels inadequate □ yes □ no |___|
- health worker told to change practice □ yes □ no |___|
- family/friends told to change practice □ yes □ no |___|
- other (specify) ………. □ yes □ no |___|
4.8. For what reasons can’t you currently feed something else to your child?
- not enough money □ yes □ no |___|
4.10. Check the positioning of the baby on the breast
□ appropriate □ not appropriate |___|
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5. Counselling
5.1. Have you ever had discussions on infant feeding practices? □ yes □ no |___|
5.2. If yes, with whom? Do not read responses initially, then read and prompt if necessary - with health workers □ yes □ no |___|
- with the PMTCT team □ yes □ no |___|
- with friends □ yes □ no |___|
- other (specify)………. □ yes □ no |___|
If caregiver answers “no” to 5.1, go to 5.6
5.3. How did you find these discussions? □ useful □ not useful |___|
If not useful go to 5.4
5.4. If useful, what did you like in the discussion? (Do not read responses initially, then read and prompt if necessary)
- gave new information □ yes □ no |___|
- meant someone to talk to □ yes □ no |___|
- helped for feeding decision □ yes □ no |___|
- other (specify) ………. □ yes □ no |___|
Go to 5.6
5.5. If not useful, explain why (Do not read responses initially, then read and prompt if necessary) - information too complicated □ yes □ no |___|
- health worker bad attitude □ yes □ no |___|
- information can’t be used □ yes □ no |___|
- caregiver disagrees □ yes □ no |___|
- other (specify) ………. □ yes □ no |___|
5.6. Have you ever received home visits? □ yes □ no |___|
5.7. If yes, by whom?
- community carers □ yes □ no |___|
- nurses □ yes □ no |___|
- counsellors □ yes □ no |___|
- other (specify)………... □ yes □ no |___|
5.8. Have you ever been taught how to :
- express breast milk □ yes □ no |___|
- heat treat breast milk □ yes □ no |___|
- prepare commercial formula □ yes □ no |___|
- prepare home modified formula □ yes □ no |___|
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6. Mother/caregiver health
Because infant feeding practices depend a lot upon the mother (caregiver) eating well and being healthy, explain that you’re going to ask a few questions targeted at the mother/usual caregiver.
6.1. Ask about the availability of the following foods in the household (tick according to availability today)
Food Yes (available today) No (not available today) Code
Millie meal |___|
6.2. What is the main reason for these foods not being available in the house today?
- not in the shops □ yes □ no |___| - can’t afford it □ yes □ no |___|
6.3. Have you eaten any of the following foods in the past 24 hours (tick all eaten foods) - sadza □ yes □ no |___| - meat □ yes □ no |___|
6.6. Have you eaten the following foods in the past 7 days (tick all eaten foods)
- sadza □ yes □ no |___| - meat □ yes □ no |___|
- milk □ yes □ no |___| - bread □ yes □ no |___|
- beans □ yes □ no |___| - fruits □ yes □ no |___|
- other (specify)……… □ yes □ no |___|
6.7. Have you experienced the following health problems in the past 7 days?
- breast swelling □ yes □ no |___| - breast tenderness □ yes □ no |___|
- sore nipples □ yes □ no |___| - cracked nipples □ yes □ no |___|
- pain during feeding □ yes □ no |___| - fever □ yes □ no |___|
- other (specify)……… □ yes □ no |___|
If mother/caregiver answered yes to one of the items listed in 6.7 (health pb), continue this section, else go to 6.11
6.8. Have you been treated for these breast problems? □ yes □ no |___|
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6.9. From whom?
- doctor □ yes □ no |___| - nurse □ yes □ no |___|
- TM □ yes □ no |___| - traditional healer □ yes □ no |___|
- relative □ yes □ no |___| - other (specify)………. □ yes □ no |___|
6.10. What kind of treatment?
- painkillers □ yes □ no |___| - other drug □ yes □ no |___|
- skin cream □ yes □ no |___| - advice, counselling □ yes □ no |___|
- traditional remedy □ yes □ no |___| - other (specify)……… □ yes □ no |___|
6.11. Are you currently using any form of contraception? □ yes □ no |___|
6.12. If yes which one? (do not prompt initially)
□ oral contraceptive pill □ depo provera injection □ norplant
□ natural method (rhythm) □ IUCD □ condoms only
□ condoms and other method (specify)………
□ other (specify)………. |___|
6.13. If no, what are the reasons for not using a contraceptive? (do not prompt initially)
- clinic out of stock □ yes □ no |___| - trying to become pregnant □ yes □ no |___|
- do not like using FP □ yes □ no |___| - husband does not want □ yes □ no |___|
- has had tubal ligation □ yes □ no |___| - not aware of FP options □ yes □ no |___|
- other (specify)………. □ yes □ no |___|
7. Infant health
Because infant feeding practices have an impact on infant health, explain you’re going to ask a few questions to see if the child is in good health.
7.1. How long ago was the last visit made to the well-baby clinic?
□ |___|___|___| days □ |___|___| weeks □ |___|___| months |___|
7.2. When was the last time your baby was unwell?
□ |___|___|___| days □ |___|___| weeks □ |___|___| months |___|
7.3. Did you change your way of feeding when this occurred? □ yes □ no |___|
If no, go to 7.5
7.4. What did you do differently when baby was unwell? Do not read responses initially, then read and prompt if necessary
- stop breastfeeding □ yes □ no |___|
- stop non-human milks □ yes □ no |___|
- stop other liquids □ yes □ no |___|
- stop solid foods □ yes □ no |___|
- begin giving non-human milks □ yes □ no |___|
- begin giving other liquids □ yes □ no |___|
- begin giving other solid foods □ yes □ no |___|
- other (specify) ………. □ yes □ no |___|
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7.5. Has the child been hospitalised since birth? □ yes □ no |___|
7.6. If yes, how many times? |___|___|
Check health card. Use it as a guide to discuss the information provided by the mother/caregiver 7.7. Date of hospitalisation 1 |___|___| / |___|___| / |___|___|___|___| to
|___|___| / |___|___| / |___|___|___|___|
7.8. Specify reasons (self reported from caregiver)
□ fever □ diarrhoea □ malnutrition
□ respiratory infection □ other (specify) ………. |___|
7.9. Date of hospitalisation 2 |___|___| / |___|___| / |___|___|___|___| to
|___|___| / |___|___| / |___|___|___|___|
7.10. Specify reasons (self reported from caregiver)
□ fever □ diarrhoea □ malnutrition
□ respiratory infection □ other (specify) ………. |___|
7.11. Date of hospitalisation 3 |___|___| / |___|___| / |___|___|___|___| to
|___|___| / |___|___| / |___|___|___|___|
7.12. Specify reasons (self reported from caregiver)
□ fever □ diarrhoea □ malnutrition
□ respiratory infection □ other (specify) ………. |___|
7.13. Date of hospitalisation 4 |___|___| / |___|___| / |___|___|___|___| to
|___|___| / |___|___| / |___|___|___|___|
7.14. Specify reasons (self reported from caregiver)
□ fever □ diarrhoea □ malnutrition
□ respiratory infection □ other (specify) ………. |___|
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Section 3 – Infant follow-up
1. Frequency of infant follow-up
This section can be answered by the mother OR the usual caregiver ONLY IF he/she stated explicitly they have knowledge of the mother HIV status
Visit number Expected date of PMTCT follow-up Date of true PMTCT follow-up Main reason for not attending
PMTCT follow-up visits Other reasons for not attending PMTCT follow-up visits
Annexe 4. Questionnaire de l’enquête sur les services d’éducation et de suivi en matière