Commented [SP1]: New questions on e.g.

, behavioral change
Table of Contents outcomes and norms
Draw questions from Madagascar
BASELINE SURVEY QUESTIONNAIRE 3
Joanna will send
- Excel version of survey
SECTION 1. HOUSEHOLD ROSTER 4 - Surveys conducted in Zinder

PART A. ROSTER 4 Chris will send

- CRS survey
PART B. EDUCATION 6
PART C. CURRENT MARRIAGES/PARTNER AND PREGNANCY 6

SECTION 2. EMPLOYMENT 7

SECTION 3. BREASTFEEDING AND COMPLEMENTARY FEEDING PRACTICES 9

PART A. INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES 9

PART B. CHILD NUTRITION-RELATED HEALTH HISTORY 11
PART C. PERCEPTION OF CHILD’S RELATIVE NUTRITIONAL STATUS 12
PART D. MATERNAL IYCF KNOWLEDGE AND PERCEPTIONS 12
PART E: ILLNESS DURING THE PREVIOUS 2 WEEKS 13

SECTION 4. EXPOSURE TO HEALTH AND NUTRITION SERVICES 15

PART A. EXPOSURE TO COMMUNITY HEALTH WORKERS (CHW) 15

PART B. EXPOSURE TO OTHER NUTRITION SERVICES 15
PART C. SOURCES OF NUTRITIONAL INFORMATION 16

SECTION 5. HOUSEHOLD HYGIENE ENVIRONMENT 17

SECTION 6. INTRAHOUSEHOLD DECISION-MAKING 18

PART A. DECISIONS REGARDING IMPORTANT HOUSEHOLD ISSUES 18

PART B. DECISIONS REGARDING FOOD PURCHASE 18

SECTION 7. HOUSEHOLD LABOR ALLOCATION 19

SECTION 8. COMMUNICATION WITH PARTNER 20

SECTION 9. GENDER NORM ATTITUDES 20

SECTION 10. MATERNAL CAPABILITIES 21

PART A. PHYSICAL HEALTH 21

PART B. SOCIAL SUPPORT SCALE 21
PART C. SOCIAL DESIRABILITY SCALE 21
PART D. TIME STRESS 22

SECTION 11. SOCIAL NETWORKS 23

SECTION 12. FOOD FREQUENCY 24

SECTION 13. HOUSEHOLD CONSUMPTION 24

PART A. NON-FOOD EXPENDITURES 25

PART B. FOOD EXPENDITURE 26
1
SECTION 14. FOOD SECURITY 29

SECTION 15. COGNITIVE ABILITY TEST 30

SECTION 16. TIME USE SURVEY 31

SECTION 17. ANTHROPOMETRIC MEASUREMENTS 36

2
 Baseline Survey Questionnaire
CLTN Impact Evaluation Study

Interview Start Time Interview End Time

AM/PM AM/PM
District Commune Village
Commune leader Village leader
Household Household head name FIRST SECOND
identification number
Respondent Name FIRST SECOND

Household GPS Phone Number

Coordinate

INTERVIEW VISIT
Interview date Result 1=Completed interview
2=No competent household member at home
3=Entire household absent for an extended time
4=Postponed
5=Refused
Interviewer code 6=Partly completed interview
7=Dwelling vacant/destroyed
8=Dwelling not found
96=Other, specify
INTERVIEW INTRODUCTION
1. THIS IS THE BASELINE INTERVIEW.
2. IF THE INTERVIEWEE GIVES CLEAR CONSENT TO BE INVOLVED, THEN SIGN BELOW:
SAY: At this time, do you want to ask me anything about the purpose or content of this interview?
May I begin the baseline survey now?

YES: RESPONDENT AGREES TO INTERVIEW 1

NO: RESPONDENT DOES NOT AGREE 2  END THE INTERVIEW

FOR INTERVIEWER:
I CONFIRM THAT INFORMED CONTENT STATEMENT HAS BEEN READ TO THE INTERVIEWEE AND THAT SHE UNDERSTANDS
AND CONSENT TO PARTICIPATE IN THE INTERVIEW.

Signature: _____________________________________________________

DEMOGRAPHIC INFORMATION
1. What is your ethnic group? Multiple choice would depend on country
2. What language do you speak at home Multiple choice would depend on country
most of the time?
3. What is your religion? Multiple choice would depend on country

3
 CHECK FOR THE PRESENCE OF OTHERS BEFORE CONTINUING.
MAKE EVERY EFFORT TO ENSURE PRIVACY.

SECTION 1. Household Roster

PART A. Roster
Ask question for all household members who live with the respondent.
SAY: We are now going to ask questions about you and your family. There are 14 sections, and the entire survey will last approximately 2
hours. we are going to start section 1. In this section, we would like to ask you questions about your household members.

Order in which you should list household member:

First=Respondent (Women); Second=Spouse; Third=Co-wives most senior wife first (only if the wives are household members); Fourth=
Grandparents; Fifth=Children of household head, oldest Children first whether still alive or not; Sixth=other household members-such as
relatives then servants, etc.

Relationship code
1= Respondent 2= Spouse 3= Son 4= Daughter 5= Father 6= Mother
7= Grandson 8= Granddaughter 9= Grandfather 10= Grandmother 11= Brother 12= Sister
13= Uncle 14= Aunt 15= Co-wife 16= Cousin 17= Niece 18= Nephew
19= Father-in-law 20= Mother-in-law 21= Brother-in-law 22= Sister-in-law 23= Uncle-in-law 24= Aunt-in-law
28= First-cousin-once
25= Cousin-in-law 26= Niece-in-law 27= Nephew-in-law 29= Stepchild 30= Foster child
removed
31=Local Friend 32= Non-resident friend 33= House helper 34= Landlord 35= Tenant/Renter 96= Other
99= Don’t Know
ID Code 1. Please give me 2. 3.Sex of 4. DATE of Birth 5. Current Age 6. If you are
the names of your Relationship (NAME) (Record in Ethiopian not sure of
household of (NAME) calendar) If known, write and skip [NAME]’s
members. to the 1= Male to Q7. exact age,
respondent 2= 99=Don’t know (for 99=Don’t KnowQ6 estimate from
HOUSEHOLD Female date/month) the following
MEMBERS **See 9999=Don’t know (for IF LESS THAN 1 YEAR age groups.
SHOULD HAVE relationship year) OLD, RECORD IN
STAYED IN THE code MONTHS 1=Less than 1
HOUSE FOR 2=1-2
MORE THAN 3 3=3-5
MONTH DURING [If less than 1 month old 4= 6-10
THE PAST 12 write 0] 5=11-15
MONTHS 6=16-20
7=21-25
8=26-30
9=31-35
A. B. C. A. B. 10=36-40
Day Month Year Years Months 11=41-45
12=46-50
13=51-55
14=56-60
15=61-65
16=66-70
17=more than
70
1
2
3
4
5
6
7
8
9
10
11
12

4
 ID 7. How many 8. What is [NAME]’s current 9. What is [NAME]’s marital status? 10. Partner of [NAME] Lives in
code months was primary occupation? household?
[NAME] away in [Skip if age < 12]
last 12 Months? 1=Farmer or person who 1=Yes
works on family farm (either 1= Married 0=No
[Round down to crops or livestock) 2= Cohabitating
whole number] 2=Person who works for a 3= DivorcedSkip to Q11
regular wage on off-farm 4= Separated Skip to Q11
employment 5= Widow Skip to Q11
3=Person who works for 6= Never married Skip to Q11
wages on a casual or
irregular basis
4=Person who operates
their own non-farm
business
5=Not employed but looking
for work
6=Student
7=Not employed and not
looking for work
8=Other, specify
1
2
3
4
5
6
7
8
9
10
11
12

5
PART B. Education
Ask question for all household members over 5 years old. Please follow the ID code from the HOUSEHOLD ROSTER.
SAY: In this section, we would like to ask you questions about your household members’ education.

ID 11. Has 12. What is the highest grade that [NAME] has 13. Is [NAME] 14. What is the current grade that
cod [NAME] ever completed? currently attending [NAME] is attending?
e attended a. Final level reached b. Number of school? a. Level b. Year
school? 1= Kindergarden (KG) Years within 0=Kindergarden
2= Primary the level 0=NoSkip to Q16 1=Primary
0=NoSkip to 3= Secondary indicated in (a) 1=Yes 2=Secondary
Q16 4= Post-Secondary 4=Post-secondary
1= Yes 5= College 5=College
6= University 6=University

1
2
3
4
5
6
7
8
9
10
11
12
ID 15. Can [NAME] listen, speak, read, and write in Amharic? Indicate 16. Can [NAME] listen, speak, read, and write in Oromigna?
cod the level of fluency. Indicate the level of fluency.
e 1=None 2=Intermediate 3=Fluent 1=None 2=Intermediate 3=Fluent
Listening Speaking Reading Writing Listening Speaking Reading Writing
1
2
3
4
5
6
7
8
9
10
11
12

PART C. Current Marriages/Partner and Pregnancy

SAY: We are now going to ask you about your current partner or husband, and your current pregnancy.

19 What is your marital status?

1=Now married, 2=Widowed, 3=Divorced, 4=Separated, 5=Not legally married but
cohabiting with someone, 6=Never married or cohabitated with a partnerSkip to Q24
20 What is your HUSBAND/PARTNER’s ethnic group?
1=Oromo, 2=Amhara, 3=Somali, 4=Tigray, 5=Gurage, 6=Wolayta, 7=Hadiya, 8=Afar,
96=Others, specify
21 What is your HUSBAND/PARTNER’s religion?
1=No religion, 2=Ethiopian Orthodox, 3=Protestants, 4=Muslim, 5=Catholic, 6=Church of
Christ, 7=Traditional religion/belief, 96=Others, specify
22 Do you currently live in the same house with this person? 1= Yes 0=No

23 Are you currently pregnant?

1=Yes 0=No  skip to Section 4 99=Not SureSkip to Section 4
24 How many months pregnant are you?
(number of completed month) MONTHS__________

6
 SECTION 2. Employment
Ask question for the respondent and her spouse/partner if any. Please follow the ID code from the HOUSEHOLD ROSTER.
SAY: In this section, we would like to ask you questions about you and your spouse/partner’s work experiences.

SAY: We would like to ask you about WAGE EMPLOYMENT IN THE PAST 4 WEEKS
ID code 1. During the Past 2. How many hours 3. What kind of trade industry or business is this work 4. For how many
4 weeks, has did [NAME] do this connected with? Years has
[NAME] worked as work on average in [Select the place which gives wage] [NAME] been
an employee of a a week of past 4 1= Farming (flowers, vegetables, bees, dairy, etc.), doing this work?
firm, government weeks? 2= N.G.O.,
or for some other 3= Research center, [If less than 1
person who is [Probe for actual 4= Government Office (health post, etc.), year, get month]
NOT a member of hours including 5= Factory (processing in establishment),
your household? overtime. Do not 6= Maintaining service (computer, machinery and tool, etc.), a. b.
include travel time, 7= Bank, Year Months
1= Yes leave, paid sick 8= Driving company, s
0= NoSkip to leave or paid 9=Restaurant/bar/hotel (waitress, cleaner, etc.),
Q8 holidays] 10= Small shop (grocery store, bakery, beauty salon, textile
shop, etc.),
[Total No of hours 11= Domestic work (maid, etc.),
for a week] 96=Others, Specify

ID code 5. Is [NAME’S] position temporary or 6. In the past 4 weeks, did [NAME] 7. In the past 4 weeks, did [NAME] receive
permanent receive a salary for this work? any in kind payment for this work?
1=Temporary If yes, If yes,
2= Permanent ___________ (in kind amount)
(“Permanent” means 3 consecutive ____ Monthly salary 0= NO
months of working) 0= NO

Amount Unit

SAY: Now we would like to ask about SELF-EMPLOYED FARMING IN THE PAST YEAR
ID 8. During the past 9. In the past 12 10. During the 11. In the past 12 12. In the past 12 months, how
Code 12 months, has months, how many months [NAME] months, how much much income did [NAME] receive
[NAME] worked on months did [NAME] worked on a farm, on income did [NAME] earn from the sale of products from
a farm, field or work in a farm? average, how much from sales of animals (e.g. milk, honey, eggs)?
garden belonging time did [NAME] agricultural production
to someone in [Total number of spend working on (e.g., crops)? [Amount in ariary per month]
your household, or months in the past your household's
has [NAME] raised 12 months] field (e.g., ploughing [Amount in ariary per
livestock planting, weeding, month]
belonging to your harvesting, drying,
household? milling brewing, sale,
home consumption)
1= Yes or caring for
0= No  Skip to animals?
Q13
[Total hours for a
week]

7
 SAY: We would now like to ask you about SELF-EMPLOYED COMMERCIAL NON-FARMING IN THE PAST 4 WEEKS
ID 13. During the past 4 weeks, 14. What type of business or 15. How many hours did 16. In the past 4 weeks, how
Code has [NAME] worked on self-employment did [NAME] [NAME] work at this much net income did [NAME]
independent business, or in work at in the past 4 weeks? business on average in a receive from this business?
some other self-employed What kind of trade, industry week of the past 4 weeks?
activity belonging to someone in or business is it connected [Amount in Ariary per month]
your household with? [Total hours for a week]
[Multiple choices possible]
1= Yes [If more than 1, begin with the [If income is not separated
0= No Skip to Section 3 one in which the most time is between the respondent and
spent] spouse, put in total amount for
1=Butcher the respondent and indicate
2=Restaurant/coffee house 0000=Not separated for the
3=Driver (bus, car, gari etc) spouse]
4=Shoe polisher
5=Beauty salon
6=Small shops (grocery,
stationery, clothes, etc.)
7=Petty trade
8=Home shop
96=Other, specify

ASSET OWNERSHIP
22 Does your household have: No Yes
1. Electricity? 0 1
2. Solar panel? 0 1
3. A radio? 0 1
4. A television? 0 1
5. Any type] of phone (e.g., mobile phone or battery phone) 0 1
6. A telephone (landline)? 0 1
7. A bed with a mattress? 0 1
8. A sofa set? 0 1
9. A table and chair(s)? 0 1
10. A refrigerator? 0 1
23 Does any member of your household own: No Yes
1. A bicycle? 0 1
2. A motorcycle or scooter? 0 1
3. A car or truck? 0 1
4. A gari? 0 1

8
 SECTION 3. Breastfeeding and Complementary Feeding Practices
SAY: In this section, we will ask you about breastfeeding and complementary feeding practices. These questions are to be answered about the
youngest child among children between 4-24 months of age.

NAME MEMBER ID
[Match name with household roster and write the corresponding member ID]

Part A. Infant and Young Child Feeding (IYCF) Practices

SAY: First, I would like to ask you about your normal child-feeding practices regarding [NAME].

Code (a)
1=Abish water 6=Infant formula 11=Tea
2=Breastmilk 7=Milk (other than breastmilk) 12=Water with rue, thyme, other herbal extract
3=Ersho 8=Plain water
4=Fruit juice 9=Raw butter 88 Cannot remember
5=Honey 10=Sugar water 99 Do not know

Q1. Did you ever breastfeed [NAME]?

0=No Skip to Q7 1=Yes
Q2. How soon after birth did you put [NAME] to the breast for the first time? Hours Days
(Enter the number of hours OR days. If immediately or <1 hour, enter “0”. If >24 hours, enter
number of days.)
Q3. Did you give [NAME] colostrum? 0=No 1=Yes
(Colostrum is the first yellow milk from the mother’s breast: “inger”)
Q4. Is [NAME] still breastfeeding?
0=No 1=Yes skip to Q5b 9=Never breastfed skip to Q7
Q5a.At what age did you stop breastfeeding [NAME] altogether?
88=Do not remember 98=Not applicable 97=Still breastfeeding month
Q5b.At what age did you stop EXCLUSIVELY breastfeeding [NAME]?
88=Do not remember 98=Not applicable 97=Still exclusively breastfeeding Month
Q6. How many times did you breastfeed [NAME] yesterday, during the day and night?
0=Did not breastfeed, 1=Once a day, 2=Twice a day, 3=3 times a day, 4=4 times a day,
5=5 times a day, 6=More than 5 times a day, 9=Every time the baby cries
Q7. Other than breastmilk, how many times did [NAME] drink other milk (cow/goat milk), infant formula,
or yogurt yesterday, during the day and night?
(Do not include the number of times the child was breastfed. This question is only to capture milk or
milk products, other than breastmilk.) times
Q8. What was put in the baby’s mouth IMMEDIATELY after birth? (Probe to ask about everything
that was given to the child, even if someone else gave it to the baby.) Code (a) [Allow multiple
responses]
Q9. During the first three days after [NAME] was born, what was given to the baby by you or by anyone
else? Code (a) [Allow multiple responses]
Q10. Yesterday, during the day and the night, did you use a baby bottle to feed [NAME]?
0=No 1=Yes
Q11. How many times did [NAME] eat solid, semi-solid, or soft foods other than liquids yesterday,
during the day and night?
(The number of times eaten includes both MEALS and SNACKS, other than trivial amounts.) times
PROBE: Does this include every time [NAME] ate meals and snacks yesterday?
Q12. Of the cooked foods that you fed [NAME] yesterday, about how many cups did you offer him/her
to eat yesterday?
(Use Ethiopian coffee cup for measurement.)
Q13. At what age did you start giving the following liquids/foods to the child? _________month
97=Never given 88=Don’t Remember 99=Don’t Know [Record 0 months if less than 1
month]
13a. Water
13b. Other non breast milk liquids (sugar/tea/fruits juice/ cow milk etc)
13c. Semi solid food such as porridge
13d. Solid food such as Injera or bread

9
 13e. Meat
13f. Eggs
13g. Legumes (pulse/peas etc)
13h. Green vegetables
13i. Fruits
13j. Snacks such as biscuit
Q14. Open recall on diet [NAME] consumed yesterday:
Probe all food items mothers fed [NAME] in the previous day. (Similar to 24 hour recall) (NOTE: THIS IS OPEN RECALL
1. Start with asking activities: e.g., what time did you wake up? What did you do next… When did you FIRST in Q14, THEN PROMPTED
feed your child between the two activities you mentioned? in Q15-16.)

2. After writing down the mother’s responses, probe and double check the mother’s recall.

For example, suppose that the mother responded that she fed the child the following items:
1. Milk 2. Porridge 3. Potato 4. Banana 5. Porridge 6. Injera 7. Shiro etc

Suppose in the subsequent questions, the mother responded that the child did not consume any
cereal. Then, from this list, you can infer and probe whether the child consumed any cereal, since
you know injera and porridge contain cereal.

Also, the mother may also say they did not feed any vegetables. However, you can double check by
asking “did you put any vegetables inside the porridge you cooked?”

MAKE SURE THIS STEP IS DONE BEFORE PROCEEDING TO QUESTIONS.

Q15. Now, I would like to ask what [NAME] drank yesterday during the day or night, whether at home (1) (2)
or outside the home. Yesterday, during the day or night, did [NAME] drink [LIQUID ITEM]? 0=NoNext If yes, how
food item many times?
1=Yes
a. Breastmilk
b. Plain water
c. Infant formula
d. Any other kind of milk (tinned, powder, or fresh animal milk)
e. Fruit juice made at home
f. Juice, soda, or fizzy drink (purchased or packaged)
g. Water based liquids (tea, sugar water, coffee)
h. Clear broth
i. Any other liquids?

Q16. Now, I would like to ask what [NAME] ate yesterday during the day or night, whether at home or (1) (2)
outside the home. Yesterday, during the day or night, did [NAME] eat [FOOD ITEM]? 0=NoNext If yes, how
food item many times?
1=Yes
a. Any porridge (made from teff, maize/corn, barley, or other grains)
b. Any gruel (thin or watery porridge made from rice, oats, wheat, or other grains)

c. Any commercially fortified food (Cerifam, Fafa, Farmixt milk, Favena, Berta, Mother’s Choice)
d. Bread, pasta, rice, noodles, or any other solid foods made from oats, maize/corn, barley, wheat,
sorghum, millet or other grains
e. Injera or kita
f. Enset (amucho), white potatoes, white yams, bulla, kocho, kasava, or any other foods made from
roots
PROBE: Are you sure it wasn’t included in shiro/porridge?
g. Pumpkin, carrot, squash, or sweet potatoes that are yellow or orange inside
h. Dark green leafy vegetables (kale, spinach, amaranth leaves)
i. Other vegetables (onion, cabbage, mushroom, starchy vegetables such as plantain)
j. Ripe papayas or ripe mangos (other local vitamin A-rich fruits)
k. Other fruits (bananas, apples, citrus fruits)
l. Liver, kidney, heart, or organ meats
m. Any meat such as beef, pork, goat or lamb (not including any organ meats, chicken, ducks, or other
birds)
n. Chicken, ducks, or other birds

10
 o. Eggs
p. Fresh or dried fish or shellfish
q. Legumes such as peas, lentils, beans or pulses
r. Nuts or seeds such as peanuts, groundnuts, sesame, or sunflower seeds
s.Milk product such as cheese or yogurt
t. Any food made from oil, fat, or butter
u. Ready-to-use therapeutic foods (Plumpy Nut, F100)
v. Kolo, chips, crisps, popcorn
w. Candies, chocolates, cakes, cookies, or biscuits
x. Spices or condiments
y. Any iron-containing tablet, syrup, or sprinkles
Q17. In the past week, did [NAME] eat by him/herself or was he/she fed?
1=Ate alone 2=Someone fed him/her
Q18. In the past week, when you were feeding [NAME] and he/she refused to eat, did you encourage
[NAME] to eat?
0= NoSkip to Part B 1=Yes 2= Child did not refuse foodSkip to Part B
Q19. In the past week, when [NAME] refused to eat, what did you do to encourage [NAME]?
[Do not read the options] [Multiple response possible]
1=Fed slowly and patiently 2=Talked to the child 3=Forced the child to eat 4=Reduced
distraction 5=Changed the flavor of the food 6=Fed other food 7=Encouraged and praised
the child 8=Waited until child became hungry 96=Others, specify ________

Part B. Child Nutrition-related Health History

SAY: Now, we would now like to ask you some questions about the nutrition-related health history of [NAME].

1. When you were pregnant with [NAME], did you want [NAME] to be a boy or a girl?
1=Boy 2=Girl 3=No preference
2. When you were pregnant with [NAME], how many times did you visit health center/health post for
antenatal care?
0= none  skip to Q4 _________ times
3. How many months pregnant were you when you first visited health center/health post for antenatal
care? _________ months
4. Did you receive education about exclusive breastfeeding during pregnancy (health center/health
post/CHWs/community gathering/NGOs/any other sources)?
1=Yes 0=No
5. Did you receive education about complementary feeding during antenatal care?
1=Yes 0=No
6. Did you receive education about how to care for your child during antenatal care?
1=Yes 0=No
7. Did you receive education about sanitation and hygiene during antenatal care?
1=Yes 0=No
8. Did you take iron supplement/syrup during pregnancy?
0=NoSkip to Q10 1=Yes 99=don’t know
9. For how long did you take iron supplement?
(if <1 month, write 1 month) _________months
10. In the past six months, did [NAME] receive a dose of vitamin A? (Show of vitamin A capsule.)
0=No 1=Yes 88=DO NOT REMEMBER picture
11. In the past six months, did [NAME] receive any micronutrient powder (sachet/packet) to add to
his/her food? (Show picture of MMN powder) 0=No 1=Yes 88=DO NOT REMEMBER
12. What type of salt do you use in your household?
1= Commercial packaged salt (with iodine), 2=Salt sold by weight/without packaging, 96=Other,
specify, 99=Don’t know, 88=Don’t remember
13. In the last 6 months, were you given any advice or information about feeding your child?
0=No 1=Yes 99=DO NOT KNOW IF NO or DO NOT KNOW, SKIP TO Q15.
14. What advice or information about child feeding did you receive?
[Multiple responses possible] [DO NOT READ THE OPTIONS]
1= exclusive breastfeeding 2=Continued breastfeeding 3=Feed infant formula
4=Complementary feeding 5=Feed other kinds of milk 6=Increase frequency of
feeding
7=Feed a variety of foods 8=Enrich child’s food with special 9=Give
food (milk, egg, meat, veg.) vitamins/supplementary food

11
 10=Feed additional food 11=Receive rehabilitation/ 96=Other, specify,
during/after illness therapeutic care for severe
malnutrition
99=Don’t know 88=Don’t remember
15. In the past 6 months, was [NAME] identified as being severely malnourished by a health personnel?
0=NoSkip to Part C 1=Yes
16. Did you receive any specific food or milk (treatment for severe acute malnutrition) for [NAME]?
0=No  skip to Part C 1=Yes
17. What type of food or milk (treatment) did you receive?
1=Infant formula, 2=Plumpy nut, 96=Other, specify, 99=Don’t know, 88=Don’t remember

Part C. Perception of Child’s Relative Nutritional Status

SAY: Now, we would like to ask you how you think about [NAME]’s nutritional status compared to other children.

1. Compared to other children of the same age and sex, how would you describe [NAME]’s size in terms of height?
1=The tallest 2=Among the tallest 3=Taller than most children 4=About average
5=A little shorter than most children 6=Among the shortest 7=The shortest
2. Compared to other children of the same age and sex, how would you describe [NAME]’s size in terms of weight?
1=The heaviest 2=Among the heaviest 3=Heavier than most children 4=About average
5=A little lighter than most children 6=Among the lightest 7=The lightest
3. Compared to other children of the same age and sex, how would you describe [NAME]’s food consumption level
in terms of quantity?
1=Eats better than any other children 2=Eats better than most children 3=About average
4=Eats less than most children 5=Eats less than any other children
4. Compared to other children of the same age and sex, how would you describe [NAME]’s food consumption level
in terms of quality?
1=Eats better than any other children 2=Eats better than most children 3=About average
4=Eats less than most children 5=Eats less than any other children

Part D. Maternal IYCF Knowledge and Perceptions

SAY: We would like to ask you about your knowledge and your thoughts on complementary feeding practices.

1. At what age should a baby first start to receive foods (such as porridge) in addition to breast milk?
99=Don’t know 88=cannot remember __________month
2. Please tell me if the following statement is true or false. If you don’t know, say don’t know.
Statements True False Don’t
know
a If a child does not eat enough iron, brain development will be delayed. X
b If a child does not eat enough iron, children will become anemic. X
c Vegetables and fruits are the best source of iron. X
d Zinc helps to prevent illness such as diarrhea. X
e Meat is the food that is rich in iron. X
f Meat is not a good source of zinc. X
g If a child does not eat enough vitamin A rich food, child will have low resistance to illness. X
h If a child does not eat enough vitamin A rich food, child will have eye disease. X
i Eggs are rich in protein that is essential for healthy growth of child. X
j Adding small amount of oil/butter will give extra energy for child’s growth. X
k Orange colored fruits and vegetables are rich in vitamin A. X

3. Please tell me if the following statement is true or false. If you don’t know, say don’t know.
Statements True False Don’t
know
a After 6 months of age, feeding only breast milk is adequate to meet the child’s needs. X
b The consequence of malnutrition is more serious for a three-years-old child than for a child who is one year X
old.
c It is not possible to reverse the effects of malnutrition that happens in the first 2 years of life. X
d At 7 months of age, babies are not ready to digest foods other than soft gruel. X
e At 9 months, babies are not ready to digest eggs. X
f An adult person needs to feed a young child rather than having an older brother/sister feed the young child. X
g At 7 months babies are not ready to digest thick porridge. Only thin porridge should be given. X
h At 7 months babies do not need fruits in their diet. X
12
 i In addition to normal feeding, children should be fed often—whenever they are hungry. X
j Children should be fed snacks between the meals. X
k Children should be fed animal foods such as egg and meat as often as possible. X
4. For a child 12 up to 24 months of age, how much complementary food should be given per day? Answer: 3
1=3 full coffee cups of food (porridge) and one snack, 2=2 full coffee cups of food (porridge) and three snacks,
3=4 full coffee cups of food (porridge) and 1 to 2 snacks, 99=don’t know
5. The quality of complementary food can be improved by [Multiple responses possible) [Do not read the options] Answer:
1=Replacing water used to make porridge with milk, 2=Adding a small amount of oil or butter to porridge,
3=Adding mashed vegetables and animal products such as meat and fish
4=None of the above, 96=Other, specify, 99=I don’t know

6. Please tell me if the following statement is true or false. If you don’t know, say don’t know.
Statements True False Don’t
know
a When a child is sick, child doesn’t have appetite, so there is no need to give solid food. Child will eat when X
they recover from illness.
b Cooking large amount of foods to consume for a longer period of time is not a problem. X
c Using clean water for cooking is important. X
d Mixing different types of cereals and legumes to make porridge powder will increase child’s nutritional status. X
e It is no problem for child to share foods from the family plate. X
f If child refuse to eat, parents should force the child to eat more. X
g Parents should help the child to eat. X
h Child’s older siblings should be responsible for feeding the child. X

7. Please look at these two pictures of porridges. Which one do you think should be given to a young child at 10 months of age? 2
(Show the images/pictures of thick and watery/thin porridges and tick one of the options here below depending on the respondent
answer.)
1=Thin watery porridge, 2=Thick porridge, 99=Does not know

8. Do you know any ways to encourage young children to eat?

[Ask open question] [Multiple choice possible] [Do not read the options]
1=Giving them attention during meals, talk to them, make meal times happy times
2=Clap hands
3=Make funny faces/play/laugh
4=Demonstrate opening your own mouth very wide/modelling how to eat
5=Say encouraging words
6=Draw the child’s attention
96=Other, specify 99=Don’t know

Part E: Illness during the previous 2 weeks

ASK: Now, we would like to ask you about any illness [NAME] experienced in the last two weeks.

Fast
Darkening
Symptom Fever Cough/cold breathing/short Diarrhea
of stool
breathing
1. .Has [NAME] had [SYMPTOM] in the past two weeks?
1=Yes 0=NoSkip to the next symptom 99=Don’t
know
2. Did you ask for advice or seek treatment when [NAME]
had the illness?
1=Yes 0=NoSkip to Section 5

13
 3. Where did you receive medical help for [NAME]’s
illness?
1=Hospital 2=Health center 3=Health post
4=Private clinic 5=CHW 6= Family/relatives
7=Friends 96= Specify others_________

14
 Section 4. Exposure to Health and Nutrition Services
SAY: In this section, we would like to ask you about your exposure to health and nutrition services.

Code (a)
1 Antenatal care 7 Family planning 13 Malaria treatment 19 Provide or sell bed nets
Management of severe Referral or management
Breastfeeding counseling Growth monitoring
2 8 14 malnutrition (OTP) 20 of sick child
Health education
Vitamin A or iron
Complementary feeding counseling about sanitation and Neonatal care
supplementation
3 9 hygiene 15 21
Nutrition and care during
Delivery care HIV/ AIDS counseling
4 10 16 pregnancy
5 Deworming 11 Immunization 17 Pneumonia treatment 96 Other, specify
Information on safe
Diarrhea treatment (ORS) Postnatal care Don't know
6 12 water use 18 99
Code (b)
Breastfeed more often during child Feed only breast milk When to introduce the
Give colostrum to baby
1 illness 5 for first 6 months 9 13 family food to the baby
How to make
Continue breastfeeding until 2 Feed the child at least When to start feeding
complementary food such
years 3 times a day complementary foods
2 6 10 as thick porridge 14
Feed the child more Put baby on the breast
Enrich porridge with milk, eggs,
often during and after immediately after birth, Other, specify
meat, or vegetables
3 7 illness 11 within 1 hour 96
Even during hot weather, breast Take vitamin A
Feed the child with
milk is sufficient to quench baby’s supplements after 45 days Don't know
patience
4 thirst/do not give water 8 12 of birth 99

Part A. Exposure to Community health workers (CHW)

SAY: First, we would like to ask you about your interaction with CHWs.

1. Do you know the Community health worker (CHW) working in your area?
0=NoSkip to Q7 1=Yes
2. In your opinion, what are the services you can receive from the CHW?
Code (a) [Multiple responses possible] [Do not read the options]
3. Did you have any contact with a CHW in the past 3 months? (at home, at the health post, or in the
community)
0=NoSkip to Q7 1=Yes
4. In the past 3 months, when you met the CHW, what topics did she discuss with you?
Code (a) [Multiple responses possible]
5. In the past 3 months, when you met the CHW, did she talk to you about breastfeeding, child feeding or
nutrition? 0=NoSkip to Q7 1=Yes
6. What did the CHW tell you about breastfeeding or child feeding?
Code (b) [Multiple responses possible]

Part B. Exposure to Other Nutrition Services

SAY: Now we would like to ask you about your exposure to other nutrition services.

7. Have you ever attended a food demonstration in your community?

0=NoSkip to Q9 1=Yes
8.During the last food demonstration you attended, what was demonstrated/shown?
[Multiple responses possible]
1=Feed the child a variety of foods, 2=Feed the child at least 3 times a day, 3=Add milk into the porridge,
4=Add an egg into the porridge, 5=Add (dried) meat into the porridge, 6=Add vegetables into the
porridge, 7=Thicken the porridge, 8=Feed the child with patience, 9=When to wash your hands,
96=Other, specify, 99=Don’t know, 88=Don’t remember
9. Have you ever attended a community conversation or gathering to talk about breastfeeding, child feeding or
nutrition? 0=NoSkip to Q11 1=Yes
10.During the last community conversation you attended, what advice or information did you receive?
[Multiple responses possible]

15
 1=Feed the child a variety of foods, 2=Feed the child at least 3 times a day, 3=Add milk into the porridge,
4=Add an egg into the porridge, 5=Add (dried) meat into the porridge, 6=Add vegetables into the
porridge, 7=Thicken the porridge, 8=Feed the child with patience, 9=When to wash your hands,
96=Other, specify, 99=Don’t know, 88=Don’t remember
11. Do you ever listen to the radio? (in your house or anywhere outside the house)
0=NoSkip to Q15 1=Yes
12. During the past 3 months, did you hear any information about breastfeeding, child feeding or nutrition on the
radio? 0=NoSkip to next section 1=Yes
13. In the past 3 months, how often did you hear information about child nutrition on the radio?
1=Almost every day, 2=Several times a week, 3=About once a week, 4=Few times a month,
5=Once a month, 6=Less than once a month
14. What messages did you hear about child nutrition on the radio?
Code (b) [Multiple responses possible]

Part C. Sources of Nutritional Information

SAY: Now we would like to ask you about your sources of nutritional information.

Code (c)
1 Aunt 5 Father 9 Grandfather-in-law 13 Husband 17 Radio 21 Traditional healer
2 Brother 6 Father-in-law 10 Grandmother 14 Midwife 18 Sister 22 TV
3 Brother-in-law 7 Friend 11 Grandmother-in-law 15 Mother 19 Sister-in-law 23 Uncle
4 Doctor 8 Grandfather 12 CHW 16 Mother-in-law 20 Son/daughter 96 Other, specify

15. From whom do you usually get information on child 16. Of the people you usually get information listed in Q16, who are the five
feeding and child care? Choose as many as you feel most influential people for you? Please list them in the order of their influence
appropriate from Code (c). on your behavior.

[Give examples from Code (c) if needed] [Rank from the most influential (Rank 1) to least influential (Rank 5)]

Rank Code (c)

1
2
3
4
5

16
 SECTION 5. Household Hygiene Environment
SAY: In this section, we are going to ask you about the hygiene status of your household environment.

1. What type of container do you use to store water?

1= Clay container 2= Aluminum/metal/steel container 3= Plastic container 4= Container with a plastic
handle and a lid that can be used to close the top 5= Glass bottle 96= Other, specify
2. Is there a cover for the container? 0=No 1=Yes
3. Where does your household dump waste and garbage?
1=Collected by municipality (public dump) 2=Collected by private establishments/individuals 3=Dumped
in street/open space 4=Dumped in river 5=Burned/buried solid waste 96=Other, specify
4. Where are cows/sheep/goats kept at night?
1=Kept in own shed 2=Tied to poles in courtyard 3=Kitchen 4=Bedroom 5=Other’s house
98=Not applicable
5. Where are chickens/ducks kept?
1=Always in their own coops 2=In their own coops at night 3=Kept in house 98=Not applicable
6. Where do you usually prepare food for the youngest child in this household? (Preparing food means taking the
child’s food into a plate or bowl and mashing it. This does NOT mean cooking the food.)
1= Inside the house 2= On the veranda/outside the house 3= Food is not mashed for youngest child
96=Other, specify
7. Where do you usually feed the child?
1= Inside the house 2= On the veranda/outside the house 96=Other, specify
8. Is there any hand washing station (water and soap/soap material/soapy water) maintained at the place of food
preparation or child feeding area?
0=NoSkip to the next section 1=Yes
9. What hand washing arrangements are available near the food preparation or child feeding area?
[Multiple responses possible]
1=Water in bucket or other container 2=Tap 3=Soap 4=Soap material 5=Soapy water
10. Do you usually wash hands before cooking?
1=Never 2=Rarely 3=Sometimes 4=Very often 5=Always
11. Do you usually wash your child’s hand before feeding the child?
1=Never 2=Rarely 3=Sometimes 4=Very often 5=Always
12. Do you usually wash food before cooking?
1=Never 2=Rarely 3=Sometimes 4=Very often 5=Always
13. Do you usually wash dishes before or after cooking and eating?
1=Never 2=Rarely 3=Sometimes 4=Very often 5=Always
14. Do you usually wash dishes with clean water?
1=Never 2=Rarely 3=Sometimes 4=Very often 5=Always
15. Do you usually wash the baby bottle?
1=Never 2=Rarely 3=Sometimes 4=Very often 5=Always 98=Not applicableSkip to next
section
16. Do you usually sterilize the baby bottle?
1=NeverSkip to next section 2=Rarely 3=Sometimes 4=Very often 5=Always
17. How often do you sterilize the baby bottle (e.g., wash in hot water)?
1=Every time after use 2=Once a day 3=2-3 times a week 4=Once a week 96=Other, specify

17
 SECTION 6. Intrahousehold Decision-making
SAY: In this section, we are going to ask you questions about how decisions are made within your household.

1. ASK: Do you currently live with your husband/partner? 1=Yes 0=NoSkip this
section
OBSERVE: Who is present during this part of the interview?
1=Alone 2=With adult females present 3=With partner/husband present 4=With non-
partner/husband adult male present 5=With adult mixed sex present (with partner/husband)
6=With adult mixed sex present (without partner/husband) 7=With children present 8=With
adult mixed sex and children present (with partner/husband) 9= With adult mixed sex and
children present (without partner/husband)

Part A. Decisions Regarding Important Household Issues

2. In the past one year, in your family, who made the decisions regarding the following issues? Was it you alone, your husband alone, or was it
a joint decision?
Pick a point in the ruler that best indicates the decision-making power at your household.

2. Who usually made the FINAL decision about …… Point on the ruler 0-10
2-1. how much education should the children receive?
2-2. whether you or your spouse/couple use contraceptives?
2-3. number of children you want to have?
2-4. expenditures on major durable goods?
2-5. health related expenditures (drugs/treatment/supplement etc)?
2-6. visits to your family or relatives?
2-7. purchasing clothes?
2-8. how to use the money you earned?
2-9. how to use the money that your spouse/partner has earned?
2-10. how to use the money that is given to your/spouse/partner’s parents/relatives?

Part B. Decisions Regarding Food Purchase

3. In the past month, in your family, who made the decisions regarding the following purchases? Was it you alone, your husband, parents, or
parents-in-law alone, or was it a joint decision? Pick a point in the ruler that best indicates the decision-making power at your household.

Who decides the purchase of… Point on the ruler 0-10

3-1. Meat
3-2. Vitamin A-rich fruits and vegetables such as mango and papaya [Show picture]
3-3. Other fruits and vegetables
3-4. Eggs
3-5. Cereals (wheat, maize, rice, barley, bread, etc.)
3-6. White roots and tubers (potatoes, yam, cassava, and other foods from roots)
3-7. Milk and milk products

18
 SECTION 7. Household Labor Allocation
SAY: In this section, we are going to ask you questions about how men and women allocate tasks within the household.

ASK: Do you currently live with your husband/partner? 1=Yes 0=NoSkip this section

Q1. In the past month, did you and your partner receive any outside help for tasks at 1= Help from child/children
home, including cleaning the house, preparing food and taking care of children? 2= Paid help (maid, nanny, etc)
3= Help from others (family, relatives)
4= No help
In the past month, how did you 1=I did almost 2=I did more 3=Shared equally 4=Other members 5=Other members
allocate the following activities everything of the household of the household
with the other members of the did more did almost
household? everything
Q2. Washing clothes
Q3. Repairing house
Q4. Shopping for food and
household items
Q5. Cleaning the house
Q6. Cooking
Q7. Farming
Q8. Trading
Q9. Collecting water
Q10. Collecting fuel
Q11. Looking after animals
Q12. Feeding child
Q13. Playing with child
Q14. Daily care of child

Q15. In the past month, how do you think the tasks were 1=I do a lot more 2=I do a little more
allocated between you and your husband/partner? 3=Same between me and my partner 4=I do a little less
5=I do a lot less
Q16. Are you satisfied with this labor allocation? 1=Very satisfied 2=Satisfied
3=Neither satisfied nor disatisfied
4=Dissatisfied 5=Very dissatisfied
Q17. Do you think your husband/partner is satisfied with this 1=Very satisfied 2=Satisfied
work division? 3=Neither satisfied nor disatisfied
4=Dissatisfied 5=Very dissatisfied

In the past month, 1=Rarely or 2=2-3 times 3=At least 4=2-3 times a 5=Everyday
never per month once/week week
(Less than
once/month)
Q18. How often did your husband play with your
child at home?
Q19. How often did your husband take care of
your child when the mother is at home?
Q20. How often did your husband cook for your
child?
Q21. How often did your husband wash clothes
for your child?
Q22. How often did your husband feed your child?
Q23. How often did your husband buy or give
money to you to buy egg/meat to cook nutritious
food for child?
19
 Section 8. Communication with Partner
SAY: In this part, we are going to ask you about communication between you and your partner.
ASK: Do you currently live with your husband/partner?
1=Yes 0=NoSkip this section
Q1. In the past week, have you discussed the following topics with your partner/spouse? 1=Yes
0=No
Q1a. Your work activities (including housework)
Q1b. Your expenditures
Q1c. Child’s health
Q1d. What to feed baby (6-24months)
Q1e. What happened in your community/area?

Section 9. Gender Norm Attitudes

SAY: In this section, we are going to ask what you think about gender norms. Please tell us whether you agree or disagree with the following
statements.

Gender norm items 1=Agree 2=Disagree 99=Don’t

Male gender norm items know
1. It is important that sons have more education than daughters.
2. Daughters should be sent to school only if they do not need to help household tasks.
3. The most important reason that sons should be more educated than daughters is so that they can
better look after their parents when they are older.
4. If there is a limited amount of money to pay for tutoring, it should be spent on sons first.
5. A woman should take good care of her own children and not worry about other people’s affairs.
6. Women should leave politics to the men.
7. A woman has to have a husband or son or some other male kinsman to protect her.
8. The only thing a woman can really rely on in her old age is her son.
9. A good woman never questions her husband’s opinions, even if she is not sure she agrees with
them.
10. When it is a question of children’s health, it is best to do whatever the father wants.
Female gender norm items
11. Daughters should be able to work outside the home after they have children if they want to.
12. Daughters should have just the same chance to work outside the home as sons.
13. Daughters should be told that an important reason not to have too many children is so they can
work outside the home and earn money.
14. I would like my daughter to be able to work outside the home so she can support herself, if
necessary.

20
 SECTION 10. Maternal Capabilities
SAY: In this section, we are going to ask you about your perception about your capabilities.

Part A. Physical health

SAY: First, we would like to ask you about how you perceive your health status.

1. In general, would you say your health is

1= excellent 2= very good 3= good 4= fair 5= poor
2. During the past month, how much of the time has your physical health or emotional problems interfered with your social
activities (like visiting with friends, relatives, etc.)?
1= all of the time 2=most of the time 3= some of the time 4=a little of the time 5=none of the time
3. Do you have any difficulty seeing? 1=Yes 0=No
4. Do you have any difficulty hearing? 1=Yes 0=No
5. Do you have any serious delay in sitting, standing, or walking? 1=Yes 0=No

Part B. Social support scale

SAY: In this part, we would like to ask you about how you perceive support from family and friends. I will read 12 statements that may or may
not apply to you. For each statement, please indicate the extent to which you agree or disagree with that statement using the following scale:

1=Definitely false 2=Probably false 3=Probably true 4=Definitely true

6. If I need help with money, I have somebody who can lend me the money I need.
7. I feel that there is no one I can share my most private worries and fears with.
8. I could easily find someone to help me with my daily chores.
9. There is someone I can turn to for advice about handling problems with my family.
10. If I decide one morning that I would like to go to the market, I could easily find someone to go with me
11. When I need suggestions on how to deal with a personal problem, I know someone I can turn to

12. I don't often get invited to do things with others

13. If I had to go out of town for a few weeks, it would be difficult to find someone who would look after my house.
(the plants, livestock, garden, etc.)
14. If I wanted to have tea or coffee with someone, I could easily find someone to join me.
15. If I was stranded from home without transportation, there is someone I could call who could come and get me.
16. If a family crisis arose, it would be difficult to find someone who could give me good advice about how to
handle it.
17. If I don’t have enough food at home, I have somebody who could help.

Part C. Social Desirability Scale

SAY: Listed below are a few statements about your relationships with others. How much is each statement TRUE or FALSE to you?

1=Definitely True 2=Mostly True 3=Don’t Know 4=Mostly False 5=Definitely False

18. I am always courteous even to people who are disagreeable.

19. There have been occasions when I took advantage of someone.
20. I sometimes try to get even rather than forgive and forget.
21. I sometimes feel resentful when I don’t get my way.
22. No matter who I am talking to, I’m always a good listener.

21
Part D. Time stress
SAY: Now, we will ask you about how much time stress you experience.
23. Are children under 24 months usually with you when you are doing household work such as cooking and
cleaning? 1=YesSkip to Q25 0=No
24. If not, who takes care of children under 24 months while you are doing household work?
1=Adult (>=15-year-old) within the house 2=Adult (>=15-year-old) outside household 3= Child (<15-year-
old) within household 4=Child (<15 15-year-old) outside household
25. Do you feel that you have enough time to take good care of your children under 24 months along with the
household work?
1=Always 2=Sometimes 3=Never
26. Do you feel that you have a very heavy workload in your household?
1=Always 2=Sometimes 3=Never
27. Do you feel tense about finishing all of the work that you must do in 1 day?
1=Always 2=Sometimes 3=Never

22
 Section 11. Social Networks
SAY: In this section, we will ask you about your social networks.

1. Who are the persons closest to you in your district? Maximum ten people. First ask, who is the person closest to you in your district?
Persons A. Name B. Sex C. Name of D. Name of E. Name of F. G. Phone Number H. Whether participated in I. Relationship with the
Spouse Commune Village Relationship Fararano in the past year Household Head
After the first person, 1=Male he/she lives he/she lives 1=Relative
ask: Who is the next 2=Female 98=Not applicable 2=Friend 1=Yes
person? 99=Don’t know 3=Others, 0=No
specify 99=Don’t Know

1=First Closest
Person
2=Second Closest
Person
3=Third Closest
Person
4=Fourth Closest
Person
5=Fifth Closest
Person
6=Sixth Closest
Person
7=Seventh Closest
Person
8=Eighth Closest
Person
9=Ninth Closest
Person
10=Tenth Closest
Person

23
 Section 12. Food frequency
SAY: Now we would like to ask you about foods that the members of your household consumed at home in the past one week.

Food frequency: 1. Number of days 2. What was the main

Could you please tell me how many days in the past eaten in previous 7 source of this food in the
week your household has eaten the following food items, days: last 7 days?
prepared and/or consumed at home and what the source
Item
of the food was? If 0Skip to next (Code b)
food item

Food Item (Code a)

1 Cereals (Teff, maize, sorghum, millet, barley)
2 Potatoes, cassava, yam, and other roots/tubers
Dark green leafy vegetables (amaranth, cassava leaves,
3
kale, spinach)
Vitamin A rich vegetables and tubers (pumpkin, carrot,
4
squash, or sweet potato—anything orange inside)
Other Vegetables (onion, tomato, eggplant, cauliflower,
5
salata, bokchoy, bowl cabbage, etc.)
Vitamin A rich fruits (papaya, mango, anything orange
6
inside)
7 Other fruits (banana, peach, lemon, strawberry)
8 Legume (beans, lentils, peas, nuts)
9 Eggs
10 Dairy products (milk, cheese, yoghurt)
11 Meat (goat, beef, lamb, pork)
12 Organ meat (liver etc.)
13 Poultry (chicken, duck, pigeon)
14 Fish (fresh and dry)
15 Oil//fats (ghee, butter, veg oil)
16 Sugar, Honey
17 Condiments (spices, ketchup)
18 Nuts and seeds (ground nut, simsim, sunflower)
19 Alcohol
20 Tobacco
21 When was the last time you visited the market to purchase food? _________ days ago

When was the last time your husband/partner visited the market to purchase food?
22 98=Not applicable (if the respondent does not live with spouse)
99=Don’t know
__________ days ago

Code a: Food Frequency Code b: Source of Food

Not eaten……..0 Own production…………………….….1
1 day…………..1 Hunting/gathering/fishing…………….2
2 days………....2 Bought using cash…………………….3
3 days………....3 Bought on credit…………………….…4
4 days……..…..4 Borrowed (friends/relatives)…………5
5 days………....5 Gifts (friends/relatives)……………….6
6 days………....6 Begging………………………………...7
7 days………....7 Received as payment………………...8
Food assistance……………………….9
Food voucher………………………….10

SECTION 13. Household Consumption

24
SAY: In this section, we will ask you about non-food and food expenditures of your household.

Part A. Non-food Expenditures

NON-FOOD EXPENDITURE ON DURABLES AND SERVICES, 6 MONTHS

SAY: Please think about non-food expenditures on durables and services in the past 6 months.

1. IN THE LAST SIX MONTHS, how much has the household spent on the following non-food items? Commented [SP2]: Edit item based on Mada/Niger household
expenditure surveys
Item Item Code Total expenditures in last 6 months (ARIARY)
Clothes/shoes/fabric for MEN 1
Clothes/shoes/fabric for WOMEN 2
Clothes/shoes/fabric for BOYS 3
Clothes/shoes/fabric for GIRLS 4
Kitchen equipment (cooking pots, etc.) 5
Bowls, glassware, plates, cutlery 6
Cleaning utensils (brushes, brooms etc) 7
Mosquito nets 8
Linens (sheets, towels, blankets) 9
Furniture 10
Lamps/torches 11
Solar panels 26
Costs (materials, wages) associated with house repairs 12
Costs (materials, wages) associated with bicycle or vehicle repairs 13
Modern medical treatment and medicines 14
Traditional medicine and healers 15
School fees 16
Other educational expenses (exercise books, pens, pencils, uniforms, 17
maintenance, club fees, etc)
Church, mosque or other religious contributions 18
Funeral costs and contributions 19
Wedding costs and contributions 20
Contributions to local, regional or national projects 21
Taxes and levies 22
Compensation and penalties 23
Contributions to iddir 24
Expenditures on health insurance 25

NON-FOOD EXPENDITURES ON SELECTED HOUSEHOLD CONSUMABLES, LAST MONTH

SAY: Please think about non-food expenditures on consumables in the last one month.

2. IN THE LAST MONTH, how much has the household spent on the following non-food items?

Item Item Code Total expenditures in last month (ARIARY)

Minutes for mobile phone 26
Transportation 27
Kerosene 28
Batteries 29
Hair oil 30
Cigarettes, tobacco, suret, gaya 31
Alcohol (beer, tella, tej etc) 32

25
Part B. Food Expenditure
SAY: Now we would like to ask you about food expenditure of your household.

ASPECTS OF FOOD CONSUMPTION

3. What was the total expenditure on prepared foods and food eaten outside the household in the last week?
(ARIARY)
PROBE: Does this include meals consumed outside of the house by all family members, especially the husband?

Code (a), Food source

1 Own production 5 PSNP
2 Purchase 6 Direct Support
3 Gifts/transfers from family or relatives 7 Other, specify
4 Gifts/transfers from neighbours

4. We now want to think about the food consumption of your household over the last 12 months. Please tell us what were the primary and secondary sources
of food consumed by this household over the last 12 months (Code a).
Year (EC)
Months
Primary
Secondary

FOOD CONSUMPTION AND EXPENDITURE

Code (c): Quantity Unit

1 11 BOBO 21 GAN 40 BIG MADABERIA 50 BUNCH 60 EGIR 70 LADAN 80 MOSHE
KILOGRAMMES (BANANAS)
2 QUINTAL 12 22 ENSIRA 41 SMALL MADABERIA 51 MELEKIA/LIK 61 WESLA 71 MESBESH 81 OTHER
PACKETS (Specify)
3 CHINET 13 BAGS 23 GURZIGNE 42 DIRIB 52 GUCHIYE 62 72 TIRESHWA
MESFERIA
4 DAWLA 14 24 TASSA 43 SAHIN/LOTERY 53 BEKOLE 63 KURFO 73 BICHERE
BUNDLES
5 KUNNA 15 PIECES 25 44 MANKORKORIA 54 ENKIB 64 KOLELA 74 KUMTA
KUBAYA/KELASA
6 MEDEB 16 BARS 26 BIRCHIKO 45 PLATIC 55 SHEKIM 65 KESHA 75 KEFER
BAG/FESTAL
7 KURBETS 17 BOXES 27 SINI 46 ZURBA 56 NUMBER 66 CHARET 76
NEFKI/NEFEK
8 SILICHA 18 LEAVES 28 GEMBO 47 AKARA 57 GOTERA 67 MOSHA 77 KALKALO
9 AKMADA 19 LITRES 29 BOTTLES 48 SMALL PLASTIC 58 LEMBA 68 TANIKA 78 DAROTA
BAG (MIKA)
10 ESIR 20 KIL 30 ARIARY 49 KERCHAT/KEMBA 59 SHIRIMERI 69 ABET 79 GEBETA

26
5. We would now like to ask you about all the food that was bought for consumption or was consumed from your own food stock, IN THE
LAST WEEK. In last week, did your household consume any of the following?
During the past If yes, how much was Did you If yes, how much did you buy
one week (7 consumed purchase this
days), how many food in last
days did you or week?
others in your
household eat:
Write “0” if the Item Quantity Unit 1=YES Quantity Unit Total
item was never Code (Code c) 0=NO (Code c) expenditure
consumed. on this item
CEREAL GRAINS AND CEREAL PRODUCTS Commented [SP3]: Edit items based on Mada/Niger
household food expenditure surveys
Maize 501
Rice 502
Millet 503
Sorghum 504
Wheat 505
Barley 506
Teff 507
Purchased Injera 508
Purchased bread or 509
biscuits
Other cereal, specify 510
ROOTS, TUBERS, PLANTAIN

Enset (e.g., kocho, 511

anchote, amicho)
Cassava 512
Potato 513
‘Bula’ of any type 514
NUTS AND PULSES

Bean 521
Groundnut 522
Cowpea 523
Horse beans 524
Chick peas 525
Lentils 526
Vetch 527
Linseed 528
Sesame 529
VEGETABLES

Onion 531
Tomato 532
Mushroom 533
Lettuce 534
Spinach 535
Cauliflower 536
Green bean 537
Green pepper 538
Carrot 539
Other cultivated or 540
gathered green leafy
vegetables
FRUIT

Mango 541

27
 During the past If yes, how much was Did you If yes, how much did you buy
one week (7 consumed purchase this
days), how many food in last
days did you or week?
others in your
household eat:
Write “0” if the Item Quantity Unit 1=YES Quantity Unit Total
item was never Code (Code c) 0=NO (Code c) expenditure
consumed. on this item
Papaya 542
Banana 543
Wild fruit 544
MEAT, POULTRY, EGGS

Eggs 551
Fish 552
Beef 553
Goat 554
Pork 555
Mutton 556
Chicken 557
Other meats or poultry 558
DAIRY AND RELATED PRODUCTS

Fresh milk 561

Powdered milk 562
Margarine - Blue band 563
Butter 564
Yoghurt 565
Cheese 566
Infant feeding formula 567
(for bottle)
SUGARS, FATS, OILS

Sugar 571
Sugar cane 572
Sweets, candy, 573
chocolate
Jam, jelly 574
Honey 575
Cooking oil 576

BEVERAGES

Tea 581
Coffee 582
Squash (Hibiscus 583
(Zobo) drink
concentrate)
Soft drinks (Coca-cola, 584
Fanta, Sprite, etc.)

SPICES, FLAVOURINGS AND RELATED ITEMS

Salt 591
Pepper 592
Spices 593
Yeast, baking powder, 594
bicarbonate of soda

28
 During the past If yes, how much was Did you If yes, how much did you buy
one week (7 consumed purchase this
days), how many food in last
days did you or week?
others in your
household eat:
Write “0” if the Item Quantity Unit 1=YES Quantity Unit Total
item was never Code (Code c) 0=NO (Code c) expenditure
consumed. on this item
Tomato sauce (bottle) 595
Hot sauce (Nali etc) 596

SECTION 14. Food Security

SAY: In this section, we will ask you about food security in your household in the past six months.

Code (a), Months

1 Meskerem 4 Tahsas 7 Megabit 10 Sene

2 Tikmit 5 Tir 8 Miazia 11 Hamle

3 Hidar 6 Yekatit 9 Guenbot 12 Nahassie

13 Pagumel

1. How many months in the last six months did you have problems
satisfying the food needs of the household?
2. During the last rainy season, did your household suffer any shortage
of food to eat? 0=No 1=Yes
3. Thinking back over the last 6 months, in which month was the
shortage of food most acute for your household? (Code a)
(If household did not experience any food shortage, skip to Q5a.)
4a. During the worst month, how many times a day did adults in your
household eat?

4b. During the worst month, how many times a day did children in your
household eat?

4c. During the worst month, did household members consume “less
preferred” foods? 0=No 1=Yes

4d. During the worst month, did household members consume wild
foods? 0=No 1=Yes

4e. During the worst month, did household members consume seed
stock? 0=No 1=Yes

5a. During a good month, how many times a day did adults in your
household eat?

5b. During a good month, how many times a day did children in your
household eat?
6. Is food from your own (beteseb's) stock shared with others in the
household?
1=All together 2=Separate stocks

29
 SECTION 15. Cognitive Ability Test Commented [SP4]: May also add Rabin’s test
SAY: In this section, we would like to ask you some calculation questions.

1. What is 4+3?
2. What is 7 – 4?
3. What is 12 – 7?
4. What is 3 times 6?
5. What is 400 divided by 10 (i.e., one tenth of 400)?

30
 SECTION 16. Time Use Survey
Time when started this section: _______________________________

1. Date of day for which activities are recorded: (This is the day before today): ________________________
2. Day of the week for which activities are recorded: (This is the day before today)
1= Monday 2= Tuesday 3= Wednesday 4= Thursday 5= Friday 6= Saturday 7= Sunday

Same Location Location

Time Description of activities Code
time? 1 2
1 to 3 activities per time period
4:00 am Yes No
To Yes No
4:30 am Yes No
4:30 am Yes No
To Yes No
5:00 am Yes No
5:00 am Yes No
To Yes No
5:30 am Yes No
5:30 am Yes No
To Yes No
6:00 am Yes No
6:00 am Yes No
To Yes No
6:30 am Yes No
6:30 am Yes No
To Yes No
7:00 am Yes No
7:00 am Yes No
To Yes No
7:30 am Yes No
7:30 am Yes No
To Yes No
8:00 am Yes No
8:00 am Yes No
To Yes No
8:30 am Yes No
8:30 am Yes No
To Yes No
9:00 am Yes No
9:00 am Yes No
to Yes No
9:30 am Yes No
9:30 am Yes No
To Yes No
10:00am Yes No
10:00am Yes No
To Yes No
10:30am Yes No
10:30am Yes No
To Yes No
11:00am Yes No
11:00am Yes No

31
 To Yes No
11:30am Yes No
11:30am Yes No
To Yes No
12:00pm Yes No
12:00pm Yes No
To Yes No
12:30pm Yes No
12:30pm Yes No
To Yes No
1:00pm Yes No
1:00pm Yes No
To Yes No
1:30pm Yes No
1:30pm Yes No
To Yes No
2:00pm Yes No
2:00pm Yes No
To Yes No
2:30pm Yes No
2:30pm Yes No
To Yes No
3:00pm Yes No
3:00pm Yes No
To Yes No
3:30pm Yes No
3:30pm Yes No
To Yes No
4:00pm Yes No
4:00pm Yes No
To Yes No
4:30pm Yes No
4:30pm Yes No
To Yes No
5:00pm Yes No
5:00pm Yes No
To Yes No
5:30pm Yes No
5:30pm Yes No
to Yes No
6:00pm Yes No
6:00pm Yes No
To Yes No
6:30pm Yes No
6:30pm Yes No
To Yes No
7:00pm Yes No
7:00pm Yes No
To Yes No
7:30pm Yes No
7:30pm Yes No
To Yes No
8:00pm Yes No
8:00pm Yes No
32
 To Yes No
8:30pm Yes No
8:30pm Yes No
To Yes No
9:00pm Yes No
9:00pm Yes No
To Yes No
9:30pm Yes No
9:30pm Yes No
To Yes No
10:00pm Yes No
10:00pm Yes No
To Yes No
10:30pm Yes No
10:30pm Yes No
To Yes No
11:00pm Yes No
11:00pm Yes No
To Yes No
11:30pm Yes No
11:30pm Yes No
To Yes No
12:00am Yes No
12:00am Yes No
To Yes No
12:30am Yes No
12:30am Yes No
to Yes No
1:00am Yes No
1:00am Yes No
To Yes No
1:30am Yes No
1:30am Yes No
To Yes No
2:00am Yes No
2:00am Yes No
To Yes No
2:30am Yes No
2:30am Yes No
To Yes No
3:00am Yes No
3:00am Yes No
To Yes No
3:30am Yes No
3:30am Yes No
To Yes No
4:00am Yes No
Note to interviewer: Probe for more activities if: (a) Any activities took much longer than you would expect. (b) Activities that normally follow
each other seem to be missing.
8. Did you spend any time during the day looking after children?
1= Yes, not mentioned all the times – go back and fill in child care activity.
2= Yes, already mentioned all the times.
3= No.
If “1”, go back and fill in extra child care activities in the diary. Write an asterisk (*) next to
the added activities. Then come back to question #9.
33
 9. Was yesterday a typical day for you?
1= Yes
2= No, because I was ill.
3= No, because it was school/university/college/technikon holidays.
4= No, because there was on leave from work.
5= No, because there was a funeral, wedding, bereavement, ETC
6= No, because there was a problem with the weather.
7= No, because I was looking after another family/household member.
8= No, because there was another family problem.
9= No, because it was a weekend day.
10= No, other reason (Describe):
10. Which activity during the day did you enjoy most?
Code: Activity:
11. Which activity during the day did you enjoy least?
Code: Activity:
12. Overall, how did you feel about the day you just described?
1= I was too busy/I had too many things to do.
2= I had a comfortable amount of things to do in the day.
3= I was not busy enough/I did not have enough to do.

Location code 1 Location code 2

1 Own dwelling 1 Inside
2 Someone else’s dwelling 2 Outside
3 Field, farm or other agricultural workplace 3 Travelling on foot
4 Other workplace outside private dwelling 4 Travelling by private transport (car, van, motorcycle)
5 Educational establishment 5 Travelling by taxi (kombi or other)
6 Public area i.e. not in a private dwelling, workplace or 6 Travelling by bus
educational establishment
7 Travelling or waiting to travel 7 Travelling by bicycle
8 Other (specify) 8 Travelling by other means(specify)

34
35
 SECTION 17. Anthropometric measurements
SAY: In this section, we are going to measure the anthropometry of you and your children under 24 months of age.

SURVEYOR: First indicate the name of the person(s) who measured and the ID number of the weight and height machine used.

All measurements must be done to ONE DECIMAL place.

Name(s) of the person(s) who measured:

Height machine ID:

Weight machine ID:

Mother
1. Roster ID 2. Name Question 3. Measurement 4. If the mother cannot be
a. First b. Second c. Third measured, specify the
reason.
1=Refused
2=Disabled
3=Too ill to be measured
96=Other, specify
1) Length/Height (cm)

2) Weight (kg)

3) Waist circumference (cm)

36
MEASUREMENT ARE TO BE TAKEN FOR ALL CHILDREN AGED 0 MONTHS TO 24 MONTHS
ALL MEASUREMENTS MUST BE DONE TO ONE DECIMAL PLACE

Children under 24 months of age

1. Roster 2. Name 3. Date of birth Question 4.Measurement 5. How was height 6. Clothes worn by
ID a. Day b. Month c. Year a. First b. Second c. Third measured? child during
(EC) 1=Standing weighing?
2=Lying 1=None 2=Light
3=Mid-weight
4=Heavy
1) Length/Height
(cm)
2) Weight (kg)

3) MUAC (cm)

1) Length/Height
(cm)
2) Weight (kg)

3) MUAC (cm)

1) Length/Height
(cm)

2) Weight (kg)

3) MUAC (cm)

37