Household Child Development Survey

An interview protocol that maps who lives in the dwelling and records each child's age, sex, schooling, clinic visits and recent treatment. It also captures verbal consent, a phone number for follow-up messages and feedback about the measurement devices used during the study.

Use this template

Introduction and verbal consent to take part in the household interview

Yes, I agree to take part Please come back later No, I would rather not

Name of the household head, including any nickname

Are you the head of this household?

Yes No

How many children aged 0 to 17 live here?

Children in the household

Name of the child

How old is {whatIs10}?

Is {whatIs10} a boy or a girl?

Boy Girl

Does {whatIs10} attend school?

Yes No Not old enough yet

How many times has {whatIs10} visited the clinic in the last 4 weeks?

How many times has a community health worker seen {whatIs10} in the last 4 weeks?

How many times has {whatIs10} received medical treatment in the last 4 weeks?

Name, including nickname, of the main caregiver of {whatIs10}

Is {whatIs17} a boy or a girl?

Boy Girl

How old is {whatIs17}?

Is there another child living here?

Yes No

Name of the child

How old is {whatIs25}?

Is {whatIs25} a boy or a girl?

Boy Girl

Does {whatIs25} attend school?

Yes No Not old enough yet

How many times has {whatIs25} visited the clinic in the last 4 weeks?

How many times has a community health worker seen {whatIs25} in the last 4 weeks?

How many times has {whatIs25} received medical treatment in the last 4 weeks?

Name, including nickname, of the main caregiver of {whatIs25}

Is {whatIs32} a boy or a girl?

Boy Girl

How old is {whatIs32}?

Is there another child living here?

Yes No

Name of the child

How old is {whatIs36}?

Is {whatIs36} a boy or a girl?

Boy Girl

Does {whatIs36} attend school?

Yes No Not old enough yet

How many times has {whatIs36} visited the clinic in the last 4 weeks?

How many times has a community health worker seen {whatIs36} in the last 4 weeks?

How many times has {whatIs36} received medical treatment in the last 4 weeks?

Name, including nickname, of the main caregiver of {whatIs36}

Is {whatIs43} a boy or a girl?

Boy Girl

How old is {whatIs43}?

Is there another child living here?

Yes No

Name of the child

How old is {whatIs47}?

Is {whatIs47} a boy or a girl?

Boy Girl

Does {whatIs47} attend school?

Yes No Not old enough yet

How many times has {whatIs47} visited the clinic in the last 4 weeks?

How many times has a community health worker seen {whatIs47} in the last 4 weeks?

How many times has {whatIs47} received medical treatment in the last 4 weeks?

Name, including nickname, of the main caregiver of {whatIs47}

Is {whatIs54} a boy or a girl?

Boy Girl

How old is {whatIs54}?

Is there another child living here?

Yes No

Does anyone in the household own a working mobile phone?

Yes No

Would you like to receive follow-up messages or calls about your children's health?

Yes, text messages Yes, phone calls Both No, thank you

Best phone number to reach the household in the coming weeks

Recent illness episodes

Fever and symptoms

For how many days?

Result of the rapid malaria test

Positive Negative Invalid test Not performed

MUAC band colour result

Green Yellow Red Not measured

Which medicines have been taken?

Caregiver background

Year and month you were born

Main source of household income

Which village are you from?

Devices used in the study

ECG hand pad

Was the ECG hand pad used on your child during the study?

Yes No Don't know

Did the ECG pad make you uncomfortable?

Yes A little No

What exactly made you uncomfortable, and what worries you?

EEG hand pad

Was the EEG hand pad used on your child during the study?

Yes No Don't know

Did the EEG pad make you uncomfortable?

Yes A little No

What exactly made you uncomfortable, and what worries you?

What do you think neighbours whose children were not measured thought about the participating families?

That they were lucky That they were curious That they were worried That they felt left out That they were indifferent Don't know

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