1. Childrens Questionnaire CARE OF ILLNESS MODULE

2. UNDER FIVE DEATHS BY CAUSE, 2000-2003 Childrens Questionnaire CARE OF ILLNESS MODULE Acute respiratory infections 19% Neonatal causes 36% HIV/AIDS 3% Measles 4% Malaria 8% Other diseases and injuries 13% Diarrhoeal diseases (post-neonatal) 17% More than half of under five deaths associated with malnutrition

3. Purpose To provide basic data to calculate indicators on – Treatment for diarrhoeal disease – Treatment and care seeking for pneumonia – Sanitary means of excreta disposal for young children Childrens Questionnaire CARE OF ILLNESS MODULE

4. WHO defines cases of suspected pneumonia as children reported to have an illness with a cough accompanied by fast and/or difficult breathing. Simple cases of cold with a blocked nose are filtered out with a second question: Were these symptoms due to a problem in the chest or a blocked nose? If a local term for rapid breathing exists, using that term may be the simplest way to obtain cases of ARI that need to be seen by a health care provider. Background Acute Respiratory Infection Childrens Questionnaire CARE OF ILLNESS MODULE

5. WHO and UNICEF recommend that children with diarrhoeal disease be treated with either Oral Rehydration Solution (ORS) or increased fluids AND continued feeding. Treatment recommendations and indicators have changed over the last ten years. New indicator has been added. Childrens Questionnaire CARE OF ILLNESS MODULE Background Diarrhoeal Disease

6. Indicators Treatment for dehydrating diarrhea: ORT use Home management of diarrhoea Received ORT or increased fluids, and continued feeding Treatment for suspected pneumonia: Antibiotic treatment of pneumonia Care seeking for pneumonia Hygiene: Sanitary disposal of childs feces Childrens Questionnaire CARE OF ILLNESS MODULE

7. Preparation Definition of appropriate health provider should be defined at country level. Adapt for country-specific term used for the ORS packet and for the pre-packaged ORS fluid. If no pre-packaged ORS is available in the country, delete this category. Include country-specific recommended home fluid. Ingredients promoted by the government for making the recommended home fluid should be reflected in this category. Childrens Questionnaire CARE OF ILLNESS MODULE

8. CARE OF ILLNESS MODULECA CA1. Has ( name ) had diarrhoea in the last two weeks, that is, since ( day of the week ) of the week before last? Diarrhoea is determined as perceived by mother or caretaker, or as three or more loose or watery stools per day, or blood in stool. Yes1 No2 DK8 2 CA5 8 CA5 CA2. During this last episode of diarrhoea, did ( name ) drink any of the following: Read each item aloud and record response before proceeding to the next item. CA2a. A fluid made from a special packet called ( local name or ORS packet solution )? CA2b. Government-recommended homemade fluid? CA2c. A pre-packaged ORS fluid for diarrhoea? Yes No DK A. Fluid from ORS packet12 8 B. Recommended homemade fluid1 2 8 C. Pre-packaged ORS fluid1 2 8 CA3. During ( names ) illness, did he/she drink much less, about the same, or more than usual? Much less or none1 About the same (or somewhat less)2 More3 DK8 CA4. During ( names ) illness, did he/she eat less, about the same, or more food than usual? If less, probe: much less or a little less? None1 Much less2 Somewhat less3 About the same4 More5 DK8 Adapt locally to include the country-specific term used for the ORS packet Adapt locally to include the country-specific recommended home fluid. Ingredients promoted by the government for making the recommended home fluid should be reflected in this category. Adapt locally to include the country-specific terms used for the pre-packaged ORS fluid. Adapt locally to include the common names/brands for pre- packaged ORS fluids available in the country. If no pre-packaged ORS is available in the country, delete this category.

9. CA5. Has ( name ) had an illness with a cough at any time in the last two weeks, that is, since ( day of the week ) of the week before last? Yes1 No2 DK8 2 CA12 8 CA12 CA6. When ( name ) had an illness with a cough, did he/she breathe faster than usual with short, quick breaths or have difficulty breathing? Yes1 No2 DK8 2 CA12 8 CA12 CA7. Were the symptoms due to a problem in the chest or a blocked nose? Problem in chest1 Blocked nose2 Both3 Other ( specify )6 DK8 2 CA12 6 CA12 CA8. Did you seek advice or treatment for the illness outside the home? Yes1 No2 DK8 2 CA10 8 CA10 CA9. From where did you seek care? Anywhere else? Circle all providers mentioned, but do NOT prompt with any suggestions. If source is hospital, health center, or clinic, write the name of the place below. Probe to identify the type of source and circle the appropriate code. (Name of place) Public sources Govt. hospitalA Govt. health centreB Govt. health postC Village health workerD Mobile/outreach clinicE Other public ( specify )H Private sources Private hospital/clinicI Private physicianJ Pharmacy K Mobile clinic L Other private medical ( specify )O Other source Relative or friendP Shop Q Traditional practitioner R Other ( specify )X

10. CA10. Was ( name ) given medicine to treat this illness? Yes1 No2 DK8 2 CA12 8 CA12 CA11. What medicine was ( name ) given? Circle all medicines given. AntibioticA Paracetamol/Panadol/AcetaminophenP AspirinQ IbupropfenR Other ( specify )X DKZ CA12. Check UF11: Child aged under 3? Yes. Continue with CA13 No. Go to CA14 CA13. The last time (name) passed stools, what was done to dispose of the stools? Child used toilet/latrine01 Put/rinsed into toilet or latrine02 Put/rinsed into drain or ditch03 Thrown into garbage (solid waste)04 Buried05 Left in the open06 Other ( specify )96 DK98 Ask the following question (CA14) only once for each caretaker. CA14. Sometimes children have severe illnesses and should be taken immediately to a health facility. What types of symptoms would cause you to take your child to a health facility right away? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, But do NOT prompt with any suggestions. Child not able to drink or breastfeedA Child becomes sickerB Child develops a feverC Child has fast breathingD Child has difficult breathingE Child has blood in stoolF Child is drinking poorlyG Other ( specify )X Other ( specify )Y Other ( specify )Z Develop categories to include locally-used antibiotics, then pre-test