| F_1 | Day | |
| F_2 | Is child available? | |
| F_3 | Did he/she eat all paste of a sachet? | |
| F_4 | Vomiting after supplementation? | |
| F_5 | Why paste not given? | |
| F_6 | Fever? | |
| F_7 | Diarrhea /vomiting? | |
| F_8 | Blood in stool? | |
| F_9 | Cough/ Shortness of breath? | |
| F_10 | Visit to health center? | |
| F_11 | Antibiotic use? | |
| F_12 | Group of Antibiotic? | |
| F_13 | Hospitalization? | |
| F_14 | Other illness | |
| F14_txt | If yes, specify | |
| F_15 | Breast milk | |
| F_16 | # times during night | |
| F_17 | # times during day | |
| F_18 | Infant formula | |
| F_19 | Animal,Tinned or powdered milk | |
| F_20 | Tea, coffee | |
| F_21 | Fruit juices | |
| F_22 | Other liquids | |
| F_23 | Lito, cerelac? | |
| F_24 | Rice or other cereals? | |
| F_25 | Dal or other lentils/pulses | |
| F_26 | White potatoes, white yams, manioc, other roots? | |
| F_27 | Meat/fish/ egg? | |
| F_28 | Green and other vegetable | |
| F_29 | Fruits like Bananas, Apples? | |
| F_30 | Curd? | |
| F_31 | Other foods |