| M_1 | Initials of the child |
| M _2 | Researcher code |
| M _3 | Date of Interview |
| M _4 | Why did the caregiver seek health care for the child (1=Diarrhoea/vomiting, 2=Cough /cold/sore throat, 3= Fever, 4= ENT problem, 5= Feeding problems, 6= Skin problem, 7=Eye, 8= Other, specify) |
| M _4txt | If other, specify |
| M _5 | Did the child seek out medical care as a result of the illness before? (1= Yes, 2=No) |
| M _6 | Was any medicine given the child for the illness? (2=No, 3= Symptomatic, 4= Antibiotic, 5=vitamins/minerals, 6= Others |
| M _6txt | If other, specify |
| M _7 | Clinical Diagnosis 1 (1=AGE, 2= AGE with dehydration, 3=Bacterial dysentery,4=URTI, 5= ALRI, 6= RAD, 7=Otitis Media, 8= Anemia, 9= Malnutrition, 10=Skin allergic rash, 11=Pyoderma, 12= Fever 13= Eye infection, 14=Others |
| M _7txt | If other, specify |
| M _8 | Hospitalization?( 2 = No, 3= Severe pneumonia, 4=AGE with dehydration, 5=High grade fever under investigations, 6=Fever with convulsion, 7=Severe PEM, 8=UTI, 9= Meningitis, 10=Other)( 2 = No, 3= Severe pneumonia, 4=AGE with dehydration, 5=High grade fever under investigations, 6=Fever with convulsion, 7=Severe PEM, 8=UTI, 9= Meningitis, 10=Other) |
| M _8txt | If other, specify |
| M _9 | Referred to other Health Facility? |
| M _9txt | If Yes, reason? |
| M_10 | Medication given (2=No, 3= Symptomatic, 4= Antibiotics, 5= Anti-convulsant, 6= Local medicine,7=Other) |
| M_10txt | If Antibiotic, which group? |