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?