P_1 |
Child enroll number |
P
_2 |
Researcher code |
P
_3 |
Date (according to
English calendar- DDMMYY) |
P_4_a |
Age |
P_4_b |
Sex (1=Male, 2=Female) |
P
_5 |
Is there any problem to feed
the paste? |
1=Yes,
2=No |
P
_6 |
If yes, what is the main
problem? |
1=Difficult
to feed any food, 2= difficult to feed only paste, 3= Frequent illness, 4= No
time to feed, 5= other, 9=NA |
P_6txt |
If other, specify |
P_7 |
Usually, how did you give the
paste? |
1=
direct only paste, 2= with water, 3=with breast feeding, 4=with liquid or
food, 5= other |
P_7txt |
If other, specify |
P_8 |
Usually, how frequently you
give the paste? 1= once a day, 2= twice a day, 3= three or more times a day. |
P _9 |
Does the child finished whole
packet of the paste most of the time? 1= yes, 2 = only 3/4 paste, 3=only1/2
paste, 4= only ¼ paste |
P
_10 |
How often child did not take
the paste? |
1=once
a week (4 days a month), 2=two to three days a month, 3=once a month, 4= less
than once a months, 5=frequently( > 4 days a month), 6= never |
P _10txt |
If frequently did not take,
Specify reason |
P _11 |
What is your impression of the
paste on growth and development of your child? 1= Very good, 2= Good, 3=
satisfactory, 4= bad |
P _12 |
Weight (in kg) |
P _13 |
Length (in cm) |
P _14 |
Head Circumference (cm) |
P _15 |
Length for age in z score:1= <-1, 2=<-2, 3=< -3, 4= >-1 |
P _16 |
Weight for length z score:1=
<-1, 2=<-2, 3=< -3, 4= >-1 |
P_17 |
Hemoglobin (g/dL) |
|
|