| Variables in End of Visit Form (EVF) | ||||
| Question# | Question | Field name | Response nature | Response options |
| 1 | Participant ID | PID | ### | |
| 2 | Child ID | evf_A | 9### | |
| 3 | Initial of participant mother | evf_B | XX | |
| 4 | Researcher code | evf_C | ## | |
| 5 | Date (according to English calendar) | evf_D | ##-XXX-## | dd-mmm-yy |
| 6 | Age of the child | evf_E | ##.# | weeks: days |
| Time spending with child | ||||
| 7 | Currently are you working? (1= Yes, 2= No) | evf_1 | # | 1=Yes, 2=No |
| 8 | If yes, when start to go for the job after delivery? (age of child in month: days) | evf_1.a | ##:## | mm:dd if evf_1=1 otherwise 99:99 |
| 9 | What is your occupation? | evf_1.b | TXT | Text if evf_1=1 otherwise NA |
| 10 | Where is your work place? | evf_1.c | TXT | Text if evf_1=1 otherwise NA |
| 11 | How many hours you will be not with your child per day? (hours: minute) | evf_2 | ##:## | hh:mm |
| 12 | Who will take care your child in absence of you? (1=Father, 2=Paternal grandmother/grandfather, 3= Maternal grandmother/grandfather, 4 = Aunt, 5=Sister/ sister in law, 6= Other | evf_3 | # | 1=Father, 2=Paternal grandmother/grandfather, 3= Maternal grandmother/grandfather, 4 = Aunt, 5=Sister/ sister in law, 6= Other |
| 13 | If other specify | evf_3.txt | TXT | TEXT if evf_3=6, else NA |
| 14 | Is father taking care for the child? | evf_4 | # | 1=Yes, 2=No |
| If yes, average how many hours father will be with child per day? (hours: minute) | evf_4.a | ##:## | hh:mm if evf_4=5 otherwise 99:99 | |
| Do you feel any stress in the last six months taking care of your child? | evf_5 | # | 1=Yes, 2=No | |
| 15 | If yes, specify | evf_6 | TXT | Text if evf_5=1 otherwise NA |
| Health and feeding status of child | ||||
| 15 | How is health of child last 6 months? 1= Very good, 2= Good, 3= Satisfactory, 4= Bad | evf_7 | # | 1= Very good, 2= Good, 3= Satisfactory, 4= Bad |
| 16 | History of illness and hospitalization in the last 6 months? (2=No, 3=Illness required antibiotic, 4= Hospitalization, 6= Referred to other hospital. | evf_7.a | # | 2=No, 3=Illness require antibiotic, 4= Hospitalization, 6= Referred to other hospital |
| If the antibiotics were used and/or hospitalization, specify reason (1= RTI, 2= GTI, 3= UTI, 4=Ear infection, 5=Fever, 6= Febrile convulsion, 7=Other | evf_8.a | # | 1= RTI, 2= GTI, 3= UTI, 4=Ear infection, 5=Fever, 6= Febrile convulsion, 7=Other | |
| Specify problems | evf_8.b | TXT | Text if evf_8.a=1 otherwise NA | |
| 17 | Is the child on breast feeding? | evf_9 | # | 1=Yes, 2=No |
| 18 | If yes how many times last 24 hours? | evf_9.a | ## | |
| 19 | How many times main meal in last 24 hours? | evf_10 | # | |
| 20 | How many times snacks in last 24 hours? | evf_11 | # | |
| 21 | Which is main food, the child is getting? (List 3 names) | evf_12 | TXT | 3 food names |
| Anthropometry of the mother | ||||
| 22 | Weight of the participant mother (KG) | evf_13 | ##.# | |
| 23 | Height of the mother (CM) | evf_14 | ###.# | |
| 24 | BMI of the mother | evf_15 | ##.# | |
| Anthropometry of the child | ||||
| 25 | Weight (KG) | evf_16 | ##.### | |
| 27 | Length (CM) | evf_17 | ###.# | |
| 29 | Head Circumference (CM) | evf_18 | ##.# | |
| 31 | Length for age in z score: | evf_19 | # | 1= <-1, 2= <-2, 3= < -3, 4= -1 to +1, 5=>+1, 6=>+2, 7= >+3 |
| 32 | Weight for length z score: | evf_20 | # | 1= <-1, 2= <-2, 3= < -3, 4= -1 to +1, 5=>+1, 6=>+2, 7= >+3 |
| 33 | Remarks | TXT | ||