Variables in Child Morbidity Form (CMF)
Question# Question Field name  Response nature Response options
1 Participant ID PID ###  
2 Child ID cmf_A 9###  
3 Initials of the participant mother cmf_B XX  
4 Study researcher  ID cmf _C ##  
5 Today’s date
(According to English calender)
cmf _D ##-XXX-##  dd-mmm-yy 
6 Why did the caregiver seek health care for the child (1=Diarrhea/vomiting, 2=Cough /cold/sore throat, 3= Fever, 4= ENT problem, 5= Feeding problems, 6= Skin problem, 7=Eye, 8= seizure/ LOC, 9= Other) cmf_1 ##-XXX-##  dd-mmm-yy 
7 Did the child seek out medical care as a result of the illness before? (1= Yes, 2=No) cmf_2 # 1= Yes, 2=No
  Was the child on any medicine currently for the illness?
 (2=No, 3= Symptomatic, 4= Antibiotic, 5=vitamins/minerals, 6= Others)
cmf_3 # 2=No, 3= Symptomatic, 4= Antibiotic, 5=vitamins/minerals, 6= Others
8 Clinical Diagnosis                                                                         (1=AGE, 2= AGE with dehydration, 3=Bacterial dysentery,4= Amoebiasis, 5=URTI, 5= ALRI, 6= RAD, 7=Otitis Media,  8= Probable viral Fever,  9=Febrile convulsion, 9=Anemia,  10=Malnutrition, 11=Skin allergic rash,  12= Pyoderma, 13= fungal infection, 14= Eye infection, 15= Seizure disorder, 16= Mouth ulcer, 17= NNJ, 18= Others) cmf_4 # (1=AGE, 2= AGE with dehydration, 3=Bacterial dysentery,4= Amoebiasis, 5=URTI, 5= ALRI, 6= RAD, 7=Otitis Media,  8= Probable viral Fever,  9=Febrile convulsion, 9=Anemia,  10=Malnutrition, 11=Skin allergic rash,  12= Pyoderma, 13= fungal infection, 14= Eye infection, 15= Seizure disorder, 16= Mouth ulcer, 17= NNJ, 18= Others
9 If more than one clinical diagnosis cmf_4_i # (1=AGE, 2= AGE with dehydration, 3=Bacterial dysentery,4= Amoebiasis, 5=URTI, 5= ALRI, 6= RAD, 7=Otitis Media,  8= Probable viral Fever,  9=Febrile convulsion, 9=Anemia,  10=Malnutrition, 11=Skin allergic rash,  12= Pyoderma, 13= fungal infection, 14= Eye infection, 15= Seizure disorder, 16= Mouth ulcer, 17= NNJ, 18= Others
10 If more other, specify cmf_4_ii TXT  
11 Hospitalization / Refer to other hospital?
(1= Yes, hospitalization, 2 = No, 3= Refer to other hospital)
cmf_5 # 1= Yes, hospitalization, 2 = No, 3= Refer to other hospital
12 If yes reason for hospitalization/ refer
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
cmf_6 # 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
13 If other, specify cmf_6txt TXT TEXT
14 Medication given                                                                        (2=No, 3= Symptomatic, 4= Antibiotics, 5= Metronidazole, 6= Local application ,7=Other) cmf_7 # 2=No, 3= Symptomatic, 4= Antibiotics, 5= Metronidazole, 6= Local application ,7=Other
15 If Antibiotic, which group generic name?   cmf_7_a TXT  
16 If other medication, specify cmf_7_b TXT