| 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 | ||||