BREAST FEEDING SURVEY FORM (Code 1=yes, 2=No, 9= Not applicable)

CHSUNO

Child Survey Number (aRrfsf] qmd;Vof)

CHSUNO

BFA_2

Date (DMY, according to English calendar)                                                                                                               -cGtjf{tf{ lnPsf] ldlt c+u|]hL Sofn]08/ cg';f/_

BFA_2

BFA_3

FW code -lkmN8 js{/ sf]8_

BFA_3

BFA_4

Name of the child  -aRrfsf] gfd_

BFA_4

BFA_5

Age in months -dlxgfdf k'/f ePsf] pd]/_

BFA_5

BFA_6

Did you get information on breastfeeding during ANC check up?

BFA_6

-ue{jtL hf“r u/fp“bf :tgkfg af/] hfgsf/L kfpg'eof]<_

BFA_7

How long (months) do you think only breast milk will be enough for child ?                                                         (99 if do not know)

BFA_7

-tkfO{sf] ljrf/df slt dlxgf;Dd aRrfnfO{ cfdfsf] b'wn] dfq} k'U5 <_

BFA_8

When was breastfeeding initiated after birth? (1=within 1 hour, 2=2-4 hours,    3= 5-24 hours, 4=after 24 hours)

BFA_8

-aRrfnfO{  cfdfsf] b'w VjfPsf] lyof]] < != Ps 306fleq @= @–$ 306f, #=#–@$ 306f, $=@$ 306fkl5_

BFA_9

Which food was given first after birth (1=breast milk, 2= glucose water, 3=formula milk, 4=animal milk, 5=others, specify)

BFA_9

-aRrfnfO{ klxnf] vfgf s] lbPsf] lyof] != cfdfsf] b'w, @=Un'sf]h kfgL #=af]6n b'w $=÷ufO{÷e};Lsf] b'w, %=cGo_

BFA_10

Did you feed with colustrum ? -z'?sf] kx]nf] afSnf] b'w lbg'ePsf] lyof] <_

BFA_10

BFA_11

Was the child ill during the first month after birth?

BFA_11

(2=no, 3 diarrhea, 4 pneumonia, 5=skin, 6= others)

BFA_11txt

If others, specify

BFA_12

Was the child hospitalized during the first month after birth?

BFA_12

(2=no, 3 diarrhea, 4 pneumonia, 5=skin, 6= others)

BFA_13txt

If others, specify

BFA_14

How long child  was feed on  exclusively/predominately breastfeeding  (months)?                                                           -aRrfnfO{ cfdfsf] b'w dfq}÷cfdfsf] b'wsf] ;fydf kfgL dfq} slxn];Dd v'jfPsf] lyof] <                  -dlxgfdf n]Vg'xf];\ _

BF_14

BFA_15

Reason for introducing other food before 6 months of age (1= crying/hungry, 2=mother illness, 3= no enough breast milk, 4=others)

BF_15

-^ dlxgf cl3 c? vfg]s'/f lbgfsf] sf/0f -!=ef]sfPsf]÷/f]Psf], @=cfdfsf] /f]u, #= b'w gk'u]sf], $=cGo_

BFA_16

Who gave advice for introduction of other food before 6 months of age (1=mother self, 2=maternal grand mother, 3 =paternal grand mother, 4=relatives/ neighbours,5=others.

BF_16

-^ dlxgf cl3 c? vfgs'/f lbg ;Nnfx s;n] lbof] < _!=cfkm}, @=aHo} cfdfkl6sf] #=aHo} a'jfkl6sf], $=l5d]sL %=cGo_

Supervisor signature    -;'k/efOh/sf] ;lx_