| FORM BF Household |
| Household Survey
for Children Under 1 Year |
| # jif{eGbf d'lgsf
aRrfx¿sf] 3/fo;L ljj/0f kmf/d |
| CHSUNO
(Child Survey No.) |
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CHSUNO |
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| BFB_1 |
Name of the child -aRrfsf] gfd_ |
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BFB_1 |
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| BFB_2 |
Date of Birth -hGd ldlt_ g]kfnL Sofn]08/ cg';f/ |
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BFB_2 |
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| BFB_3 |
Age in months
(completed) pd]/ dlxgfdf -k'/f ePsf]_ |
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BFB_3 |
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| BFB_4 |
Sex (1=Male, 2=Female) ln· -!=k'?if,
@=dlxnf_ |
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BFB_4 |
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| BFB_5 |
Birth order of the child
-aRrfsf] hGd qmd ;+Vof_ |
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BFB_5 |
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| BFB_6 |
Date of Interview -cGtjf{tf{ lnPsf] ldlt_–c+u|]hL Sofn]08/ |
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BFB_6 |
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| BFB_7 |
Informant (3=mother,
4=grandparents, 5=father, 6=Other relative) |
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BFB_7 |
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hfgsf/L lbg] JolQm -#=cfdf, $=xh'/ a'jf÷cfdf, %=a'jf, ^=c?
gft]bf/_ |
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| BFB_8 |
Mother's occupation -cfdfsf] k]zf_ |
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BFB_8 |
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| BFB_9 |
Father's occupation -afa'sf] k]zf_ |
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BFB_9 |
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Occupation (1=no work, 2= agriculture, 3= Carpet worker, 4=
daily wage earner, 5=self employs, 6=Services, 7=other, 9 not applicable) |
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Literacy -;fÔ/tf_ |
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| BFB_10 |
Father -afa'_ |
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BFB_10 |
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| BFB_11 |
Mother -cfdf_ |
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BFB_11 |
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(1=Illiterate,
2=Primary, 3=Up to class 10, 4=Intermediate, 5=bachelor, 6=Above) |
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;fÔ/tf -!=lg/Ô/,
@=k|fylds, #=!) sÔf;Dd , $=k|df0f–kq tx,
%=:gfts
tx ^=:gfts eGbf dfly_ |
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olb 5 eg] s'g vf]k
lbPsf] xf] pNn]v ug'{xf];\ |
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| BFB_12 |
Where was the child born
? (1=Home, 2=Health Facility, 3=others) |
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BFB_12 |
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aRrf sxfF hlGdPsf] lyof]
< -!=3/df @=c:ktfndf #=cGo_ |
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| BFB_13 |
Written documentation of
birthweight (1=Yes, 2=No) |
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BFB_13 |
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aRrfsf] hGdFbfv]/Lsf]
tf}n pNn]v ul/Psf] sfuhkq -!=5,
@=5}g_ |
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| BFB_14 |
Birth weight in grams if according to card/Mother's
recall (Not applicable 9999) |
BFB_14 |
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aRrfsf] hGdFbfv]/Lsf] tf}n, sf8{ cg';f/÷cfdfsf]
egfO{ cg';f/ -nfu' ug{ g;lsg] ((((_ |
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| BFB_15 |
Hours spent away from
child every day by mother
cfdfn] aRrf 5f]8]/ b}lgs slt 306f sfd ul5{g\ < |
BFB_15 |
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| BFB_16 |
If B_29 is not zero, who is taking care of the
child during absence of mother? |
BFB_16 |
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(1=father,
2=Grandparents, 3=Older sister, 4=Day-care centre, 5=others) |
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olb aL–@& hL/f]
ePdf cfdf gePsf] a]nf aRrfsf] x]/rfx s:n] u/]sf] 5 <
-!=a'jf, @=xh'/cfdf÷af, #=lbbL, $=lzz' :ofxf/ s]Gb|, %=cGo_ |
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| BFB_17 |
Does the child still
breastfeed ? (1=Yes, 2=No) |
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BFB_17 |
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aRrfn] clxn];Dd klg
cfdfsf] b'w vfg] u/]sf] 5 < -!=5, @=5}g_ |
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| BFB_18 |
If yes, number of
breastfeeding in last 24 hours |
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BFB_18 |
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olb vfO/x]sf]] 5 eg] ut @$ 306fdf slt j6s v'jfpg' eof] . |
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| BFB_19 |
If no, at what age
breast feeding stopped ? (in months) not applicable 99 |
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BFB_19 |
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olb 5}g eg], aRrfn]
slt dlxgfdf cfdfsf] b'w vfg 5f]8]sf] lyof] <
-dlxgfdf n]Vg'xf];\_ nfu' ug{ g;lsg] ePdf (( |
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| BFB_20 |
Child was exclusively
breast fed till what age ? (in months) 99 Not applicable |
BFB_20 |
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aRrfnfO{ cfdfsf] b'w
dfq} slxn];Dd v'jfPsf] lyof] < -dlxgfdf n]Vg'xf];\_ (( cg'dfg ug{ g;lsg] |
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| BFB_21 |
If not exclusively
breastfed, at what age complementary food was introduced (in months) 99 Not
applicable |
BFB_21 |
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cfdfsf] b'w jfx]s c?
7f]; cfxf/ v'jfPsf] -dlxgfdf n]Vg'xf];\_ (( cg'dfg ug{ g;lsg] |
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Supervisor |
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Data Entry 1 |
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Data Entry 2 |
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