Part one: questionnaire on socio-demographic characteristics

Identification code ----------------------------------

Questionnaire on identification of the Alternative choice for Responses Skip Code
No. respondents
1 Sex 1. Male

2. Female

2 Age _______years

3 Residence 1. urban

2. rural

4 What is your educational status of the 1.Illitrate

child or parent?
2. Only read & write

3. Primary completed

4.Secondary completed

5. College and university

6._________________
6 What is the sources of water for 1. Unprotected
drinking for your child? 2. surface water
3.Piped tap water

7 How and where your child and family 1. open defecation

use toilet?
2. simple pit latrine

3.water carriage (flush)

4.______________
9 When did you wash your hand (for 1.before preparing food
parents)?
2. after defecating child

3. after toilet use

4.___________

10 When did your/you (if a child is able to 1. before meal

respond) child wash his/her hand? 2.after toilet
3._________
11 Nutritional status of the child as 1.normal (MUAC greater than 11
measured by the clinicians cm)
2.undernutritioned (MUAC less
than 11cm)

3. Weight _________kg

4. lateral edema