VACCINATION STATUS OF CHILDREN (AGED 1-8 YEARS) QUESTIONAIRE

1. Name of child: 2.Age:

3. Gender: Male Female Other

4. Relation of attendant with child:

5. Education of mother: 6.Education of father:

Primary (1st to 5th grade) Primary (1st to 5th grade)

Middle (5th to 8th grade) Middle (5th to 8th grade)

Secondary (9th to 10th grade) Secondary (9th to 10th grade)

Higher Secondary (11th to 12th grade) Higher Secondary (11th to 12th grade)

Graduate and postgraduate Graduate and postgraduate

Madrassa Madrassa

No formal education No formal education

7. Mother occupation:

8. Father occupation:

9. Mother age: 10.Father Age:

11. Child born at: Home Hospital

12. Residence: Rural Urban

13. Monthly income: PKR. <30,000 30,000-1,00,000 100,000-1,50,000

14. At time of birth counseled about vaccines: Yes No

15. Address:

16. BCG scar: Present Absent

17. Vaccination card: Present Absent

18. History of vaccination: Present Absent

19. What is the reason for low vaccination status of your child?