TITLE- FACTOR ASSOCIATED WITH MALNOURISHED AMONG UNDER FIVE YRS CHILDREN IN

TRIBAL COMMUNITY:- BLOCK SATANWADA SHIVPURI M.P. CROSS SECTIONAL STUDY.

QUESTIONARRIES FOR UNDER FIVE CHILDREN

CHILD NAME -…………………………………………… FATHER’S NAME:-………………………………………

MOTHER’S NAME:-…………………………………….. MOB.NO.:-…………………………………………………

DATE OF BIRTH :-………………………………………… AGE:-…………………………………………………………

ADDRESS:-………………………………………………….. INCOME SOURCE:-……………………………………….

WHERE DELIVERY CHILD :- HOME/HOSPITAL . BIRTH WEIGHT:-………..LBW/NORMAL

SIGNIFICANT PAST HEALTH ISSUES :-……….

HAVE YOU TAKE TREATMENT IF YES WHERE NO WHY…

CHILD RECEIVE VACCINE:- YES OR NOT

NOT RECEIVE REASON:-………………………………

DID YOU GIVE FIRST MILK THAT COMES OUT BREAST(CLOSTRUM):-YES/NO

IF NO :- REASON…..

HE/SHE STILL BEING BREASTFEED: YES/NO

SINCE THIS TIME YESTERDAY, HOW MANY FOOD DETAIL………………………..

TIMES DID (name) EAT SOLID, SEMISOLID, OR :- NO. OF TIMES…
SOFT FOODS OTHER THAN LIQUIDS? DON’T KNOW

HE/ SHE PRESENT ANY ILLNESS:-………….YES/NO IF YES …DETAIL ILLNESS

HAVE YOU TAKE TREATMENT IF YES, WHERE , IF NO -WHY…

ANTHROPOMETRY

WEIGHT:-………………. HEIGHT/LENGTH(C.M.):-……………………………….

MUAC:-………………

RESULT:-SAM/MAM/WASTING/STUNTING/NORMAL