Interview Schedule for Mothers

Serial no.................................... DATE:

PLACE........................
1. Name of the respondents:................................................................................
2. Age of the respondent:
3. Address:- Village:
Block:
District:
4. Religion: - Hindu  Muslim 
Christian 
Others 
6. Caste: - Gen  ......................... OBC  .............................
ST  ....................... SC ..............................
OTHERS ................................
Sl. Name of the Sex Age Marital Relation with Educational occupation
No members status the respondent status
5. Family composition: -
Code column
(col.3) sex: male-M female- F
(col.5) marital status: married- 1 unmarried- 2 widow- 3
Divorced- 4
(col.7) education: illiterate- 1 primary-2 middle-3
Matric- 4 intermediate- 5 graduate and above- 6
(col.8) occupation: farm labour- 1 cultivator- 2 service- 3
Unemployed- 4 Housewife- 5 mines worker- 6
Construction worker-7 any other-8

6. What is the annual income of your family? ...............................................

7. Do you have savings? Yes/No

If yes, how much
........................
8. If taken loan from any source? If yes how much?
........................................
 When the loan was taken?
.............................
 mode of repayment of loan
..........................

9. Preference of income spend on

Food ......... Festivals ............
Clothes .......... Education ...................
Health ............. Any other ….…………

10. Anthropometric details of the child

 Sl. No. Position of the child Sex Age Weight height
in terms of birth At birth present

11. How frequently do you visit the Anganwadi or Health centres? Do you weight your child
during the visit over there?
..............................................................

12. Do you get any complementary /supplementary food from any government or non-
government health service centre?
Yes/ No
12. Awareness:-
What do you mean by malnutrition?
.......................................................................................................................
Why it happens?
.....................................................................................................................
Any preventive or treatment service adopted relating to it?
....................................................................................................................
Are you aware of the programs and schemes related to it?
....................................................................................................................
What is the role of anganwadi? and are you availing any services from it?
........................................................................................................................
................................................................................................................................
Are you aware of MTC’s?
................................................................................................................................

12.Quantity and quality of food received from anganwadi;-

For malnourished children
 .....................................................................................................
For normal children
....................................................................................................

13. Information on prevalent diseases.

 Did your child suffer from any diseases in the past? And for how long?

.................................................................................
 Frequency of falling ill.

.........................................................
 Is your child suffering from any diseases or disorder at present?

......................................................
14. Socio-cultural factors influencing the nutritional status of the children in the age group of
0 to 5 years

 What type of food do you eat?

Vegetarian
Non-vegetarian
Not strictly vegetarian

 What type of food do you give to your children?

Food orange in colour (carrot/papaya etc.) -

Food white in colour (milk/wheat etc) -
Food green in colour (green vegetables) –
 What are the foods available for consumption?

 Where do you prefer to get the food from? Why

Market Govt. and non-govt. centres

Farm any other source
Hygiene:
  Do you wash your hands before cooking or feeding the child?
-Yes - No - Sometimes
 Do you wash the utensils before preparing the food for the child?

Addiction:
Do you or any of your family member consume alchol or tobacco?
.................................................................................................
15. Attitude of the people:
 Male child needs more nutritious food than female child.
Agree/disagree and why? If yes how much more?

 Breast feeding is important for the infants.

Agree/ disagree and why?

 Breast milk is sufficient for your child even after 6 months?

Agree/ disagree and why?

 Any kind of home remedies if they use for diseases (for particularly anaemia)?
YES/NO

Observations:

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